RU2732043C2 - Блокирующие механизмы для отсоединяемых узлов стволов с шарнирно поворачиваемыми хирургическими концевыми эффекторами - Google Patents
Блокирующие механизмы для отсоединяемых узлов стволов с шарнирно поворачиваемыми хирургическими концевыми эффекторами Download PDFInfo
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Abstract
Изобретение относится к медицинской технике, а именно к хирургическим режущим и сшивающим инструментам. Хирургический сшивающий инструмент содержит корпус, сменный узел ствола, хирургический концевой эффектор, систему шарнирного поворота и средства предотвращения отсоединения сменного узла ствола от корпуса. Сменный узел ствола присоединен с возможностью отсоединения к корпусу и содержит удлиненный ствол. Хирургический концевой эффектор функционально соединен с удлиненным стволом для избирательного шарнирного поворота относительно него. Система шарнирного поворота выполнена с возможностью выборочного приложения движений шарнирного поворота к хирургическому концевому эффектору, когда система шарнирного поворота находится в ориентации приведения в действие. Средства предотвращения отсоединения сменного узла ствола от корпуса, когда система шарнирного поворота находится в ориентации приведения в действие. Сменный узел ствола соединен с возможностью отсоединения с корпусом посредством стопорного элемента, который выполнен с возможностью выборочного перемещения между зафиксированным положением и незафиксированным положением. Средства для предотвращения отсоединения функционально связаны с системой шарнирного поворота и стопорным элементом. Система шарнирного поворота содержит приводной механизм шарнирного поворота, поддерживаемый с возможностью движения по сменному узлу ствола и с возможностью выборочного перемещения между незадействованной ориентацией, при которой хирургический концевой эффектор находится в отсоединенной ориентации, и множеством ориентаций приведения в действие, при которых хирургический концевой эффектор шарнирно повернут относительно оси ствола, образованной удлиненным стволом. Изобретение характеризуется тем, что приводной механизм шарнирного поворота поддерживается с возможностью движения по сменному узлу ствола и также функционально связан со средством предотвращения отсоединения сменного узла ствола от корпуса. 7 з.п. ф-лы, 32 ил.
Description
Предпосылки создания изобретения
Настоящее изобретение относится к хирургическим инструментам и в различных вариантах осуществления к хирургическим сшивающим и режущим инструментам и предназначенным для применения с ними кассетам со скобами.
Краткое описание чертежей
Особенности и преимущества настоящего изобретения, а также способ их достижения станут более очевидными, а само изобретение станет более понятным после ознакомления со следующим описанием вариантов осуществления изобретения в сочетании с сопроводительными чертежами, причем:
на ФИГ. 1 представлен вид в перспективе хирургического инструмента с электропитанием, содержащего рукоятку, ствол и шарнирно поворачиваемый концевой эффектор;
на ФИГ. 2 представлен общий вид с пространственным разделением компонентов корпуса хирургического инструмента;
на ФИГ. 3 представлен вид в перспективе части сменного узла ствола;
на ФИГ. 4 представлен частичный вид в перспективе части сменного узла ствола с ФИГ. 3, причем стопорный барабан и насадка исключены для ясности;
на ФИГ. 5 представлен вид в перспективе в поперечном сечении сменного узла ствола с ФИГ. 4;
на ФИГ. 6 представлен вид в перспективе в поперечном сечении части сменного узла ствола с ФИГ. 5;
на ФИГ. 7 представлен другой вид в поперечном сечении сменного узла ствола и части хирургического концевого эффектора с концевым эффектором в отсоединенной ориентации;
на ФИГ. 8 представлен другой вид в поперечном сечении сменного узла ствола с ФИГ. 7 с концевым эффектором в ориентации с шарнирным поворотом;
на ФИГ. 9 представлен частичный вид в перспективе части другого сменного узла ствола;
на ФИГ. 10 представлен другой вид в перспективе части сменного узла ствола с ФИГ. 9 с различными компонентами, исключенными для ясности;
на ФИГ. 11 представлен частичный вид в поперечном сечении части сменного узла ствола с ФИГ. 10 с некоторыми компонентами, исключенными для ясности;
на ФИГ. 12 представлен частичный вид в поперечном сечении части другого сменного узла ствола в отсоединенной конфигурации;
на ФИГ. 13 представлен другой частичный вид в поперечном сечении сменного узла ствола с ФИГ. 12 в шарнирно повернутой конфигурации;
на ФИГ. 14 представлен другой вид в перспективе части другого сменного узла ствола;
на ФИГ. 15 представлен другой вид в перспективе части сменного узла ствола с ФИГ. 14 с различными компонентами, исключенными для ясности;
на ФИГ. 16 представлен другой вид в перспективе части сменного узла ствола с ФИГ. 14 и 15 с различными компонентами, исключенными для ясности;
на ФИГ. 17 представлен частичный общий вид в разобранном состоянии части сменного узла ствола с ФИГ. 14-16;
на ФИГ. 18 представлен вид в перспективе в поперечном сечении части сменного узла ствола с ФИГ. 14-17 с различными компонентами, исключенными для ясности, и на ней муфта в сборе находится в ориентации с шарнирным поворотом;
на ФИГ. 19 представлен другой вид в перспективе в поперечном сечении части сменного узла ствола с ФИГ. 14-18 с различными компонентами, исключенными для ясности, и на ней муфта в сборе находится в пусковой ориентации;
на ФИГ. 20 представлен другой вид в поперечном сечении части сменного узла ствола с ФИГ. 14-19 с концевым эффектором в отсоединенной ориентации;
на ФИГ. 21 представлен другой вид в поперечном сечении части сменного узла ствола с ФИГ. 14-20 с концевым эффектором в ориентации с шарнирным поворотом;
на ФИГ. 22 представлен вид в поперечном сечении сменного узла ствола с ФИГ. 14-21, взятый по линиям 22-22 на ФИГ. 21;
на ФИГ. 23 представлен другой вид в поперечном сечении части сменного узла ствола с ФИГ. 14-22 с концевым эффектором в ориентации с шарнирным поворотом и муфтой в сборе в пусковой ориентации;
на ФИГ. 24 представлен вид в поперечном сечении сменного узла ствола с ФИГ. 14-23, взятый по линиям 24-24 на ФИГ. 23;
на ФИГ. 25 представлен вид в перспективе другого хирургического инструмента с шарнирно поворачиваемым хирургическим концевым эффектором, функционально соединенным с ним;
на ФИГ. 26 представлен вид в перспективе части в виде рукоятки хирургического инструмента с ФИГ. 25 с частью корпуса насадки, исключенного для ясности;
на ФИГ. 27 представлен вид в перспективе в разобранном состоянии части хирургического инструмента с ФИГ. 25 и 26;
на ФИГ. 28 представлен общий вид в разобранном состоянии частей блокиратора хирургического инструмента в сборе с ФИГ. 25-27;
на ФИГ. 29 представлен вид в поперечном сечении удлиненного узла ствола хирургического инструмента;
на ФИГ. 30 представлен вид в поперечном сечении другого удлиненного узла ствола другого хирургического инструмента;
на ФИГ. 31 представлено схематическое изображение части другого хирургического инструмента; и
на ФИГ. 32 представлено схематическое изображение части другого хирургического инструмента.
Соответствующие элементы на разных видах обозначаются соответствующими условными обозначениями. Примеры, представленные в настоящем документе, в одной форме иллюстрируют некоторые варианты осуществления настоящего изобретения, и такие примеры не следует рассматривать как каким-либо образом ограничивающие объем настоящего изобретения.
Подробное описание
Заявителю настоящей заявки принадлежат нижеуказанные заявки на патенты, поданные 1 марта 2013 г., каждая из которых полностью включена в настоящий документ путем ссылки:
- заявка на патент США № 13/782,295, озаглавленная Articulatable Surgical Instruments With Conductive Pathways For Signal Communication, в настоящее время публикация заявки на патент США № 2014/0246471;
- заявка на патент США № 13/782,323, озаглавленная Rotary Powered Articulation Joints For Surgical Instruments, в настоящее время патентная публикация США № 2014/0246472;
- заявка на патент США № 13/782,338, озаглавленная Thumbwheel Switch Arrangements For Surgical Instruments, в настоящее время патентная публикация США № 2014/0249557;
- заявка на патент США № 13/782,499, озаглавленная Electromechanical Surgical Device with Signal Relay Arrangement, в настоящее время публикация заявки на патент США № 2014/0246474;
- заявка на патент США № 13/782,460, озаглавленная Multiple Processor Motor Control for Modular Surgical Instruments, в настоящее время публикация заявки на патент США № 2014/0246478;
- заявка на патент США № 13/782,358, озаглавленная Joystick Switch Assemblies For Surgical Instruments, в настоящее время патентная публикация США № 2014/0246477;
- заявка на патент США № 13/782,481, озаглавленная Sensor Straightened End Effector During Removal Through Trocar, в настоящее время публикация заявки на патент США № 2014/0246479;
- заявка на патент США № 13/782,518, озаглавленная Control Methods for Surgical Instruments with Removable Implement Portions, в настоящее время публикация заявки на патент США № 2014/0246475;
- заявка на патент США № 13/782,375, озаглавленная Rotary Powered Surgical Instruments With Multiple Degrees of Freedom, в настоящее время публикация заявки на патент США № 2014/0246473; и
- заявка на патент США № 13/782,536, озаглавленная Surgical Instrument Soft Stop, в настоящее время публикация заявки на патент США № 2014/0246476.
Заявителю настоящей заявки также принадлежат нижеуказанные заявки на патенты, поданные 14 марта 2013 г., каждая из которых полностью включена в настоящий документ путем ссылки:
- заявка на патент США № 13/803,097, озаглавленная ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, в настоящее время публикация заявки на патент США № 2014/0263542;
- заявка на патент США № 13/803,193, озаглавленная CONTROL ARRANGEMENTS FOR A DRIVE MEMBER OF A SURGICAL INSTRUMENT, в настоящее время патентная публикация США № 2014/0263537;
- заявка на патент США № 13/803,053, озаглавленная INTERCHANGEABLE SHAFT ASSEMBLIES FOR USE WITH A SURGICAL INSTRUMENT, в настоящее время патентная публикация США № 2014/0263564;
- заявка на патент США № 13/803,086, озаглавленная ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK, в настоящее время публикация заявки на патент США № 2014/0263541;
- заявка на патент США № 13/803,210, озаглавленная SENSOR ARRANGEMENTS FOR ABSOLUTE POSITIONING SYSTEM FOR SURGICAL INSTRUMENTS, в настоящее время публикация заявки на патент США № 2014/0263538;
- заявка на патент США № 13/803,148, озаглавленная MULTI-FUNCTION MOTOR FOR A SURGICAL INSTRUMENT, в настоящее время патентная публикация США № 2014/0263554;
- заявка на патент США № 13/803,066, озаглавленная DRIVE SYSTEM LOCKOUT ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS, в настоящее время публикация заявки на патент США № 2014/0263565;
- заявка на патент США № 13/803,117, озаглавленная ARTICULATION CONTROL SYSTEM FOR ARTICULATABLE SURGICAL INSTRUMENTS, в настоящее время публикация заявки на патент США № 2014/0263553;
- заявка на патент США № 13/803,130, озаглавленная DRIVE TRAIN CONTROL ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS, в настоящее время публикация заявки на патент США № 2014/0263543; и
- заявка на патент США № 13/803,159, озаглавленная METHOD AND SYSTEM FOR OPERATING A SURGICAL INSTRUMENT, в настоящее время патентная публикация США № 2014/0277017.
Заявителю настоящей заявки принадлежит представленная ниже заявка на патент, поданная 7 марта 2014 г., которая полностью включена в настоящий документ путем ссылки:
- заявка на патент США № 14/200,111, озаглавленная CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS, в настоящее время патентная публикация США № 2014/0263539.
Заявителю настоящей заявки принадлежат нижеуказанные заявки на патенты, поданные 26 марта 2014 г., каждая из которых полностью включена в настоящий документ путем ссылки:
заявка на патент США № 14/226,106, озаглавленная POWER MANAGEMENT CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS;
заявка на патент США № 14/226,099, озаглавленная STERILIZATION VERIFICATION CIRCUIT;
заявка на патент США № 14/226,094, озаглавленная VERIFICATION OF NUMBER OF BATTERY EXCHANGES/PROCEDURE COUNT;
заявка на патент США № 14/226,117, озаглавленная POWER MANAGEMENT THROUGH SLEEP OPTIONS OF SEGMENTED CIRCUIT AND WAKE UP CONTROL;
заявка на патент США № 14/226,075, озаглавленная MODULAR POWERED SURGICAL INSTRUMENT WITH DETACHABLE SHAFT ASSEMBLIES;
заявка на патент США № 14/226,093, озаглавленная FEEDBACK ALGORITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICAL INSTRUMENTS;
заявка на патент США № 14/226,116, озаглавленная SURGICAL INSTRUMENT UTILIZING SENSOR ADAPTATION;
заявка на патент США № 14/226,071, озаглавленная SURGICAL INSTRUMENT CONTROL CIRCUIT HAVING A SAFETY PROCESSOR;
заявка на патент США № 14/226 097, озаглавленная SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS;
заявка на патент США № 14/226,126, озаглавленная INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRUMENTS;
заявка на патент США № 14/226,133, озаглавленная MODULAR SURGICAL INSTRUMENT SYSTEM;
заявка на патент США № 14/226,081, озаглавленная SYSTEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT;
заявка на патент США № 14/226,076, озаглавленная POWER MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIABLE VOLTAGE PROTECTION;
заявка на патент США № 14/226,111, озаглавленная SURGICAL STAPLING INSTRUMENT SYSTEM; и
заявка на патент США № 14/226,125, озаглавленная SURGICAL INSTRUMENT COMPRISING A ROTATABLE SHAFT.
Заявителю настоящей заявки также принадлежат нижеуказанные заявки на патенты, поданные 5 сентября 2014 г., каждая из которых полностью включена в настоящий документ путем ссылки:
- заявка на патент США № 14/479,103, озаглавленная CIRCUITRY AND SENSORS FOR POWERED MEDICAL DEVICE;
- заявка на патент США № 14/479,119, озаглавленная ADJUNCT WITH INTEGRATED SENSORS TO QUANTIFY TISSUE COMPRESSION;
- заявка на патент США № 14/478,908, озаглавленная MONITORING DEVICE DEGRADATION BASED ON COMPONENT EVALUATION;
- заявка на патент США № 14/478,895, озаглавленная MULTIPLE SENSORS WITH ONE SENSOR AFFECTING A SECOND SENSORʹS OUTPUT OR INTERPRETATION;
- заявка на патент США № 14/479,110, озаглавленная USE OF POLARITY OF HALL MAGNET DETECTION TO DETECT MISLOADED CARTRIDGE;
- заявка на патент США № 14/479,098, озаглавленная SMART CARTRIDGE WAKE UP OPERATION AND DATA RETENTION;
- заявка на патент США № 14/479,115, озаглавленная MULTIPLE MOTOR CONTROL FOR POWERED MEDICAL DEVICE; и
- заявка на патент США № 14/479,108, озаглавленная LOCAL DISPLAY OF TISSUE PARAMETER STABILIZATION.
Заявителю настоящей заявки также принадлежат нижеуказанные заявки на патенты, поданные 9 апреля 2014 г., каждая из которых полностью включена в настоящий документ путем ссылки:
- заявка на патент США № 14/248,590, озаглавленная MOTOR DRIVEN SURGICAL INSTRUMENTS WITH LOCKABLE DUAL DRIVE SHAFTS, в настоящее время публикация заявки на патент США № 2014/0305987;
- заявка на патент США № 14/248,581, озаглавленная SURGICAL INSTRUMENT COMPRISING A CLOSING DRIVE AND A FIRING DRIVE OPERATED FROM THE SAME ROTATABLE OUTPUT, в настоящее время публикация заявки на патент США № 2014/0305989;
- заявка на патент США № 14/248,595, озаглавленная SURGICAL INSTRUMENT SHAFT INCLUDING SWITCHES FOR CONTROLLING THE OPERATION OF THE SURGICAL INSTRUMENT, в настоящее время публикация заявки на патент США № 2014/0305988;
- заявка на патент США № 14/248,588, озаглавленная POWERED LINEAR SURGICAL STAPLER, в настоящее время публикация заявки на патент США № 2014/0309666;
- заявка на патент США № 14/248,591, озаглавленная TRANSMISSION ARRANGEMENT FOR A SURGICAL INSTRUMENT, в настоящее время публикация заявки на патент США № 2014/0305991;
- заявка на патент США 14/248,584, озаглавленная MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH ALIGNMENT FEATURES FOR ALIGNING ROTARY DRIVE SHAFTS WITH SURGICAL END EFFECTOR SHAFTS, в настоящее время публикация заявки на патент США № 2014/0305994;
- заявка на патент США № 14/248,587, озаглавленная POWERED SURGICAL STAPLER, в настоящее время публикация заявки на патент США № 2014/0309665;
- заявка на патент США № 14/248,586, озаглавленная DRIVE SYSTEM DECOUPLING ARRANGEMENT FOR A SURGICAL INSTRUMENT, в настоящее время публикация заявки на патент США № 2014/0305990; и
- заявка на патент США № 14/248,607, озаглавленная MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH STATUS INDICATION ARRANGEMENTS, в настоящее время публикация заявки на патент США № 2014/0305992.
Заявителю настоящей заявки также принадлежат нижеуказанные заявки на патенты, поданные 16 апреля 2013 г., каждая из которых полностью включена в настоящий документ путем ссылки:
- предварительная заявка на патент США № 61/812,365, озаглавленная SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY A SINGLE MOTOR;
- предварительная заявка на патент США № 61/812,376, озаглавленная LINEAR CUTTER WITH POWER;
- предварительная заявка на патент США № 61/812,382, озаглавленная LINEAR CUTTER WITH MOTOR AND PISTOL GRIP;
- предварительная заявка на патент США № 61/812,385, озаглавленная SURGICAL INSTRUMENT HANDLE WITH MULTIPLE ACTUATION MOTORS AND MOTOR CONTROL; и
- предварительная заявка на патент США № 61/812,372, озаглавленная SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY A SINGLE MOTOR.
