TW200814963A - Pneumatically powered surgical cutting and fastening instrument with replaceable power sources - Google Patents
Pneumatically powered surgical cutting and fastening instrument with replaceable power sources Download PDFInfo
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200814963 九、發明說明: 【發明所屬之技術領域】 5 10 15 2〇 本發明大體上關於外科器具,更特定言之係關於氣動外 ^刀割及緊固器具。本發明可應用於f知内視鏡和開放性 外科儀器且可應用於機器人辅助的外科手術。 【先前技術】 外科切割及緊固器具(針合器)在習知技藝中已被用來 ^織巾造成-縱長切σ並將賴肘釘施加於該切口 3侧上。此等器具通常包含―對合作顆夾構件,當該哭 於内視鏡或腹腔鏡制的情況,輯财構件^ ==套管通道。該等顯夹構件之—者收納—釘匠,該 二、有至二列橫向間隔的財釘。另一顎夾構件界定一 且;:砧f有與該g内之肘釘列對準的財釘成形穴。該器 匣d丈楔’該等楔在被從遠端傳動時通過該釘 釘朝向制之擊承該等肘釘的傳動器以執行該等財 件的二方過/ ^頃ί開發出多種不同作動切割及肘釘展開組 Π;7:;2Γ;^5Γ^ 上夕夂Γ —種外科釘合器具,其使用經由把手 展機構之手動驅動作用帶動的組織切斷及肘釘 f置0使用電池動力馬達的其他外科釘合 :二二“揭示於授證— 96422 遇有其他外科釘合器係由一加壓氣體源作動。舉例來 6 200814963 5 10 15 20 說,授證給Green望λ *、,m出 播人 如荨人之吴國專利第6,619,529號揭示一 卜科:…其利用把手中之一加麗氣體源 == 的厂“供給動力。該氣缸裝有-活塞總成,該 與二氣體進入該氣红而被作動。該活塞經建構 裝在遠端之:端===内之組件-起行動以導致安 士十接用一乍用°。中的財釘和手術刀展開。但此種設 °r m雜的組件集合將安裝在把手之活塞的運動傳浐 到位於裝置之终端作用哭却八士 丞们連動得輸 -…八2 中之組件。此外,當使用此 、々:抛:冒有動力源在外科程序期間耗盡的風險,因為 ::,法監測氣匿内剩餘之氣體量。如果是在擊發或= 新容器或辅助動力源的乏易於將耗盡容器換成一 另一種氣動外科釘合裝置揭示於授證給一之 利公開案US 2006/0151567號。此種壯w 、,專 装詈加车““ 現此種裝置利用-被支承在 中之氣動馬達或活塞系統產生— 動來作動終端作用哭。+插狀m 連助且利用此運 是從置可由可卸式e供給動力或 疋攸一外界動力源譬如醫院之既有高飞 供給動力。 另二虱或虱體供應源 此等使用裝置把手部分中之Ε或容器的氣動,為 ,要儲存充分體積之加壓氣體以實現該I置在又 壓力下之期望作動次數所需要的貯氣瓶限 =用 =針對大多數應用/程序設計的裝置會需要二= 供H或者在使用較小貯氣瓶之 ^ 具有不想要的高屢。此外,運用可卸心二 96422 7 200814963 的裝置必須接受再處理及再消毒。這些安排可能大幅改變 表現能力且因此可能較不為人所喜。200814963 IX. DESCRIPTION OF THE INVENTION: TECHNICAL FIELD OF THE INVENTION 5 10 15 2〇 The present invention relates generally to surgical instruments, and more particularly to pneumatic outer cutting and fastening devices. The present invention is applicable to endoscopic and open surgical instruments and can be applied to robot-assisted surgery. [Prior Art] Surgical cutting and fastening devices (knotters) have been used in the prior art to make a longitudinal slit σ and apply a yoke to the side of the slit 3. These devices usually contain a pair of cooperating clip members. When the crying is performed by an endoscope or a laparoscope, the wealth component is ^== cannula channel. The storage of the clip members - the nailsmith, the second, there are two columns of horizontally spaced financial nails. The other jaw member defines a sum; the anvil f has a nail forming pocket aligned with the column of staples in the g. The wedges of the wedges are developed by the staples that are driven by the staples toward the actuators of the staples to perform the two pieces of the fasteners. Different actuation cutting and elbow deployment group; 7:; 2Γ; ^5Γ^ 上上夂Γ - a kind of surgical stapling instrument, which uses the manual driving action of the handle mechanism to cut the tissue and the elbow f Other surgical staples using a battery-powered motor: 22" Revealed in the Charter - 96422 Other surgical staplers are operated by a pressurized gas source. For example, 6 200814963 5 10 15 20 said that the certificate was given to Green. λ *,, m is a broadcaster, such as the Wu Guo patent No. 6,619,529, which reveals a branch: ... which uses one of the handles of the Garry gas source == factory to supply power. The cylinder is equipped with a piston assembly which is actuated by the entry of the two gases into the gas red. The piston is constructed at the distal end: the component within the end === - acts to cause the october to use one. The financial nails and scalpels are unfolding. However, the assembly of such a set of components is to transfer the movement of the piston mounted on the handle to the terminal at the end of the device to cry but the eight-members are connected to the components of the eight-two. In addition, when using this, 々: throw: risk of depletion of the power source during the surgical procedure, because ::, the method monitors the amount of gas remaining in the stagnation. If it is in the firing or = new container or auxiliary power source, it is easy to replace the depleted container with another. Another pneumatic surgical stapling device is disclosed in the patent application No. US 2006/0151567. This kind of strong, and specially installed car "is now used by the air motor or piston system supported by the device" to move to the terminal to cry. + Plug-in m-assisted and use this transport is powered by the detachable e-powered or an external power source such as the hospital. The other two or the carcass supply source, such as the pneumatics of the bowl or the container in the handle portion of the device, is to store a sufficient volume of pressurized gas to achieve the desired number of actuations of the I placed under pressure. Bottle Limit = Use = Devices designed for most applications/programs will require two = for H or for use with smaller gas cylinders ^ with unwanted high frequency. In addition, devices using the Removable Heart II 96422 7 200814963 must be reprocessed and resterilized. These arrangements may significantly change performance and may therefore be less desirable.
習知氣力作動内切割器(endocutter)存在著其他問題。 ,例來說’-旦外科醫師透過—單開關或啟動扳機起動此 為具,盗具會進行或至少試圖完成擊發循環。然後 組件可被傳動系統縮回。儘管使用美國專利公 X ίο 15 20 Γ中T二所揭示之裝置的外科醫師可透過:扳機總 ㈣魏且/或調整送到震置之氣流量,但並沒有監 置之進程的器件。此外,此等f知裝置缺乏萬一在 =喪失操作壓力或因故情時手_回刀具 動施加額床醫師向傳動系統手 =力❺卜力1以協助擊發機構推進或是減緩推進的器 生::二;;:=2用大量組件之集合即能將氣力產 合^置運動轉移至終端作用器組件的氣動外科針 又’需要一種氣動外科釘合I 4 制並又監測該裝置進行擊發及回縮循環時 又,需要一種氣動外斜知人壯φ 廷粒的态件。 關擊發期間遭遇之力量的觸二他其:外科醫師提供有 其已作動位置並備便要被二 今需要一種經濟且具有輕易替 f.J .b # ^ # a ^ ^ ^ A ^ ^ ^ ^ ^ ^ 96422 又,需要更有效率地將氣體儲存在用以向;=合裝置 200814963 供、口動力之貝丁氣瓶内的方法及裝置,使得單一貯氣瓶可供 給動力進行更多次使用。 5There are other problems with conventional pneumatic actuators (endocutter). For example, if the surgeon activates the device through a single switch or a trigger, the thief will perform or at least attempt to complete the firing cycle. The assembly can then be retracted by the drive train. Despite the use of the device disclosed in U.S. Patent No. 2, T2, the surgeon can pass through: the trigger (4) Wei and/or adjust the flow of gas delivered to the set, but there is no process to monitor the process. In addition, these devices are lacking in the case of = loss of operating pressure or due to the circumstances of the hand _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Health::2;;:=2Pneumatic surgical needle that can transfer the pneumatic production to the end effector assembly with a large number of components. It also requires a pneumatic surgical staple I 4 system and monitors the device. In the firing and retracting cycle, a state of aerodynamic exotropy is known. The power of the power encountered during the firing is the same: the surgeon provides the position that he has acted and is prepared to be economically and easily replaced by fJ.b # ^ # a ^ ^ ^ A ^ ^ ^ ^ ^ ^ 96422 In addition, there is a need for a method and apparatus for more efficiently storing gas in a petrol cylinder for supplying and powering the unit to the power supply unit, so that a single gas cylinder can be powered for more uses. 5
又而要種具有用以在萬一發生氣動力喪失或中斷時 手動縮回刀具和擊發桿總成之器件的氣動釘合裝置。 口又,而要具備上述特徵之一或多者且亦具有一終端作用 器的裝置’該終端仙器可㈣於把手總成及域其所附接 之長軸桿總成部分選擇性地活節運動。 又 10 【發明内容】 在一總體觀點中,本發明斜斟—接办L u 车她士《 針對種外科器具,其包括一 把手心成及一可移除地附接於該把手總 15 20 氣動力源。-氣動傳動系統可被該外科器具可 且經建構用以流體耗合於該氣動力源。一與該 合的閉鎖系統經建構用以在該氣動 〜、、Ό 部分及該氣動傳動系統分開預;手總成主要 對該把丰嫡成士 φ立 、 後阻隔δ亥氣動力源 : 成主要部分及該氣動傳動系統之連接。 在另一總體觀點中,本於明^ 含一把手緘出,姑1月針對一種外科器具,其可包 分。哕管:r :'成有一内含-管集箱區的主要部 刀心集相區可有一穿透的接 胥| 蓋該接取埠。該把手總成可更進一牛 阻卩早構件可覆 該主要部分的握把部分。—氣 一可釋地連接到 操作地支承在該把手總成主八系統可被至少局部可 96422 要口15刀内。該氣動傳動系統可 9 200814963 與該主要部分尹之該管集箱區流體連通。— 支承在該握把部分内。一供氣線可 二=被 5 且經建構用以在該握把部分附接於;二:氣動力源 痒接收。一計數器可被該把手雜成承刀%被該接取 分已附接於該主要部分的次數。以计數該握把部 計,以在該握把部分已二 之後阻止該㈣部分再切接於該 〃預疋-人數 【實施方式】 刀。 10 15 以下搭配隨附圖式以舉例方式說 例,其中可利用相同數字敘述相同部件。夕個貝細 干出今一翻種到ϋ’各圖中以相同數字標示相同組件,圖! 斷器具1〇。圖!所示實二=獨“處的外科釘合及切 桿總成100、及一連接於二二:―把手總成300、-長軸 太私明夕夂者 、、車才干、、么成i〇〇的終端作用器12。 削且被可枢轉地附接於長軸桿總成 车! Λ Λ 轉帶動的終端作用器,譬如鳩 ΗΑνίΝΓ Δ\τ 明之發明名稱為、、SURGICALINSTRUMENT ==3織⑶LATING END EF_air之美國專 以引;弟11/329,〇2〇號所揭示者,該申請案之内容 淮一,n/併亡本文中。但隨著本發明的詳細說明逐漸 用:因:、二此技蟄者會理解到本發明之各實施例可關於採 5區π機構和控制之終端作用器配置成功地實行,且 的:1:將更進一步詳細說明,甚至可成功地利用無活節 的終端作用器配置。 96422 20 5 10 15 20 200814963 如圖1所示,器具10之把手總成3 機302和一擊發扳機310。應理解到具有針對不门—才1&扳 務使用之終端作用器的器| 十對不同外科任 機或是其他適合操作一終端二 === 端作用器12藉由較佳為圖中所不終 田叙仫馮長形的軸桿總成1〇〇分 成300。臨床醫師可利用_活節㈣器 ‘手= 12相對於軸桿總成⑽進行活節運動。作用為 μ外到^如錯直、水平、右、左等之空間用語係在假 -卜科〜、10之縱向軸線與長軸桿總成 轴且扳機跡31〇從把手總成⑽底部== 可以多1隹貝際貝仃當中,外科器具10 科哭且10太^由又疋向,且因此這些空間用語係相對於外 科口口具10本身使用0又,· 明蚩中伤以一身产4 4 近側(proximal) —辭在本說 看:此臨庆以把手總成3 0 0背後之臨床醫師的觀點來 看此臨床诸師將終端作用器12放成遠離自己。 立在本說明書中’'、加壓氣體-辭意指適合用在無菌環 系統内的任何氣體。此等媒介的非限制性 ^二m二氧化碳(c〇2),氮氣,氧氣,氮氣, 氣氣氣化納,丙烧,異丁烧,丁燒,氟氯碳化物^,二 甲基醚’甲基乙基喊’ ^化亞說,氮氣烧類(騰),例如 HFA 13如(1,1,1,2,-四氟乙烧)或1^ 227 ( 1,1,1,2,3 3 3- 七氟丙烷.)。 ’ ’ 在本兒月曰中,流體耦合(fiuidically coupled )7/ —辭 μ才曰元件經適當線路或其他構件耦接以許可加壓氣體在 96422 11 200814963 其間通行。在本說明書中’用在、、供氣管線路、 線路中的、、線路’’係指一由剛性或可撓導管、管件、二 =形成用以將加壓氣體從-組件輸送到另—組件的適^ 似一在本說明書中,'、氣力信號1、、氣力傳動信號夕 Γ生加?氣體源流到流體耦合於該加壓氣體源之-或多; 、則的乳流或是經流體搞合在一起之組件之間的氣流。 係轴在兒:叉中,、、大致橫斷縱向軸線(其中 '縱㈣ ίο 15 _ 20 庳理: 指—幾近垂直於該縱向軸線的方向。但 ^解到稍稍偏離垂直於該縱向軸線的方向也是大 縱向軸線。 「』也疋大致松斷 且Λ2^~?用在本發明各實施例之—種氣力操作工 /、〜成或終端作用器的分解組裝圖。圖丨_4所示 工具總成12經建構當作一内切割 2朱乍 說明逐漸進行,會理解到本發明匕2 =明的詳細 新穎傳動配置亦可想見被用來驅動妹建構用二:不=獨特 移除、修改或增添。又,應理解所:組件 12可針對特定外科制客製化5 4所轉端作用器 圖所於本發明各實施例的終端作用器示於圖2。如 成〇1〇 2作用《12㈣_Ε形樑擊發機構(、、刀且她 釘筒内^ 了㈣組織並擊發位於安裝在其中之二 野於钉^更有利地控制終端作用器^之-站部分相 、針同的間距形樑擊發機構之多樣觀點已在授證: 96422 、口 200814963Further, a pneumatic stapling device having means for manually retracting the cutter and the firing rod assembly in the event of loss or interruption of aerodynamic forces is required. And a device having one or more of the above features and also having an end effector. The terminal device can selectively (4) selectively live on the handle assembly and the long shaft assembly portion to which the field is attached. Festival sports. 10 [Summary of the Invention] In a general view, the present invention is a slanting shackle-supplied to a sneaker, "for a surgical instrument, which includes a handle and a removably attached to the handle. Source of force. - A pneumatic transmission system can be constructed by the surgical instrument for fluid consumption of the aerodynamic source. A locking system is constructed to separate the pneumatic ~, Ό part and the pneumatic transmission system; the hand assembly is mainly for the Feng 嫡 嫡 、 , , , , , , , , , , , , , , , , , , , , , The main part and the connection of the pneumatic drive system. In another general view, Ben Yuming has a handle, and in January, it can be used for a surgical instrument.哕 tube: r: 'The main part of the tube-box area is formed. The center of the center of the knife can have a penetrating joint | cover the pick-up. The handle assembly can be further advanced to prevent the early component from covering the grip portion of the main portion. - The gas is releasably connected to the operatively supported main assembly of the handle assembly. The eight systems can be at least partially 96 422. The pneumatic transmission system can be in fluid communication with the main part of the tube compartment of the main part of the year 2008. — supported in the grip portion. A gas supply line can be two = 5 and is configured to be attached to the grip portion; 2: an aerodynamic source is itchy. A counter can be mismatched by the handle to the number of times the pick-up has been attached to the main portion. The grip portion is counted to prevent the (four) portion from being re-cut to the cymbal-number of people after the grip portion has been halved. [Embodiment] A knife. 10 15 The following description is by way of example with reference to the accompanying drawings, wherein夕一贝细 Dry out of this one to ϋ ϋ each figure with the same number to indicate the same components, figure! Disconnect the appliance 1〇. Figure! The actual two are shown as the sole surgical stapling and cutting rod assembly 100, and one connected to the second two: the handle assembly 300, the long axis is too private, the car is dry, and the The end effector 12 of the crucible is cut and pivotally attached to the long axle assembly car! Λ Λ The end effector of the turn, such as 鸠ΗΑνίΝΓ Δ\τ, the name of the invention is, SURGICALINSTRUMENT ==3 Weaving (3) LATING END EF_air of the United States specifically cited; brother 11/329, 〇 2 所 revealed by the content of the application, Huai Yi, n / and died in this article. But with the detailed description of the invention gradually used: It will be understood by those skilled in the art that embodiments of the present invention can be successfully implemented with respect to the configuration of the terminal mechanism of the 5-zone π mechanism and control, and: 1: will be further elaborated and even successfully utilized. There is no active end effector configuration. 