Заявителю настоящей заявки принадлежат представленные ниже заявки на патенты, поданные в тот же день, причем каждая из них полностью включена в настоящий документ путем ссылки:
- заявка на патент США № _______, озаглавленная хирургический инструмент SURGICAL INSTRUMENT SYSTEMS COMPRISING AN ARTICULATABLE END EFFECTOR AND MEANS FOR ADJUSTING THE FIRING STROKE OF A FIRING MEMBER; № в досье патентного поверенного END7415USNP/140289;
- заявка на патент США № _______, озаглавленная SURGICAL INSTRUMENT ASSEMBLY COMPRISING LOCKABLE SYSTEMS; № в досье патентного поверенного END7416USNP/140291;
- заявка на патент США № _______, озаглавленная DRIVE ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS, досье патентного поверенного № END7418USNP/140292;
- заявка на патент США № _______, озаглавленная SURGICAL INSTRUMENT WITH AN ANVIL THAT IS SELECTIVELY MOVABLE ABOUT A DISCRETE NON-MOVABLE AXIS RELATIVE TO A STAPLE CARTRIDGE, № в досье патентного поверенного END7485USNP/140295;
- заявка на патент США № _______, озаглавленная SURGICAL INSTRUMENTS WITH IMPROVED CLOSURE ARRANGEMENTS; № в досье патентного поверенного END7486/140296;
заявка на патент США № __________, озаглавленная SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS, досье патентного поверенного № END7489USNP/140299;
заявка на патент США № __________, озаглавленная SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND IMPROVED FIRING BEAM SUPPORT ARRANGEMENTS, досье патентного поверенного № END7491USNP/140301;
- заявка на патент США № _______, озаглавленная SURGICAL INSTRUMENT ASSEMBLY COMPRISING A FLEXIBLE ARTICULATION SYSTEM; № в досье патентного поверенного END7492USNP/140302; и
- заявка на патент США № _______, озаглавленная SURGICAL INSTRUMENT ASSEMBLY COMPRISING A LOCKABLE ARTICULATION SYSTEM; № в досье патентного поверенного END7494USNP/140304.
В настоящем документе приведены подробные сведения, необходимые для понимания общей конструкции, функциональности, особенностей изготовления и применения различных вариантов осуществления, описание которых предоставлено в спецификации и проиллюстрировано сопроводительными чертежами. Хорошо известные принципы работы, компоненты и элементы не получили в настоящем документе подробного описания, чтобы не затруднять понимание вариантов осуществления, описанных в спецификации. Читатель должен понимать, что варианты осуществления, описанные и проиллюстрированные в настоящем документе, являются не имеющими ограничительного характера примерами. Следует понимать, что определенные конструктивные и функциональные особенности, описанные в данном документе, могут иметь показательный или пояснительный характер. Изменения и модификации вариантов осуществления, описанных и проиллюстрированных в данном документе, могут выполняться в пределах объема формулы изобретения.
Термины «содержать» (и любые его формы, такие как «содержит» и «содержащий»), «иметь» (и любые его формы, такие как «имеет» и «имеющий»), «включать» (и любые его формы, такие как «включает» и «включающий»), «вмещать» (и любые его формы, такие как «вмещает» и «вмещающий») представляют собой неограниченные связующие глаголы. В результате, хирургическая система или устройство, которое «содержит», «имеет», «включает» или «вмещает» один или более элементов, обладает этим одним или более элементами, но обладание не ограничивается только этим одним или более элементами. Аналогично элемент системы или устройства, который «содержит», «имеет», «включает» или «вмещает» один или более элементов, обладает этим одним или более элементами, но обладание не ограничивается только этим одним или более элементами.
Термины «проксимальный» и «дистальный» в настоящем документе определяются относительно врача, управляющего рукояткой хирургического инструмента. Термин «проксимальный» относится к участку, расположенному ближе всего к врачу, а термин «дистальный» относится к участку, удаленному от врача. Предлагается также для удобства и ясности применительно к рисункам использовать в настоящем документе такие пространственные термины, как «вертикальный», «горизонтальный», «вверх» и «вниз». Тем не менее, поскольку использование хирургических инструментов предполагает множество ориентаций и положений, указанные термины не следует толковать как ограничивающие и (или) абсолютные.
Для выполнения лапароскопических и минимально инвазивных хирургических вмешательств предложены различные примеры устройств и способов. Однако читателю будет вполне понятно, что различные способы и устройства, описанные в настоящем документе, можно применять в множестве хирургических вмешательств и сфер применения, включая, например, те, что связаны открытыми оперативными вмешательствами. При изучении данного подробного описания читатель сможет дополнительно оценить, что разнообразные инструменты, описанные в данном документе, можно вводить в тело любым способом - как через естественные отверстия, так и через разрез или пункционное отверстие, проделанное в тканях, и т. п. Рабочие части или части концевых эффекторов таких инструментов можно вводить непосредственно в тело пациента или через устройство доступа, которое имеет рабочий канал, через который можно проводить концевой эффектор и удлиненный ствол хирургического инструмента.
Хирургическая сшивающая система может содержать ствол и концевой проходящий от ствола эффектор. Концевой эффектор может включать первую браншу и вторую браншу. Первая бранша содержит кассету со скобами. Кассета со скобами выполнена с возможностью вставки в первую браншу и удаления из нее; однако предусмотрены другие варианты осуществления, в которых кассета со скобами выполнена без возможности извлечения из первой бранши или, по меньшей мере, выполнена с возможностью быстрой замены из первой бранши. Вторая бранша содержит упор, выполненный с возможностью деформации скоб, выталкиваемых из кассеты со скобами. Вторая бранша выполнена с возможностью поворота относительно первой бранши вокруг оси закрытия; однако предусмотрены другие варианты осуществления, в которых первая бранша выполнена с возможностью поворота относительно второй бранши. Хирургическая сшивающая система дополнительно содержит шарнирное сочленение, выполненное с возможностью обеспечения вращения или шарнирного поворота концевого эффектора относительно ствола. Концевой эффектор выполнен с возможностью вращения вокруг оси шарнирного сочленения, проходящей через шарнирное сочленение. Предусмотрены другие варианты осуществления, которые не включают шарнирное сочленение.
Кассета со скобами содержит корпус кассеты. Корпус кассеты включает проксимальный конец, дистальный конец и платформу, проходящую между проксимальным концом и дистальным концом. В процессе применения кассета со скобами расположена на первой стороне ткани, подлежащей сшиванию, а упор расположен на второй стороне ткани. Упор перемещается к кассете со скобами для сжатия и прижимания ткани к платформе. После этого скобы, хранящиеся в корпусе кассеты с возможностью извлечения, можно размещать в ткани. Корпус кассеты включает сформированные в нем полости для скоб, при этом скобы хранятся в полостях для скоб с возможностью извлечения. Полости для скоб расположены в шесть продольных рядов. Три ряда полостей для скоб расположены на первой стороне продольного паза, и три ряда полостей для скоб расположены на второй стороне продольного паза. Возможны другие конструкции скоб и полостей для скоб.
В корпусе кассеты скобы поддерживаются с помощью выталкивателей скоб. Выталкиватели выполнены с возможностью перемещения между первым или неактивированным положением и вторым или активированным положением для выталкивания скоб из полостей для скоб. Выталкиватели удерживаются в корпусе кассеты с помощью фиксатора, который проходит вокруг нижней части корпуса кассеты и включает упругие элементы, выполненные с возможностью захвата корпуса кассеты и удерживания фиксатора относительно корпуса кассеты. Выталкиватели выполнены с возможностью перемещения между их неактивированными положениями и активированными положениями с помощью салазок. Салазки выполнены с возможностью перемещения между проксимальным положением, смежным с проксимальным концом, и дистальным положением, смежным с дистальным концом. Салазки содержат множество наклонных поверхностей, выполненных с возможностью скольжения под выталкивателями и подъема выталкивателей и поддерживаемых на них скоб к упору.
В дополнение к указанному выше, салазки перемещаются дистально с помощью пускового элемента. Пусковой элемент выполнен с возможностью контакта с салазками и проталкивания салазок к дистальному концу. Продольный паз, сформированный в корпусе кассеты, выполнен с возможностью приема пускового элемента. Упор также включает паз, выполненный с возможностью приема пускового элемента. Пусковой элемент дополнительно содержит первый кулачок, который взаимодействует с первой браншей, и второй кулачок, который взаимодействует со второй браншей. При выдвижении пускового элемента дистально первый кулачок и второй кулачок позволяют контролировать расстояние, или тканевый зазор, между платформой кассеты со скобами и упором. Пусковой элемент также содержит скальпель, выполненный с возможностью рассечения ткани, захваченной между кассетой со скобами и упором. Желательно, по меньшей мере, частично располагать скальпель проксимально по отношению к наклонным поверхностям таким образом, чтобы скобы выталкивались раньше скальпеля.
На ФИГ. 1 изображен иллюстративный хирургический инструмент 10 с приводом от двигателя (или «с электропитанием») который содержит корпус 100, удлиненный сменный ствол 200 в сборе и хирургический концевой эффектор 300, который функционально соединен со сменным удлиненным стволом 200 в сборе. Несмотря на то, что узел ствола изображен отсоединяемым от корпуса 100, различные уникальные и новые характеристики могут быть в равной степени предусмотрены с помощью конструкций, в которых используется специально предназначенный (несменный) узел ствола. Показанный хирургический концевой эффектор 300 выполнен с возможностью выполнения функции эндоножниц для фиксации, разрезания и сшивания скобами ткани. Однако следует понимать, что различные варианты осуществления могут включать в себя концевые эффекторы, выполненные с возможностью функционирования в качестве других хирургических устройств, включая, например, зажимы, режущие инструменты, сшивающие инструменты, клипсонакладыватели, устройства доступа, устройства доставки препаратов лекарственной/генной терапии, ультразвуковые, РЧ и/или лазерные устройства и т. п. Как указано выше и будет дополнительно описано ниже, различные участки хирургического инструмента 10 приводятся в действие двигателем. Более подробная информация о многих аспектах компонентов с приводом от двигателя для хирургического инструмента 10 может быть найдена, например, в заявке на патент США № 13/803086, озаглавленной ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK, существующей публикации заявки на патент США № 2014/0263541 A1, которая включена в данный документ посредством ссылки во всей его полноте. Однако следует понимать, что различные конструкции и характеристики, раскрытые в данном документе, могут быть эффективно использованы по отношению к хирургическим системам с роботизированным управлением. Например, различные конструкции, раскрытые в данном документе, могут быть использованы с различными роботизированными системами, инструментами, компонентами и способами, раскрытыми в заявке на патент США № 13/118241, озаглавленной SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, существующей публикации заявки на патент США № 2012/0298719, а также в патенте США № 6132368, озаглавленном MULTI-COMPONENT TELEPRESENCE SYSTEM AND METHOD, пат. США № 5878193, озаглавленном AUTOMATED ENDOSCOPE SYSTEM FOR OPTIMAL POSITIONING, пат. США № 5792135, озаглавленном ARTICULATED SURGICAL INSTRUMENT FOR PERFORMING MINIMALLY INVASIVE SURGERY WITH ENHANCED DEXTERITY AND SENSITIVITY, патенте США № 6231565, озаглавленном ROBOTIC ARM DLUS FOR PERFORMING SURGICAL TASKS, патенте США № 6783524, озаглавленном ROBOTIC SURGICAL TOOL WITH ULTRASOUND CAUTERIZING AND CUTTING INSTRUMENT, патенте США № 6364888, озаглавленном ALIGNMENT OF MASTER AND SLAVE IN A MINIMALLY INVASIVE SURGICAL APPARATUS, патенте США № 7524320, озаглавленном MECHANICAL ACTUATOR INTERFACE SYSTEM FOR ROBOTIC SURGICAL TOOLS, патенте США № 7691098, озаглавленном PLATFORM LINK WRIST MECHANISM, патенте США № 7806891, озаглавленном REPOSITIONING AND REORIENTATION OF MASTER/SLAVE RELATIONSHIP IN MINIMALLY INVASIVE TELESURGERY, и патенте США № 7824401, озаглавленном SURGICAL TOOL WITH WRITED MONOPOLAR ELECTROSURGICAL END EFFECTORS, полные раскрытия каждого из которых включены в данный документ посредством ссылки.
Таким образом, в настоящем документе термин «корпус» также может охватывать корпус или аналогичную часть роботизированной системы, которая вмещает или иным образом функционально поддерживает, по меньшей мере, одну приводную систему, выполненную с возможностью генерирования и применения, по меньшей мере, одного управляющего движения, которое может применяться для приведения в действие сменных узлов ствола, описанных в настоящем документе, и их соответствующих эквивалентов. Термин «рама» может относиться к части портативного хирургического инструмента, например «ручке». Термин «рама» также может представлять собой часть хирургического инструмента с роботизированным управлением и/или часть роботизированной системы, которая может применяться для функционального управления хирургическим инструментом.
Следует понимать, что пространственные термины, такие как вертикальный, горизонтальный, правый, левый и т.д., приведены в данном документе в отношении фигур с учетом предположения о том, что «продольная ось ствола» хирургического инструмента 10 расположена соосно центральной оси ствола 200. Однако в действительной практике хирургический инструмент 10 может быть ориентирован под разными углами, и как таковые эти пространственные термины применяются относительно самого хирургического инструмента. Дополнительно, для корпуса, который держат в руке, «проксимальный» применяется для обозначения угла зрения врача, который находится позади рукоятки и размещает концевой эффектор 300 дистально или от себя. В настоящем документе фраза «по существу поперечен продольной оси», где «продольная ось» представляет собой ось стержня, относится к направлению, которое почти перпендикулярно продольной оси. Однако следует понимать, что направления, которые несколько отклоняются от перпендикуляра относительно продольной оси, также являются по существу поперечными продольной оси.
Как видно на ФИГ. 1, концевой эффектор 300 соединен с возможностью шарнирного поворота с узлом ствола 200 при шарнирном соединении 240. Разнообразные шарнирные соединения и системы управления раскрыты в различных патентах и патентных заявках, которые были включены в данный документ посредством ссылки и могут быть использованы по отношению к различным характеристикам, раскрытым и заявленным в данном документе. Другие шарнирные соединения и системы шарнирных соединений раскрыты в патенте США № 7753245, озаглавленном SURGICAL STAPLING INSTRUMENTS, и патенте США № 7670334, озаглавленная SURGICAL INSTRUMENT HAVING AN ARTICULATING END EFFECTOR, полные раскрытия каждого из которых включены в данный документ посредством ссылки. Различные другие средства шарнирного поворота концевого эффектора 300 более подробно описаны ниже.
Изображенный концевой эффектор 300 содержит удлиненный канал 302, который выполнен с возможностью функциональной поддержки кассеты 310 с хирургическими скобами в нем. Кассета 310 со скобами содержит корпус 312 кассеты, который функционально поддерживает множество хирургических скоб или крепежных элементов (не показаны) в ней. В одном варианте осуществления скобы функционально поддерживаются на шкивах, которые поддерживаются с возможностью движения в соответствующих карманах 314 со скобами, образованных в корпусе 312 кассеты. Корпус 312 кассеты дополнительно содержит удлиненный паз 316, который расположен по центру между линиями карманов 314 со скобами. Удлиненный паз 316 выполнен с возможностью вмещать разрезающий ткань элемент (не показан), который поддерживается для продольного перемещения по корпусу 312 кассеты при применении по отношению к нему пускового движения от пусковой системы, как будет рассмотрено более подробно ниже. В некоторых вариантах осуществления разрезающий ткань элемент может стыковаться с исполнительным элементом, иногда называемым «клиновидными салазками» или просто «салазками», который выполнен с возможностью приложения направленного вверх усилия к выталкивателям скоб по мере перемещения клиновидных салазок дистально с разрезающим ткань элементом. Как можно также видеть на ФИГ. 1, концевой эффектор 300 содержит упор 320, который поддерживается с возможностью движения по удлиненному каналу 302 для избирательного перемещения вперед и назад от удлиненного канала 302 и кассеты 310 со скобами, поддерживаемой в нем. Удлиненный канал и упор также могут называться «браншами», которые находятся с возможностью перемещения между открытым и закрытым положениями. Упор 320 имеет скобообразующую обращенную вниз поверхность (не показана), которая служит для образования концов скоб по мере того как они приводятся в формирующий контакт с ней. Упор 320 выполнен с возможностью перемещения между открытым и закрытым положениями посредством закрывающего элемента 210 в сборе, который связан с закрывающей системой, которая функционально поддерживается корпусом 100, как будет рассмотрено более подробно ниже. В изображенном варианте осуществления упор 320 перемещается по направлению к кассете 310 со скобами в закрытое положение, когда закрывающий элемент 210 в сборе приводится в действие в дистальном направлении ʺDDʺ, и возвращается в открытое положение, когда закрывающий элемент 210 в сборе перемещается в проксимальном направлении ʺPDʺ. Ряд различных конструкций и конфигураций концевого эффектора известен и может быть использован с различными уникальными и новыми характеристиками, раскрытыми в данном документе. Таким образом, многие из заявленных объектов, представленных в данном документе, могут не ограничиваться конкретной конструкцией концевого эффектора, изображенной, например, на ФИГ. 1. Более подробная информация о конкретной конструкции и работе альтернативных концевых эффекторов может быть найдена в различных заявках на патент США и патентах США, которые были включены в данный документ посредством ссылки.
В изображенной форме хирургический инструмент 10 содержит корпус 100, который содержит рукоятку 102. По меньшей мере в одной форме рукоятка 102 содержит пару взаимосоединяемых сегментов 104, 106 корпуса, которые взаимосоединяются болтами, защелками, клеем и т. п. В изображенной конструкции рукоятка сегментов 104, 106 корпуса взаимодействуют с образованием части 108 в виде пистолетной рукоятки, которая может быть захвачена и которой может управлять врач. Как будет дополнительно более подробно описано ниже, ручка 102 функционально поддерживает в себе множество приводных систем, которые выполнены с возможностью генерирования и приложения различных управляющих движений к соответствующим участкам сменного узла стержня, к которому эти системы функционально прикреплены.
Как показано на ФИГ. 2, ручка 102 может дополнительно иметь раму 110, функционально поддерживающую множество приводных систем. Например, рама 110 может функционально поддерживать первую систему, или систему закрывающего привода, по существу обозначенную как элемент 120, которая может быть реализована для приложения закрывающих и открывающих движений к стволу 200 в сборе, который функционально связан с ним или прикреплен к нему. По меньшей мере, в одной форме система закрывающего привода 120 может включать в себя исполнительный механизм в форме закрывающего спускового механизма 122, который вращательно поддерживается рамой 110. Более конкретно, как показано на ФИГ. 2, закрывающий спусковой механизм 122 может вращательно поддерживаться рамой 110 так, что когда врач захватывает часть пистолетной рукоятки 108 рукоятки 102, закрывающий спусковой механизм 122 может быть легко повернут из исходного или неактивированного положения в активированное положение, а более конкретно в полностью нажатое или полностью активированное положение. Закрывающий спусковой механизм 122 может быть смещен в неактивированное положение с помощью пружины или другого смещающего механизма (не показан). В различных формах система закрывающего привода 120 дополнительно включает в себя узел 124 закрывающего звена, который вращательно соединен с закрывающим спусковым механизмом 122. Как показано на ФИГ. 2, узел 124 закрывающего звена может иметь закрывающее звено 126, которое шарнирно соединено с закрывающим спусковым механизмом 122. Дополнительно, узел 124 закрывающего звена содержит другое закрывающее звено 127, которое имеет пару выступающих сбоку проушин крепления или частей 128, выступающих из него.