96422 20 5 10 15 20 200814963 As shown in Figure 1, the handle assembly 3 of the appliance 10 is a machine 302 and a firing trigger 310. It should be understood that there is a problem with the door - only 1 & Terminal device for use | Ten pairs of different surgical machines or other suitable exercises A terminal two === The end effector 12 is divided into 300 by a shaft assembly 1 which is preferably not shown in the figure. The clinician can use the _day (four) device 'hand = 12 The joint movement is performed with respect to the shaft assembly (10). The effect is from the outside of the μ to the horizontal, horizontal, right, left, etc., and the spatial language is in the longitudinal axis of the false-Buco~10 and the long shaft assembly axis. And the trigger trace 31〇 from the bottom of the handle assembly (10) == can be more than 1 隹 际 , , 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科 外科The use of 0 itself, · Alum injury and injury to a body 4 4 proximal (proximal) - the words in this view: this Linqing with the handle assembly 300 behind the clinician's point of view, this clinical division will be the terminal Actuator 12 is placed away from itself. As used in this specification, 'pressurized gas' means any gas suitable for use in a sterile loop system. Non-restrictive ^2 m carbon dioxide (c〇2) of such media , nitrogen, oxygen, nitrogen, gas gasification, propylene, isobutyl, butyl, chlorofluorocarbon ^, dimethyl ether 'A Base ethyl shout ' ^ Hua Ya said, nitrogen burning class (Teng), such as HFA 13 such as (1,1,1,2,-tetrafluoroethane) or 1^ 227 ( 1,1,1,2,3 3 3- Heptafluoropropane.) ' ' In this case, a fluidly coupled 7/--------------------------------------------------------------------------------------------------------------------------------------------------- In the present specification, 'used in, gas supply line, line, line' means a rigid or flexible conduit, pipe, two = formed to transport pressurized gas from the assembly to another component Appropriate one in this manual, ', pneumatic signal 1, pneumatic transmission signal Γ Γ 加? The source of gas flows to - or more of the fluid-coupled source of the pressurized gas; or the flow of water between the components that are brought together by the fluid. The tether is in the middle: the fork, and is substantially transverse to the longitudinal axis (where 'longitudinal (four) ίο 15 _ 20 庳: refers to a direction that is nearly perpendicular to the longitudinal axis. However, the solution is slightly offset from the longitudinal axis. The direction is also the large longitudinal axis. "" is also roughly loose and Λ2^~? used in the various embodiments of the present invention - the pneumatic assembly operator /, ~ into the end of the assembly diagram of the decomposition. Figure _4 The tool assembly 12 is constructed as an inner cut. The description of the Zhu Xi is gradually carried out. It will be understood that the detailed novel transmission configuration of the present invention 明 2 = Ming can also be imagined to be used to drive the sister construction. In addition, it is to be understood that the component 12 can be customized for a particular surgical system. The terminal actuators of the embodiments of the present invention are shown in Figure 2. 〇 2 function "12 (four) _ Ε beam firing mechanism (,, knife and her nail cylinder ^ (4) organization and firing in the two installed in the field of nails ^ more favorable control of the terminal action ^ - station part phase, needle with The diverse views of the pitch beam firing mechanism have been chartered: 96422, port 20 0814963
Shelt〇n,IV 等人之發明名稱為、' Surgical StaplingShelt〇n, IV et al.'s invention name is 'Surgical Stapling
Instrument Incorporating An Ε·Β_ 削叫 Mechanism々的 吳國專利第號中提及’該專利之相關部分以引 用的方f併入本文中。但隨著本發明的詳細說明逐漸進 行&热4此技蟄者會理解到可能可用其他刀具和擊發機構 組態而不脫離本發明之精神及範圍。 。。在本說明書中’、、擊發機構〃意指氣動工具及/或終端作 ίο 15 20 。。之或夕個部分,其從一該擊發機構可能本質上處於 休止狀態的未作動位置移動至—該或該被 立置到-最終位置的已作動、終端位置,4中此移二 導致邊I |因應對其施加之至少__擊發運動而完成一或多 項動作。擊發機構舉例來說可包括:(i)完全被氣動工具 支承且與外科裝置中之組件交界的的組件;(“)位於氣動 =具内及外科裝置内之組件的—個組合;《(叫被外科 衣置、支承且可移入及移出氣動工具的組件。在本說明書 中垂擊發行程〃意指擊發機構從未作動位置到已作動位置 ^際移動。文中、、回縮行程"意指擊發機構從已作動位 罝私回未作動位置的回行移動。Instrument Incorporating An Ε Β 削 々 々 々 々 々 々 々 々 々 々 吴 吴 吴 吴 吴 吴 吴 吴 。 。 。 。 。 。 。 。 。 。 。 。 。 。 。 However, as the detailed description of the invention proceeds gradually & heat 4, the skilled artisan will appreciate that other tooling and firing mechanisms may be utilized without departing from the spirit and scope of the invention. . . In this specification, the firing mechanism means a pneumatic tool and/or a terminal for ίο 15 20 . . Or a portion that moves from an unactuated position in which the firing mechanism may be essentially in a resting state to the activated or terminal position that is or is set to the final position, and the shift in the fourth causes the edge I | One or more actions are completed in response to at least the __firing motion applied thereto. The firing mechanism may include, by way of example,: (i) a component that is fully supported by the pneumatic tool and interfaces with components in the surgical device; (") a combination of components within the pneumatic device and within the surgical device; An assembly that is placed, supported, and moved in and out of a pneumatic tool. In this specification, a slamming stroke means that the firing mechanism moves from an unactuated position to an actuated position. In the text, the retraction stroke " The firing mechanism moves back from the active position to the unactuated position.
Mi如+圖2所不,終端作用器12包含一遠端構件,該遠端 構件在各非限制性實施例中包括一長槽道20,有一可樞轉 ::的砧4〇附接於該長槽道。長槽道20經建構用以接收 亚支承一釘Ε 50,該釘Μ對於刀具總成3〇作 ^與石“〇發生成形接觸。應理解到儘管本應文= '出一可輕易替換的釘匣,可將一與本發明之觀點一致 96422 13 200814963 的釘II永久性地固定或整合於長槽道2〇。 在各實施例中,擊發機構或刀具總成3G包含在擊發 間控制終端作用器12之間距的鉛直間隔銷。特定言之:上 部銷32經布置以進入位在石占4〇與長槽道⑼間之柩轴附近 5進入:砧穴42。參見圖4’當在砧4〇關閉之狀態下擊發時, 上部銷32在-往遠側延伸穿過石占4〇的縱向石占槽孔 遠侧推進。石占40中之任何微小往上偏轉均被 仏 ❿予之一向下力克服。 刀具總成30亦包含一往上接合於形成在長槽道2〇中 1〇 -槽道槽孔23 (圖2)的刀棒帽34,藉此與上部銷”合 乍、田萬石占40與長槽道20之間夾住太多組織時將石占 ,長槽道20稍稍互相拉近。在各實施例中,刀具總成如 最2可包含通過形成在釘匣5〇之一下表面中及長槽道扣 之一向上表面中之一擊發傳動槽孔(圖中未示)的中間銷 赢36,藉此如下文所述驅動其内之肘釘7〇。中間銷刊藉由 _抵住長槽道20滑動而有利地抗拒終端仙器12於其^ 被描住關閉的任何傾向。然本發明各實施例之獨特新 點亦可經由其他刀具總成配置的使用實現。 、 回到圖2,一位在刀具總成30上介於上部銷32與中間 銷36之間位於遠侧的切割刃%橫越釘匣5〇中之一位於^ 侧的氣直槽孔54以切斷夾住的組織。刀具總成3〇相關於 長槽道20及站4〇的確實定位確保執行有效切割。在各實 施例中’站4G之下表面可在其内具備複數個肘釘成形穴Λ (圖中未示),這些肘釘成形穴被排列成在釘匣5〇收納於 96422 14 200814963 長槽道内時對應於釘E5G之-上表面56中 %。在各實施例中’釘E50可扣接配合於長槽道2〇内。 特定言之,釘E50之加長特徵部6〇、62分別與長槽道2〇 之凹處24、26摩擦地且可釋地接合。 ίο 15 亦如圖2所示,釘E 5〇包括一 £主體51、—楔形滑槪 64、肘釘傳動器66、肘釘7〇、及一昆托板68。在組襄時, S把板68將楔形滑橇64、肘針傳動器66及財釘7〇固持 在s主體51内侧。長槽道2G藉由長軸桿總成ι⑼柄接於 把手總成3GG’該長軸桿總成包含—遠侧脊或骨架段ιι〇 =近㈣或骨架段13G。長槽道2G具有安置在近側的附 者八22每p付著八接收一個形成於遠側脊段η 〇之遠端 上的對應槽道料構件114。長槽道2G亦具有可樞轉地接 收石占40上一對應石占樞轴43的石占凸輪槽孔28。一閉合套 總成170套在脊總力102上且包含遠側閉合管區段18〇及 ,侧閉合管區段!90。如下文所將說明’閉合套筒總成η。 相對於脊總成102之轴向移動會導致石占4〇相 20樞轉。 7切、 如圖2所示,一鎖簧112安裝在遠側脊段110中當作刀 八…成30之閉鎖态件。遠側和近側方形孔!丨〗、J3形 20成於遠侧脊段110之頂±以在其間界定一接收鎖菁112之 一上^ 116的夾桿115,該鎖簧之朝遠側延伸的下臂118 在氣缸、^成501之一遠端上施加一向下力以支承從刀具 總成30突出的活塞桿部分35,詳見下文。應理解到各實 施例可包含其他類型的閉鎖器件或完全沒有閉鎖器件。 96422 15 200814963 對於近侧閉合二一9 = 動。熟習此技= 綱)進行活節運 之裝置使用的3;=ΓΓ為可搭 侧脊段in)之近端於』在此實施例中,遠 、、/、上有一殺U2。近側脊段13〇之遠 土 /、 通孔136的柄腳134。近側脊段130相對於 =側脊段m定位致使孔136與轂122之—孔124同轴對 10 =讓一樞軸銷138能夠穿過。參見圖4。此種配置在組 衣¥許可終端作用器12相躲近侧脊段㈣以樞軸線Μ 為中心樞轉。 、如础所述,此實施例利用帶使終端作用器12進行活節 運動。特定言之,帶150、16〇可如圖2和3所示往遠侧朝 ^節樞軸104延伸。帶150可沿近側閉合管區段19〇左侧 15穿過該近侧閉合管區段,在此繞過帶構件160並橫跨至近 •側閉合管區段之右側。其中,帶15〇舉例來說可在連接點 123機械地耦接於轂122。同樣的,帶16〇可沿近侧閉合管 區段I90右側穿過該近侧閉合管區段,在此繞過帶構件15〇 並橫跨至近侧閉合管區段190之左侧。其中,帶16〇可在 20連接點125機械地耦接於轂122。 圖3是終端作用器及脊總成1〇2之一俯視圖,其中以虛 線示出閉合管總成1 〇〇。圖4是器具10之相同部分的局部 側剖面圖。如圖4所示,依據一非限制性實施例,帶15〇 和160被示為彼此偏離以防在移動中彼此干擾。舉例來 96422 16 200814963 j,贡150被示在一低於帶} 6〇的位置。在另一非限制性 貝轭例中,帶150和160之鉛直向定位可為颠倒。亦如圖 2和3所示,帶構件15〇繞近側骨架段13〇之柄腳部分134 中的一銷140延伸。同樣的,帶16〇繞近侧骨架段13〇之 5柄腳部分134中的銷142延伸。亦參見圖2。 ‘ 帶部分150和160可從轂122伸出沿著近側閉合管區段 190 L伸到圖5所示活節控制器2〇〇〇活節控制器200可包 _含一活節滑件202、一框架204及一封閉件206。帶部分 150、160可經由槽孔2〇8或其他孔通過活節滑件2〇2,但 10應理解到帶部分15〇、16〇可藉由任何適當器件耦接於滑件 202。活節滑件2〇2可如圖5所示為一件式,或者在一非限 制性實施例中可包含二部件,於此二部件之間有一界定槽 孔208的父界處。在一非限制性實施例中,活節滑件2〇2 可包含多個槽孔,例如以每一槽孔對應於帶部分15〇、工⑼ 15之一者。封閉件2〇6可覆蓋控制器2〇〇之各組件以防碎屑 鲁進入。 在各實施例中,帶部分150、160可在較槽孔208靠近 近侧的連接點210、212錨定於框架204。圖5之非限制性 貫例顯示帶部分150、160從連接點210、212到位在近侧 20閉合管區段19〇之縱向軸線附近的槽孔208經預先彎曲。 應理解到帶部分150、160可被錨定至器具1〇中任何較槽 孔208靠近近側之處、包括把手總成3〇〇。 在使用中,圖2之實施例可具有如圖3所示之一未活節 運動位置。活節控制器200及帶150、160被示為在一大約 96422 17 200814963 位於軸桿總成100之縱向轴線的置中位置。因此,終端作 用器12係處於一中立或未活節運動位置。在圖6中,活節 控制器200被示為活節滑件2〇2被推穿過活節框架到軸桿 總成100之右側。因此,帶15〇、16〇朝軸桿總成1〇〇之右 5侧彎曲。從圖中可見帶150向右彎曲會在轂122上施加一 、 偏離轂122之樞軸點的侧向力。此偏離力量導致轂122以 活節樞軸104為中心轉動,從而導致終端作用器12如圖所 _不向右樞轉。應理解到將活節滑件2〇2往轴桿總成1〇〇之 左側推動可在帶150、1 60上施加一侧向力,使帶15〇、16〇 1〇二者均朝軸桿總成1〇〇之左侧彎曲。然後帶16〇之彎曲在 章又122上施加一側向力,此側向力如前所述偏離轂丨22之 樞軸點。此隨後導致殺122以活節樞軸為中心轉動,導致 終端作用器12向左樞轉。 在各實施例中,軸桿總成100係由一閉合管總成17〇 15套j脊總成102上構成。參見圖2。閉合管總成17〇包括 _ 遠侧閉合管區段180和一近侧閉合管區段190。遠侧閉 合管區段18〇和近侧閉合管區段19〇可由一聚合物或其他 適菖材料製成。近側閉合管區段1 9〇為中空且有一穿透延 伸的軸向通暹191,該軸向通道經訂定大小以在其内接收 20 脊總成102之一部分。 在圖2和4所示實施例中’使用一雙枢軸閉合接頭 Π2。應理解到本發明並不侷限於雙樞軸閉合接頭設計,且 可包含任何適當的閉合管或套筒,或是完全沒有閉合管或 套筒。特別參照圖4,遠側閉合管區段18〇具有上部和下 96422 18 200814963 部往近側突出的柄腳1 82、 Λ 184。运側閉合管區段180更包 I置:广開/關舌片46致…在開啟 見t St樞轉的馬蹄—…一詳 = '合又區段⑽類似地具備一往遠側延伸的上柄 174勺入V主Γ侧延?的下柄腳194。一上部雙樞軸連桿 ο 3 4上犬出的遠側和近侧樞軸75 軸銷分別接合於一往近侧穿屮夕及寺樞 扞舖m… 柄腳182中的上部遠側 ίο 15 、為83及一在遠側突出之上柄腳192中的上部近側插 銷孔⑼。接頭配置更包含—下部雙樞軸連桿π,該連桿 具有往下突出的遠側和近侧樞軸銷178、179 (圖2未示, 但見於圖4),該等樞軸銷分別接合於一往近侧突出之下柄 腳184中的下σρ遠側插銷孔j 87及一往遠側突出之下柄腳 194中的下部近側插銷孔丨95。 在使用中,閉合管總成170例如回應閉合扳機31〇之作 動往遠侧平移以關閉砧40。砧40因閉合管總成17〇在脊 總成102上往遠侧平移導致馬蹄形孔^ 85之背部撞擊站4〇 上之開/關舌片46並導致砧40樞轉至關閉位置而關閉。要 開啟站40時,使閉合管總成no在脊總成ι〇2上依近側方 向軸向地移動導致舌片186接觸並推抵開/關舌片46以使 砧40柩轉至開啟位置。 圖7例示本發明各實施例之一非限制性把手總成3〇〇 之一分解組裝圖。在圖7所示實施例中,把手總成具有一 手%握把型組態且由一右邊機殼構件3 2 0和一左邊機 96422 19 20 200814963 殼構件330構成,該等機殼構件係由一聚合物或其他適當 材料模製或其他方式製造且經設計匹配在一起。機殼構件 320和330可藉由扣接特徵部、經模製或以其他方式形成 於其中之短樁和承窩,且/或藉由黏著劑、螺釘、螺栓、夾 5 子、及類似物附接在一起。右邊機殼構件320之上部部分 ‘ 322與左邊機殼構件330之一對應上部部分323配合以形 成一標示為340的主殼體部分。相似地,右邊機殼構件320 _ 上之下部握把部分324與左邊機殼構件之下部握把部分 344配合以形成一整體標示為342的握把部分。在圖7所 10 示實施例中,整個握把部分342與主殼體部分340整合。 此種配置可能特別適合加壓氣體源係永久性安裝在握把部 分342内的應用。此種配置亦適合用於加壓氣體源係在把 手總成300以外經由殼體總成上之一或多個埠口接通裝在 把手總成内之控制組件。在其他實施例中,如下文所將詳 15 述,握把部分342係可卸離主殼體部分340。隨著本發明 _ 的詳細說明逐漸進行,此種配置提供非常多的好處和優 點。但熟習此技藝者會理解到把手總成300可以多種不同 形狀和大小提供。 為求圖面簡潔,圖7僅例示用來控制最終控制砧40之 20 開啟及關閉的閉合管總成170之軸向移動的組件。如圖所 示,一藉由一連桿總成430辆接於閉合扳機302的閉合梭 400被支承在主殼體部分340内。閉合梭400亦可被製作 成由一聚合物或其他適當材料模製或其他方式製造且經設 計匹配在一起的兩個部分402、404。舉例來說,在圖7所 96422 20 200814963 不實施财,右邊部分術可具備經設計要收納在左 分綱之對應承窩(圖♦未示)内的緊固检4〇3。右邊和 左邊部分402、404可藉由扣接構件及/或黏著劑及/或螺 栓、螺釘、夹子、及類似物以其他方式固持在—起。如圖 5中所示 止動溝196提供在近侧閉合管區段190之近端 中。閉合梭400之右邊部分術具有一右止動凸緣區段 405,δ亥右止動凸緣區段適於與閉合梭4⑻左邊部分 #上之一左止動凸緣區段(圖中未示)合作形成一伸入近 閉合管區段190之止動溝196内的止動凸緣總成。 1〇 #如® 7所示’-右脊總成止動樁326從右邊機殼構件 320往内伸。此樁326伸入閉合梭4〇〇之右邊部分4〇2之 二長形槽孔或窗406内。一相似閉合梭止動樁(圖中未示) 從左邊機殼構件330往内伸且欲收納於閉合梭4〇〇之左邊 部分404之另一窗或槽孔4〇8中。此等止動樁用來在許^ 15閉合梭4〇〇相對於把手總成3〇〇軸向移動的同時將近側脊 籲段130之近端133(圖7未示)不可動地固定於把手總成 300。止動樁舉例來說可藉由螺栓、螺釘、黏著劑、扣接特 徵部、及類似物機械地附接於近側脊段13〇之近端。此外, 閉合梭400具備侧向延伸的導執41〇、411。軌道4ι〇建構 2〇為可滑動地收納在右邊機殼構件32〇之轨道導件328内, 且執道411建構為可滑動地收納在左邊機殼構件之一 執道導件(圖中未示)内。 閉合梭400及閉合管總成170在遠侧方向(箭頭、、c//) 中之軸向移動係由閉合扳機302朝把手總成3〇〇之握把部 96422 21 200814963 5 10 15 20 分342移動產生,且閉合梭400在近側方向(箭頭、、D„) 中之軸向移動係由閉合扳機302移離握把部分342之移動 產生。在各實施例+,閉合梭_具備-讓閉合連桿總成 430與其附接的連接器舌片412。參見圖8和9。閉合連桿 總成430包含一藉由一銷414可樞轉地銷接於連 M2的輛部分432。閉合連桿總成43〇更有一閉合臂, 該閉合臂如圖7所示藉由一閉合銷436可樞轉地銷接於一 形成在閉合扳機3〇2上之軛總成3〇4。閉合扳機藉由 一延伸於右邊機殼構件320與左邊機殼部分33〇之間的樞 轴鎖306可樞轉地安裝在把手總成300内。 當,床醫師想要關閉砧4〇以將組織夾緊於終端作用器 12g内時,臨床醫師將扳機302拉往握把部分342。隨著臨 床西師將閉合扳機3〇2拉往握把部分342, 她 彻依遠w方向移動閉合梭彻直到閉合連連;^ 430移至圖8所示鎖定位置為止。當處於該位置時,連桿 總成430會傾向於將閉合梭4〇〇保持在該鎖定位置。隨著 閉合,彻移到鎖定位置,閉合管總成170在脊總成102 遠=移動,導致砧4〇上之關閉/開啟舌片私被遠侧閉 合官區段180之馬蹄形孔185之近端碰觸從而將砧仞樞 至關閉(夾緊)位置。 在各貝靶例中,為更進一步將梭4⑽保持在關閉位置, 閉合扳機302可具備一適於接合握把部分342並將閉合板 機302可釋地保持在較位置的可釋敎機構則。亦可 能利用其他鎖定裝置將閉合梭棚可釋地保持在鎖定位 96422 22 200814963 置。在圖8、8A、8B、及9所示實施例中,閉合扳機302 包含一可撓縱向臂303,——侧向銷305從該臂伸出。臂303 和銷305舉例來說可由模製塑膠製成。把手總成300之手 槍握把部分342包含一開口 350,該開口於其内放有一侧 、向延伸楔352。當閉合扳機302縮回時,銷305接合於楔 ‘ 352,且銷305被楔352之下表面354迫使其向下(亦即使 臂303以順時針方向轉動)。當銷305完全通過下表面354 φ 時,臂303上之順時針方向力移除,且銷305以逆時針方 向轉動致使銷305停在楔352背後之一凹口 356中從而鎖 10 定閉合扳機302。銷305因一從楔352伸出之可撓擋止358 而被更進一步保持在鎖定位置。 要解鎖閉合扳機302時,操作者可更進一步擠壓閉合扳 機302,導致銷305接合於開口 350之一傾斜後壁359,迫 使銷305向上通過可撓擂止358。然後銷305能自由離開 15 開口 360之一上部槽道致使閉合扳機302不再被鎖定於手 _ 槍握把部分342。此配置之更多細節可參見2006年1月3 1 曰申請之授證給Shelton, IV等人之發明名稱為、Surgical Instrument Having A Removable Battery〃的美國專利申請 案序號第11/344,020號中提及,該專利申請案之相關部分 20 以引用的方式併入本文中。亦可採用其他可釋鎖定配置。 在本發明各實施例中,刀具總成30可有一自其伸出或 以其他方式附接的大致剛性活塞桿部分35,該活塞桿部分 係為傳動構件500之局部,其被遠侧脊段110可操作地支 承且經建構用以向刀具總成30施予至少二驅動運動(例如 96422 23 200814963 擊發運動及回縮運動)。在圖3、4、1〇、及 中,傳動構件包括-兩段式氣力作動氣㈣例 5 10 15 馨 20 30可包括一元組件或者其可以多部件提供以利 益具10組裝。舉例來說,如圖10和u所示,刀 30包括一含有上部銷32、帽34、中間銷36、及刀ϋ成土 側部分。遠側部分31可於其中具備—經訂^大 = 接收活+塞桿部分35遠端上之一突出部37的孔33。突出 37可藉由摩擦力收納在孔33内且/或藉由黏著 類似方式固持。 合按或 孔k成則包括一第一氣缸殼體51〇,該第_氣虹殼 體具^ —第-封閉近端512及—通入第—氣紅殼體51〇内 之一弟—軸向通道516内的第-開放遠端514。氣紅總成 5〇1亦包括一第一氣缸殼體520,該第二氣缸殼體具有一第 :近端522及一通入一第二軸向通道526内的第二開放遠 端524。第二封閉近端522有一第一活塞頭528形成於其 上,該第一活塞頭經相對於第一軸向通道516訂定大小用 =料-氣缸殼體51〇之第一壁511產生一大致氣密滑動 岔封错以在第一近端512之遠側與第一活塞頭528之近侧 y曰1界定一第一氣缸區515。帛—氣紅殼體51〇之第一遠 端514更有一形成於其上的向内延伸第一凸緣η?,該第 :四緣用於與第二氣缸殼體52〇之外壁表面建立一大致氣 在^動岔封藉以在第一凸緣517之近側與第一活塞頭528 之返侧之間界定一第二氣紅區518。 一第一通迢527穿透第一活塞頭528。如圖1〇和u所 96422 24 200814963 示,活塞桿35之近端穿過第二氣缸殼體520之第二開放遠 端524伸入第二轴向通道526内。一第二活塞頭53〇形5 於或以其他方式附接於活塞桿35之近端。第二活塞頭 經相對於第二轴向通道526訂定大小用以與第二氣缸殼體 5 5>20之一第二壁521產生一大致氣密滑動密封藉以界定一 、第三氣缸區532。第二氣缸殼體52〇之第二遠端524更有 一形成於其上的向内延伸第二凸緣525,該第二凸緣用於 響與活塞桿35建立一大致氣密滑動密封以在第二凸緣25之 近側與第二活塞頭530之遠側之間界定一第四氣缸區兄4。 10 如圖3和4所示,氣缸總成501安裝在遠侧脊段110 内j在&各實施例中,一對耳軸519提供在第一氣缸殼體51〇 之近端上。耳軸519被收納在遠侧脊段11()之耳轴孔119 内以使氣缸總成501能夠在遠侧脊段11〇内以一樞軸線 B B為中%、樞轉。參見圖3。一第一供氣線路或供氣導管 15 540攸把手總成3〇〇之一定向控制閥61〇 (圖8和9)延伸 • f過,耦接於第-氣缸殼體510第-近端512之近侧閉合 官,段190藉以供給加壓氣體通過第一氣缸殼體51〇第一 近端512 =一第一供氣埠513或開口。參見圖10和u。 此外,一第二供氣線路542從定向控制閥61〇延伸穿過近 〇側閉口 :區段19〇且在第一氣缸殼體51〇之遠端514附近 連接至第氣缸殼體510藉以經由一第二埠529將加壓氣 體送入第二氣缸區518内。 、、圖8-11,今詳細說明擊發機構或刀具總成3〇之伸 長及回縮。如圖8和9所示,供氣線路54〇和542麵接於 96422 25 200814963 10 15 20 ^統定向閥610,該閥係為裝在把手殼體350内之-驅 #為系統_的一部分。在各實施例中,定向閥610可能 =由一可透過把手殼體35〇可用之選擇開關612或按紐以 A動方式使其在前進(伸長)與倒轉(回縮)位置間切換。 :見圖1在圖8和9所示實施例中,使用一可移除加壓 f體源62G°如下文所將詳述,此種加壓氣體源包括-可 月t*可用一較佳加壓氣體再充氣的貯氣瓶622。但孰習此技 藝者會理解到亦可有效地利用不可替換/再充氣的加壓氣 體源(%氣瓶)。在更其他實施例中,把手總成3〇〇可具備 一用以從一外界加壓氣體源618供給加壓氣體的埠口 /、 舉例來5兒,态具10可透過一可撓供氣線路017耦接 於设施中之壓縮空氣供應器618。參見圖8Β。 士以下將更詳細地說明可移除/可再充氣貯氣瓶622的獨 特新穎觀點。但為了解釋活塞桿35及刀具總成3〇之伸長 及回縮,由圖中可見加壓氣體從貯氣瓶622 (或外界壓力 源618)通過一供氣線路65〇流入一可能包括一傳統比例 閥660之可變力驅動器。如圖9和55中特別顯示,比例閥 耦接於一附接至一啟動扳機670之供氣連桿662。在本 δ兄明書中,V、可變力驅動總成,,至少包括比例閥060和啟動 扳機670及其相應等效結構。在各實施例中,啟動扳機 ,支承在擊發扳機31〇附近,該擊發扳機藉由一在右邊機 殼構件320與左邊機殼構件330之間延伸的樞軸銷37〇可 樞轉地耦合於把手總成3〇〇。將啟動扳機67〇向内朝擊發 扳機310擠壓會導致比例閥66〇加大加壓氣體從貯氣瓶 96422 26 200814963 622流入—耦接於定向閥610之供氣線路680内的流率。 視定向閥610之位置而定,加壓氣體會流入供氣線:54〇 或542内。舉例來說,當定向閥61〇被臨床醫師作動以擊 發刀具總成30時,加壓氣體在啟動扳機67〇作動後被允許 5流過供氣線路54〇經由第一活塞頭528中之第一開口 My '流入第一氣缸區515内且流入第三氣缸區532内。隨著加 壓氣體進入第三氣缸區532,第二活塞頭53〇向活^桿 馨朝遠侧施力。位於第四氣缸區内的氣體透過第二氣體 520之排氣口 523排放。相似地,第二氣缸區518中容納 10之氣體被許可透過第二開口 529排入第二供氣線路5二、·· 内。第二供氣線路542將排放氣體送到定向閥6ι〇,最終 從該定向閥排出。加壓氣體持續施加於第—氣虹區和 第三氣缸區532會導致刀具總成30完全延伸穿過終端作用 器12。隨著刀具總成30通過終端作用器I],其切斷該終 15端作用器中夾緊的組織且擊發釘匣5〇内之肘釘7〇 (驅使 籲肘釘與砧40之下表面發生成形接觸)。一旦刀具總成% 已推進至其在終端作用器12内之最遠側位置,臨=醫師放 開啟動扳機670以中斷加壓氣體之施加。 要縮回擊發機構或刀具總成30時,臨床醫師手動地移 20動選擇開關612或適當按鈕將定向閥61〇調整成回縮位置 並開始擠壓啟動扳機670,導致加壓氣體流入第氣線 路542内。流過第二供氣線路542的氣體進入笙一 # % 、, 弟二氣缸區 518’導致弟^一氣缸殼體520往近侧縮入第— ^ 虱缸殼體510 内。第一氣缸區515内之氣體被允許經由第—供々口 η) 96422 27 200814963 排入第供氣線路540内。通過第一供氣線路540的氣體 進入,向閥610並由此排出。一旦進入第二氣缸區518之 加,氣體已導致第二氣缸殼體52〇如圖1〇所示縮入第一氣 缸,體510内,通過第二開口 529的氣體此時能夠通過第 5二,缸殼體51〇之排氣口 523並流入第四氣缸區534内。 ^著加壓氣體進入第四氣缸區534,第二活塞頭530將活 基桿35往近侧拉入第二氣缸殼體52〇内。第三氣缸區 之氣體通過第一開口 527進入第一氣缸區515内,從該 第一氣缸區内依前述方式排出。 10 本發明各實施例中呈比例閥060形式的可變力驅動器 可利用彈簧或其他偏動器件(圖中未示)以將比例闕_ 偏動至未作動位置。當處於未作動位置時,比例閥660 可為建構成阻止任何氣體從氣體源620或618流過閥66〇 内之一孔口(圖中未示)。因此,當驅動器扳機67〇處於未 U作動位置時,裝置本質上處於、、關〃的狀態。 馨*在前述實施例中,比例閥66〇可為藉由供氣連桿臂662 機械地耦接於啟動扳機670,致使當臨床醫師向内朝擊發 扳機jio擠壓啟動扳機670時,連桿臂662導致比例閥66〇 許可氣體流率加大通過閥66〇。因此,快速擠壓啟動扳機 20 670可能導致裝置之擊發速率提高,且放慢擠壓啟動扳機 670^之速率會減緩擊發速率。因此,被允許通過比例閥66〇 之氣體流量與施加於啟動扳機67〇之手動力量大致成比 例。 在其他實施例中,比例閥6 6 0可經電子式控制致使在啟 96422 28 200814963 動扳機作動後,比例闕660自其數位化喷放氣體。比例闕 660以一脈衝方式放出少量氣體,且啟動扳機670被越大 力擠壓,脈衝間隔越近。此配置用於選擇性地調節被用來 作動裝置的氣體體積。 又在更其他實施例中’驅動機構可包括一不同類型的 機構,其不像啟動扳機670相對於把手總成受到可樞轉地 支承。舉例來說,啟動扳機可包括一彈簧驅動滑移開關或 類似物。因此,提供給本發明這些實施例的保護不應僅限 在使用一樞轉驅動扳機之實施例。 10 又’在各貫施例中,^— 堅力e十541可如圖8和8A所示 15 20 流體耦合於供氣線路540。一窗543可穿過把手總 〇 之一對應部分提供以讓臨床醫師能夠觀看壓力計541,或 者可使用#他配置以讓臨床醫師在使用期間觀看壓力計〆 541。參見圖7。在各實施例中,壓力計54ι可包括一 ♦子 :壓=或-標度盤式壓力計。在這些非限制性實“ :的=計3提供一用以提供在擊發行程遭遇之力之回 Γ;二;者會理解到在某些非限制性實施例 1成::二 需要的力直接與氣缸總相内之麼 就能作‘ 力為小,則氣缸總成5()1不需要大壓力為大,則會必須將更多氣體釋入自而要勺力 壓力藉以完全作動擊發機構力j 5G1内提高其中 提供終端作用器正在遭受之力量的成比例=向臨床醫師 在其他實施例中,一聲立出 貝 耳曰出口 545可如圖8C所示提供 96422 29 200814963 5 10 15 20 在供氣線路540中。此聲音出口許可少量氣體從供氣線路 540釋出。因氣體排出而造成之後續哨音音階會隨著壓力 加大而上揚。然後臨床醫師可建立哺音音階與擊發機構所 經受之力的關聯。故此配置為臨床醫師提供一用以監測傳 動系統500所經受及最終擊發機構所經受之擊發力簦立 回饋。 曰 /各非限制性實施例亦可具備用以在擊發機構已抵達擊 發仃程之末端時自動通知臨床醫師的器件。舉例來說,如 圖4所示,一限制開關546可提供在遠侧脊段11〇内用以 偵測一如圖U所示埋入或經其他方式附接於擊發桿”之 啟動構件547。啟動構件547經定位致使當擊發桿3 5和擊 發機構抵達擊發行程之末端時,啟動構件547被限制開關 M6偵測到,該限制開關可電耦合於定向控制閥61〇以對 該閥傳送一適當信號。在收到此信號之後,定向控制閥61〇 可建構為自動地切換至回縮位置且許可擊發機構被縮回。 此夕匕卜:限制開關546可麵接於-在圖8中整體標示為549 之j不構件。在各實施例中,指示構件可向臨床醫師提供 耳曰。彳3唬、一視覺信號或是聲音和視覺信號之一組合, 指出擊發機構已抵達擊發行程之末端。舉例來說,指示構 件可包括-聲音產生裝置、發《二_、振動產生裝置、 ^類似物、或此等裝置之一組合。限制開關及相關控制組 ^可由一被支承在殼體總成300内之電池(圖中未示)供 $或者其可得到來自一外界電源之電力供應。因此,本 發明各非限制性實施例可具備一用以向臨床醫師提供一視 96422 30 200814963 覺及/或聲音信料丨擊發機 器件及/或一用以將墼於德摄 低運#毛仃私之末铫的 置的哭件。、s機構以氣力自動縮回至未作動位 如圖4、1〇及^所 一 5 10 15 ㈣之底部上。當刀且确成^;;出部39可形成於活塞 位詈,舖笪η, 八〜、成3〇如圖4所示處於完全縮回 動力。由於气缸Π 118對氣缸總成5〇1之遠端施加-偏 下枢轉且更進-步導端在遠側脊段u。内向 导择指9n + 、,泠致/舌基扣35上之鎖定突出部39掉入 …曰9盘1中^^開口 21内。此配置用來藉由鎖定突出 刀且:: 開口之長槽道20部分的摩擦接合使 =且:鎖r回縮位置。如圖…所示,鎖定i 及離開長槽道20中之鎖定開口。熟習此技藝 ^可成功運用其他刀桿較配置而不脫離本發明 之精神及範圍。 乃 圖—叫6八例示本發明之另—實施例,其中傳動構件· 士乱虹總& _ ’該氣缸總成之構造與前述氣缸總成 目似’差異之處在下文說明。舉例來說,在本實施例 一=用彈黃850、852縮回活塞桿35。如圖12和13所 :三氧缸總成800包含一第一殼體81〇,該第一殼體且有 一弟—封閉端812及一穿透的第一供氣埠813。一第一供 讀,840附接於第—封閉端812以供應加壓氣體通過第 供氧埠813。在此實施例中,第一氣缸殼體81〇沒有關 96422 200814963 於前述各實施例提及之第二開口 529。一第二氣缸殼體82〇 可滑動地_收納在第一氣缸殼體810内且有一第二封閉近端 822,一第一活塞頭828形成於該第二封閉近端上。一第一 5 氣缸區815界定於第一封閉端812與第一活塞頭828之 間。一第一回縮彈簧850提供在第一活塞頭828與一形成 於第一氣缸殼體810遠端上之第一凸緣817之間。第一回 縮彈簧850用來如圖12所示將第二氣缸殼體82〇偏動至第 一氣缸810中之回縮位置4舌塞桿35具有一經訂定大小用 10 以,^第二氣缸殼體820之第二遠端824的階梯狀端%,。 ,第凸緣825形成於弟一退端824上以與活塞桿35之階 梯狀4刀’35產生-大致侧面密封。一第二活塞頭請提 供,階梯狀活塞桿區段35,之近端上以在第二活塞頭謂 與第一活塞頭828之間界定一第三氣叙1 832。-第一開 15 20 穿透第—活塞頭m以讓空氣能在第—氣紅區… 兵弟二氣缸區832之間通行。—第二回縮彈簧852如圖12 戶:二提供在第二凸緣825與第二活塞頭請之間以將第二 請和階梯狀活塞桿35,如圖12所示偏動至第二氣 缸双體820内之完全縮回位置。 本發㈣實施財依下财絲作。如圖16所示,把 手、、、心成300如前所被且供 j. 習此技藝者合===可替換加屢氣體源620。但熟 源ΐ 效地運用不可替換的加i氣體 、I才;开。更其他實施例中,把手總成300可且備一 制闕610及相關組件附接於-外界加I氣體 原618料口 616。參見圖16Α。舉例來說,器具10可透 96422 32 200814963 過可撓供氣線路617搞接於設施中之塵縮空氣線路。 要刼作此益具時,臨床醫師將定向控制閥選擇開關 (圖1 )或按鈕移到前進(伸長)位置且開始擠壓啟動扳 機6 7 0,許可加壓氣體從貯氣瓶6 2 2 (或外界氣源6〗8 )通 5過供氣線路680通過定向控制閥61〇流入供氣線路84〇 •内。加壓氣體從第一供氣線路8 4 0通過第一供氣埠8丨3流 入第氣=區8丨5,通過第一開口 m流入第三氣缸區 ⑩832。進入第三氣缸區832的氣體導致第二活塞頭mo及活 塞桿35之階梯狀部分35,往遠側移動。在第二活塞頭請 10已移到一完全伸長位置(圖13)後,持續進入第一氣缸區 815的氣體將第二殼體82〇偏動至其完全伸長位置。一旦 刀具總成30已推進至其在終端作用器12内之最遠侧位 置’臨床醫師放開啟動扳機67〇以中斷加壓氣體之施加。 要、、宿回皋赉機構或刀具總成3 〇時,臨床醫師將定向閥 15選擇開關612移到倒轉(回縮)位置,其中第 • =〇被連接到定向閥61〇之一排氣口。第三氣紅區奶及 第,缸區815内之氣體被允許經由第一供氣線路Μ)排 ^供,線路840内且最終透過定向閥61〇排出。隨著氣體 離開第三氣缸區832,第二回縮彈簧852使活塞桿h之阡 2〇梯狀部分35,縮入第二氣缸殼體82_。同樣的,隨著氣白 體離開第-氣缸區815 ’第一回縮彈菁85〇使第二氣缸殼 體520縮入第一氣缸殼體81〇内。 一同樣在此實施例中,一壓力計541可如圖16和i6A所 示流體耦合於供氣線路840,該壓力計可如前文所述發揮 96422 33 200814963 向臨床醫師提供終端作用器正在遭受之力量的 一 ^ °貝。在其他實施例中,一聲音出口 545可如圖16Β 5Mi, as in Fig. 2, the end effector 12 includes a distal member that, in each non-limiting embodiment, includes a long channel 20 with a pivotable: anvil 4 attached to The long channel. The long channel 20 is configured to receive a sub-supporting nail 50 which is in contact with the stone assembly for the tool assembly. It should be understood that although this should be replaced by an easily replaceable Nail, a staple II of 96422 13 200814963 can be permanently fixed or integrated into the long channel 2〇 in accordance with the teachings of the present invention. In various embodiments, the firing mechanism or tool assembly 3G is included in the firing control terminal. The vertical spacing pin between the actuators 12. In particular: the upper pin 32 is arranged to enter the vicinity of the 柩 axis between the stone 〇 4 〇 and the long channel (9) 5: the anvil 42. See Figure 4' When the anvil 4 is fired in the closed state, the upper pin 32 is advanced in the longitudinal direction of the slot extending through the stone to the far side. Any slight upward deflection of the rock accountant 40 is given. One of the downward force overcomes. The tool assembly 30 also includes a knife bar cap 34 that is coupled upwardly to form a 1 - channel slot 23 (Fig. 2) in the long channel 2, thereby engaging the upper pin When the 组织, 田万石占40 and the long channel 20 sandwich too much tissue, the stone is occupied, and the long channel 20 is slightly closer to each other. In various embodiments, the tool assembly, such as the secondmost, may include an intermediate pin that is fired through a transmission slot (not shown) through one of the lower surfaces of one of the magazines 5'' and the upper surface of the long channel buckles. Win 36, thereby driving the elbow 7 in it as described below. The intermediate sales advantageously resist any tendency of the terminal fairy 12 to be turned off by the _ sliding against the long channel 20. However, the unique new features of various embodiments of the present invention can also be achieved through the use of other tool assembly configurations. Referring back to FIG. 2, a straight edge of the cutting edge % between the upper pin 32 and the intermediate pin 36 on the cutter assembly 30 is traversed by one of the nails 5 位于 on the side of the pin. To cut off the clamped tissue. The exact positioning of the tool assembly 3〇 associated with the long channel 20 and the station 4〇 ensures efficient cutting. In each of the embodiments, the lower surface of the station 4G may have a plurality of nail forming holes (not shown) therein, and the nail forming holes are arranged to be received in the long groove of the 96422 14 200814963. The inner time corresponds to the % of the upper surface 56 of the nail E5G. In various embodiments, the staple E50 can be snap-fitted into the long channel 2〇. In particular, the elongated features 6〇, 62 of the staple E50 are frictionally and releasably engaged with the recesses 24, 26 of the long channel 2, respectively. Ίο 15 As also shown in Fig. 2, the staple E 5 〇 includes a £ body 51, a wedge-shaped slider 64, a staple driver 66, a staple 7 〇, and a quinque plate 68. At the time of assembly, the S-pad 68 holds the wedge slider 64, the toggle actuator 66, and the nail 7 内侧 inside the s main body 51. The long channel 2G is attached to the handle assembly 3GG' by a long shaft assembly ι (9). The long shaft assembly includes a distal ridge or a skeleton segment ιι = near (four) or a skeleton segment 13G. The long channel 2G has an appendage member 22 disposed on the proximal side and a corresponding channel member 114 formed on the distal end of the distal ridge segment η 每. The long channel 2G also has a rock-accumulating cam slot 28 that pivotally receives the stone occupying 40 of the corresponding stone-occupant pivot 43. A closure sleeve assembly 170 is placed over the total ridge 102 and includes a distal closure tube section 18 , and a side closure tube section! 90. The closure sleeve assembly η will be described as will be described below. The axial movement relative to the ridge assembly 102 causes the rock to pivot. 7 Cut, as shown in Fig. 2, a lock spring 112 is mounted in the distal spine section 110 as a latching member of the blade. Distal and proximal square holes! J 、, J3 20 is formed at the top of the distal ridge 110 ± with a clamping rod 115 defining a receiving 126 on one of the locking dies 112, the lower arm 118 of the locking spring extending distally in the cylinder, A downward force is applied to one of the distal ends of the 501 to support the piston rod portion 35 projecting from the cutter assembly 30, as will be described below. It should be understood that embodiments may include other types of latching devices or no latching devices at all. 96422 15 200814963 For the proximal closure of the two 9 = motion. 3) = ΓΓ is the proximal end of the ridge section in). In this embodiment, there is a kill U2 on the far side, /, on the top. The proximal ridge section 13 is far away from the soil /, the shank 134 of the through hole 136. The proximal spine segment 130 is positioned relative to the = side spine segment m such that the bore 136 is coaxial with the bore 124 of the hub 122. 10 = allows a pivot pin 138 to pass therethrough. See Figure 4. This configuration pivots around the pivotal ridge (4) in the vicinity of the side ridge section (4). As described above, this embodiment utilizes the belt to cause the end effector 12 to perform a joint motion. In particular, the straps 150, 16 can extend distally toward the hinge pivot 104 as shown in Figures 2 and 3. The strap 150 can be closed along the proximal side of the tube section 19 to the left side 15 through the proximal closure tube section where it bypasses the strap member 160 and spans to the right side of the proximal side closure tube section. Wherein, the belt 15 can be mechanically coupled to the hub 122 at the connection point 123, for example. Similarly, the band 16 can pass through the proximal closure tube section along the right side of the proximal closure tube section I90 where it bypasses the strap member 15A and spans to the left side of the proximal closure tube section 190. The strap 16 can be mechanically coupled to the hub 122 at the 20 connection point 125. Figure 3 is a top plan view of the end effector and ridge assembly 1 , 2 with the closed tube assembly 1 以 shown in dashed lines. Figure 4 is a partial side cross-sectional view of the same portion of the appliance 10. As shown in Figure 4, in accordance with a non-limiting embodiment, the bands 15 and 160 are shown offset from one another to prevent interference with each other during movement. For example, 96422 16 200814963 j, tribute 150 is shown in a position below the band 6 〇. In another non-limiting example of a yoke, the straight orientation of the leads of strips 150 and 160 can be reversed. As also shown in Figures 2 and 3, the strap member 15 extends around a pin 140 in the tang portion 134 of the proximal frame segment 13〇. Similarly, the pin 142 in the 5 tang portion 134 of the band 16 about the proximal skeletal section 13 延伸 extends. See also Figure 2. The belt portions 150 and 160 can extend from the hub 122 and extend along the proximal closure tube section 190 L to the joint controller 2 shown in FIG. 5. The joint controller 200 can include a joint slider 202 , a frame 204 and a closure 206. The strap portions 150, 160 can pass through the slot slider 2〇2 via slots 2〇8 or other apertures, but it should be understood that the strap portions 15〇, 16〇 can be coupled to the slider 202 by any suitable means. The hinge slider 2〇2 can be a one-piece as shown in Figure 5, or can comprise two components in a non-limiting embodiment with a parent boundary defining a slot 208 therebetween. In a non-limiting embodiment, the hinge slide 2〇2 may comprise a plurality of slots, for example, with each slot corresponding to one of the belt portion 15〇, the work (9) 15. The closure member 2〇6 can cover the components of the controller 2〇〇 to prevent debris from entering. In various embodiments, the strap portions 150, 160 can be anchored to the frame 204 at attachment points 210, 212 that are proximal to the slot 208. The non-limiting example of Figure 5 shows that the strap portions 150, 160 are pre-bent from the attachment points 210, 212 to the slots 208 near the longitudinal axis of the proximal side closure tube section 19A. It will be appreciated that the strap portions 150, 160 can be anchored to any of the closer slots 208 of the appliance 1 靠近 near the proximal side, including the handle assembly 3 〇〇. In use, the embodiment of Figure 2 can have one of the unjointed motion positions as shown in Figure 3. The joint controller 200 and belts 150, 160 are shown in a centered position at a longitudinal axis of the shaft assembly 100 at approximately 96422 17 200814963. Thus, the terminal 12 is in a neutral or unjointed position. In Figure 6, the joint controller 200 is shown with the hinge slide 2〇2 pushed through the joint frame to the right of the shaft assembly 100. Therefore, the belts 15〇, 16〇 are bent toward the right 5 side of the shaft assembly 1〇〇. It can be seen from the figure that the bending of the belt 150 to the right exerts a lateral force on the hub 122 that is offset from the pivot point of the hub 122. This offset force causes the hub 122 to rotate about the hinge pivot 104, causing the end effector 12 to pivot to the right as shown. It should be understood that pushing the joint slider 2〇2 to the left side of the shaft assembly 1〇〇 can exert a lateral force on the belts 150, 160, so that the belts 15〇, 16〇1〇 both face the shaft. The rod assembly is bent to the left of 1〇〇. The bend of the belt 16 then exerts a lateral force on the chapter 122 which is offset from the pivot point of the hub 22 as previously described. This then causes the kill 122 to pivot about the hinge of the joint, causing the end effector 12 to pivot to the left. In various embodiments, the shaft assembly 100 is constructed from a closed tube assembly 17 〇 15 sets of j ridge assemblies 102. See Figure 2. The closure tube assembly 17A includes a distal closure tube segment 180 and a proximal closure tube segment 190. The distal closure tube section 18〇 and the proximal closure tube section 19〇 can be made of a polymer or other suitable material. The proximal closure tube section 19 is hollow and has a penetratingly extending axial passage Siam 191 that is sized to receive a portion of the 20 ridge assembly 102 therein. In the embodiment shown in Figures 2 and 4, a double pivot closure joint Π 2 is used. It should be understood that the present invention is not limited to a dual pivot closed joint design and may include any suitable closure tube or sleeve, or no closure tube or sleeve at all. With particular reference to Figure 4, the distal closure tube section 18A has tangs 1 82, Λ 184 projecting proximally from the upper and lower portions 96422 18 200814963. The transport side closing pipe section 180 is further provided with a wide open/closed tongue 46. The horseshoe is pivoted when it is opened. See the detail. The 'closed section (10) similarly has a distal extension. 