Снова обращаясь к ФИГ. 2, можно увидеть, что закрывающее звено 126 может иметь блокирующую стенку 130, выполненную с возможностью совместной работы с узлом высвобождения закрывающего механизма 140, шарнирно соединенным с рамой 110. По меньшей мере в одной форме узел высвобождения закрывающего механизма 140 может содержать узел кнопки высвобождения 142, на котором имеется выступающее дистально плечо элемента, приводимого в действие кулачком, 144. Узел кнопки высвобождения 142 может вращаться в направлении против часовой стрелки с помощью пружины высвобождения 146. Когда врач нажимает на закрывающий спусковой механизм 122 в его неактивированном положении в направлении части пистолетной рукоятки 108 рукоятки 102, закрывающее звено 126 вращается вверх до точки, в которой плечо элемента, приводимого в действие кулачком, 144 входит в удерживающее зацепление с блокирующей стенкой 130 на закрывающем звене 126, посредством этого не позволяя закрывающему спусковому механизму 122 вернуться в неактивированное положение. Таким образом, узел высвобождения закрывающего механизма 140 служит для блокировки закрывающего спускового механизма 122 в полностью активированном положении. Когда врачу нужно разблокировать закрывающий спусковой механизм 122, чтобы он смог сместиться в неактивированное положение, врач просто вращает узел кнопки высвобождения закрывающего механизма 142 так, чтобы плечо 144 элемента, приводимого в действие кулачком, вышло из зацепления с блокирующей стенкой 130 на закрывающем звене 126. После того как плечо 144 элемента, приводимого в действие кулачком, вышло из зацепления с закрывающим звеном 126, закрывающий спусковой механизм 122 может шарнирно повернуться назад в неактивированное положение. Также возможна реализация других блокирующих и высвобождающих механизмов закрывающего спускового механизма.
По меньшей мере, в одной форме рукоятка 102 и рама 110 могут функционально поддерживать другую приводную систему, которая в настоящем документе называется системой пускового привода 150, выполненной с возможностью прилагать пусковые движения к соответствующим частям прикрепленного к нему сменного ствола 200 в сборе. Также в настоящем документе система пускового привода может называться «второй приводной системой». В пусковой приводной системе 150 может применяться электродвигатель («пусковой двигатель») 152, размещенный в части 108 в виде пистолетной рукоятки 102. В различных формах пусковой двигатель 152 может представлять собой приводной щеточный двигатель постоянного тока с максимальной скоростью вращения, составляющей, например, приблизительно 25000 оборотов в минуту. В других конструкциях пусковой двигатель может включать в себя бесщеточный двигатель, беспроводной двигатель, синхронный двигатель, шаговый двигатель или любой другой подходящий электрический двигатель. Батарея 154 (или «источник питания», или «блок питания»), такая как, например, литий-ионная батарея, может быть соединена с рукояткой 102 и может подавать питание на узел платы со схемой управления 156 и, в конечном итоге, пусковой двигатель 152.
Пусковой двигатель 152 может включать в себя вращающийся вал (не показан), функционально связанный с узлом 158 зубчатого редуктора, который монтируется так, что находится в зубчатом зацеплении с набором или рейкой приводных зубцов 162 на выполненном с возможностью продольного перемещения приводном элементе 160. При применении полярность напряжения, обеспечиваемая батареей, позволяет пусковому двигателю 152 работать в направлении по часовой стрелке, причем полярность напряжения, приложенная к электрическому двигателю батареей, может быть изменена на обратную для работы электрического двигателя 152 в направлении против часовой стрелки. Когда электрический двигатель 152 поворачивается в одном направлении, приводной элемент 160 будет приводиться в движение в дистальном направлении DD по оси. При приведении двигателя 152 в движение в противоположном направлении вращения приводной элемент 160 будет приводиться в движение по оси в проксимальном направлении PD. Рукоятка 102 может включать в себя переключатель, который может быть выполнен с возможностью изменять на обратную полярность, прилагаемую к пусковому двигателю 152 батареей. Как и в других формах, описанных в настоящем документе, ручка 102 также может включать в себя датчик или датчики, выполненные с возможностью обнаружения положения(-ий) приводного элемента 160 и/или направления(-ий), в котором(-ых) перемещается приводной элемент 160.
В изображенном инструменте приведение в действие пускового двигателя 152 управляется пусковым крючком 170, который шарнирно поддерживается на рукоятке 102. Пусковой крючок 170 можно вращать между неактивированным положением и активированным положением. Пусковой крючок 170 может смещаться в неактивированное положение с помощью пружины (не показана) или другого смещающего механизма так, что когда врач высвобождает пусковой крючок 170, его можно вращать или иным образом возвращать в неактивированное положение с помощью пружины или смещающего механизма. В изображенной форме пусковой крючок 170 расположен на удалении от закрывающего спускового механизма 122, как было описано выше. По меньшей мере, в одной форме к закрывающему спусковому механизму 122 может быть шарнирно монтирована кнопка 172 предохранителя пускового крючка. Кнопка 172 предохранителя расположена между пусковым крючком 170 и закрывающим спусковым механизмом 122 и имеет выступающее поворотное плечо 174. Когда закрывающий спусковой механизм 122 находится в неактивированном положении, кнопка 172 предохранителя содержится в корпусе 100 рукоятки, где врач не может получить к ней простой доступ и переместить ее между безопасным положением, предотвращающим активацию пускового крючка 170, и пусковым положением, в котором пусковой крючок 170 может быть нажат. Когда врач нажимает на закрывающий спусковой механизм 122, кнопка предохранителя 172 и пусковой крючок 170 вращаются вниз, и в этом положении врач может манипулировать ими.
Как указано выше, по меньшей мере, в одной форме выполненный с возможностью продольного перемещения приводной элемент 160 имеет рейку образованных на нем зубцов 162 для сцепленного зацепления с соответствующей приводной шестерней 159 узла зубчатого редуктора 158. По меньшей мере, одна форма также может включать в себя приводимый в действие вручную «аварийный» узел 180, выполненный с возможностью того, чтобы врач мог вручную оттянуть выполненный с возможностью продольного перемещения приводной элемент 160, если приводной двигатель 152 становится недоступен. Аварийный узел 180 может включать в себя узел рычага или аварийной рукоятки 182, выполненный с возможностью ручного вращения в храповое зацепление с зубцом 162 приводного элемента 160. Таким образом, врач может вручную оттянуть приводной элемент 160 с помощью узла аварийной рукоятки 182, чтобы передвинуть приводной элемент с помощью храпового механизма в проксимальном направлении ʺPDʺ. В публикации заявки на патент США № 2010/0089970 раскрыты аварийные механизмы и другие компоненты, механизмы и системы, которые также могут применяться с различными инструментами, раскрытыми в настоящем документе. Заявка на патент США № 12/249,117, озаглавленная POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM, в настоящее время публикация заявки на патент США № 2010/0089970, включена в данный документ посредством ссылки во всей своей полноте.
На ФИГ. 1 показан хирургический инструмент 10 с функционально соединенным с ним сменным узлом 200 стержня. Как указано выше, узел ствола 200 может быть выполнен с возможностью быстрого присоединения к корпусу 100 и быстрого отсоединения от него. Закрывающий элемент 210 в сборе содержит дистальный сегмент 220 закрывающего элемента, который шарнирно присоединен к проксимальному сегменту 230 закрывающего элемента при шарнирном соединении 240. Дистальный сегмент 220 закрывающего элемента содержит U-образное отверстие 222, которое выполнено с возможностью функционального зацепления с выступающей вверх лапкой 322 упора на упоре 320, когда закрывающий элемент в сборе втягивается в проксимальном направлении ʺPDʺ. Когда U-образное отверстие 222 зацепляется с лапкой 322 упора, упор 320 шарнирно поворачивается в открытое положение. Конкретные детали, касающиеся примеров шарнирного соединения 240 и/или других подходящих конструкций шарнирного соединения, могут быть найдены в различных документах, которые были включены в данный документ посредством ссылки.
Обращаясь теперь к ФИГ. 3 и 7, ствол 200 в сборе содержит цапфу 250 в сборе, на которой закрывающий элемент 210 в сборе поддерживается с возможностью движения. Цапфа 250 в сборе содержит дистальный конец 252, который шарнирно присоединен к проксимальному концу 304 удлиненного канала 302. См. ФИГ. 7. Такая конструкция облегчает шарнирный поворот концевого эффектора 300 относительно дистального конца 252 цапфы 250 в сборе по оси A-A шарнирного соединения, которая является поперечной оси SA-SA ствола. См. ФИГ. 1. В различных вариантах осуществления концевой эффектор 300 также может быть выборочно вращающимся относительно корпуса 100 по оси SA-SA ствола (изображена стрелкой ʺRʺ на ФИГ. 1). Поскольку концевой эффектор 300 непосредственно присоединен к дистальному концу 252 цапфы 250 в сборе, поворот цапфы 250 в сборе относительно корпуса 100 также приводит к повороту концевого эффектора 300. В изображенном варианте осуществления сменный ствол 200 в сборе содержит поворачивающуюся насадку 400, которая опирается с возможностью поворота или иным образом поддерживается с возможностью поворота на рукоятке 102. В изображенном варианте осуществления, например, поворачивающаяся насадка 400 содержит две части насадки 402, 404, которые соединены вместе защелками, болтами, клеем и т. п., и содержит два противоположных проходящих внутрь ушка 406, которые располагают в соответствующих выемках 254 в проксимальном конце 252 цапфы 250 в сборе. См. ФИГ. 3. Такая конструкция облегчает поворот цапфы 250 в сборе, когда поворачивается насадка 400.
Шарнирный поворот концевого эффектора 300 по оси A-A шарнирного соединения осуществляется посредством приведения в действия системы 500 шарнирного поворота. В изображенном варианте осуществления, например, система 500 шарнирного поворота содержит двигатель 510 шарнирного поворота, который применяется для шарнирного поворота первого и второго шкивов 520, 530 шарнирного поворота. См. Фиг. 5 и 6. Двигатель 510 шарнирного поворота может представлять собой двигатель, аналогичный пусковому двигателю или любой одной из различных конфигураций двигателей, рассмотренных в данном документе, и содержит ведущее зубчатое колесо 512 шарнирного поворота, которое находится в зацеплении с первой зубчатой рейкой 524 на проксимальном конце 522 первого шкива 520 шарнирного поворота. Зубчатое колесо 512 шарнирного поворота также находится в зацеплении со второй зубчатой рейкой 534 на проксимальном конце 532 второго шкива 530 шарнирного поворота. В частности, как можно увидеть на ФИГ. 5, зубчатое колесо 512 шарнирного поворота расположено по центру между первой и второй зубчатыми рейками 524, 534 так, что поворот зубчатого колеса шарнирного поворота в первом направлении будет приводить к осевому перемещению первого шкива 520 шарнирного поворота в дистальном направлении ʺDDʺ и одновременному осевому перемещению второго шкива 530 шарнирного поворота в проксимальном ʺPDʺ или противоположном осевом направлении. Аналогичным образом, поворот зубчатого колеса 512 шарнирного поворота во втором направлении вращения будет приводить к осевому перемещению второго шкива 530 шарнирного поворота в дистальном направлении ʺDDʺ и одновременному осевому перемещению первого шкива 520 шарнирного поворота в проксимальном или противоположном направлении ʺPDʺ. Со ссылкой на ФИГ. 7, дистальный конец 526 первого шкива 520 шарнирного поворота содержит паз 528, который выполнен с возможностью приема соответствующего штифта 304, образованного на удлиненном канале 302. Аналогичным образом, дистальный конец 536 второго шкива 530 шарнирного поворота содержит паз 538, который выполнен с возможностью приема соответствующего штифта 306, образованного на удлиненном канале 302. Таким образом, осевое перемещение шкивов 520, 530 шарнирного поворота в описанном выше порядке будет обеспечивать прикладывание одновременных толкающих и вытягивающих движений к удлиненному каналу 302 и тем самым будет приводить к шарнирному повороту концевого эффектора 300 по оси A-A шарнирного соединения.
Как указано выше, хирургический инструмент 10 также содержит разрезающий ткань элемент, который выполнен с возможностью осевого перемещения по удлиненному пазу 316 в кассете 310 с хирургическими скобами. В изображенном варианте осуществления, например, разрезающий ткань элемент или разрезающая ткань поверхность (не показаны) образованы на или иным образом присоединены к дистальному пусковому элементу 550. Дистальный пусковой элемент 550 может быть выполнен в виде слоистой конструкции для облегчения изгиба по оси A-A шарнирного соединения при сохранении достаточно жесткости с обеспечением режущей ткань кромки, подлежащей перемещению по ткани, которая зажимается между кассетой с хирургическими скобами и упором, а также тем самым перемещение по клиновидным салазкам. Различные конфигурации дистального пускового элемента и разрезающего ткань элемента известны и раскрыты в патентах и/или патентных заявках, которые были включены в данный документ посредством ссылки. Дистальный пусковой элемент 550 присоединен к проксимальному пусковому элементу 560, который поддерживается для осевого перемещения относительно цапфы 250 в сборе. Проксимальный пусковой элемент 560 имеет внутри расположенный по центру осевой паз 562 для вмещения приводного вала 511 двигателя 510 шарнирного поворота. См. ФИГ. 5. Такая конструкция облегчает осевое перемещение проксимального пускового элемента 560 под действием приложенных к нему пусковых движений пусковой системой. Проксимальный конец 564 проксимального пускового элемента 560 содержит ушко 566, которое выполнено с возможностью приема в седловой опоре 164 для присоединения пускового стержня, предусмотренной на дистальном конце 162 подвижного приводного элемента 160. См. ФИГ. 2. Таким образом, приведение в действие пускового двигателя 152 будет приводить к осевому перемещению подвижного приводного элемента 160, а также проксимального пускового элемента 560 и дистального пускового элемента 550.
Пусковой двигатель 152 и двигатель 510 шарнирного поворота сообщаются со схемой управления 156 (на ФИГ. 2) и взаимно соединены посредством переключательного устройства, обозначенного в целом 600. В изображенной конфигурации переключательное устройство 600 содержит барабан 610 переключателя, который поддерживается с возможностью поворота на проксимальном сегменте 230 закрывающего элемента. См. ФИГ. 3. Барабан 610 переключателя содержит выступающую сбоку выпуклость 611, которая имеет проходящий внутрь штифт 612 криволинейного сечения, установленный (с тугой посадкой) в ней. Штифт 612 криволинейного сечения проходит внутрь криволинейного паза 232, предусмотренного в проксимальном сегменте 230 закрывающего элемента. См. ФИГ. 4. Барабан 610 переключателя дополнительно содержит противоположные пазы 614, которые выполнены для способствования поворота ушек 406 насадки. Паз 617 шарнирного поворота также предусмотрен для облегчения поворота барабана 610 переключателя относительно двигателя 510 шарнирного поворота. См. ФИГ. 3. Переключательное устройство 600 также содержит узел 620 контактных вращающихся колец, который выполнен с возможностью проведения электрической энергии и/или сигналов к и/или от концевого эффектора 300 к рукоятке 102 и, конкретнее, к схеме управления 156 в рукоятке 102. Узел 620 контактных вращающихся колец содержит множество концентрических или, по меньшей мере, по существу, концентрических проводников 622 на их противоположных сторонах, которые могут быть выполнены с возможностью обеспечения относительного поворачивания между половинами узла 620 контактных вращающихся колец с поддержанием электропроводящих путей между ними. Примеры таких узлов контактных вращающихся колец раскрыты в заявке на патент США № 13/800067, озаглавленной STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, в настоящее время публикации заявки на патент США № 2014/0263552, и заявке на патент США № 13/800025, озаглавленной STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, в настоящее время публикации заявки на патент США № 2014/0263551, при этом каждая из которых тем самым включена в данный документ посредством ссылки в своей полноте. В изображенном варианте осуществления узел 620 контактных вращающихся колец содержит перегородку 624, которая имеет компонент 626 переключателя, который обеспечивает связь узла 620 контактных вращающихся колец со схемой 156 управления. Переключательное устройство 600 также содержит подвижный компонент 618 переключателя, который установлен на часть 616 в виде рычага переключателя барабана 610 переключателя.
Со ссылкой на ФИГ. 4, можно увидеть, что криволинейный паз 232 имеет первую часть 232A и вторую часть 232B. Когда закрывающий элемент 230 находится в проксимальном (незадействованном) положении, штифт 612 криволинейного сечения находится в первой части 232A криволинейного паза 232. Блокирующая пружина 630 установлена на выпуклость 611 барабана переключателя для смещения барабана 610 переключателя в такое первое положение, при котором штифт 612 криволинейного сечения находится в первой части 232A криволинейного паза 232. См. ФИГ. 3. В случае такого первого положения подвижный компонент 618 переключателя не находится в контакте или в состоянии «приближения приведения в действие» с компонентом 626 переключателя. В случае данного положения «блокировки пуска» схема управления обеспечивает предохранение от приведения в действие пускового двигателя 152. Другими словами, пока подвижный компонент 618 переключателя не приведет в движение компонент 626 переключателя, какая-либо энергия не будет подана в пусковой двигатель 152. Таким образом, даже если врач привел в действие пусковой крючок 170 с целью приведения в действие пускового двигателя 152, пусковой двигатель 152 не будет приведен в действие.
В ходе типичной хирургической процедуры врач может вводить концевой эффектор 300 в операционное поле через трокар или другое отверстие у пациента для доступа к целевой ткани. При попытке размещения концевого эффектора в желаемом положении относительно целевой ткани врач может приводить в действие двигатель 510 шарнирного поворота посредством приведения в действие кулисного переключателя 515, установленного на рукоятке 102. Кулисный переключатель 515 взаимодействует со схемой 156 управления, и при этом посредством качания кулисного переключателя 515 в первом направлении будет обеспечиваться приведение в действие двигателя 510 шарнирного поворота для поворота в первом направлении и обеспечиваться шарнирный поворот концевого эффектора 300 в первом направлении шарнирного поворота. Качание переключателя 515 во втором направлении будет приводить к вращению двигателя 510 шарнирного поворота в противоположном направлении вращения и приводить к шарнирному повороту концевого эффектора 300 во второе противоположное направление шарнирного поворота. Как только врач поместит концевой эффектор 300 в необходимое положение, врач может отпустить переключатель 515 для остановки шарнирного поворота. На данном этапе целевая ткань может быть размещена между кассетой 310 с хирургическими скобами и упором 320. Затем врач может переместить упор 320 в закрытое положение, при котором целевая ткань зажимается между кассетой 310 со скобами и упором 320.