174 spoons into the V main Γ side extension? Lower tang 194. The distal and proximal pivots of the upper double pivot link ο 3 4 are respectively engaged with a shaft pin which is respectively joined to the proximal side of the temple and the temple pivoting m... the upper distal side of the shank 182 15 is 83 and an upper proximal pin hole (9) in the upper tang 192 protruding distally. The joint arrangement further includes a lower double pivot link π having distal and proximal pivot pins 178, 179 projecting downwardly (not shown in Figure 2, but seen in Figure 4), the pivot pins respectively The lower σρ distal latch hole j 87 in a proximally projecting lower tang 184 and a lower proximal latch bore 95 in the distally projecting tang 194 are engaged. In use, the closure tube assembly 170 translates distally, for example, in response to closing the trigger 31 to close the anvil 40. The anvil 40 is translated distally on the ridge assembly 102 by the closure tube assembly 17 and causes the back of the horseshoe hole 85 to impact the tab 46 on the station 4 and causes the anvil 40 to pivot to the closed position to close. To open the station 40, axially moving the closure tube assembly no in the proximal direction on the ridge assembly ι 2 causes the tab 186 to contact and push against the tab 46 to open the anvil 40 to the opening position. Figure 7 illustrates an exploded assembly view of one of the non-limiting handle assemblies 3 of one of the various embodiments of the present invention. In the embodiment shown in Figure 7, the handle assembly has a one-hand % grip type configuration and is comprised of a right housing member 320 and a left unit 96422 19 20 200814963 housing member 330, which are A polymer or other suitable material is molded or otherwise fabricated and designed to fit together. The casing members 320 and 330 may be formed by snap-on features, short piles and sockets molded or otherwise formed therein, and/or by adhesives, screws, bolts, clips, and the like Attached together. The upper portion of the right casing member 320 '322 cooperates with one of the left casing members 330 corresponding to the upper portion 323 to form a main casing portion designated 340. Similarly, the right upper housing member 320_ upper upper grip portion 324 mates with the lower housing member lower grip portion 344 to form a grip portion generally designated 342. In the illustrated embodiment of Figure 7, the entire grip portion 342 is integral with the main housing portion 340. Such a configuration may be particularly suitable for applications where the pressurized gas source is permanently mounted within the grip portion 342. This configuration is also suitable for use in a control assembly in which the pressurized gas source is coupled to the handle assembly via one or more ports on the housing assembly other than the handle assembly 300. In other embodiments, as will be described in detail below, the grip portion 342 is detachable from the main housing portion 340. This configuration provides a number of benefits and advantages as the detailed description of the present invention proceeds gradually. However, those skilled in the art will appreciate that the handle assembly 300 can be provided in a variety of different shapes and sizes. For the sake of simplicity, Figure 7 illustrates only the components used to control the axial movement of the closure tube assembly 170 that ultimately controls the opening and closing of the anvil 40. As shown, a closure shuttle 400 that is coupled to the closure trigger 302 by a linkage assembly 430 is supported within the main housing portion 340. The closure shuttle 400 can also be fabricated as two portions 402, 404 that are molded or otherwise fabricated from a polymer or other suitable material and that are designed to fit together. For example, in Figure 7 where 96422 20 200814963 is not implemented, the right part of the technique may have a fastening check 4〇3 designed to be received in the corresponding socket of the left sub-frame (Fig. ♦ not shown). The right and left portions 402, 404 can be otherwise held in place by fastening members and/or adhesives and/or bolts, screws, clips, and the like. A stop groove 196 is provided in the proximal end of the proximal closure tube section 190 as shown in FIG. The right portion of the closure shuttle 400 has a right stop flange section 405 that is adapted to engage with a left stop flange section on the left side of the closing shuttle 4 (8) (not shown) Cooperating to form a stop flange assembly that extends into the retaining groove 196 of the proximal closure tube section 190. 1 〇 #如® 7' The right ridge assembly stop pile 326 extends inwardly from the right casing member 320. This post 326 extends into the elongated slot or window 406 of the right portion 4〇2 of the closed shuttle 4〇〇. A similar closed shuttle stop post (not shown) extends inwardly from the left casing member 330 and is intended to be received in another window or slot 4 〇 8 of the left portion 404 of the closing shuttle. The stop posts are used to immovably fix the proximal end 133 (not shown in FIG. 7) of the proximal spine segment 130 to the proximal end of the proximal stalk portion 130 while axially moving relative to the handle assembly 3〇〇. The handle assembly is 300. The stop post can be mechanically attached to the proximal end of the proximal spine 13 by, for example, a bolt, a screw, an adhesive, a snap feature, and the like. Further, the closing shuttle 400 is provided with laterally extending guides 41A, 411. The track 4 〇 2 is slidably received in the track guide 328 of the right casing member 32 ,, and the 411 is configured to be slidably received in one of the left casing members (not shown) Show). The axial movement of the closure shuttle 400 and the closure tube assembly 170 in the distal direction (arrows, c//) is by the closure trigger 302 toward the handle assembly 3 握 grip portion 96422 21 200814963 5 10 15 20 points Movement of 342 occurs and axial movement of the closure shuttle 400 in the proximal direction (arrows, D...) is produced by movement of the closure trigger 302 away from the grip portion 342. In each embodiment +, the closure shuttle has - The connector tab 412 is attached to the closure link assembly 430. See Figures 8 and 9. The closure link assembly 430 includes a portion 432 that is pivotally pinned to the M2 by a pin 414. The closure link assembly 43A further has a closure arm that is pivotally pinned to a yoke assembly 3〇4 formed on the closure trigger 3〇2 by a closure pin 436 as shown in FIG. The closure trigger is pivotally mounted within the handle assembly 300 by a pivot lock 306 extending between the right housing member 320 and the left housing portion 33. When the bed physician wants to close the anvil 4 When the tissue is clamped within the terminal applicator 12g, the clinician pulls the trigger 302 to the grip portion 342. As the clinical officer closes the wrench 3〇2 is pulled to the grip portion 342, and she moves in the far w direction to close the shuttle until the closure is closed; ^ 430 moves to the locked position shown in Fig. 8. When in this position, the link assembly 430 tends to The closing shuttle 4〇〇 is held in the locked position. As it is closed, it is moved to the locked position, and the closing tube assembly 170 is moved away from the ridge assembly 102, causing the closing/opening of the tongue on the anvil 4 The proximal end of the horseshoe shaped aperture 185 of the side closure section 180 is brought into contact to pivot the anvil to the closed (clamped) position. In each of the shell examples, to further maintain the shuttle 4 (10) in the closed position, the trigger 302 can be closed. There is a releasable mechanism adapted to engage the grip portion 342 and releasably retain the closure trigger 302 in a relatively positional position. It is also possible to releasably hold the closure shuttle in the locked position 96422 22 200814963 using other locking devices. In the embodiment illustrated in Figures 8, 8A, 8B, and 9, the closure trigger 302 includes a flexible longitudinal arm 303 from which the lateral pin 305 extends. The arm 303 and the pin 305 are, for example, moldable. Made of plastic. The handle portion 342 of the handle assembly 300 includes a Port 350, the opening having a side, extending wedge 352 therein. When the closure trigger 302 is retracted, the pin 305 engages the wedge '352 and the pin 305 is forced downward by the lower surface 354 of the wedge 352 (even The arm 303 is rotated in a clockwise direction. When the pin 305 completely passes the lower surface 354 φ, the clockwise force on the arm 303 is removed, and the pin 305 is rotated in the counterclockwise direction to cause the pin 305 to stop at the back of the wedge 352. The trigger 301 is thus closed by the lock 10 in the mouth 356. The pin 305 is further retained in the locked position by a flexible stop 358 extending from the wedge 352. To unlock the closure trigger 302, the operator can further squeeze the closure trigger 302, causing the pin 305 to engage one of the openings 350 to tilt the rear wall 359, forcing the pin 305 up through the flexible stop 358. The pin 305 can then freely exit one of the upper channels of the opening 360 such that the closure trigger 302 is no longer locked to the hand grip portion 342. Further details of this configuration can be found in the January 31, 2006 application. The application of the name to Shelton, IV et al., Surgical Instrument Having A Removable Battery, US Patent Application Serial No. 11/344,020 And, the relevant portion 20 of this patent application is incorporated herein by reference. Other release lock configurations are also available. In various embodiments of the invention, the tool assembly 30 can have a generally rigid piston rod portion 35 extending therefrom or otherwise attached thereto, the piston rod portion being a portion of the transmission member 500 that is distally ridged 110 is operatively supported and configured to impart at least two drive motions to the tool assembly 30 (eg, 96422 23 200814963 firing motion and retraction motion). In Figures 3, 4, 1 and , the transmission member comprises - two-stage pneumatically actuated gas (four). 5 10 15 Xin 20 30 may comprise a one-piece assembly or it may be provided in multiple parts to assemble the benefit 10 . For example, as shown in Figures 10 and u, the knife 30 includes an upper pin 32, a cap 34, an intermediate pin 36, and a soil-forming side portion. The distal portion 31 can be provided therein with a hole 33 that is stapled = one of the projections 37 on the distal end of the receiving live + plug stem portion 35. The projections 37 can be received in the holes 33 by friction and/or held in a similar manner by adhesion. The pressing or hole k includes a first cylinder housing 51〇, the first gas-filled housing has a first-closed proximal end 512 and a first-in-one in the first gas red shell 51〇 A first open distal end 514 within the axial passage 516. The gas red assembly 〇1 also includes a first cylinder housing 520 having a first proximal end 522 and a second open distal end 524 that opens into a second axial passage 526. The second closed proximal end 522 has a first piston head 528 formed thereon, and the first piston head is sized to be opposite to the first axial passage 516 by a first wall 511 of the cylinder-cylinder casing 51. The substantially airtight sliding jaw seals to define a first cylinder region 515 on the distal side of the first proximal end 512 from the proximal side y1 of the first piston head 528. The first distal end 514 of the helium-red-red housing 51 has an inwardly extending first flange η? formed thereon for establishing an outer wall surface of the second cylinder housing 52〇 A substantially gas seal defines a second reddish region 518 between the proximal side of the first flange 517 and the return side of the first piston head 528. A first port 527 penetrates the first piston head 528. The proximal end of the piston rod 35 extends through the second open distal end 524 of the second cylinder housing 520 into the second axial passage 526 as shown in Figures 1A and 96422 24 200814963. A second piston head 53 is or is otherwise attached to the proximal end of the piston rod 35. The second piston head is sized relative to the second axial passage 526 for producing a substantially airtight sliding seal with the second wall 521 of the second cylinder housing 5 5 > 20 to define a first and third cylinder region 532 . The second distal end 524 of the second cylinder housing 52 further has an inwardly extending second flange 525 formed thereon for establishing a substantially airtight sliding seal with the piston rod 35 for A fourth cylinder zone brother 4 is defined between the proximal side of the second flange 25 and the distal side of the second piston head 530. 10, as shown in Figures 3 and 4, the cylinder assembly 501 is mounted in the distal spine section 110. In various embodiments, a pair of trunnions 519 are provided on the proximal end of the first cylinder housing 51A. The trunnion 519 is received within the trunnion aperture 119 of the distal spine segment 11 () to enable the cylinder assembly 501 to pivot within the distal spine segment 11 with a pivot axis B B of %. See Figure 3. A first air supply line or air supply conduit 15 540 攸 handle assembly 3 directional control valve 61 〇 (Figs. 8 and 9) extends • f over, coupled to the first end of the first cylinder housing 510 The proximal side of the 512 is closed, and the section 190 is supplied with pressurized gas through the first cylinder housing 51, the first proximal end 512 = a first air supply port 513 or opening. See Figures 10 and u. In addition, a second air supply line 542 extends from the directional control valve 61 穿过 through the proximal side closure: a section 19 连接 and is coupled to the first cylinder housing 510 near the distal end 514 of the first cylinder housing 51 借A second crucible 529 feeds pressurized gas into the second cylinder region 518. Figure 8-11 shows the extension and retraction of the firing mechanism or tool assembly. As shown in Figures 8 and 9, the gas supply lines 54A and 542 are connected to the 96422 25 200814963 10 15 20 directional valve 610, which is housed in the handle housing 350. . In various embodiments, the directional valve 610 may be switched between a forward (elongation) and an inverted (retracted) position by a selectable switch 612 or button that is permeable to the handle housing 35. See Fig. 1 in the embodiment shown in Figs. 8 and 9, using a removable pressurized f body source 62G as will be described in more detail below, such a pressurized gas source comprising - may be used at a monthly rate A gas cylinder 622 that is refilled with pressurized gas. However, those skilled in the art will appreciate that an irreplaceable/refillable pressurized gas source (% cylinder) can also be utilized effectively. In still other embodiments, the handle assembly 3 can have a port for supplying pressurized gas from an external pressurized gas source 618, for example, the state 10 can be permeable to a flexible gas supply. Line 017 is coupled to a compressed air supply 618 in the facility. See Figure 8Β. The unique novelty of the removable/refillable gas cylinder 622 will be described in more detail below. However, in order to explain the elongation and retraction of the piston rod 35 and the cutter assembly 3, it can be seen that the pressurized gas flows from the gas cylinder 622 (or the external pressure source 618) through a gas supply line 65, which may include a conventional Variable force drive for proportional valve 660. As particularly shown in Figures 9 and 55, the proportional valve is coupled to a supply air link 662 that is attached to a start trigger 670. In the δ brothers book, V, the variable force drive assembly, at least includes the proportional valve 060 and the start trigger 670 and their corresponding equivalent structures. In various embodiments, the trigger is activated adjacent to the firing trigger 31A that is pivotally coupled by a pivot pin 37 that extends between the right housing member 320 and the left housing member 330. The handle assembly is 3 inches. Pressing the trigger 67 〇 inwardly toward the firing trigger 310 causes the proportional valve 66 to increase the flow rate of pressurized gas from the gas cylinder 96422 26 200814963 622 into the gas supply line 680 of the directional valve 610. Depending on the position of the directional valve 610, pressurized gas will flow into the supply line: 54 〇 or 542. For example, when the directional valve 61 is actuated by the clinician to fire the tool assembly 30, the pressurized gas is allowed to flow through the gas supply line 54 via the first piston head 528 after the activation trigger 67 is actuated. An opening My' flows into the first cylinder region 515 and flows into the third cylinder region 532. As the pressurized gas enters the third cylinder region 532, the second piston head 53 urges the force toward the distal side. The gas located in the fourth cylinder region is discharged through the exhaust port 523 of the second gas 520. Similarly, the gas containing 10 in the second cylinder zone 518 is permitted to be discharged through the second opening 529 into the second gas supply line 5, . The second gas supply line 542 sends the exhaust gas to the directional valve 6 〇 and is finally discharged from the directional valve. Continued application of pressurized gas to the first gas zone and the third cylinder zone 532 causes the tool assembly 30 to extend completely through the end effector 12. As the tool assembly 30 passes through the end effector I], it cuts off the clamped tissue in the final 15-end effector and fires the staples 7〇 in the staples 5〇 (driving the staples and the underside of the anvil 40) Forming contact occurs). Once the tool assembly % has advanced to its most distal position within the end effector 12, the physician = release trigger trigger 670 to interrupt the application of pressurized gas. To retract the firing mechanism or tool assembly 30, the clinician manually moves the 20-way selector switch 612 or the appropriate button to adjust the directional valve 61 成 to the retracted position and begins to squeeze the trigger 670, causing pressurized gas to flow into the qi. Within line 542. The gas flowing through the second gas supply line 542 enters the first #%, and the second cylinder area 518' causes the cylinder housing 520 to be retracted proximally into the first cylinder housing 510. The gas in the first cylinder region 515 is allowed to be discharged into the first gas supply line 540 via the first supply port η) 96422 27 200814963. The gas entering through the first gas supply line 540 enters the valve 610 and is thereby discharged. Upon entering the second cylinder region 518, the gas has caused the second cylinder housing 52 to be retracted into the first cylinder as shown in FIG. 1A, and the gas passing through the second opening 529 can pass the fifth step at this time. The cylinder housing 51 has an exhaust port 523 and flows into the fourth cylinder region 534. The pressurized gas enters the fourth cylinder region 534, and the second piston head 530 pulls the living rod 35 proximally into the second cylinder housing 52A. The gas in the third cylinder region enters the first cylinder region 515 through the first opening 527, and is discharged from the first cylinder region in the aforementioned manner. 10 Variable force actuators in the form of proportional valves 060 in various embodiments of the invention may utilize springs or other biasing means (not shown) to bias the ratio 阙_ to the unactuated position. When in the unactuated position, the proportional valve 660 can be constructed to prevent any gas from flowing from the gas source 620 or 618 through an orifice (not shown) in the valve 66. Therefore, when the driver trigger 67 is in the U-actuated position, the device is essentially in a closed state. In the foregoing embodiment, the proportional valve 66 is mechanically coupled to the activation trigger 670 by the air supply link arm 662, so that when the clinician presses the trigger 670 to the trigger trigger ji, the link The arm 662 causes the proportional valve 66 to permit the gas flow rate to increase through the valve 66. Therefore, a quick squeeze to activate the trigger 20 670 may result in an increased firing rate of the device, and a slower rate of squeezing the trigger 670^ will slow down the firing rate. Therefore, the flow rate of gas allowed to pass through the proportional valve 66 is approximately proportional to the manual force applied to the start trigger 67. In other embodiments, the proportional valve 660 can be electronically controlled such that after the trigger is actuated at 96422 28 200814963, the proportional 阙 660 is digitally vented from the gas. The ratio 阙 660 releases a small amount of gas in a pulse, and the trigger 670 is activated by a larger force, and the closer the pulse interval is. This configuration is used to selectively adjust the volume of gas used to actuate the device. In still other embodiments, the drive mechanism can include a different type of mechanism that is not pivotally supported relative to the handle assembly as the trigger trigger 670. For example, the trigger can be a spring driven slip switch or the like. Accordingly, the protection provided to these embodiments of the invention should not be limited to the use of a pivoting drive trigger embodiment. 10 Further, in each of the embodiments, ^ - the force e 541 may be fluidly coupled to the gas supply line 540 as shown in Figures 8 and 8A. A window 543 can be provided through a corresponding portion of the handle handle to enable the clinician to view the pressure gauge 541, or can be configured to allow the clinician to view the pressure gauge 541 during use. See Figure 7. In various embodiments, the pressure gauge 54i can include a pressure gauge or a gauge disc gauge. In these non-limiting real terms: a meter 3 provides a response to the force encountered in the firing stroke; two; it will be understood that in some non-limiting embodiments 1 :: 2 the required force is directly It can be used in the total phase of the cylinder. If the force is small, the cylinder assembly 5()1 does not need to be large, so it is necessary to release more gas into the piston pressure to fully actuate the firing mechanism. The force j 5G1 increases the proportion of the force in which the terminal actuator is being subjected to = to the clinician. In other embodiments, the pop-up exit 545 can be provided as shown in Figure 8C. 96422 29 200814963 5 10 15 20 In the gas supply line 540. This sound outlet permits a small amount of gas to be released from the gas supply line 540. The subsequent whistle scale due to gas discharge rises as the pressure increases. The clinician can then establish a feeding scale and firing. The association with which the mechanism is subjected. Therefore, the configuration provides a clinician with a feedback to monitor the firing force experienced by the transmission system 500 and the final firing mechanism. 曰/Non-limiting embodiments may also be provided for Fire The device automatically informs the clinician of the device when it has reached the end of the firing process. For example, as shown in Figure 4, a limit switch 546 can be provided in the distal ridge 11 用以 for detecting a U The activation member 547 is embedded or otherwise attached to the firing bar. The actuating member 547 is positioned such that when the firing rod 35 and the firing mechanism reach the end of the firing stroke, the activation member 547 is detected by the limit switch M6, which can be electrically coupled to the directional control valve 61 to transmit a valve to the valve Appropriate signal. Upon receipt of this signal, the directional control valve 61 can be configured to automatically switch to the retracted position and permit the firing mechanism to be retracted. Further, the limit switch 546 can be surface-attached to a component that is generally designated 549 in FIG. In various embodiments, the indicator member can provide deafness to the clinician. A combination of a visual signal or a combination of sound and visual signals indicates that the firing mechanism has reached the end of the firing stroke. For example, the indicating component can include a sound generating device, a "two", a vibration generating device, a ^ analog, or a combination of such devices. The limit switch and associated control group can be supplied by a battery (not shown) supported in the housing assembly 300 or it can be supplied with power from an external power source. Accordingly, each of the non-limiting embodiments of the present invention may be provided with a device for providing a view to the clinician 96422 30 200814963 and/or a sound sniper device and/or a device for use in The crying of the end of the smuggling. The s mechanism automatically retracts to the unactuated position as shown in Figure 4, 1〇 and ^5 5 15 (4). When the knife is confirmed to be ^;; the outlet portion 39 can be formed at the piston position, and the 笪, 〜8, and 3〇 are fully retracted as shown in FIG. 4. Since the cylinder bore 118 is applied to the distal end of the cylinder assembly 5〇1, it is pivoted downward and the further step is at the distal spine u. The inward guide finger 9n + , the locking projection 39 on the tongue/tongue button 35 is dropped into the opening 21 of the disk 9 . This configuration is used to lock the protruding knife and:: the