Закрывающий элемент 210 в сборе приводится в действие посредством приведения в действие закрывающего спускового механизма 122. Проксимальный конец проксимального сегмента 230 закрывающего элемента поддерживается в скобе крепления закрывающего элемента (не показана), которая поддерживается с возможностью движения в части рамы (не показана) узла ствола 200. Примеры скобы крепления закрывающего элемента и части рамы узла ствола описаны более подробно в заявке на патент США № 13/803097, озаглавленной ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, в настоящее время публикации заявки на патент США № 2014/0263542, которая была включена в данный документ посредством ссылки во всей своей полноте. По мере того как врач нажимает на закрывающий спусковой механизм 122, закрывающий элемент 210 в сборе перемещается в дистальном направлении ʺDDʺ, что, в конце концов, приводит к шарнирному повороту упора 320 в фиксированное положение на целевой ткани. По мере того как закрывающий элемент 210 в сборе перемещается дистально, штифт 612 криволинейного сечения взаимодействует с криволинейным пазом 232 и отводится в часть 232B криволинейного паза 232. Движение штифта 612 криволинейного сечения в части 232B криволинейного паза 232 приводит к вращательному движению барабана переключателя 610 в сборе в направлении срабатывания (изображено стрелкой ʺADʺ на ФИГ. 3). По мере того как барабан 610 переключателя смещается в направлении срабатывания ʺADʺ против силы пружины 630, компонент 618 переключателя приводится в действие/совмещение с компонентом 626 переключателя, что приводит к тому, что с платы схемы 156 управления подается питание на пусковой двигатель 152 при приведении в действие пускового крючка 170. В случае такого закрытого положения закрывающий элемент 210 в сборе и упор 320 заблокированы в закрытом положении в порядке, описанном выше. Схема 156 управления также может быть выполнена так, что когда компоненты 618 и 626 переключателя приводятся в действие/совмещение, схема 156 управления предотвращает подачу любого потока энергии в двигатель 510 шарнирного поворота, в случае если кулисный переключатель 515 был непреднамеренно приведен в действие. Как только закрывающий элемент 210 в сборе и упор 320 блокируются в фиксированном положении, врач может приводить в действие пусковой крючок 170 для запуска режущего элемента в концевом эффекторе 300 и разрезания зафиксированной целевой ткани в нем, а также запуска сшивания хирургическими крепежными элементами с каждой стороны линии разрезания ткани. Концевой эффектор 300 также может быть оснащен датчиками, которые сообщаются со схемой 156 управления, для определения момента, когда разрезающий ткань элемент достигает своего наиболее дальнего положения, тем самым подавая сигнал пусковому двигателю 152 для остановки и изменения своего направления с втягиванием разрезающего ткань элемента в его исходное положение. Могут быть использованы другие датчики для определения момента, когда разрезающий ткань элемент возвращается в исходное положение и сообщается со схемой 156 управления, обеспечивая тем самым врачу индикацию состояния разрезающего ткань элемента и/или позволяя разблокировать закрывающий элемент в сборе. Как только закрывающий элемент 210 в сборе становится разблокированным, блокирующая пружина 630, оказывающая действие на барабан 610 переключателя, будет обеспечивать возврат с поворотом штифта 612 криволинейного сечения в часть 232A криволинейного паза 232. Поворот барабана 610 переключателя обратно в его исходное положение будет деактивировать переключатель 626, который после этого снова предотвратит приведение в действие пускового двигателя 152.
На ФИГ. 9-11 показан другой узел ствола 200ʹ, который является по сути аналогичным узлу ствола 200, за исключением различий, рассмотренных ниже. Те части/компоненты узла ствола200ʹ, которые также находятся в узле ствола 200, будут обозначены одинаковыми номерами элементов. Как можно видеть ФИГ. 9-11, узел ствол 200ʹ содержит систему 500ʹ шарнирного поворота, которая содержит двигатель 510ʹ шарнирного поворота, который применяется для приведения в действие первого и второго шкивов 520ʹ, 530ʹ шарнирного поворота. См. Фиг. 10 и 11. Двигатель 510ʹ шарнирного поворота содержит червячное колесо 512ʹ шарнирного поворота, которое находится в зацеплении с узлом 700 зубчатого колеса шарнирного поворота. В одной форме узел зубчатого колеса шарнирного поворота содержит прямозубое цилиндрическое зубчатое колесо 702 шарнирного поворота, которое находится в зацеплении с червячным колесом 512ʹ шарнирного поворота, и ведущее зубчатое колесо 704 шарнирного поворота, которое находится в зацеплении с частями первого и второго шкивов 520ʹ, 530ʹ шарнирного поворота. Узел 700 зубчатого колеса шарнирного поворота, а конкретнее, ведущее зубчатое колесо 704, расположен по центру между первой зубчатой рейкой 524ʹ на первом шкиве 520ʹ шарнирного поворота и второй зубчатой рейкой 534ʹ шарнирного поворота на втором шкиве 530ʹ шарнирного поворота. Поворот ведущего зубчатого колеса 704 шарнирного поворота в первом направлении будет приводить к осевому перемещению первого шкива 520ʹ шарнирного поворота в дистальном направлении ʺDDʺ и одновременному осевому перемещению второго шкива 530ʹ шарнирного поворота в проксимальном ʺPDʺ или противоположном осевом направлении. Аналогичным образом, поворот ведущего зубчатого колеса 704 шарнирного поворота во втором направлении вращения будет приводить к осевому перемещению второго шкива 530ʹ шарнирного поворота в дистальном направлении ʺDDʺ и одновременному осевому перемещению первого шкива 520ʹ шарнирного поворота в проксимальном или противоположном направлении ʺPDʺ.
Со ссылкой на ФИГ. 11, дистальный конец 526ʹ первого шкива 520ʹ шарнирного поворота содержит паз 528ʹ, который выполнен с возможностью приема соответствующего штифта 304, образованного на удлиненном канале концевого эффектора 300. Аналогичным образом, дистальный конец 536ʹ второго шкива 530ʹ шарнирного поворота содержит паз 538ʹ, который выполнен с возможностью приема соответствующего штифта 306, образованного на удлиненном канале. Таким образом, осевое перемещение шкивов 520ʹ, 530ʹ шарнирного поворота в описанном выше порядке будет обеспечивать прикладывание одновременных толкающих и вытягивающих движений к удлиненному каналу концевого эффектора 300 и тем самым будет приводить к шарнирному повороту концевого эффектора 300 по оси шарнирного соединения. Как указано выше, хирургический инструмент 10 также содержит разрезающий ткань элемент, который выполнен с возможностью осевого перемещения по удлиненному пазу в кассете с хирургическими скобами, которая поддерживается в концевом эффекторе 300. Разрезающий ткань элемент или разрезающая ткань поверхность (не показаны) образованы на или иным образом присоединены к дистальному пусковому элементу 550. Дистальный пусковой элемент 550 присоединен к пусковому стержню 560ʹ, который поддерживается для осевого перемещения в цапфе 250 в сборе. Проксимальный пусковой элемент 560ʹ расположен по центру осевого паза (не показан) для вмещения приводного вала 701 зубчатого колеса, на котором установлены прямозубое цилиндрическое зубчатое колесо 702 шарнирного поворота и ведущее зубчатое колесо 704 шарнирного поворота. См. Фиг. 9 и 10. Такая конструкция облегчает осевое перемещение проксимального пускового элемента 560ʹ под действием приложенных к нему пусковых движений пусковой системой. Проксимальный конец 564ʹ проксимального пускового элемента 560ʹ содержит ушко 566ʹ, которое выполнено с возможностью приема в седловой опоре 164 для присоединения пускового стержня, предусмотренной на дистальном конце 163 приводного элемента 160. См. ФИГ. 2. Таким образом, приведение в действие пускового двигателя 152 будет приводить к осевому перемещению приводного элемента 160, а также проксимального пускового элемента 560ʹ и дистального пускового элемента 550.
Пусковой двигатель 152 и двигатель 510 шарнирного поворота сообщаются со схемой управления 156 (на ФИГ. 2) и взаимно соединены посредством переключательного устройства, обозначенного в целом 600. В изображенной конфигурации переключательное устройство 600 содержит барабан 610ʹ переключателя, который поддерживается с возможностью поворота на проксимальном закрывающем элементе 230ʹ. Барабан 610ʹ переключателя содержит выступающую сбоку выпуклость 611ʹ, которая имеет проходящий внутрь штифт 612ʹ криволинейного сечения, установленный в ней. В аналогичной конструкции, описанной выше штифт 612ʹ криволинейного сечения проходит внутрь криволинейного паза, предусмотренного в закрывающем элементе 230ʹ. Барабан 610ʹ переключателя дополнительно содержит противоположные пазы 614ʹ, которые выполнены для способствования поворота ушек 406 насадки. Барабан 610ʹ переключателя имеет открытую нижнюю часть 613ʹ для облегчения поворота барабана 610ʹ переключателя относительно двигателя 510ʹ шарнирного поворота и узла 700 зубчатого колеса шарнирного поворота. См. ФИГ. 9. Переключательное устройство 600ʹ также содержит подвижный компонент 618ʹ переключателя, который установлен на часть 616ʹ в виде рычага переключателя барабана 610ʹ переключателя.
Как обсуждалось выше, когда закрывающий элемент 230ʹ находится в проксимальном (незадействованном) положении, штифт 612ʹ криволинейного сечения находится в первой части криволинейного паза. Блокирующая пружина 630ʹ установлена на выпуклость 611ʹ барабана переключателя для смещения барабана 610ʹ переключателя в такое первое положение, при котором штифт 612ʹ криволинейного сечения находится в первой части криволинейного паза. В случае такого первого положения подвижный компонент 618ʹ переключателя не находится в контакте или в состоянии «приближения приведения в действие» с компонентом 626 переключателя. В случае данного положения «блокировки пуска» схема управления обеспечивает предохранение от приведения в действие пускового двигателя 152. Другими словами, пока подвижный компонент переключателя не приведет в движение компонент 626 переключателя, какая-либо энергия не будет подана в пусковой двигатель 152. Таким образом, даже если врач привел в действие пусковой крючок 170 с целью приведения в действие пускового двигателя 152, пусковой двигатель 152 не будет приведен в действие.
В изображенном примере закрывающий элемент 230ʹ в сборе приводится в действие посредством приведения в действие закрывающего спускового механизма 122. По мере того как врач нажимает на закрывающий спусковой механизм 122, закрывающий элемент 230ʹ в сборе перемещается в дистальном направлении ʺDDʺ, что, в конце концов, приводит к шарнирному повороту упора в фиксированное положение на целевой ткани. По мере того как закрывающий элемент 230ʹ перемещается дистально, штифт 612ʹ криволинейного сечения взаимодействует с криволинейным пазом, который приводит к вращательному движению барабана 610ʹ переключателя в сборе. По мере того как барабан 610ʹ переключателя смещается в направлении срабатывания против силы пружины 612ʹ, компонент 618ʹ переключателя приводится в действие/совмещение с компонентом 626 переключателя, что приводит к тому, что с платы схемы 156 управления подается питание на пусковой двигатель 152 при приведении в действие пускового крючка 170. В случае такого закрытого положения закрывающий элемент 210ʹ в сборе и упор заблокированы в закрытом положении в порядке, описанном выше. Схема 156 управления также может быть выполнена так, что когда компоненты 618ʹ и 626 переключателя приводятся в действие/совмещение, схема 156 управления предотвращает подачу любого потока энергии в двигатель 510ʹ шарнирного поворота, в случае если кулисный переключатель 515 был непреднамеренно приведен в действие. Как только закрывающий элемент 210ʹ в сборе и упор блокируются в фиксированном положении, врач может приводить в действие пусковой крючок 170 для запуска режущего элемента в концевом эффекторе 300 и разрезания зафиксированной целевой ткани в нем, а также запуска сшивания хирургическими крепежными элементами с каждой стороны линии разрезания ткани. Концевой эффектор 300 также может быть оснащен датчиком(-ами) (не показаны), которые сообщаются со схемой 156 управления, для определения момента, когда разрезающий ткань элемент достигает своего наиболее дальнего положения, тем самым подавая входной сигнал схеме управления с обеспечением остановки пускового двигателя 152 и изменения его направления с втягиванием разрезающего ткань элемента в его исходное положение. Может быть использован другой датчик(-и) для определения момента, когда разрезающий ткань элемент возвращается в исходное положение и сообщается со схемой 156 управления с передачей тем самым информации врачу и/или обеспечением разблокировки закрывающего элемента в сборе. Как только снимается блокировка с закрывающего элемента 210ʹ в сборе, блокирующая пружина 630ʹ, оказывающая действие на барабан 610ʹ переключателя, будет обеспечивать с помощью штифта 612ʹ криволинейного сечения возврат с поворотом барабана 610ʹ переключателя в такое исходное положение, при котором будет происходить деактивация переключателя 626, и при этом снова приведение в действие пускового двигателя 152 будет предотвращаться схемой управления.
На ФИГ. 12 и 13 показан альтернативный узел ствола 200ʺ, который является по сути аналогичным узлу ствола 200, за исключением различий, рассмотренных ниже. Те части/компоненты узла ствола 200ʺ, которые также находятся в узле ствола 200, будут обозначены одинаковыми номерами элементов. Как можно видеть на данных фигурах, узел ствола 200ʺ содержит цапфу 250ʺ в сборе, которая содержит проксимальный конец рамы или проксимальный элемент 252ʺ рамы, который присоединен к раме 260 ствола, которая шарнирно соединена с вставным элементом 330 рамы концевого эффектора, который присоединен к удлиненному каналу 302. Рама 260 ствола содержит шарнирный палец 262, который выполнен с возможностью приема с поворотом в осевое отверстие (не показано) во вставном элементе 330 рамы концевого эффектора. Такая конструкция служит для образования шарнирного соединения 240, с помощью которого концевой эффектор 300 может выполнять шарнирный поворот.
Изображенный узел ствола 200ʺ содержит первый и второй шкивы 520ʺ, 530ʺ шарнирного поворота, которые аналогичны шкивам 520, 530 шарнирного поворота, как обсуждалось выше, за исключением отличий, описанных ниже. Как можно видеть на ФИГ. 12 и 13, например, первый и второй шкивы 520ʺ, 530ʺ шарнирного поворота поддерживаются с возможностью скольжения между цапфой 250ʺ в сборе и закрывающим элементом 210 в сбореʺ. Таким образом, шкивы 520ʺ, 530ʺ шарнирного поворота скользят по оси между такими компонентами, когда приводятся в действие для осуществления шарнирного поворота концевого эффектора 300 с помощью шарнирного соединения 240. Для того, чтобы обеспечить поддержку первого и второго шкивов 520ʺ, 530ʺ шарнирного поворота в ходе их приведения в действие, по центру между шкивами 520ʺ и 530ʺ шарнирного поворота расположено промежуточное зубчатое колесо 264. Первый шкив 520ʺ шарнирного поворота содержит первую дистальную зубчатую рейку 527, и второй шкив 530ʺ шарнирного поворота содержит вторую дистальную зубчатую рейку 537. Первая и вторая дистальные зубчатые рейки 527, 537 находятся в зацеплении с промежуточным зубчатым колесом 264, как показано. Дополнительно, проксимальный сегмент 230ʺ закрывающего элемента содержит первый обеспечивающий трение стопор или запорный зуб 234, который выполнен с возможностью скольжения с зацеплением первой зубчатой или зазубренной части 529 на первом шкиве 520ʺ шарнирного поворота. Проксимальный сегмент 230ʺ закрывающего элемента также содержит второй обеспечивающий трение стопор или запорный зуб 236, который выполнен с возможностью скольжения с зацеплением второй зубчатой или зазубренной части 539 на втором шкиве 530ʺ шарнирного поворота. Для обеспечения некоторого изгиба зазубренных частей 529, 539 первый и второй шкивы 520ʺ, 530ʺ шарнирного поворота, соответственно, в ходе шарнирного поворота концевого эффектора 300, предусматривается некоторая величина зазора между соответствующей частью проксимального элемента 252ʺ рамы и зазубренными частями 529, 539 шкивов 520ʺ, 530ʺ шарнирного поворота. Например, части проксимального элемента 252ʺ рамы, которые не соответствуют зазубренным частям 529, 539, могут иметь диаметр ʺDʺ, и часть проксимального элемента 252ʺ рамы, которая соответствует зазубренным частям 529, 539, может иметь наименьший диаметр ʺMʺ, где M < D. Такая конструкция обеспечивает зазор для изгиба шкивов 520ʺ, 530ʺ шарнирного поворота по мере продвижения шкивов 520ʺ, 530ʺ по оси. В ходе такого продвижения по оси стопорные зубы 234, 236 входят в зацепление с соответствующими зазубренными частями 529, 539 для предотвращения движения шкивов 520ʺ, 530ʺ шарнирного поворота и по сути «блокирования» концевого эффектора в определенном положении. Это преимущественно не только для удерживания концевого эффектора в ориентации с шарнирным поворотом в ходе осуществления хирургической процедуры, но также в ходе транспортировки устройства, что может предотвратить случайное повреждение его частей. Дополнительно, такие блокирующие механизмы служат для удерживания шкивов шарнирного поворота в их соответствующих положениях присоединения до присоединения узла ствола к рукоятке или корпусу. В альтернативных конструкциях каждый из обеспечивающего трения стопора или запорных зубов может отклоняться пружиной с приведением в контакт с соответствующими зазубренными частями шкивов шарнирного поворота. Например, каждый зуб может быть подвижным по отдельности в направлениях, поперечных зазубренным частям. Смещающий элемент или пружина может быть расположен по отношению к каждому запорному зубу для смещения зуба с удержанием зацепления с соответствующей зазубренной частью.
На ФИГ. 14-24 показаны части другого сменного узла ствола 1200, который может быть использован с хирургическим инструментом 10. Такие компоненты сменного узла ствола 1200, которые являются идентичными компонентам сменного узла ствола 200, описанным выше, будут описаны ниже с одинаковыми номерами элементов. В изображенной конструкции узел ствола 1200 содержит цапфу 1250 в сборе, на которой закрывающий элемент 1210 в сборе поддерживается с возможностью движения. Цапфа в сборе 1250 содержит проксимальный сегмент 1252 цапфы, который поддерживается с возможностью поворота в части рамы узла ствола 1200. Проксимальный сегмент 1252 цапфы имеет две диаметрально противоположные выемки 1253, которые выполнены с возможностью приема соответствующих частей 1406 в виде ушек, проходящих внутрь от частей 1402 насадки. Дополнительная информация относительно узла рамы ствола и поворотного присоединения проксимального сегмента 1252 цапфы в нем, а также поворотного присоединения частей 1402 насадки к нему, может быть найдена в заявке на патент США № 13/803097, озаглавленной ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, публикации заявки на патент США № 2014/0263542, которые были включены в данный документ посредством ссылки во всей своей полноте.
Ссылаясь на ФИГ. 16, 17, 18, 19, 22 и 24, проксимальный сегмент 1252 цапфы соединен с дистальным элементом 1256 рамы посредством ребра 1254 рамы, которое проходит между ними в закрывающем элементе 1210 в сборе. Как можно видеть на ФИГ. 20 и 21, дистальный элемент 1256 рамы соединен с рамой 1260. Концевой эффектор 1300 является аналогичным концевому эффектору 300 и выполнен с возможностью разрезания и сшивания скобами/ткани описанным выше способом. Концевой эффектор 1300 содержит удлиненный канал 1302, который имеет вставной элемент 1330 рамы концевого эффектора, присоединенный к нему. Дополнительная информация относительно рамы и вставного элемента рамы концевого эффектора также может быть найдена в заявке на патент США № 13/803097, озаглавленной ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, публикации заявки на патент США № 2014/0263542. Рама ствола 1260 содержит шарнирный палец 1262, который выполнен с возможностью приема с поворотом в осевое отверстие (не показано) во вставном элементе 1330 рамы концевого эффектора. Такая конструкция служит для образования шарнирного соединения 1240, с помощью которого концевой эффектор 1300 может выполнять шарнирный поворот. В изображенном варианте осуществления сменный узел ствола 1200 содержит проксимальный шкив 1242 шарнирного поворота, который связан с фиксатором 1270 шарнирного поворота. Дополнительная информация относительно фиксатора 1270 шарнирного поворота также может быть найдена в заявке на патент США № 13/803097, озаглавленной ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, публикации заявки на патент США № 2014/0263542. Как обсуждалось более подробно в данной патентной заявке, движение проксимального шкива 1240 шарнирного поворота, будь то проксимальный или дистальный, может обеспечивать разблокировку фиксатора 1270 шарнирного поворота.
Все еще ссылаясь на ФИГ. 19 и 20, фиксатор 1270 шарнирного поворота содержит дистальный шкив 1272 шарнирного поворота, который подвижно соединен с приводным штифтом 1332 на вставном элементе 1330 рамы концевого эффектора. Например, приводной штифт 1332 может плотно приниматься внутрь выемки 1274 для штифта, образованной в дистальном конце 1273 дистального шкива 1272 шарнира так, что приводной штифт 1332 может прилегать к проксимальной боковой стенке выемки 1274 для штифта и передавать проксимальное толкающее усилие P к дистальному шкиву 1272 шарнира. Такое проксимальное толкающее усилие P будет служить не только для укрепления блокирующего зацепления, достигнутого с помощью фиксатора 1270 шарнирного поворота. С целью устранения блокирующего зацепления и обеспечения поворота концевого эффектора 1300 в направлении, указанном стрелкой 1241, обращаясь теперь к ФИГ. 21, проксимальный шкив 1242 шарнирного поворота проталкивается проксимально для достаточной разблокировки зафиксированных компонентов и обеспечения проксимального движения дистального шкива 1272 шарнирного поворота. В различных условиях проксимальный шкив 1242 шарнирного поворота может и дальше выталкиваться проксимально, пока его часть проксимально выталкивает дистальный шкив 1272 шарнирного поворота с шарнирным поворотом концевого эффектора 1300. После того как концевой эффектор 1300 был надлежащим образом шарнирно повернут в направлении стрелки 1241, проксимальный шкив 10040 шарнирного поворота может быть освобожден, с обеспечением в различных условиях повторной блокировки с помощью фиксатора 1270 шарнирного поворота дистального шарнирного элемента 1272 в определенном положении. Более подробная информация о конструкции и работе фиксатора 1270 шарнирного поворота может быть найдена в заявке на патент США № 13/803097, озаглавленной ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, публикации заявки на патент США № 2014/0263542, которые были включены в данный документ посредством ссылки во всей своей полноте.
Как обсуждалось выше, одна форма сменного узла ствола 1200 содержит систему шкивов шарнирного поворота, содержащую проксимальный шкив 1242 шарнирного поворота и дистальный шкив 1272 шарнирного поворота. Когда приводное усилие передается на проксимальный шкив 1242 шарнирного поворота, будь то в проксимальном направлении или дистальном направлении, приводное усилие может передаваться дистальному шкиву 1272 шарнирного поворота через фиксатор 1270 шарнирного поворота. В различных условиях, в дополнение к указанному выше, приводной элемент 160 хирургического инструмента 10 может использоваться для передачи такого приводного усилия проксимальному шкиву 1242 шарнирного поворота. Например, сменный узел ствола 1200 содержит систему 1700 сцепления, которая может быть выполнена с возможностью выборочного соединения проксимального шкива 1242 шарнирного поворота с приводным элементом 160 хирургического инструмента 10 так, что движение приводного элемента 160 передается проксимальному шкиву 1242 шарнирного поворота. В ходе применения система 1700 сцепления является перемещаемой между зацепленным состоянием (на ФИГ. 22), в котором проксимальный шкив 1242 шарнирного поворота функционально зацеплен с проксимальным пусковым элементом 1560 (и приводным элементом 160), и расцепленным состоянием (на ФИГ. 24), в котором проксимальный шкив 1242 шарнирного поворота функционально не зацеплен с проксимальным пусковым элементом 1560 (и приводным элементом 160).
В одной форме система 1700 сцепления содержит зацепляющий элемент 1710, который может быть выполнен с возможностью непосредственного соединения проксимального шкива 1242 шарнирного поворота с проксимальным пусковым элементом 1560. Как можно видеть на ФИГ. 16, например, проксимальный шкив 1242 шарнирного поворота содержит проксимальную лапку 1243, которая принимается в кольцевую канавку 1712, предусмотренную по периметру зацепляющего элемента 1710 для соединения проксимального шкива 1242 шарнирного поворота с зацепляющим элементом 1710 при обеспечении относительного поворота между ними. Как можно видеть на ФИГ. 17, проксимальный пусковой элемент 1560 содержит часть 1562 в виде удлиненного стержня, который имеет проушину 1564 крепления, образованную на его проксимальном конце. Проушина 1564 крепления выполнена поддерживаемой с возможностью поворота в седловой опоре 162 на приводном элементе 160. См. ФИГ. 2. Как можно подробнее увидеть на ФИГ. 17, проксимальный пусковой элемент 1560 дополнительно содержит соединительную муфту 1566 для пускового стержня, которая образована на дистальном конце стержня 1562. Соединительная муфта 1566 для пускового стержня содержит закрытый дистальный конец 1567, который образует цилиндрический проход 1568. Отверстие 1569 образовано со стороны закрытого дистального конца 1567, а именно, выполнено с возможностью приема со скольжением проксимального конца 1572 промежуточного пускового элемента 1570 через него. В изображенном примере промежуточный пусковой элемент 1570 содержит стопорный элемент в форме диска 1574, который образован на его проксимальном конце 1572 и рассчитан на перемещение со скольжением в цилиндрическом проходе 1568 в соединительной муфте 1566 для пускового стержня. Дистальный конец промежуточного пускового элемент 1570 соединен с проксимальным концом дистальным пусковым элементом 550 различным образом, раскрытым, например, в заявке на патент США № 13/803,097, озаглавленной ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, публикации заявки на патент США № 2014/0263542, которые включены в данный документ посредством ссылки. В изображенной конструкции две диаметрально-противоположные V-образные зацепляющие канавки 1580 образованы по периметру соединительной муфты 1566 для пускового стержня. См. ФИГ. 17-19. V-образные канавки 1580 выполнены с возможностью приема со скольжением соответствующими V-образными стопорами 1714, 1715 шарнирного поворота, образованными на внутренней поверхности 1713 зацепляющего элемента 1710.
В дополнение к вышесказанному, ссылаясь снова на ФИГ. 16-24, система 1700 сцепления также содержит исполнительный элемент 1720, который выполнен с возможностью осевого перемещения по зацепляющему элементу 1710. В частности, как можно увидеть на ФИГ. 17, например, первый зацепляющий штифт 1716 проходит наружу из зацепляющего элемента 1710 и выполнен с возможностью приема со скольжением в пазу 1722, проходящему по исполнительному элементу 1720. Такая конструкция облегчает относительное осевое перемещение исполнительного элемента 1720 и зацепляющего элемента 1710, при этом также обеспечивая поворот исполнительного элемента 1720 и зацепляющего элемента 1710 в виде блока. Также в изображенной конструкции система 1700 сцепления содержит штифт 1724 криволинейного сечения, который выступает из исполнительного элемента 1720. Как и в описанной выше конструкции, штифт 1724 криволинейного сечения проходит наружу по криволинейному пазу 1232 в проксимальном сегменте закрывающего элемента 1230. См. ФИГ. 15.
Пусковой двигатель 152 взаимодействует со схемой 156 управления и переключательным устройством, обозначенным в целом как 1600. В изображенной конфигурации переключательное устройство 1600 содержит барабан 1610 переключателя, который поддерживается с возможностью поворота на проксимальном сегменте 1230 закрывающего элемента. Барабан 1610 переключателя содержит выступающую сбоку выпуклость 1611, которая выполнена с возможностью приема конца 1724 штифта криволинейного сечения в ней. Барабан 1610 переключателя дополнительно содержит противоположные пазы 1614, которые выполнены для способствования поворота ушек 1406 насадки. См. ФИГ. 14. Переключательное устройство 1600 также содержит узел 1620 контактных вращающихся колец, который выполнен с возможностью проведения электрической энергии и/или сигналов к и/или от концевого эффектора 1300 к рукоятке 102 и, конкретнее, к схеме управления 156 в рукоятке 102. Узел 1620 контактных вращающихся колец содержит множество концентрических или, по меньшей мере, по существу, концентрических проводников 1622 на их противоположных сторонах, которые могут быть выполнены с возможностью обеспечения относительного поворачивания между половинами узла 1620 контактных вращающихся колец с поддержанием электропроводящих путей между ними. В изображенном варианте осуществления узел 1620 контактных вращающихся колец содержит перегородку 1624, которая имеет компонент 1626 переключателя, который обеспечивает связь контактного вращающегося кольца 1620 со схемой 156 управления. Переключательное устройство 1600 также содержит подвижный компонент 1618 переключателя, который установлен на часть 1616 в виде рычага переключателя барабана 1610 переключателя. См. ФИГ. 14.
Как обсуждалось выше, в ходе типичной хирургической процедуры врач может вводить концевой эффектор 1300 в операционное поле через трокар или другое отверстие у пациента для доступа к целевой ткани. На ФИГ. 20 изображено положение концевого эффектора 1300 для вставки через отверстие трокара или иным образом в пациента для доступа к целевой ткани. Как можно видеть на данной фигуре, концевой эффектор 1300 не совершает шарнирный поворот или, другими словами, выравнен по оси с осью SA-SA ствола. Как только концевой эффектор 1300 проходит через отверстие трокара, врачу, например, может понадобиться осуществление шарнирного поворота концевого эффектора 1300, чтобы выгодно разместить его вблизи целевой ткани. На ФИГ. 15, 18, 20, 21 и 22 показаны положения компонентов системы сцепления, когда система 1700 сцепления находится в ориентации шарнирного поворота. В ходе процесса шарнирного поворота концевой эффектор 1300 находится в открытом положении. Другими словами, закрывающий элемент 1210 в сборе расположен в его проксимальном «незадействованном» положении так, что дистальный конец упора концевого эффектора 1300 отделяется от кассеты с хирургическими скобами. На ФИГ. 15 изображено положение проксимального сегмента 1230 закрывающего элемента, когда он находится в незадействованном или открытом положении. Как можно видеть на данной фигуре, штифт 1724 криволинейного сечения расположен в верхней части криволинейного паза 1232. В случае такого положения штифт 1724 криволинейного сечения обеспечивает расположение барабана 1610 переключателя так, что компонент 1618 переключателя на рычаге переключателя 1616 не находится в состоянии, близком к приведению в действие, или состоянии выравнивания с компонентом 1626 переключателя на перегородке 1624 переключателя. Таким образом, когда переключатель 1626 не приводится в действие переключателем 1618, схема 156 управления может быть выполнена с возможностью обеспечения запуска пускового двигателя 152 для ограниченного хода с сжатием, но без возможности обеспечения запуска на период, который является достаточным для приведения в действие или продвижения промежуточного пускового элемента 1570 и дистального пускового элемента 550, как будет рассмотрено более подробно ниже. Как можно видеть на ФИГ. 14, блокирующая пружина 1150 пусковой системы предусмотрена на выпуклости 1611 барабана 1610 переключателя для смещения барабана 1610 переключателя и, в конце концов, штифта 1724 криволинейного сечения выше части криволинейного паза 1232 в незадействованном или открытом положении. См. ФИГ. 14. Таким образом, когда закрывающий элемент 1210 в сборе и, в конце концов, упор 1300 концевого эффектора находятся в открытом положении, приведение в действие пускового двигателя 152 не будет приводить к продвижению промежуточного пускового элемента 1570 и дистального пускового элемента 550 по концевому эффектору 1300.
Ссылаясь на ФИГ. 18 и 22, когда система 1700 сцепления находится в ориентации шарнирного поворота, V-образные стопоры 1714, 1715 не выравниваются с соответствующими V-образными пазами 1580 в соединительной муфте 1566 для пускового стержня. Таким образом, продвижение приводного элемента 160 и проксимального пускового элемента 1560 в дистальном направлении ʺDDʺ будет приводить к дистальному продвижению проксимального шкива 1242 шарнирного поворота, показанного, например, на ФИГ. 21. Такая конструкция служит для шарнирного поворота концевого эффектора 1300 в направлении, изображенном стрелкой 1241 на ФИГ. 21. Приводной элемент 160 и проксимальный пусковой элемент 1560 продвигаются дистально посредством приведения в действие пускового двигателя 152 в первом направлении. В одном варианте осуществления пусковой двигатель 152 может быть приведен в действие посредством приведения в действие кулисного переключателя 515, установленного на рукоятке 102 в первом направлении. Для осуществления шарнирного поворота концевого эффектора 1300 во втором противоположном направлении (изображенном стрелкой 1243 на ФИГ. 21), кулисный переключатель 515 приводится в действие во второе или противоположное направление. Однако, в любом случае, поскольку закрывающий элемент 1210 в сборе находится в открытом положении, и переключатель 1618 на барабане 1610 переключателя не находится в ориентации приведения в действие с переключателем 1626 на перегородке 1624 переключателя, схема 156 управления обеспечивает приведение в действие лишь пускового двигателя 152 в течение времени, необходимого для достижения необходимого хода с шарнирным поворотом, но недостаточной продолжительности для дистального продвижения промежуточного пускового элемента 1570. На ФИГ. 20 изображено положение стопорного элемента 1574, расположенного на дистальном конце промежуточного пускового элемента 1570 в цилиндрическом проходе 1568 в соединительной муфте 1566 для пускового стержня, когда система 1700 сцепления находится в режиме шарнирного поворота, но до приведения в действие пускового двигателя 152. На ФИГ. 21 изображено положение стопорного элемента 1574 в цилиндрическом проходе 1568 после приведения в действие пускового двигателя 152 с перемещением проксимального пускового элемента 1560 в проксимальном направлении ʺPDʺ. Поскольку V-образные стопоры 1714 и 1715 не выравнены с соответствующими V-образными пазами 1580, движение проксимального пускового элемента 1560 и соединительной муфты 1566 для пускового стержня в проксимальном направлении ʺPDʺ приводит к контакту нижней части соединительной муфты 1566 для пускового стержня с проксимальными стопорами 1715, а также перемещению зацепляющего элемента 1710 в проксимальном направлении ʺPDʺ. Движение соединительной муфты 1566 для пускового стержня также обеспечивает перемещение шкива 1242 шарнирного поворота в проксимальном направлении, тем самым обеспечивая шарнирный поворот концевого эффектора 1300 в направлении, изображенном стрелкой 1241 на ФИГ. 21. Приведение в действие пускового двигателя 152 в противоположном направлении вращения будет приводить к движению проксимального пускового элемента 1560 в дистальном направлении ʺDDʺ так, что его конец 1567 будет приводиться в контакт с дистальными стопорами 1714 с дистальным перемещением зацепляющего элемента 1710. Такое дистальное движение зацепляющего элемента 1710 также касается шкива 1242 шарнирного поворота в дистальном направлении ʺDDʺ, что приводит к шарнирному повороту концевого эффектора 1300 в противоположном направлении шарнирного поворота (изображенном стрелкой 1243 на ФИГ. 21). Таким образом, из вышеизложенного следует принять во внимание, что проксимальный пусковой элемент 1560 может перемещаться по оси для заданного количественного выражения осевого перемещения без осевого продвижения промежуточного пускового элемента 1570 и дистального пускового элемента 550, присоединенного к нему. Данное заданное количественное выражение осевого перемещения может быть определено по длине оси ʺLʺ цилиндрического прохода 1568 в соединительной муфте 1566 для пускового стержня. См. ФИГ. 19.