frictional engagement of the portion of the long channel 20 of the opening to make = and: lock r retracted position. As shown in the figure, lock i and leave the locking opening in the long channel 20. Skilled in the art, other shanks can be successfully employed without departing from the spirit and scope of the present invention. Fig. 6 shows an alternative embodiment of the present invention, in which the transmission member, the singularity of the squirrel, and the configuration of the cylinder assembly, which are different from the above-described cylinder assembly, are explained below. For example, in the present embodiment, the piston rod 35 is retracted by the spring 850, 852. As shown in Figures 12 and 13, the three oxygen cylinder assembly 800 includes a first housing 81A having a first closed end 812 and a penetrating first air supply port 813. A first reading, 840 is attached to the first closed end 812 to supply pressurized gas through the first oxygen supply 813. In this embodiment, the first cylinder housing 81 is not closed to the second opening 529 mentioned in the foregoing embodiments. A second cylinder housing 82 is slidably received within the first cylinder housing 810 and has a second closed proximal end 822 formed on the second closed proximal end. A first 5 cylinder region 815 is defined between the first closed end 812 and the first piston head 828. A first retraction spring 850 is provided between the first piston head 828 and a first flange 817 formed on the distal end of the first cylinder housing 810. The first retracting spring 850 is used to bias the second cylinder housing 82 to the retracted position in the first cylinder 810 as shown in FIG. 12. The tongue plug lever 35 has a predetermined size of 10, ^ second The stepped end % of the second distal end 824 of the cylinder housing 820. The flange 825 is formed on the retracted end 824 to produce a substantially side seal with the stepped 4 knives '35 of the piston rod 35. A second piston head is provided with a stepped piston rod section 35 on the proximal end to define a third tempering 1 832 between the second piston head and the first piston head 828. - The first opening 15 20 penetrates the first piston head m to allow air to pass between the first gas zone and the second cylinder zone 832. - a second retracting spring 852 as shown in Figure 12: two is provided between the second flange 825 and the second piston head to bias the second and stepped piston rod 35, as shown in Figure 12 to the second The fully retracted position within the cylinder double body 820. This issue (4) implements the financial affairs of the financial sector. As shown in Fig. 16, the hand, the heart, and the heart are 300 as before. This artisan === replaces the additive gas source 620. However, the cooked source uses the irreplaceable addition of i gas and I; In still other embodiments, the handle assembly 300 can be configured with a 阙 610 and associated components attached to the external IG inlet 616. See Figure 16Α. For example, the appliance 10 can be accessed through a flexible air supply line 617 through a dust-tight air line in the facility through 96422 32 200814963. To make this benefit, the clinician moves the directional control valve selector switch (Fig. 1) or button to the forward (elongation) position and begins to squeeze the trigger 65 7 0, permitting pressurized gas from the gas cylinder 6 2 2 (or external air source 6) 8) The air supply line 680 passes through the directional control valve 61 and flows into the air supply line 84. The pressurized gas flows from the first supply line 840 through the first supply port 8丨3 into the first gas = zone 8丨5, and flows into the third cylinder zone 10832 through the first opening m. The gas entering the third cylinder region 832 causes the second piston head mo and the stepped portion 35 of the piston rod 35 to move distally. After the second piston head 10 has moved to a fully extended position (Fig. 13), the gas continuing into the first cylinder region 815 biases the second housing 82 to its fully extended position. Once the cutter assembly 30 has advanced to its most distal position within the end effector 12, the clinician releases the activation trigger 67 to interrupt the application of pressurized gas. When the squatting mechanism or the tool assembly is 3 ,, the clinician moves the directional valve 15 selection switch 612 to the reverse (retracted) position, where the 〇 〇 is connected to one of the directional valves 61 排气mouth. The third gas red zone milk and the gas in the cylinder zone 815 are allowed to be discharged via the first gas supply line ,), and are discharged in the line 840 and finally through the directional valve 61. As the gas leaves the third cylinder region 832, the second retraction spring 852 retracts the piston rod h into the second cylinder housing 82_. Similarly, as the gas white body leaves the first cylinder region 815', the first cylinder casing 520 retracts the second cylinder casing 520 into the first cylinder casing 81. Also in this embodiment, a pressure gauge 541 can be fluidly coupled to the gas supply line 840 as shown in Figures 16 and i6A, which can be used as described above to provide the clinician with an end effector being subjected to 96422 33 200814963. A ^ ° shell of strength. In other embodiments, an audio outlet 545 can be as shown in FIG.
10 1510 15
20 用Γ用Γ在供讀路請中,該聲音出口可如前文所述作 ;5 -玖Γ向5品床醫師提供一用以監測傳動系、统500所經受 秩:二|機構所經受之擊發力的聲音回饋機構。在其他 例中’可將—限制開關546 (圖15 )提供在遠侧 ^ 内用以偵測一埋入擊發桿35内之啟動構件547 扣I二2和13),藉此自動地控制定向開關610且/或提供 #發機構已抵達擊發行程末端的視覺及/或聲音信號。 遍^7 ^ 2以例不本發明之更另—實施例,其中傳動構件 500包括—波紋管總成觸。波紋管總成辦可有—附接於 刀桿總成30之遠側部分31㈣端902。遠端902有一突 =部904形成於其上’該突出部經訂定大小用以收納在部 刀Η之^ Μ中。突出部904可為藉由摩擦力收納在孔 3内且/或藉由黏著劑、溶接或類似方式固持。遠侧 31可如前文所述建構。 波紋管總成900更包含一可擴張/縮回波紋管部分 910 ’此部分經訂定大小用以在如圖18所示之遠侧 -波紋管通道117内伸長及縮回。波紋管部分9ι〇可 20所示用金屬絲約束環912形成且附接於一基座部分° 914’該基座部分不可動地附接於遠側脊段11〇或包^ 土 脊段110之一體部分。基座914可藉由黏著劑、螺^相 似物附接於遠侧脊段110。一供氣埠916穿過波纟文其 914且-供氣線路940附接於供氣琿916。供氣線‘二上 96422 34 200814963 亦耦接於把手總成3〇〇中之定 ^ 21Α。疋向控制閥61〇亦透 α 把丰她赤3⑽士 士 具空線路922與一安裝在20 Use the Γ in the road for reading, the sound outlet can be as described above; 5 - 玖Γ provide a five-bed physician to monitor the drive train, the system 500 is subject to the rank: two | The sound feedback mechanism of the hitting force. In other examples, a limit switch 546 (Fig. 15) can be provided in the distal side to detect activating member 547 buckles I2 and 2) embedded in the firing bar 35, thereby automatically controlling the orientation. The switch 610 and/or provides a visual and/or acoustic signal that the #发机构 has reached the end of the firing stroke. In a further embodiment of the invention, wherein the transmission member 500 comprises a bellows assembly contact. The bellows assembly can be attached to the distal end portion 31 (four) end 902 of the arbor assembly 30. The distal end 902 has a protrusion 904 formed thereon. The projection is sized to be received in the knives. The projection 904 can be received within the aperture 3 by friction and/or held by an adhesive, agitation or the like. The distal side 31 can be constructed as previously described. The bellows assembly 900 further includes an expandable/retractable bellows portion 910' which is sized to elongate and retract within the distal-corrugated tube passage 117 as shown in FIG. The bellows portion 9 is formed with a wire confinement ring 912 and attached to a base portion 914' that is non-movably attached to the distal ridge segment 11 or the ridge segment 110 One body part. The pedestal 914 can be attached to the distal spine 110 by an adhesive, a screw. A gas supply 916 passes through the wave 914 and a gas supply line 940 is attached to the gas supply 916. The gas supply line ‘二上96422 34 200814963 is also coupled to the handlebar assembly 3〇〇. The 疋 控制 控制 控制 控制 控制 α α α α α α α α 丰 丰 丰 丰 赤 赤 赤 赤 922 922 922 922 922
St二真空埠920連通。真空㈣舉例來說 了精由一可撓線路632附接於—直办 為讯竑、人士 一工源630。该真空源可 為汉施中之一水久真空供應線路。 产檢οοη、去从一 可撓真空線路632可 仗埠920連接到真空源63〇以讓 器具。 表°°床酉師旎夠自由操縱該 ίο 15 20 此器具可具備前文所述閉合管總成ΐ7〇*閉合扳機η。 ^置n組織可依前文所述方式被夾緊在終端作用器 中。在組織6被夾緊於終端作用器12内後,臨床醫師 可如下所述擊發該器具。臨床醫師將用於定向控制閥_ 之選擇開關612(圖υ或按鈕移到前進(伸長)位置且開 始擠壓啟動扳機670。隨著啟動扳機_被擠壓,比例闕 660許可加壓氣體從壓力源62〇 (圖21)或618 (圖2ia) 机^疋向控制閥610。定向控制閥61〇許可加壓氣體通過 供氣線路940流入波紋管91〇導致該波紋管往遠側延伸。 隨著波紋管910往遠側延伸,其驅使刀具總成3〇通過終端 作用态12切斷終端作用器夹住的組織,且驅使釘匣%内 之肘釘70與砧40之底部表面發生成形接觸。在刀具總成 3〇已被帶動到其在終端作用器12中之最遠側位置後,臨 床醫師放開啟動扳機670。要縮回刀具總成3〇時,臨床醫 師將用於定向控制閥610之選擇開關612移到回縮位置藉 以許可真空源630耦接於供氣線路940。真空施加於供氣 線路940會導致波紋管910縮回圖18所示其回縮位置。在 96422 35 200814963 波紋管910已完全縮回後,臨床醫師可將選擇開關612或 按紐移到一使定向控制閥停止向供氣線路940施加真空的 位置。但供氣線路940内之殘餘真空可用來將波紋管910 保持在回縮位置。 5 在圖21所示實施例中,使用一可移除的加壓氣體源 ’ 620。如下文所將詳述,此加壓氣體源包括一可能是可再充 氣的貯氣瓶622。然熟習此技藝者會理解到亦可有效地運 ⑩用不可替換/可再充填加壓氣體或加壓流體源(貯氣瓶)。 在其他實施例中,把手總成300可具備一用於向一外界加 1〇壓氣體源供應加壓氣體的埠口 616。舉例來說,器具1〇可 透過一可撓供氣線路617耦接於設施之壓縮空氣線路。參 見圖21A。 15 20 同樣在此實施例中,一壓力計541可如圖21和2ia所 示流體耦合於供氣線路940,該壓力計可如前文所述發揮 作用且用來向臨床醫師提供終端作用器正在遭受之力^的 成比例讀數。在其他實施例中,一聲音出口 545可如圖 所示提供在供氣線路940中,該聲音出口可如前文所述作 用且用來向臨床醫師提供一用以監測傳動系統5〇〇所經為 及最終擊發機構所經受之擊發力的聲音回饋機構。在= 替㈣施例中,可將一限制開關546 (圖18)提供在遠侧 脊段U〇内用以偵測一波紋管總成900上之啟動構件912, (圖20),藉此自動地控制定向開關61〇且/或提供指 =構或刀具總成3〇已抵達擊發行程末端的視覺及/或聲 96422 36 200814963 圖22-27例示一使用前述實施例之 的無活節拋棄式終端作用器i 2。如圖2 3夕獨4寸新,質 可採用終端作用哭n s、, , α 23所不,此實施例 在本詳述之任何傳動構件。但 之獨軸桿總成可藉由—整體標示為雜 =寸新頭快拆式接頭可卸軸接於一近側轴桿總成St two vacuum 埠 920 connected. Vacuum (4) For example, the fine is attached to a flexible line 632 - directly to the information source, the person a source 630. The vacuum source can be one of the long-term vacuum supply lines in Hanshi. The inspection οοη, from a flexible vacuum line 632, can be connected to a vacuum source 63〇 to allow the appliance. The watcher is free to manipulate the ίο 15 20 This appliance can be equipped with the closed tube assembly ΐ7〇* closed trigger η as described above. The n-structure can be clamped in the end effector as described above. After the tissue 6 is clamped into the terminal effector 12, the clinician can fire the appliance as described below. The clinician will use the selector switch 612 for the directional control valve _ (the figure or button is moved to the forward (elongated) position and the squeezing start trigger 670 is started. As the start trigger _ is squeezed, the proportional 阙 660 permits the pressurized gas from The pressure source 62A (Fig. 21) or 618 (Fig. 2ia) is directed to the control valve 610. The directional control valve 61 allows the pressurized gas to flow into the bellows 91 through the supply line 940, causing the bellows to extend distally. As the bellows 910 extends distally, it drives the cutter assembly 3 to cut the tissue clamped by the end effector through the terminal action state 12, and drives the staples 70 in the nail % to form the bottom surface of the anvil 40. Contact. After the tool assembly 3 has been brought to its most distal position in the end effector 12, the clinician releases the start trigger 670. To retract the tool assembly 3, the clinician will use it for orientation. The selector switch 612 of the control valve 610 is moved to the retracted position to permit the vacuum source 630 to be coupled to the supply line 940. The application of vacuum to the supply line 940 causes the bellows 910 to retract to its retracted position as shown in Figure 18. 35 200814963 Bellows 910 has been fully retracted The clinician can move the selector switch 612 or button to a position that causes the directional control valve to stop applying vacuum to the supply line 940. However, residual vacuum within the supply line 940 can be used to maintain the bellows 910 in the retracted position. 5 In the embodiment shown in Figure 21, a removable source of pressurized gas '620 is used. As will be detailed below, the source of pressurized gas includes a gas cylinder 622 that may be refillable. The skilled artisan will appreciate that a non-replaceable/refillable pressurized gas or pressurized fluid source (a gas cylinder) can also be effectively utilized. In other embodiments, the handle assembly 300 can be provided with a A port 616 for supplying pressurized gas is externally applied to the source of the pressurized gas. For example, the device 1 can be coupled to the compressed air line of the facility through a flexible gas supply line 617. See Fig. 21A. 15 20 Also here In an embodiment, a pressure gauge 541 can be fluidly coupled to the gas supply line 940 as shown in Figures 21 and 2ia, which can function as described above and be used to provide the clinician with the force that the end effector is suffering. Proportional reading. In other implementations Wherein, a sound outlet 545 can be provided in the gas supply line 940 as shown, and the sound outlet can function as described above and be used to provide the clinician with a means for monitoring the drive system 5 and the final firing mechanism. A sound feedback mechanism that is subjected to the firing force. In the alternative embodiment, a limit switch 546 (Fig. 18) can be provided in the distal spine U〇 for detecting activation of a bellows assembly 900. Member 912, (Fig. 20), thereby automatically controlling the directional switch 61 and/or providing the visual and/or acoustical of the finger or tool assembly 3 〇 having reached the end of the firing stroke 96422 36 200814963 Figure 22-27 illustrates a The gangless disposable end effector i 2 of the previous embodiment is used. As shown in Fig. 2, the 4th inch is new, the quality can be used to end the crying n s,,, α 23, this embodiment is any of the transmission members in this detailed description. However, the single shaft assembly can be connected to a proximal shaft assembly by means of an integral marking as a miscellaneous = inch new quick-release joint.