Как только врач расположит концевой эффектор 1300 в необходимой ориентации, при которой целевая ткань располагается между упором и кассетой со скобами, врач может закрыть упор для зажимания целевой ткани между упором и кассетой со скобами. Как обсуждалось выше, упор может быть закрыт посредством приведения в действие закрывающего спускового механизма 122 с осевым продвижением закрывающего элемента 1210 в сборе в дистальном направлении ʺDDʺ. По мере того как закрывающий элемент 1210 в сборе перемещается дистально, криволинейный паз 1232 в проксимальном сегменте 1230 закрывающего элемента приводит штифт 1724 криволинейного сечения в движение к нижней части криволинейного паза 1232 (данное движение изображено стрелкой 1725 на ФИГ. 15). По мере того как штифт 1724 криволинейного сечения перемещается в направлении 1725, барабан 1610 переключателя поворачивается на закрывающий элемент 1210 в сборе так, что рычаг 1616 переключателя сдвигает компонент 1618 переключателя с приведение в действие с совмещением с компонентом 1626 переключателя с обеспечением тем самым сигнала для схемы 156 управления, указывающего на то, что закрывающий элемент 1210 в сборе и, более точно, что упор находится в закрытом положении и готов к запуску. Схема 156 управления затем будет обеспечивать вращение пускового двигателя 152, при приведении в действие пускового крючка 170, в течение достаточного времени запуска по мере перемещения дистального пускового элемента 550 (и режущего инструмента, присоединенного к нему или иным образом установленного на нем) к его окончанию или полностью запущенному положению в концевом эффекторе 1300. На ФИГ. 19, 23 и 24 показаны положения различных компонентов системы 1700 сцепления в пусковой ориентации.
Во многих моторизованных хирургических инструментах для разрезания и скрепления используют отдельный приводной стержень для обеспечения шарнирного поворота и запуска устройства. Хотя в данном способе используется несколько простая конструкция, он может оказаться дорогостоящим и иметь повышенную надежность в связи с тем, что полноприводные системы воспроизводятся по конструкции. В различных конструкциях, раскрытых в данном документе, используют механизм с одним приводом для выполнения как шарнирного поворота, так и запуска, что также обеспечивает средства для блокировки шарнирного поворота перед запуском.
В случае применения в хирургии шарнирно-поворачиваемого концевого эффектора необходимо предотвратить непреднамеренное отсоединение концевого эффектора от хирургического инструмента, в частности, когда концевой эффектор находится в ориентации с шарнирным поворотом. Эта проблема может быть обострена при использовании хирургических инструментов, в которых используют сменные стволы в сборе, которые отсоединяются от рукоятки или корпус инструмента. Например, в ходе применения важно избегать непреднамеренного или в некоторых случаях неосмотрительного отсоединения узла ствола или концевого эффектора от инструмента, когда концевой эффектор находится в ориентации с шарнирным поворотом. На ФИГ. 25 изображен другой шарнирно-поворачиваемый хирургический инструмент 2010, который содержит сменный ствол 2200 в сборе, который установлен с возможностью отсоединения на рукоятке 2102 инструмента 2010. Концевой эффектор 2300 присоединен к сменному стволу 2200 в сборе и является выборочно шарнирно-поворачиваемым по оси B-B шарнирного поворота. Узел ствола 2200 содержит уникальную и новую систему блокировки для предотвращения отсоединения сменного узла ствола 2200 от рукоятки 2102, когда концевой эффектор находится в ориентации с шарнирным поворотом. Хирургический инструмент 2010 является идентичным хирургическому инструменту 10, описанному выше, за исключением по меньшей мере некоторых различий, рассматриваемых ниже. Как можно видеть на данной фигуре, изображен хирургический инструмент 2010 с приводом от двигателя (или «с электропитанием»), и при этом он содержит корпус или рукоятку 2102, которая имеет сменный узел ствола 2200, функционально присоединенный к ней. Различные характеристики и более подробная информация в отношении сменных стволов в сборе может быть найдена в заявке на патент США № 13/803053, озаглавленной INTERCHANGEABLE SHAFT ASSEMBLIES FOR USE WITH A SURGICAL INSTRUMENT, публикации заявки на патент США № 2014/0263564, полное раскрытие которых включено в данный документ посредством ссылки, и в заявке на патент США № 14/226075, поданной 26 марта 2014 г., озаглавленной MODULAR POWERED SURGICAL INSTRUMENT WITH DETACHABLE SHAFT ASSEMBLIES, полное раскрытие которых также включено в данный документ посредством ссылки.
Все еще со ссылкой на ФИГ. 25, концевой эффектор 2300 функционально присоединен к сменному узлу ствола 2000. Концевой эффектор 2300 может быть, например, идентичным концевому эффектору 300, и может содержать, среди прочего, удлиненный канал 2302, который выполнен с возможностью функциональной поддержки кассеты со скобами 2310 в нем. Концевой эффектор 2300 дополнительно содержит упор 2350, который имеет скобообразующую обращенную вниз поверхность на нем. Упор 2350 перемещается между открытым и закрытым положениями посредством закрывающей трубки 2120 в сборе, которая продвигается по оси в дистальном и проксимальном направлениях посредством приведения в действие закрывающего спускового механизма 2122. Закрывающая трубка 2120 в сборе содержит проксимальный сегмент 2230 ствола закрывающей трубки, который функционально соединен с дистальный сегментом 2220 закрывающей трубки посредством шарнирного соединения 2240 для облегчения шарнирного поворота концевого эффектора 2300 по оси B-B шарнирного поворота, которая является поперечной оси SA-SA ствола, образованной сменным узлом ствола 2200.
Со ссылкой на ФИГ. 26, узел ствола 2200 содержит ходовую часть 2270, которая выполнен соединенной с рукояткой 2102 с возможностью отсоединения. В различных вариантах осуществления узла ствола используют систему 2280 фиксации для соединения с возможностью отсоединения узла ствола 2200 с рукояткой 2102 и, более конкретно, с рамой рукоятки. Как показано на ФИГ. 26, например, по меньшей мере, в одной форме система фиксации 2280 содержит в себе элемент блокировки, или блокирующую вилку 2282, которая съемно соединена с шасси 2270. В показанном варианте осуществления, например, блокирующая вилка 2282 имеет U-образную форму с двумя находящимися на некотором расстоянии ножками 2284, направленными вниз. Каждая из ножек 2284 имеет поворотное ушко 2285, образованное на ней, которое приспособлено для размещения в соответствующих отверстиях (не показаны), которые образованы в ходовой части 2270. См. ФИГ. 27. Такая конструкция обеспечивает поворотное крепление блокирующей вилки 2282 к шасси 2270. Блокирующая скоба 2282 может содержать два проксимально выступающих блокирующих ушка 2286, которые выполнены с возможностью разъемного зацепления с соответствующими блокирующими стопорами или канавками 2105 в дистальном крепежном фланце 2103 рамы. См. ФИГ. 27. Блокирующая скоба 2282 может быть смещена в проксимальном направлении ʺPDʺ первой пружиной или смещающим элементом (не показаны). Приведение в действие блокирующей скобы 2282 может быть выполнено посредством запорной кнопки 2287, которая установлена с возможностью скольжения на приводе защелки в сборе, который установлен на ходовой части 2270. Блокирующая кнопка 2287 может быть смещена в проксимальном направлении относительно блокирующей вилки 2282. Как будет рассмотрено более подробно ниже, блокирующая скоба 2282 может перемещаться в разблокированное положение посредством смещения запорной кнопки 2287 в дистальном направлении ʺDDʺ, что также приводит к шарнирному повороту блокирующей скобы 2282 из удерживающего зацепления с дистальным крепежным фланцем 2103 рамы. Когда блокирующая скоба 2282 находится в «удерживающем зацеплении» с дистальным крепежным фланцем 2103 рамы, блокирующие ушки 2286 фиксируются с удерживанием в соответствующих блокирующих стопорах или канавках 2105 в дистальном крепежном фланце 2103.
Сменный узел ствола 2200 содержит закрывающий челнок 2136, который поддерживается с возможностью скольжения в ходовой части 2270. Проксимальный сегмент 2230 закрывающей трубки соединен с закрывающим челноком 2136 для обеспечения возможность вращения относительно него. Например, соединитель 2137 U-образной формы вставляется в кольцевой паз 2231 в проксимальном сегменте 2230 закрывающей трубки и удерживается внутри вертикальных пазов в закрывающем челноке 2136. Такая конструкция служит для крепления проксимального сегмента 2230 закрывающей трубки к закрывающему челноку 2136 для осевого перемещения вместе с ним, при этом проксимальный сегмент 2230 закрывающей трубки может поворачиваться относительно закрывающего челнока 2136 вокруг оси SA-SA ствола. Проксимальный закрывающий челнок 2136 содержит крючки 2138, которые приспособлены для крючкового зацепления крепежного штифта (не показан), который присоединен ко второму закрывающему звену (не показано), которое функционально соединено с закрывающим спусковым механизмом 2122, описанным подробно в заявке на патент США с серийным № 14/226075. Как описано в данной ссылке, приведение в действие закрывающего спускового механизма 2122 будет обеспечивать дистальное продвижение закрывающего звена и прикладывать дистальное закрывающее движение к проксимальному закрывающему челноку 2136 и, в конце концов, к проксимальному сегменту 2230 закрывающей трубки. Закрывающая пружина (не показана) опирается на проксимальный сегмент 2230 закрывающей трубки и служит для смещения проксимального сегмента 2230 закрывающей трубки в проксимальном направлении ʺPDʺ, что может служить для шарнирного поворота закрывающего спускового механизма 2122 в незадействованное положение, когда узел ствола 2200 функционально соединен с рукояткой 2102.
Сменный узел ствола 2200 дополнительно содержит систему 2500 шарнирного поворота для приложения шарнирного движения к первой и второй планке 2510, 2520 шарнирного поворота, которые проходят по узлу ствола с функциональной стыковкой с концевым эффектором 2300. В изображенном примере система 2500 шарнирного поворота дополнительно содержит приводной механизм 2550 шарнирного поворота, который поддерживается с возможностью поворота на корпусе 2530 насадки, который поддерживается на ходовой части 2270. Корпус насадки может содержать два сегмента 2532, 2534 насадки, которые соединены вместе посредством множества крепежных элементов 2536. Приводной механизм 2550 шарнирного поворота содержит ручку 2552 для управления шарнирным поворотом, которая соединена с узлом 2560 зубчатого колеса шарнирного поворота, который имеет зубчатое колесо 2562 шарнирного поворота на нем. Зубчатое колесо 2562 шарнирного поворота поддерживается в зацеплении с первой зубчатой рейкой 2512 шарнирного поворота, которая присоединена к первой планке 2510 шарнирного поворота, и второй зубчатой рейкой 2522 шарнирного поворота, которая присоединена ко второй планке 2520 шарнирного поворота. Поворот ручки для управления шарнирным поворотом 2552 обеспечивает продвижение с возможностью передачи приводного усилия одной из планок 2510, 2520 шарнирного поворота в проксимальном или дистальном направлении и другой из планок 2510, 2520 шарнирного поворота в противоположном направлении с обеспечением шарнирного поворота концевого эффектора 2300 по оси шарнирного соединения в необходимом направлении.
Хирургический концевой эффектор 2300 содержит пусковой элемент в форме разрезающего ткань элемента (не показан). Сменный узел ствола 2200 также содержит сегмент 2570 пускового стержня, который выполнен с возможностью приложения пусковых движений к пусковому элементу. В изображенном примере сегмент пускового стержня перемещается вдоль оси по узлу ствола 2000 посредством пусковой системы с приводом от двигателя различными способами, описанными более подробно в различных ссылках, включенных в данный документ.
Чтобы предотвратить непреднамеренное отсоединение сменного узла ствола 2200 от рукоятки 2102, когда концевой эффектор 2300 находится в ориентации с шарнирным поворотом, узел ствола 2200 дополнительно содержит уникальный и новый блокиратор в сборе, обозначенный в целом как 2580. В изображенном примере узел 2560 зубчатой передачи дополнительно содержит стопорный фланец 2564, который имеет блокирующую выемку 2566 в нем. Блокиратор 2580 в сборе дополнительно содержит блокирующий элемент 2582, который имеет остроконечный или конусообразный дистальный конец 2584, который выполнен с возможностью блокирующего зацепления с блокирующей выемкой 2566. Блокирующий элемент 2582 присоединен к блокирующей скобе 2282. В изображенном примере блокирующий элемент 2582 имеет отверстие 2588, которое выполнено с возможностью приема блокирующей выпуклости 2283, образованной на блокирующей скобе 2282 для облегчения присоединения блокирующего элемента 2582 к блокирующей скобе 2282. См. ФИГ. 26. В изображенном примере ручка 2552 для управления шарнирным поворотом присоединена к блокиратору 2560 шарнирного поворота в сборе так, что блокирующая выемка 2566 выравнивается для блокирующего зацепления с блокирующим элементом 2582, когда части 2553 в виде ребра исполнительного элемента ручки 2552 для управления шарнирным поворотом выравниваются по оси с осью A-A ствола. См. на ФИГ. 25. В случае такого расположения части в виде ребра указывают врачу, что концевой эффектор 2300 отсоединен и по сути выравнен по оси с осью ствола SA. Также в случае такого положения дистальный конец 2584 блокирующего элемента 2582 принимается в блокирующей выемке 2566. В случае такого положения предусматривается достаточный зазор между дистальным концом 2584 блокирующего элемента 2582 и блокирующей выемкой 2566 для обеспечения движения блокирующей скобы 2282 в дистальном направлении с отсоединением тем самым сменного узла ствола 2200 от рукоятки. Таким образом, когда концевой эффектор находится в отсоединенной ориентации, узел ствола 2200 является отсоединяемым от рукоятки или корпуса.
Когда врачу необходимо осуществить шарнирный поворот концевого эффектора 2300, врач прикладывает вращательное усилие к частям 2553 в виде ребра исполнительного элемента, которое является достаточным для обеспечения поворота узла 2560 зубчатой передачи. По мере того как узел 2560 зубчатой передачи поворачивается, блокирующий элемент 2582 перемещается в проксимальном направлении с обеспечением перемещения конца 2584 блокирующего элемента 2582 из блокирующей выемки 2566. Конец 2584 проходит вокруг ободка стопорного фланца 2564 в ходе шарнирного поворота. В случае такого положения блокирующий элемент 2582 предотвращает движение блокирующей скобы 2282 в достаточной степени в дистальном направлении с возможностью отсоединения узла ствола 2200 от рукоятки. Таким образом, когда концевой эффектор находится в шарнирно-повернутом положении, предотвращается движение блокирующей скобы с обеспечением отсоединенного или разблокированного положения. Данное расположение не только предотвращает непреднамеренное отсоединение узла ствола от рукоятки (то есть случайно), на также предотвращает возможность отсоединения врачом узла ствола 2200 при применении запорной кнопки 2287.
На ФИГ. 28 представлен вид в поперечном сечении гибкого шарнирного элемента 2600 типа, например, показанного на ФИГ. 25. Соединительный элемент содержит гибкую основу 2602, которая имеет расположенный по центру проход 2604, который выполнен с возможностью поддержания со скольжением гибкой пусковой штанги 2610 в нем. В данной конструкции основа 2602 содержит два верхних прохода 2606, которые имеют такие размеры и выполнены с возможностью вмещения соответствующего соединительного кабеля 2620 в них. Соединительные кабели 2620 выполняют те же функции, что и шкивы шарнирного поворота, раскрытые в данном документе. Например, каждый из кабелей 2620 присоединен к или иным образом связан с хирургическим концевым эффектором. Проксимальные концы или части кабелей 2620 стыкуются с системой контроля шарнирного поворота для приведения в действие кабелей с осуществлением шарнирного поворота концевого эффектора. Основа 2602 дополнительно содержит два нижних прохода 2608, которые приспособлены для того, чтобы вмещать соответствующие части рамы 2630 в сборе. В данном примере рама в сборе содержит первую полосу 2640 рамы и вторую полосу 2650 рамы. Полосы 2640, 2650 расположены на каждой боковой стороне гибкой пусковой штанги 2610 и проходят обратно к рукоятке или корпусу. Каждая полоса 2640, 2650 может содержать консольный подпружиненный рычаг, который проходит по соответствующим нижним проходам 2608 и соединен с или иным образом связан с концевым эффектором. Например, дистальный конец каждой полосы 2640, 2650 может быть присоединен к соответствующей из частей удлиненного канала концевого эффектора. Полосы 2640, 2650 будут сгибаться с предоставлением шарнирного поворота концевого эффектора. Однако, как можно видеть на ФИГ. 28, каждая полоса 2640, 2650 выполнена с возможностью сцепления силами трения с соответствующими частями стенок 2609 каждого из нижних проходов 2608. В изображенном примере каждая полоса 2640, 2650 содержит обеспечивающий трение кулак или образование 2642, 2652 на них, как показано. Такая конструкция служит для удерживания трением основной части 2602 в ориентации с шарнирным поворотом.
На ФИГ. 29 представлен вид в поперечном сечении гибкого шарнирного элемента 2700 типа, например, показанного на ФИГ. 25. Соединительный элемент содержит гибкую основу 2702, которая имеет расположенный по центру проход 2704, который выполнен с возможностью поддержания со скольжением гибкой пусковой штанги 2610 в нем. В данной конструкции основа 2702 содержит два боковых прохода 2706, которые имеют такие размеры и выполнены с возможностью вмещать соответствующий соединительный кабель 2620 в них. В изображенной конструкции проходы 2706 имеют такие размеры по отношению к кабелям 2620, что возникает трение между каждым кабелем и стенкой соответствующего прохода 2706. Основа 2702 дополнительно содержит нижний проход 2708, который приспособлен для вмещения соответствующих частей рамы 2730 в сборе. В данном примере рама в сборе содержит первую полосу 2740 рамы и вторую полосу 2750 рамы. Полосы 2740, 2750 расположены ниже гибкой пусковой штанги 2610 и проходят обратно к рукоятке или корпусу. Каждая полоса 2740, 2750 может содержать консольный подпружиненный рычаг, который проходит по соответствующим нижним проходам 2708 и соединен с или иным образом связан с концевым эффектором. Например, дистальный конец каждой полосы 2740, 2750 может быть присоединен к соответствующей из частей удлиненного канала концевого эффектора. Полосы 2740, 7650 будут сгибаться с предоставлением шарнирного поворота концевого эффектора. Как можно видеть на ФИГ. 29, полосы 2740, 2750 находятся в сцеплении силами трения с пусковым лучом 2610, а также со стенкой нижнего прохода 2708. Такая конструкция служит для удерживания трением основной части 2702 в ориентации с шарнирным поворотом.
На ФИГ. 31 изображена несколько схематичная форма хирургического инструмента 3010 с шарнирно поворачиваемым концевым эффектором 3300, в котором используется уникальная и новая система 3500 шарнирного поворота для осуществления шарнирного поворота концевого эффектора 3300 по шарнирному соединению, обозначенному в целом как 3240. В частности, хирургический инструмент 3010 содержит раму 3600 в сборе, которая присоединена к удлиненному каналу 3302 хирургического концевого эффектора 3300 так, что хирургический концевой эффектор 3300 может выборочно шарнирно поворачиваться по шарнирному соединению 3240. Система 3500 шарнирного поворота содержит первый шарнирный элемент или планку 3510 и второй шарнирный элемент или планку 3520. Каждая из первой и второй планок 3510, 3520 шарнирного поворота присоединена к удлиненному каналу 3302 хирургического концевого эффектора 3300 и расположена с возможностью осевого перемещения относительно рамы 3600 в сборе. Например, первая планка шарнирного поворота 3510 может поддерживаться для осевого перемещения относительно рамы 3600 в сборе посредством первой опоры 3511, и вторая планка 3520 шарнирного поворота может поддерживаться для осевого перемещения относительно рамы 3600 в сборе посредством второй опоры 3521.
Хирургический концевой эффектор 3300 может содержать хирургическое режущее и сшивающее скобами устройство и содержит пусковой элемент (не показан), который выполнен с возможностью осевого перемещения в концевом эффекторе 3300, как это изложено во многих ссылочных документах, которые были включены в данный документ посредством ссылки. Хирургический инструмент 3010 оснащен пусковым элементом или стержнем 3560, который выполнен с возможностью осевого перемещения под действием приводных движений от пусковой приводной системы различных типов, раскрытых в данном документе, а также раскрытых в различных ссылках, включенных в данный документ. Система 3500 шарнирного поворота, в общем изображенная на ФИГ. 31, содержит привод 3530 шарнирного поворота в сборе, который выполнен с возможностью функциональной стыковки с пусковой приводной системой с приемом пусковых движений из нее. Например, шкив 3532 шарнирного поворота привода 3530 шарнирного поворота в сборе может быть функционально связан с пусковым стержнем 3560 по переключающей или сцепляющей конструкции 3600 типа, раскрытого в данном документе и/или в ссылках, включенных в данный документ. Таким образом, когда в переключательное устройство 3600 находится в «режиме шарнирного поворота», действие пускового привода передается на шкив 3532 шарнирного поворота с приложением осевого шарнирного движения к нему. Когда переключательное устройство 3600 находится в «режиме запуска», приведение в действие пускового привода будет приводить к продвижению по оси пускового элемента в хирургическом концевом эффекторе 3300.
Как можно подробнее увидеть на ФИГ. 31, привод 3532 шарнирного поворота в сборе дополнительно содержит электромагнит 3534 двухстороннего действия в сборе, который присоединен к шкиву 3532 шарнирного поворота. Электромагнит 3534 в сборе содержит шарнирный зацепляющий элемент 3536, который выполнен для избирательного приводного зацепления с частью первого шкива 3510 шарнирного поворота. Дополнительно, электромагнит 3534 в сборе содержит второй шарнирный зацепляющий элемент 3538, который выполнен для избирательного приводного зацепления со второй планкой 3520 шарнирного поворота. Например, на ФИГ. 31 изображена часть первого шкива 3536, принимаемая первым отверстием 3512 привода в первом шкиве 3510 шарнирного поворота. Аналогичное второе отверстие 3522 привода показано на втором шкиве 3520 шарнирного поворота, однако на ФИГ. 31 второй шкив 3538 находится во втянутом или расцепленном положении. Также могут быть использоваться другие конструкции, выполненные зацепления и расцепления с возможностью передачи приводного усилия с приводом 3530 шарнирного поворота в сборе. Таким образом, когда первый шарнирный зацепляющий элемент 3536 находится в приводном зацеплении с первым шкивом 3510 шарнирного поворота, приведение в действие пусковой приводной системы будет приводить к продвижению по оси первого шкива 3510 шарнирного поворота, и когда второй шарнирный зацепляющий элемент 3538 находится в приводном зацеплении со вторым шкивом 3520 шарнирного поворота, приведение в действие пусковой приводной системы будет приводить к продвижению по оси второго шкива 3520 шарнирного поворота.
Как обсуждалось более подробно в данном документе, для хирургического инструмента может быть необходимость в использовании средств блокировки шкивов шарнирного поворота в некотором положении перед применением устройства и/или после осуществления шарнирного поворота концевого эффектора в необходимое положение. С этой целью хирургический инструмент 3010 показан с системой 3700 фиксации шарнирного поворота. Система 3700 фиксации шарнирного поворота содержит первый блокирующий элемент 3702, выполненный с возможностью блокирующего зацепления с первой зазубренной или зубчатой фиксирующей частью 3514 первого шкива 3510 шарнирного поворота, и второй блокирующий элемент 3704, выполненный с возможностью блокирующего зацепления со второй зубчатой или фиксирующей частью 3524 второго шкива 3520 шарнирного поворота. Когда первый блокирующий элемент 3702 находится в зацеплении с первой зазубренной частью 3514 первого шкива 3510 шарнирного поворота, первый шкив 3510 шарнирного поворота будет удерживаться в данном осевом положении. Аналогично, когда второй блокирующий элемент 3704 находится в зацеплении с второй зазубренной частью 3524 второго шкива 3520 шарнирного поворота, второй шкив 3520 шарнирного поворота будет удерживаться в данном осевом положении.
На ФИГ. 31 изображен первый шарнирный зацепляющий элемент 3536 в приводном зацеплении с отверстием 3512. Как можно видеть на данной фигуре, по меньшей мере, соответствующая часть 3516 первого шкива 3510 шарнирного поворота перемещается в сторону в первом боковом направлении ʺFLDʺ так, что первая зазубренной часть 3514 выходит из зацепления с первым блокирующим элементом 3702. Как можно видеть на ФИГ. 31, второй шарнирный зацепляющий элемент 3538 втянут с зацеплением с отверстием 3522 привода. В случае такого положения первый шкив 3510 шарнирного поворота находится в разблокированной ориентации и свободен для осевого продвижения в дистальном направлении ʺDDʺ с осуществлением шарнирного поворота хирургического концевого эффектора 3300 в первом направлении шарнирного поворота ʺFADʺ по шарнирному соединению 3240. По мере того как первый шкив 3510 шарнирного поворота перемещается дистально, второй шкив 3520 шарнирного поворота обязательно будет двигаться в проксимальном направлении ʺPDʺ за счет его соединения с удлиненным каналом 3302 хирургического концевого эффектора 3300. Такое проксимальное движение второго шкива 3520 шарнирного поворота будет приспосабливаться вторым блокирующим элементом 3704 с «натыканием», или ездой, или скольжением по соответствующей резьбе 3524. Аналогичным образом, для осуществления шарнирного поворота хирургического концевого эффектора во втором направлении шарнирного поворота ʺSADʺ по шарнирному соединению 3240 первый шарнирный зацепляющий элемент 3536 убран из зацепления с первым отверстием 3512 привода, и второй шарнирный зацепляющий элемент 3538 перемещается в сторону во втором боковом направлении ʺSLDʺ в зацеплении со вторым отверстием 3522 привода со смещением или выводом иным образом второй зазубренной части 3524 второго шкива 3520 шарнирного поворота из зацепления со вторым блокирующим элементом 3707. В случае такого положения второй шкив 3520 шарнирного поворота находится в разблокированной ориентации и свободен для осевого продвижения в дистальном направлении ʺDDʺ с осуществлением шарнирного поворота хирургического концевого эффектора 3300 во втором направлении шарнирного поворота ʺSADʺ по шарнирному соединению 3240. По мере того как второй шкив 3520 шарнирного поворота перемещается дистально, первый шкив 3510 шарнирного поворота обязательно будет двигаться в проксимальном направлении ʺPDʺ за счет его соединения с удлиненным каналом 3302 хирургического концевого эффектора 3300. Такое проксимальное движение первого шкива 3510 шарнирного поворота будет приспосабливаться первым блокирующим элементом 3702 с «натыканием», или ездой, или скольжением по соответствующей резьбе 3514.
На ФИГ. 32 изображена несколько схематичная форма хирургического инструмента 4010 с шарнирно поворачиваемым концевым эффектором 4300, в котором используется уникальная и новая система 4500 шарнирного поворота для осуществления шарнирного поворота концевого эффектора 4300 по шарнирному соединению, обозначенному в целом как 4240. В частности, хирургический инструмент 4010 содержит раму 4600 в сборе, которая присоединена к удлиненному каналу 4302 хирургического концевого эффектора 4300 так, что хирургический концевой эффектор 4300 может выборочно шарнирно поворачиваться по шарнирному соединению 4240. Система 4500 шарнирного поворота содержит первый шарнирный элемент или планку 4510 и второй шарнирный элемент или планку 4520. Каждая из первой и второй планок 4510, 4520 шарнирного поворота присоединена к удлиненному каналу 4302 хирургического концевого эффектора 4300 и расположена с возможностью осевого перемещения относительно рамы 4600 в сборе. Например, первая планка 4510 шарнирного поворота может поддерживаться для осевого перемещения относительно рамы 4600 в сборе посредством первой опоры 4511, и вторая планка 4520 шарнирного поворота может поддерживаться для осевого перемещения относительно рамы 4600 в сборе посредством второй опоры 4521.
Хирургический концевой эффектор 4300 может содержать хирургическое режущее и сшивающее скобами устройство и содержит пусковой элемент (не показан), который выполнен с возможностью осевого перемещения в концевом эффекторе 4300, как это изложено во многих ссылочных документах, которые были включены в данный документ посредством ссылки. Хирургический инструмент 4010 оснащен пусковым элементом или стержнем 4560, который выполнен с возможностью осевого перемещения под действием приводных движений от пусковой приводной системы различных типов, раскрытых в данном документе, а также в различных ссылках, включенных в данный документ. Система 4500 шарнирного поворота, в общем изображенная на ФИГ. 32, содержит первый приводной двигатель 4530 шарнирного поворота, который выполнен с возможностью функциональной стыковки с первым шкивом 4510 шарнирного поворота так, что действие первого двигателя шарнирного поворота в одном направлении приводит к продвижению по оси первой планки 4510 шарнирного поворота в дистальном направлении ʺDDʺ, и действие первой приводной системы шарнирного поворота в противоположном направлении приводит к осевому перемещению первой планки 4510 шарнирного поворота в проксимальном направлении ʺPDʺ. Аналогично, система 4500 шарнирного поворота дополнительно содержит второй приводной двигатель 4540 шарнирного поворота, который выполнен с возможностью функциональной стыковки со вторым шкивом шарнирного поворота 4520 так, что действие второго приводного двигателя 4540 шарнирного поворота в одном направлении будет приводить к продвижению по оси второго шкива шарнирного поворота в дистальном направлении ʺDDʺ, и действие второго двигателя шарнирного поворота в противоположном направлении будет приводить к продвижению по оси второго шкива шарнирного поворота в проксимальном направлении ʺPDʺ. Первый и второй приводные двигатели 4530, 4540 шарнирного поворота управляются схемой управления и устройством управления так, что, когда один из приводных двигателей 4530 приводится в действие с приведением в действие шкива шарнирного поворота, функционально присоединенного к нему, в одном осевом направлении для первого осевого расстояния, другой приводной двигатель шарнирного поворота приводится в действие в противоположном направлении с перемещением другого шкива шарнирного поворота, функционально соединенного с ним, в противоположном осевом направлении для второго осевого расстояния, которое равняется первому осевому расстояния, для вмещения шарнирного соединения хирургического концевого эффектора.
ПРИМЕРЫ
Пример 1 - Хирургический инструмент, содержащий корпус, который имеет сменный узел ствола с возможностью отсоединения, присоединенный к нему, который содержит удлиненный ствол. Хирургический концевой эффектор функционально соединен с удлиненным стволом для избирательного шарнирного поворота относительно него. Система шарнирного поворота выполнена с возможностью выборочного приложения движений шарнирного поворота к хирургическому концевому эффектору, когда система шарнирного поворота находится в ориентации приведения в действие. Хирургический инструмент дополнительно содержит средства предотвращения отсоединения сменного узла ствола от корпуса, когда система шарнирного поворота находится в ориентации приведения в действие.
Пример 2 - Хирургический инструмент из примера 1, где сменный узел ствола соединен с возможностью отсоединения с корпусом посредством стопорного элемента, который выполнен с возможностью выборочного перемещения между зафиксированным положением и незафиксированным положением, и где средства для предотвращения отсоединения функционально связаны с системой шарнирного поворота и стопорным элементом.
Пример 3 - Хирургический инструмент из примеров 1 или 2, где система шарнирного поворота содержит приводной механизм шарнирного поворота, который поддерживаются с возможностью движения по сменному узлу ствола и с возможностью выборочного перемещения между незадействованной ориентацией, при которой хирургический концевой эффектор находится в отсоединенной ориентации, и множеством ориентаций приведения в действие, при которых хирургический концевой эффектор шарнирно повернут относительно оси ствола, образованной удлиненным стволом. Первый шарнирный элемент функционально связан с хирургическим концевым эффектором и приводным механизмом шарнирного поворота. Второй шарнирный элемент функционально связан с хирургическим концевым эффектором и приводным механизмом шарнирного поворота.
Пример 4 - Хирургический инструмент из примера 3, где приводной механизм шарнирного поворота содержит узел ведущего зубчатого колеса шарнирного поворота, который находится в зацеплении с первым и вторым шарнирными элементами.
Пример 5 - Хирургический инструмент из примера 4, где узел ведущего зубчатого колеса шарнирного поворота выполнен с возможностью перемещения между незадействованной ориентацией и ориентацией приведения в действие, и где средства для предотвращения отсоединения представляют собой блокирующий элемент, который функционально связан с узлом ведущего зубчатого колеса шарнирного поворота, и стопорный элемент так, что, когда узел ведущего зубчатого колеса шарнирного поворота находится в незадействованном положении, стопорный элемент обладает возможностью перемещения в незафиксированное положение, и когда узел ведущего зубчатого колеса шарнирного поворота находится в любом одном из положений приведения в действие, блокирующий элемент предотвращает перемещение стопорного элемента в незафиксированное положение.
Пример 6 - Хирургический инструмент из примеров 4 или 5, где узел ведущего зубчатого колеса шарнирного поворота содержит стопорный фланец, который функционально взаимодействует с приводным механизмом шарнирного поворота. Ведущее зубчатое колесо шарнирного поворота соединено со стопорным фланцем, и
выемка отсоединения расположена в стопорном фланце. Выемка отсоединения расположена на стопорном фланце так, что когда узел ведущего зубчатого колеса шарнирного поворота находится в незадействованной ориентации, часть блокирующего элемента может проходить в выемку отсоединения под действием движения стопорного элемента из зафиксированного положения в незафиксированное положение, и когда узел ведущего зубчатого колеса шарнирного поворота находится в любом одном из положений приведения в действие, часть блокирующего элемента зацепляет стопорный фланец с удерживанием блокирующего элемента в положении фиксации, при котором предотвращается движение стопорного элемента из зафиксированного положения в незафиксированное положение.
Пример 7 - Хирургический инструмент из примеров 1, 2, 3, 4, 5 или 6, где хирургический концевой эффектор содержит пару браншей, где одна бранша выполнена с возможностью выборочного перемещения относительно другой бранши при приложении закрывающего движения к ней, и где удлиненный ствол дополнительно содержит закрывающий элемент, который функционально связан с одной браншей с приложением закрывающего движения к ней при приведении в действие закрывающей системы, функционально поддерживаемой в корпусе.
Пример 8 - Хирургический инструмент из примеров 1, 2, 3, 4, 5, 6 или 7, где хирургический концевой эффектор дополнительно содержит пусковой элемент, функционально поддерживаемый для осевого перемещения по хирургическому концевому эффектору при приложении пускового движения к нему, и где удлиненный ствол дополнительно содержит пусковой стержень, который функционально связан с пусковым элементом с приложением пускового движения к нему при приведении в действие пусковой системы, которая функционально поддерживается в корпусе.
Пример 9 - Хирургический инструмент из примеров 1, 2, 3, 4, 5,6, 7, 8 или 9, где корпус содержит рукоятку.
Пример 10 - Хирургический инструмент, содержащий систему шарнирного поворота, которая является приводимой между незадействованной ориентацией и ориентациями приведения в действие, где система шарнирного поворота обеспечивает соответствующее движение с шарнирным поворотом. Хирургический инструмент дополнительно содержит хирургический концевой эффектор и удлиненный узел ствола, который функционально связан с хирургическим концевым эффектором с возможностью его избирательного шарнирного поворота относительно удлиненного узла ствола. Удлиненный узел ствола содержит, по меньшей мере, один шарнирный элемент, который функционально связан с хирургическим концевым эффектором и системой шарнирного поворота. По меньшей мере, один шарнирный элемент поддерживается с возможностью избирательного осевого перемещения под действием приложения движений шарнирного поворота к нему системой шарнирного поворота. Хирургический инструмент дополнительно содержит средства, которые поддерживаются в удлиненном узле ствола и выполнены с возможностью удерживаемого зацепления с, по меньшей мере, одним шарнирным элементом и предотвращением его осевого перемещения, когда система шарнирного поворота находится в незадействованной ориентации.
Пример 11 - Хирургический инструмент из примера 10, где система шарнирного поворота функционально поддерживается в корпусе, и где удлиненный узел ствола является отсоединяемым с возможностью отсоединения от корпуса, и где каждый из, по меньшей мере, одного шарнирного элемента выполнен с возможностью осевого перемещения из нейтрального положения, при котором каждый шарнирный элемент является функционально отсоединяемым от системы шарнирного поворота при присоединении удлиненного узла ствола к корпусу, и где средства для удерживаемого зацепления удерживают каждый шарнирный элемент в нейтральном положении, когда удлиненный узел ствола отсоединяется от корпуса.
Пример 12 - Хирургический инструмент из примеров 10 или 11, где средства для зацепления с удерживанием содержат зазубренную часть на каждом из шарнирных элементов. Каждая зазубренная часть поддерживается в зацеплении с, по меньшей мере, одним соответствующим блокирующим зубом на другой части удлиненного узла ствола.
Пример 13 - Хирургический инструмент из примера 12, где каждый шарнирный элемент поддерживается для осевого перемещения в полом элементе, и где каждый соответствующий блокирующий зуб выступает внутрь полого элемента.
Пример 14 - Хирургический инструмент из примеров 10, 11, 12 или 13, где хирургический концевой эффектор содержит пару браншей, где одна бранша выполнена с возможностью выборочного перемещения относительно другой бранши при приложении закрывающего движения к ней, и где удлиненный ствол дополнительно содержит полую закрывающую трубку, которая функционально связана с одной из браншей и принимает каждый из шарнирных элементов в ней, и где каждый соответствующий зуб образован на внутренней стенке полой закрывающей трубки.