15 :垃終端作用器12已被使用,終端作㈣12及盆 f 3 可將一連同自有遠侧軸桿總成1010 側_…心及下文述’遠 、 退側含& 1110及一遠側閉合管區 近侧軸杯總成1020包含一近側脊段1150、一近 側閉合管區段1190及一釋放㈣1200。 、15: The end effector 12 has been used, the terminal for (4) 12 and the basin f 3 can be combined with the own distal shaft assembly 1010 side _... heart and the following 'far, retracted side & 1110 and one far away The side closure tube region proximal shaft cup assembly 1020 includes a proximal ridge segment 1150, a proximal closure tube segment 1190, and a release (four) 1200. ,
遠側脊段1110與近側脊段115〇合作形成一脊總成 030。在此實施例中,遠侧脊段niG可與前文所述遠侧脊 又1大致相同,差別在於各自的近端不同。同樣的,近 側脊^ 1150可與前文所述近側脊段13〇大致相㈤,差別在 於其遠端不同以讓遠侧脊段Π10和近侧脊段1150能夠非 樞轉地麵合在。又,在此實施例中,遠侧閉合管區段 1180可與蝻文所述遠侧閉合管區段180大致相同,差別在 於其近端不同。同樣的,近侧閉合管區段1190可與前文所 4^側閉合官區段19G大致相同,差別在於其遠端不同以 讓遠侧閉合管區段118〇和近側閉合管區段119〇非樞轉地 96422 37 5 10 15 20 200814963 彼此附接。 如圖23所不,一鎖簣112安褒在遠倒脊段nJ〇内當作 活基桿35之閉鎖器件。遠側和近側方形孔⑴ji⑴形 成於遠側脊段111G之頂上以於其間界定—接收鎖菩ιΐ2 = 的夾桿1115,該㈣之往遠側延伸的下臂ιΐ8 =所述在氣缸總成之-遠端上施加—向下力。應理解到 各貝鈿例可包含其他類型之閉鎖器件或完全沒有閉鎖器 件。 ' 通側脊& 1110之近端1114有_遠側連接器部分⑴6 形成於其上。參見圖24和27。如 ^ 邺八不z/如圖24所不,遠侧連接器 σ刀 八有一耦接於第一供氣線路區段54〇,的第一 侧供氣痒ιιπ。-第二遠側供氣埠112〇提供於遠側連接 盗部分1116中且搞接於一第二供氣線路區段%,。如圖 23所了,第:供氣線路區段54(^接於第―氣虹殼體训 中之弟-供4埠513且第二供氣線路區段542, 一 殼體51〇遠端中之第二供氣埠529。一第一供氣噴嘴^分 lm如圖所不從第-遠側供氣埠1117依近侧方向突出。 一第二供氣噴嘴部分1122從第二供氣琿112G依近側方向 往外突出。 乃问 相似地’近側脊段115〇之遠端1152具有一第二連 部分1154 ’該第二連接11部分有-㈣於另-第-供氣i 路區段置的第-近侧供氣埠1156。第二連接器部分= 更在其中冑耦接於另一第二供氣線路區段542”二 近侧供氣琿1160。第一近側供氣埠心經建構用以在其 96422 38 200814963 =移除地接收第—供氣噴嘴1118 (圖27),且第二近側 仏乳槔1160經訂定大小用以在其内可移除地接收 ,噴嘴⑽。如圖24*27所示,一第一 〇環封⑽與 弟-㈣供氣埠1156結合以在第—喷嘴ιιΐ8插入第一近 侧i、氣埠1156内時在第—供氣線路區段54〇,i另 一 ίο 15 20 ,氣線路區段540”之間形成一大致㈣(或液密)密封。 虽依该方式耦接在-起時,第—供氣線路區段54〇,和別” ϊί形^第-供氣線路•同樣的,-第二〇環封1162 ::弟一近側供氣埠1160結合以在第二供氣噴嘴U22插入 =::近侧供氣埠譲㈣在第二供氣線路區段542,盎另 二^供氣線路區段542,,之間形成另一大致氣密(或液 〇, ^ 解^/2形成—第二供氣線路542。熟習此技藝者會理 = 可卸式搞合配置、快拆配置使第-供氣線 與另一第一供氣線路區段540”可移除地連接 及^氣練路區段542’與另一第二供氣:區:接 可移除地連接而殘離本發明之精神及範圍。 m接器部分1116及近侧連接器部分出4可經 =付錢可以-種取向祕在—起。舉例來說,如圖 彳連接器部分1116可具備—料與近側連接 刀1154之一凹口部分1155配合的另一凹 ^口^喷人㈣:接合於一^ 貝 接口於第一近側供氣埠1160。此種獨特 新顆的附著配置防止第一喷嘴⑽意外附接於第二種= 96422 39 200814963 供耽埠1160及第二喷嘴1122意外附接於第一近側供氣璋 1156可利用其他鍵類組態確保遠側連接器部分1116與近 侧連接器部分1154以正確取向耦接。 亦如圖24和27所示,近側脊段1150之遠端1152具有 5 —往遠側突出的中空套筒部分117〇。此中空套筒部分ιΐ7〇 、經訂^大小用以在其内接收遠侧脊段111〇之近端1114。 為將遠側脊段1110可釋地鎖定於近侧脊段115〇,一對相 ⑩=的掣止構件1124形成於遠側脊段111〇之近端1114上。 掣止1124被定位在經切割或其他方式形成於遠侧脊段 10 1110中之可撓舌片1126上,致使當遠侧脊段111〇之近端 1114插入近侧脊段115〇之中空套筒部分117〇且第一喷嘴 1J18與第一近側供氣埠1156密封耦合且第二噴嘴1122與 第二近侧供氣埠1160密封耦合時,掣止構件1124被收納 在中空套筒部分1170之對應開口 1172内。參見圖24和 15 27。 肇以下I照圖24-27說明遠侧閉合管區段〗〗8〇對近侧閉 合管區段1190之可釋附著。如這些圖式所示,遠侧閉合管 區段1180之近端1182有至少二個插接型鎖定舌片1184 自其以一近侧方向突出。每一鎖定舌片1184有一錐狀鎖定 2〇楔1186形成於其上,該楔經訂定大小用以收納於近側閉合 管區段1190之對應鎖定開口 1194中。當處於圖26和27 所示位置時,遠侧脊段111〇被鎖定至近侧脊段ιΐ5〇以形 成脊總成1030,且遠侧閉合管區段118〇被鎖定至近側閉 S苢區#又1190以形成閉合管總成n78。此配置許可閉合 96422 200814963 管總成1178在脊總成1030上依前文所述各種方式往近側 及往遠侧移動以開啟及關閉終端作用器12上之砧4〇。 ίο 15 20 要將遠側軸桿總成1010附接於近側轴桿總成1〇2〇時, 使用者如圖24所示將遠側軸桿總成1〇1〇之近端1〇12對準 近側轴柃總成1020之遠端1〇22然後將遠端1〇12插入近端 1022内。當掣止1124被收納到鎖定開口 1172内且鎖定模 1186被收納到開口 1194内時,遠側軸桿總成1〇1〇被鎖定 至近侧轴桿總成1020。石占40可因依前文所述方式抓住閉 合扳機310將該閉合扳機樞轉至把手總成3〇〇之握把部分 342致使閉合官總成1178往遠側移動而被關閉。刀桿% 可因依珂文所述方式作動啟動扳機67〇而被帶動。 為使遠側軸桿總成ΗΠ0易於卸離近侧轴桿總成_, 多個實施例採用-釋放套筒配置。在這些實施例中,一釋 放套筒區段12GG可滑動地套在近側脊段U5G上介於近側 脊段1150與近側閉合管區段119〇之_。在各實施例中, 釋放套筒1200之近端可具備一釋放紐職,該释放紐穿 過近侧閉合管區段119〇之近端1195中之―對應槽孔 參見圖22和3卜此配置許可釋放套筒‘在近侧 二段115G上軸向地往遠織近侧㈣⑽妨礙近侧閉合 管區段1190在脊總成1〇3〇上的軸向行進。 如圖27最明顯示出’釋放套筒12〇〇之遠端㈣往内 斜切且經定向致使其鄰近近·合管區段咖中之 ,合管鎖定開π 1194。要使遠側軸桿總成 轴桿總成時,制者使釋放㈣槽孔1196内往^ 96422 41 200814963 移動藉以使釋放套筒1200往遠侧移動。隨著釋放套筒i2〇〇 之斜切遠端U04接觸到鎖定楔1186,鎖定楔1186往内 動脫離其與近侧閉合管區段119G中之較開口 ιΐ94的接 5 10 15 20 ^釋放套筒1200依遠侧方向的更進—步移動會導致釋放 、,筒1200之一第二斜切内緣12〇6接觸到鎖定掣止^4 亚使該等鎖定掣止往内偏動脫離其與近侧脊段ιΐ5〇中之 ^ 1172的接合,從而讓遠側軸桿總成1010能夠卸離近 侧脊總成1020。 圖22-28所不實施例可有效地搭配前文所述氣缸總成 # 1使用。圖29和30所示實施例可有效地搭配前文所述 =缸總成800或波紋管總成9〇〇使用。如圖”和3〇所示, ,侧連接器部分1116僅有一琿口丨形成於其中叙接至 1線路區段940’。一第一供氣喷嘴13〇2如圖所示從第 -通側供氣埠1300以近侧方向突出。同樣的,連接器部分 #154僅有-輕接於另—第—供氣線路區段州,’的近侧供 虱埠1306。近侧供氣埠13〇6經建構用以在其内可移除地 收納第-供氣噴嘴1302。如圖29和3〇所示一 〇環封 ⑽8與近側供氣埠_結合以在供氣噴嘴13〇2插入近側 ,氣埠1306内時在第一供氣線路區段94〇,與另一第一供 氣,路區#又940之間形成一大致氣密(或液密)密封。當 二方式麵接在一起時,第一供氣線路區段94〇,和94〇” 接。形成第供氣線路940。然後供氣線路940可依前 文所述方向向氣缸總成800或波紋管總成900供給加壓氣 唇& 0 96422 42 200814963 圖32例示一替代可活節運動的外科切割及釘合器具 2000,其有一可搭配前文所述終端作用器12及閉合管總成 170使用的氣動活節接頭總成2002。此實施例亦可使用前 文所述氣缸總成501。如圖33-35所示,接頭總成2002包 、含一脊總成2004,該脊總成包括一遠侧脊段2010,有一樞 . 軸構件2014從該遠侧脊段之近端2012突出。樞軸構件 2014有一驅動器片2016自其突出。如圖35所示,氣缸總 _ 成501在耳軸519上可樞轉地安裝於遠側脊段2010内。 柩軸構件2014被可樞轉地收納在一形成於近侧脊段 10 2030遠端2032上的樞軸承窩2034内。樞軸構件2014能 自由地以樞軸線E-E為中心相對於近侧脊構件2030樞 轉。參見圖36。如圖35所示,近側脊段2030之遠端2032 有一溝2036形成於其中用以容納第一供氣線路540之一部 分。相似地,一第二溝2038提供在近侧脊段2030之遠端 15 2032中用以容納第二供氣線路542。供氣線路540、542 _ 繞過樞軸承窩2034進入遠侧脊段2010之近端2012,其中 其以前文所述各種方式附接於氣缸總成501。熟習此技藝 者會理解到可在中空近侧脊段2030内提供供氣線路540 和542之足夠鬆弛量以讓遠側脊段2010能夠相對於近侧脊 20 段2030以樞軸線E-E為中心自由樞轉。藉由使供氣線路 540、542分別支承於溝2036、2038中,這些供氣線路不 會干擾到閉合管總成170相對於脊總成2004之軸向移動。 亦如圖35所示,一第一鉛直供氣通道2040經提供與柩 軸承窩2034連通。相似地,一第二鉛直供氣通道2050亦 96422 43 200814963 如圖35所示經提供與枢軸承窩2034連通。一從安裝在把 手總成300内之一開關總成21〇〇伸出的第三供氣線路 2042與第錯直供氣通道2040連通,且一從開關總成21⑼ 伸出的第四供氣線路2052與第二鉛直通道2〇5〇連通。要 5組裝接頭總成2002時,將樞軸構件2014插入柩軸承窩 2034内且將一蓋2060如圖所示用螺釘2〇62或其他適當繫 結件附接於近侧脊段2030。因此,從第三供氣線路2二2、 ⑩進入第一鉛直供氣通道2040的加壓氣體會導致遠側脊段 2010以樞軸線E_E為中心依、、方向樞轉,且從第四供 10氣線路2052進入第二鉛直供氣槔2〇5〇的加壓氣體會導致 遠侧脊段2010相對於近侧脊段2〇3〇以枢軸線E_E為中心 依、、G〃方向樞轉。參見圖34。 麥照圖37-45,以下說明各實施例之開關總成21〇〇的 構造和操作。在各非限制性實施例中,開關總成2100包括 15 一内有一供氣埠2112的開關塊2110。供氣埠2112耦接於 ⑩一供氣線路051用以從加壓氣體源62〇(圖44)或618 (圖 45)接收加壓氣體。特定言之,一供氣線路651可從供氣 線路650延伸至埠口 2112。一開關腔2114提供於開關塊 2110中且經訂定大小用以在其内可樞轉地接收一選擇器 20構件總成2130之一主體部分215〇。一樞軸桿2151突出主 體部分2150之底部外被可樞轉地安裝在開關塊211〇之樞 軸孔2111中。參見圖39。此配置許可選擇器構件總成213〇 以開關軸線H-H為中心選擇性地轉動。參見圖38。一對〇 壞封2152、2154或其他適當密封構件可如圖38和39所示 96422 44 200814963 5 提供藉以在選擇器構件總成213〇之主體部分⑽與開關 塊2110之間建立一大致氣密密封。一短桿2156從主體部 分2150突出以接收一選擇器把手2158。選擇器把手⑴$ 之旋轉導致主體部分2150在開關腔2114内轉動。如圖39 所不,供氣埠2112與開關塊211〇之一供氣通道2116連 通,该供氣通道與一亦形成於開關塊211〇中之管 2118連通。 一祁啦 _ 選擇器構件總成2130之主體部分2150有一與管集箱區 2118連通的穿透中央供氣埠2160。-第三供氣通道2〇45 1〇提供於開關塊2110中。參見圖40。第三供氣通道2〇45在 開關腔2114與一第三供氣埠2〇44之間延伸,第三供氣線 路204曰2附接於該第三供氣埠。同樣的,一第四供氣通道 2055提供於開關塊211〇中且在開關腔2114與一第四供氣 埠2054之間延伸,第四供氣線路2〇52附接於該第四供1 15埠。當選擇器構件總成213〇如圖4〇所示定位,經由供氣 _埠2112進入開關塊211〇到供氣通道2116内的加壓氣體進 入官集箱區2118内且可能流入中央供氣通道216〇内。但 加壓氣體會被擋在中央供氣通道216〇之末端。因此,開關 在圖4 〇中係處於、、關”位置。 20 要使遠侧脊段2010往右樞轉(相反於圖34所示位置) 時,將選擇器構件總成2130枢轉至圖41所示位置。如該 圖所示,經由供氣埠2112進入開關塊2110通過供氣通道 2116並進入管集箱區2118内的加壓氣體透過中央供氣埠 2160轉移到第三供氣通道2〇45内及第三供氣線路2⑽2 96422 45 ,200814963 内然後加Μ氣體流入第一錯直供氣通道2040内並接觸樞 軸構件2014上之驅動器片2〇16以迫使樞軸構件2〇14依 10 15 20 方向移動。驅動器片2〇16相對侧上之加壓氣體進入 第一錯直通道2050並流入第四供氣線路2〇52内。隨著加 壓氣體進入開關塊211G中之第四埠口 2054,其流入第四 供氣通道2055並流入主體部分215〇中之一第四排氣通道 = 7^0。第四排氣通道217〇與選擇器構件總成213〇之主體 戸刀215〇中之一底切排氣區2155連通。參見圖43。因此, 第四供氣線路2052内的加壓氣體經由第四排氣通道217q 排放且經由底切排氣區2155排出開關外。 要將运側脊^又201 〇樞轉至圖34所示位置時,臨床醫師 轉動選擇器構件總成213G致使中央供氣通道216()此時在 官,箱區2118與第四供氣通道2〇55之間延伸。因此,從 供乳線路651流入供氣通道2116並流入管集箱區2ιΐ8内 的加壓氣體會通過中央供氣通道216〇流入第四供氣通道 :内。ί壓氣體流出第四供氣埠2054到第四供氣線路 内。第四供氣線路2052將加壓氣體轉移至第二妒 =氣通道2050内。隨著加壓氣體進人第二錯直供氣^道 ^巨,驅動器片2〇16使樞軸構件2〇14依、、y方向樞 =圖驅動器片鳩相對側上的氣體氣體通過第— ° (、氣通迢2040流入第三供氣線路2042内。氣體離 第三供氣線路2G42進人第观由,離開 禾—仏乳通運2045内並流入提供 ;—崢分2150中之一第三排氣通道218〇。第三排 這2180經定向使氣體經由底切排氣區川5排出。才、k 96422 46 200814963 本發明之另一獨特新穎特徵係一自動中立特徵配置,此 配置讓臨床醫師能夠簡單地藉由放開選擇器開關把手 2158而將遠侧脊段2〇1〇(及終端作用器12)鎖定在一期 .望活節運動位置。更特定言之,一如圖所示建構之回動菩 5 2190如圖40、41及43所示安褒在開關塊211〇中。為使 .彈簧219〇固持在開關塊2110内,一對相對的圓突部 2192 2194攸開關塊2110之底部表面2113突出。彈簧2190 • ^別被固持在圓突部Μ%、^94之槽孔Μ%、Μ%内。 筝見圖43。如圖43所示,一回行桿2153從選擇器構件總 10成2130之主體部分2150突出。回行桿2153收納在回動菩 2190之自由端2196、2198之間。圖43例示處於中立或關 閉位置的主體部分2150。 因此,當臨床醫師想要使終端作用器12進行活節運動 時,他或她轉動選擇器把手2158使選擇器構件總成213〇 15之主體部分2150依對應於期望活節運動之旋轉方向移 春動。當臨床醫師轉動主體部分215〇時,其係抵抗回動箬 2190之自由端2196、2198其中一者產生之力轉動。一旦 臨床醫師已將終端作用器12轉到期望位置,他或她放開選 擇器把手2158且回動簧219〇將主體部分215〇移到關閉位 置,此使終端作用器12保持在該位置。若臨床醫師想要調 整終端作用器U之活節運動位置,他或她只要依期望方向 轉動選擇器把手2158以獲得期望位置然後放開把手2158 就能使終端作用器12保持在該位置。 圖44例示用於本發明各非限制性實施例搭配開關2100 96422 47 200814963 5The distal spine segment 1110 cooperates with the proximal spine segment 115 to form a ridge assembly 030. In this embodiment, the distal ridge segment niG can be substantially identical to the distal ridge 1 described above, with the difference that the respective proximal ends are different. Similarly, the proximal ridge 1150 can be substantially identical to the proximal ridge 13 前 previously described, with the difference that the distal ends are different to allow the distal ridge 10 and the proximal ridge 1150 to be non-pivoted. . Again, in this embodiment, the distal closure tube segment 1180 can be substantially identical to the distal closure tube segment 180 described herein, with the difference being different at its proximal end. Similarly, the proximal closure tube segment 1190 can be substantially identical to the previously described proximal closure segment 19G, with the difference that the distal ends are different to allow the distal closure tube segment 118 and the proximal closure tube segment 119 to be non-pivoting. Ground 96422 37 5 10 15 20 200814963 Attached to each other. As shown in Fig. 23, a lock amp 112 is used as a latching means for the living base 35 in the distal ridge section nJ. The distal and proximal square holes (1) ji (1) are formed on top of the distal ridge segment 111G to define therebetween - a clamping rod 1115 for receiving the lock , ΐ = 2 =, and the lower arm ι ΐ 8 extending to the distal side of the (4) = the cylinder assembly - Apply on the distal end - downward force. It should be understood that each case may include other types of latching devices or no latching devices at all. The proximal end 1114 of the 'passing side ridge & 1110 has a distal connector portion (1) 6 formed thereon. See Figures 24 and 27. For example, as shown in Fig. 24, the distal connector σ knife 八 has a first side supply air itch ιιπ. - A second distal air supply port 112 is provided in the distal connection portion 1116 and is coupled to a second air supply line segment %. As shown in Fig. 23, the first: the gas supply line section 54 (^ is connected to the younger brother of the first gas-chasing shell - for the fourth gas supply line section 542, the second gas supply line section 542, a distal end of the casing 51 The second air supply port 529. The first air supply nozzle is not protruded from the first-distal air supply port 1117 in the near side direction. A second air supply nozzle portion 1122 is supplied from the second air supply.