Пример 15 - Хирургический инструмент из примеров 10, 11, 12, 13 или 14, где, по меньшей мере, один шарнирный элемент содержит первый шарнирный элемент, который функционально связан с хирургическим концевым эффектором, и второй шарнирный элемент, который функционально связан с хирургическим концевым эффектором, и где система шарнирного поворота содержит электромагнит двухстороннего действия, который выполнен с возможностью выборочного вхождения в зацепление с каждым из первого и второго шарнирных элементов.
Пример 16 - Хирургический инструмент из примера 15, где средства для удерживаемого зацепления включают в себя первую зазубренную часть на первом шарнирном элементе, первый блокирующий элемент на удлиненном узле ствола, который выполнен с возможностью вхождения в удерживаемое зацепление с первый зазубренной частью и второй зазубренной частью на втором шарнирном элементе, и второй блокирующий элемент на удлиненном узле ствола, который выполнен с возможностью вхождения в удерживаемое зацепление со второй зазубренной частью.
Пример 17 - Хирургический инструмент из примера 16, где в случае, когда электромагнит двухстороннего действия зацепляется с первым шарнирным элементом, электромагнит двухстороннего действия перемещает первую зазубренную часть из зацепления с первым блокирующим элементом, и когда электромагнит двухстороннего действия зацепляется со вторым шарнирным элементом, электромагнит двухстороннего действия перемещает вторую зазубренную часть из зацепления со вторым блокирующим элементом.
Пример 18 - Хирургический инструмент из примеров 15, 16 или 17, где электромагнит двухстороннего действия функционально связан с пусковой приводной системой хирургического инструмента.
Пример 19 - Хирургический инструмент, который содержит удлиненный узел ствола, который содержит шарнирное соединение. Хирургический концевой эффектор функционально соединен с удлиненным узлом ствола для избирательного шарнирного поворота по шарнирному соединению. Первый шарнирный элемент функционально связан с хирургическим концевым эффектором и поддерживается для избирательного осевого перемещения под действием приложения первых движений шарнирного поворота с помощью первого двигателя шарнирного поворота, функционально соединенного с ним. Хирургический инструмент дополнительно содержит второй шарнирный элемент, который функционально связан с хирургическим концевым эффектором и поддерживается для избирательного осевого перемещения под действием приложения вторых движений шарнирного поворота с помощью второго двигателя шарнирного поворота, который функционально соединенного с ним.
Пример 20 - Хирургический инструмент из примера 19, дополнительно содержащий систему управления для управления первым и вторым двигателями шарнирного поворота так, что, когда первый двигатель шарнирного поворота приводится в действие с перемещением первого шарнирного элемента в одном осевом направлении для первого осевого расстояния, второй двигатель шарнирного поворота приводится в действие с перемещением второго шарнирного элемента в противоположном осевом направлении для второго осевого расстояния, которое равняется первому осевому расстоянию.
Полное описание:
патента США № 5,403,312, озаглавленного ELECTROSURGICAL HEMOSTATIC DEVICE, выданного 4 апреля 1995 г.;
патента США № 7,000,818, озаглавленного SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS, выданного 21 февраля 2006 г.;
патента США № 7,422,139, озаглавленного MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK, выданного 9 сентября 2008 г.;
патента США № 7,464,849, озаглавленного ELECTRO-MECHANICAL SURGICAL INSTRUMENT WITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS, выданного 16 декабря 2008 г.;
патента США № 7,670,334, озаглавленного SURGICAL INSTRUMENT HAVING AN ARTICULATING END EFFECTOR, выданного 2 марта 2010 г.;
патента США № 7,753,245, озаглавленного SURGICAL STAPLING INSTRUMENTS, выданного 13 июля 2010 г.;
патента США № 8,393,514, озаглавленного SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE, выданного 12 марта 2013 г.;
патента США № 7845537, озаглавленного SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES; выданного 7 декабря 2010 г.;
заявки на патент США № 12/031,573, озаглавленной SURGICAL CUTTING AND FASTENING INSTRUMENT HAVING RF ELECTRODES, поданной 14 февраля 2008 г.;
патента США № 7980443, озаглавленного END EFFECTORS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT, выданного 19 июля 2011 г.;
патента США № 8210411, озаглавленного MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT, выданного 3 июля 2012 г.;
патента США № 8608045, озаглавленного POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM, выданного 17 декабря 2013 г.;
патента США № 8220688, озаглавленного MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT WITH ELECTRIC ACTUATOR DIRECTIONAL CONTROL ASSEMBLY, выданного 17 июля 2012 г.;
патента США № 8733613, озаглавленного STAPLE CARTRIDGE, выданного 27 мая 2014 г.;
патента США № 8561870, озаглавленного SURGICAL STAPLING INSTRUMENT, выданного 22 октября 2013 г.;
публикации заявки на патент США № 2012/0298719, озаглавленной SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, поданной 27 мая 2011 г.;
публикации заявки на патент США № 2013/0334278, озаглавленной ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, поданной 15 июня 2012 г.;
заявки на патент США № 13/800,025, озаглавленной STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, поданной 13 марта 2013 г.;
заявки на патент США № 13/800 067, озаглавленной STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, поданной 13 марта 2013 г.;
опубликованной заявки на патент США № 2007/0175955, озаглавленной SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM, поданной 31 января 2006 г.; и
патента США № 8308040, озаглавленного SURGICAL STAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR, выданного 13 ноября 2012 г., включены в данный документ посредством ссылки.
Несмотря на то что в настоящем документе описаны различные варианты осуществления изделий в их связи с определенными раскрытыми вариантами осуществления, в отношении изделия могут быть реализованы различные модификации и изменения. Также для некоторых компонентов, для которых раскрыты материалы, можно применять другие материалы. Кроме того, в соответствии с различными вариантами осуществления один компонент может быть заменен несколькими компонентами, а несколько компонентов - одним компонентом (для выполнения определенных функций). Представленное выше описание и приложенная формула изобретения охватывают все указанные изменения и дополнения.
В отношении применения по существу любых случаев множественного и/или единственного числа для терминов в настоящем документе специалисты в данной области могут изменять множественное число на единственное и/или единственное на множественное в соответствии с требованиями контекста и/или сферой применения. Различные комбинации единственного/множественного числа для ясности в настоящем документе явным образом не указаны.
Описанный в настоящем документе объект изобретения иногда иллюстрирует различные компоненты, содержащиеся внутри различных других компонентов или соединенные с ними. Следует понимать, что такие показанные архитектуры являются лишь примерами и что фактически могут быть реализованы многие другие архитектуры с такой же функциональностью. В концептуальном смысле любая конфигурация компонентов для достижения такой же функциональности практически «связывается» так, чтобы достичь желаемой функциональности. Таким образом, любые два компонента, скомбинированные в настоящем документе для достижения конкретной функциональности, могут рассматриваться как «связанные» друг с другом так, чтобы достигалась желаемая функциональность, независимо от архитектур или промежуточных компонентов. Аналогичным образом любые два компонента, соединенные таким образом, можно рассматривать как «функционально соединенные» или «функционально связанные» друг с другом для достижения желаемой функциональности, и любые два компонента, которые могут быть связаны таким образом, также могут рассматриваться как «функционально соединяемые» друг с другом для достижения желаемой функциональности. Конкретные примеры функционально соединяемых компонентов включают, помимо прочего, физически сопрягаемые, и/или физически взаимодействующие компоненты, и/или беспроводно взаимодействующие, и/или логически взаимодействующие, и/или логически взаимодействующие компоненты.
Хотя в настоящем документе описаны различные варианты осуществления, специалистам в данной области может быть очевидна возможность множества модификаций, вариантов, замен, изменений и эквивалентов для этих вариантов осуществления. Также для некоторых компонентов, для которых раскрыты материалы, можно применять другие материалы. Таким образом, следует понимать, что представленное выше описание и приложенные пункты формулы изобретения должны охватывать все такие модификации и варианты как попадающие в рамки объема раскрытых вариантов осуществления. Предполагается, что следующие пункты формулы изобретения охватывают все такие модификации и варианты.
Устройства, описанные в настоящем документе, могут быть выполнены с возможностью утилизации после однократного применения или они могут быть выполнены с возможностью применения множество раз. Однако в любом случае устройство можно восстановить для повторного применения после, по меньшей мере, одного применения. Восстановление может включать в себя любую комбинацию этапов разборки устройства, последующей очистки или замены конкретных частей и последующей повторной сборки. В частности, устройство можно разобрать и любое число конкретных деталей или частей устройства можно селективно заменить или удалить в любой комбинации. После очистки и/или замены конкретных частей устройство можно снова собрать для последующего применения либо в мастерской по восстановлению, либо силами хирургической бригады непосредственно перед хирургическим вмешательством. Специалистам в данной области будет очевидно, что для восстановления устройства можно использовать различные методики разборки, очистки, замены и повторной сборки. Применение таких методик, а также полученное восстановленное устройство целиком входят в объем настоящей заявки.
Предпочтительно описанный здесь предмет изобретения будет проходить обработку перед проведением хирургической операции. Сначала, после получения нового или уже использованного инструмента, его при необходимости очищают. Затем инструмент можно стерилизовать. Согласно одному способу стерилизации инструмент помещают в закрытый и герметичный контейнер, например пластиковый пакет или пакет Тайвек (TYVEK). Затем тару и инструмент помещают в поле излучения, которое может проникать в тару, такого как гамма-излучение, рентгеновское излучение или быстрые электроны. Излучение уничтожает бактерии на инструменте и в таре. Стерилизованный инструмент может затем храниться в стерильной таре. Герметичная тара сохраняет инструмент стерильным до его вскрытия в медицинском учреждении.
Любой патент, публикация или другой материал описания, полностью или частично, который указан как включенный в настоящий документ путем ссылки, включен в настоящий документ только в той степени, в какой включенный материал не противоречит существующим определениям, положениям и другому материалу описания, представленному в настоящем описании. Таким образом, в необходимой степени описание, как явно представлено в настоящем документе, имеет преимущество перед любым противоречащим ему материалом, включенным в настоящий документ путем ссылки. Любой материал или его часть, включенный в настоящий документ путем ссылки, но противоречащий существующим определениям, положениям или другому материалу описания, представленному в настоящем документе, будет включен в настоящий документ только в той мере, в которой между включенным материалом и существующим материалом описания не возникает противоречий.
В целом использование описанных в настоящем документе принципов настоящего изобретения обеспечивает получение множества преимуществ. Представленное выше описание одного или более вариантов осуществления было представлено для целей иллюстрации и описания. Считается, что описание не является исчерпывающим или ограничивающим точной раскрытым вариантом. В свете всего вышесказанного возможны модификации и варианты. Один или более вариантов осуществления были выбраны и описаны для иллюстрации принципов и способов практической реализации, посредством чего позволяя специалисту в данной области использовать различные варианты осуществления изобретения, а также с различными модификациями, соответствующими конкретной предполагаемой сфере применения. Предполагается, что полный объем изобретения определен в прилагаемых пунктах формулы изобретения.
Claims (21)
1. Хирургический сшивающий инструмент (2010), содержащий:
корпус (2102);
сменный узел (2200) ствола, присоединенный с возможностью отсоединения к указанному корпусу (2102) и содержащий удлиненный ствол (2230);
хирургический концевой эффектор (2300), функционально соединенный с указанным удлиненным стволом (2230) для избирательного шарнирного поворота относительно него;
систему (2500) шарнирного поворота, выполненную с возможностью выборочного приложения движений шарнирного поворота к указанному хирургическому концевому эффектору (2300), когда указанная система (2500) шарнирного поворота находится в ориентации приведения в действие; и
средства (2580) предотвращения отсоединения указанного сменного узла (2280) ствола от указанного корпуса (2102), когда указанная система (2500) шарнирного поворота находится в указанной ориентации приведения в действие,
при этом указанный сменный узел (2200) ствола соединен с возможностью отсоединения с указанным корпусом (2102) посредством стопорного элемента (2280), который выполнен с возможностью выборочного перемещения между зафиксированным положением и незафиксированным положением, и при этом указанные средства (2580) для предотвращения отсоединения функционально связаны с указанной системой (2500) шарнирного поворота и указанным стопорным элементом (2280), и
указанная система (2500) шарнирного поворота содержит:
приводной механизм (2550) шарнирного поворота, поддерживаемый с возможностью движения по указанному сменному узлу (2200) ствола и с возможностью выборочного перемещения между незадействованной ориентацией, при которой указанный хирургический концевой эффектор (2300) находится в отсоединенной ориентации, и множеством ориентаций приведения в действие, при которых указанный хирургический концевой эффектор (2300) шарнирно повернут относительно оси (SA) ствола, образованной указанным удлиненным стволом (2230).
2. Хирургический сшивающий инструмент по п.1, в котором указанная система (2500) шарнирного поворота содержит:
первый шарнирный элемент (2510), функционально связанный с указанным хирургическим концевым эффектором (2300) и указанным приводным механизмом (2550) шарнирного поворота; и
второй шарнирный элемент (2520), функционально связанный с указанным хирургическим концевым эффектором (2300) и указанным приводным механизмом (2550) шарнирного поворота.
3. Хирургический сшивающий инструмент по п.2, в котором указанный приводной механизм (2550) шарнирного поворота содержит узел (2560) ведущего зубчатого колеса шарнирного поворота, находящийся в зацеплении с указанным первым и вторым шарнирными элементами (2510, 2520).
4. Хирургический сшивающий инструмент по п.3, в котором указанный узел (2560) ведущего зубчатого колеса шарнирного поворота выполнен с возможностью перемещения между указанной незадействованной ориентацией и указанной ориентацией приведения в действие и в котором указанные средства (2580) для предотвращения отсоединения содержат блокирующий элемент (2582), функционально связанный с указанным узлом (2560) ведущего зубчатого колеса шарнирного поворота, и указанный стопорный элемент (2580) так, что, когда указанный узел (2560) ведущего зубчатого колеса шарнирного поворота находится в указанном незадействованном положении, указанный стопорный элемент (2280) обладает возможностью перемещения в указанное незафиксированное положение и, когда указанный узел (2560) ведущего зубчатого колеса шарнирного поворота находится в любом одном из указанных положений приведения в действие, указанный блокирующий элемент (2582) предотвращает перемещение указанного стопорного элемента (2280) в указанное незафиксированное положение.
5. Хирургический сшивающий инструмент по п.4, в котором указанный узел (2560) ведущего зубчатого колеса шарнирного поворота содержит:
стопорный фланец (2564), функционально сообщающийся с указанным приводным механизмом (2550) шарнирного поворота;
ведущее зубчатое колесо (2562) шарнирного поворота, соединенное с указанным стопорным фланцем (2564); и
выемку (2566) отсоединения в указанном стопорном фланце (2564), при этом указанная выемка (2566) отсоединения расположена на указанном стопорном фланце (2564) так, что, когда указанный узел (2560) ведущего зубчатого колеса шарнирного поворота находится в указанной незадействованной ориентации, часть указанного блокирующего элемента (2582) может проходить в указанную выемку (2566) отсоединения под действием движения указанного стопорного элемента (2280) из указанного зафиксированного положения в указанное незафиксированное положение и, когда указанный узел (2560) ведущего зубчатого колеса шарнирного поворота находится в любом одном из указанных положений приведения в действие, указанная часть указанного блокирующего элемента (2582) зацепляет указанный стопорный фланец (2564) с удерживанием указанного блокирующего элемента (2582) в положении фиксации, при котором предотвращается движение указанного стопорного элемента (2280) из указанного зафиксированного положения в указанное незафиксированное положение.
6. Хирургический сшивающий инструмент по п.1, в котором указанный хирургический концевой эффектор (2300) содержит пару браншей, причем одна указанная бранша выполнена с возможностью выборочного перемещения относительно другой указанной бранши при приложении закрывающего движения к ней, и указанный удлиненный ствол (2230) дополнительно содержит закрывающий элемент (2120), функционально связанный с указанной одной из указанных браншей для приложения указанного закрывающего движения к ней при приведении в действие закрывающей системы, функционально поддерживаемой в указанном корпусе.
7. Хирургический сшивающий инструмент по п.6, в котором указанный хирургический концевой эффектор (2300) дополнительно содержит пусковой элемент, функционально поддерживаемый для осевого перемещения по указанному хирургическому концевому эффектору (2300) при приложении пускового движения к нему, и в котором указанный удлиненный ствол (2200) дополнительно содержит пусковой стержень (2570), функционально связанный с указанным пусковым элементом для приложения указанного пускового движения к нему при приведении в действие пусковой системы, функционально поддерживаемой в указанном корпусе.
8. Хирургический сшивающий инструмент по п.1, в котором указанный корпус содержит рукоятку (2102).
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US14/575,148 US10085748B2 (en) | 2014-12-18 | 2014-12-18 | Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors |
PCT/US2015/063960 WO2016099957A2 (en) | 2014-12-18 | 2015-12-04 | Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors |
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RU2017125412A3 RU2017125412A3 (ru) | 2019-06-11 |
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2014
- 2014-12-18 US US14/575,148 patent/US10085748B2/en active Active
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2015
- 2015-12-04 CN CN201580076418.3A patent/CN107257664B/zh active Active
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- 2015-12-04 RU RU2017125412A patent/RU2732043C2/ru active
- 2015-12-04 WO PCT/US2015/063960 patent/WO2016099957A2/en active Application Filing
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- 2015-12-04 MX MX2017008110A patent/MX2017008110A/es unknown
- 2015-12-17 EP EP15200727.4A patent/EP3042617B1/en active Active
- 2015-12-17 EP EP19191101.5A patent/EP3590440A1/en not_active Withdrawn
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2017
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2018
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2021
- 2021-03-10 US US17/197,337 patent/US11812958B2/en active Active
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JP6702976B2 (ja) | 2020-06-03 |
US20180368837A1 (en) | 2018-12-27 |
CN107257664B (zh) | 2020-06-30 |
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BR112017013037B1 (pt) | 2022-05-24 |
JP2017538527A (ja) | 2017-12-28 |
WO2016099957A2 (en) | 2016-06-23 |
RU2017125412A3 (ru) | 2019-06-11 |
CN107257664A (zh) | 2017-10-17 |
MX2017008110A (es) | 2018-03-06 |
EP3590440A1 (en) | 2020-01-08 |
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MX2021015346A (es) | 2022-01-24 |
EP3042617B1 (en) | 2020-03-04 |
BR112017013037A2 (pt) | 2018-01-02 |
EP3042617A2 (en) | 2016-07-13 |
EP3042617A3 (en) | 2016-11-02 |
WO2016099957A3 (en) | 2016-10-27 |
RU2017125412A (ru) | 2019-01-23 |
US11812958B2 (en) | 2023-11-14 |
US10945728B2 (en) | 2021-03-16 |
US20210267594A1 (en) | 2021-09-02 |
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