珲112G protrudes outward in the proximal direction. Similarly, the distal end 1152 of the proximal ridge segment 115 has a second connecting portion 1154. The second connecting portion 11 has - (d) the other-first-supply air path The first proximal side air supply port 1156 is disposed. The second connector portion = more in the middle of the other second air supply line portion 542" two proximal air supply ports 1160. The first proximal side is provided The pneumatic heart is configured to receive the first air supply nozzle 1118 (Fig. 27) at its 96422 38 200814963 = removal, and the second proximal sputum 1160 is sized to be removably received therein a nozzle (10). As shown in Fig. 24*27, a first loop seal (10) is combined with a disc-aid air supply flap 1156 to be inserted in the first proximal side i, the air pocket 1156 when the first nozzle ιι 8 is inserted. Gas line area 54〇, i another ίο 15 20 , forming a substantially (four) (or liquid-tight) seal between the gas line segments 540". Although coupled in this manner, the first gas supply line section 54 is And other" ϊ 形 ^ ^ - gas supply line • the same, - second 〇 ring seal 1162 :: brother a proximal air supply 埠 1160 combined to insert in the second air supply nozzle U22 =:: proximal air supply 埠譲 (d) Forming another substantially airtight (or liquid helium, ^ solution ^ 2 formation - second gas supply line 542) between the second gas supply line section 542 and the second gas supply line section 542. Skilled by the skilled person = detachable configuration, quick release configuration to removably connect the first supply line to another first supply line section 540" and to the air section 542' Removably connected to another second air supply: zone: the spirit and scope of the present invention is removed. The m connector portion 1116 and the proximal connector portion 4 can be paid by For example, the connector portion 1116 can be provided with another recess that cooperates with the notch portion 1155 of the proximal connecting blade 1154. a proximal air supply port 1160. This unique new attachment configuration prevents the first nozzle (10) from accidentally attaching to the second type = 96422 39 200814963 for the port 1160 and the second nozzle 1122 for accidental attachment to the first proximal side. The balloon 1156 can utilize other key configuration to ensure that the distal connector portion 1116 and the proximal connector portion 1154 are coupled in the correct orientation. As also shown in Figures 24 and 27, the distal end 1152 of the proximal spine 1150 has 5 - a hollow sleeve portion 117 that protrudes distally. The hollow sleeve portion is sized to receive the proximal end 1114 of the distal spine 111〇 therein. To releasably lock the distal spine segment 1110 to the proximal spine segment 115, a pair of phase 10= stop members 1124 are formed on the proximal end 1114 of the distal spine segment 111〇. The stop 1124 is positioned on the flexible tab 1126 that is cut or otherwise formed in the distal spine 10 1110 such that when the proximal end 1114 of the distal spine 111 turns into the hollow sleeve of the proximal spine 115 When the barrel portion 117 〇 and the first nozzle 1J18 is sealingly coupled with the first proximal air supply port 1156 and the second nozzle 1122 is sealingly coupled with the second proximal air supply port 1160, the blocking member 1124 is received in the hollow sleeve portion 1170 Corresponding to the opening 1172. See Figures 24 and 15 27. The following is a description of the releasable attachment of the distal closure tube segment 1190 to the proximal closure tube segment 1190 as shown in Figures 24-27. As shown in these figures, the proximal end 1182 of the distal closure tube section 1180 has at least two plug-type locking tabs 1184 projecting therefrom in a proximal direction. Each of the locking tabs 1184 has a tapered locking member 2 formed thereon, the wedge being sized to receive in a corresponding locking opening 1194 of the proximal closure tube section 1190. When in the position shown in Figures 26 and 27, the distal spine 111〇 is locked to the proximal spine ΐ5ΐ to form the spine assembly 1030, and the distal closed tubular section 118〇 is locked to the proximal closed S苢 zone# again 1190 to form a closed tube assembly n78. This configuration permits closure 96422 200814963 The tube assembly 1178 is moved proximally and distally on the ridge assembly 1030 in various manners as previously described to open and close the anvil 4 on the end effector 12. Ίο 15 20 To attach the distal shaft assembly 1010 to the proximal shaft assembly 1〇2〇, the user has the proximal shaft assembly 1〇1〇 proximal 1〇 as shown in Figure 24. 12 is aligned with the distal end 1〇22 of the proximal axial hub assembly 1020 and then the distal end 1〇12 is inserted into the proximal end 1022. When the stop 1124 is received into the locking opening 1172 and the locking die 1186 is received within the opening 1194, the distal shaft assembly 1〇1〇 is locked to the proximal shaft assembly 1020. The rocker 40 can be closed by pivoting the closure trigger 310 to the grip portion 342 of the handle assembly 3 by causing the closure assembly 1178 to move distally as described above. The shank % can be driven by actuating the trigger 67 珂 as described in the text. To facilitate easy removal of the distal shaft assembly ΗΠ0 from the proximal shaft assembly _, various embodiments employ a -release sleeve configuration. In these embodiments, a release sleeve section 12GG is slidably fitted over the proximal ridge segment U5G between the proximal ridge segment 1150 and the proximal closure tube segment 119. In various embodiments, the proximal end of the release sleeve 1200 can be provided with a release button that passes through the corresponding slot in the proximal end 1195 of the proximal closure tube section 119. See Figures 22 and 3 for this configuration. The permissible release sleeve 'axially abuts the proximal (4) (10) axially on the proximal two segments 115G obstructing axial travel of the proximal closure tube segment 1190 on the ridge assembly 1〇3〇. As best shown in Fig. 27, the distal end (four) of the release sleeve 12 is chamfered inwardly and oriented such that it is adjacent to the adjacent tube section, and the tube is locked open π 1194. To enable the distal shaft assembly shaft assembly, the maker moves the release (four) slot 1196 toward the ^ 96422 41 200814963 to move the release sleeve 1200 distally. As the beveled distal end U04 of the release sleeve i2 contacts the locking wedge 1186, the locking wedge 1186 is moved inwardly away from the opening 10 of the proximal closure tube section 119G. The further advancement of the 1200 in the distal direction causes the release, and the second beveled inner edge 12〇6 of the barrel 1200 contacts the locking stop 44 so that the locks are biased inwardly away from the The engagement of the 1172 in the proximal ridge ΐ5〇 allows the distal shaft assembly 1010 to be disengaged from the proximal ridge assembly 1020. The non-embodiments of Figures 22-28 can be effectively used with the cylinder assembly #1 described above. The embodiment shown in Figures 29 and 30 can be used effectively with the previously described = cylinder assembly 800 or bellows assembly 9". As shown in FIGS. 3 and 3, the side connector portion 1116 has only one port formed therein to be connected to the 1 line segment 940'. A first air supply nozzle 13〇2 is shown from the first pass. The side air supply port 1300 protrudes in the proximal direction. Similarly, the connector portion #154 is only - lightly connected to the other - the first gas supply line segment state, 'the proximal side supply port 1306. The proximal air supply port 13 The crucible 6 is configured to removably receive the first air supply nozzle 1302 therein. As shown in Figures 29 and 3, a loop seal (10) 8 is combined with the proximal air supply port _ to the air supply nozzle 13 〇 2 Inserted proximally, within the first gas supply line section 94, within the gas cylinder 1306, forms a substantially airtight (or liquid-tight) seal with the other first gas supply, the road zone # 940. When the faces are joined together, the first gas supply line section 94 is connected to the 94". A first gas supply line 940 is formed. The gas supply line 940 can then supply the pressurized air lip to the cylinder assembly 800 or the bellows assembly 900 in the direction described above. 0 96422 42 200814963 FIG. 32 illustrates an alternative cutting movable surgical cutting and stapling instrument 2000 There is a pneumatic joint assembly 2002 that can be used with the end effector 12 and the closure tube assembly 170 described above. This embodiment can also use the cylinder assembly 501 described above. As shown in Figures 33-35, the joint assembly 2002 includes a ridge assembly 2004 that includes a distal spine section 2010 having a pivot. The shaft member 2014 protrudes from the proximal end 2012 of the distal spine. . The pivot member 2014 has a driver piece 2016 protruding therefrom. As shown in Figure 35, the cylinder 501 is pivotally mounted on the trunnion 519 within the distal spine section 2010. The reel member 2014 is pivotally received within a pivot bearing pocket 2034 formed on the distal end 2032 of the proximal spine 10 2030. The pivot member 2014 is free to pivot relative to the proximal ridge member 2030 about the pivot axis E-E. See Figure 36. As shown in Figure 35, the distal end 2032 of the proximal spine 2030 has a groove 2036 formed therein for receiving a portion of the first gas supply line 540. Similarly, a second groove 2038 is provided in the distal end 15 2032 of the proximal spine 2030 for receiving the second gas supply line 542. The gas supply lines 540, 542 _ bypass the pivot bearing pocket 2034 into the proximal end 2012 of the distal spine section 2010, wherein it is attached to the cylinder assembly 501 in various manners as previously described. Those skilled in the art will appreciate that a sufficient amount of relaxation of the supply lines 540 and 542 can be provided within the hollow proximal ridge 2030 to allow the distal ridge segment 2010 to be centered about the pivot axis EE relative to the proximal ridge 20 segment 2030. Pivot. By supporting the supply lines 540, 542 in the grooves 2036, 2038, respectively, these supply lines do not interfere with the axial movement of the closure tube assembly 170 relative to the ridge assembly 2004. As also shown in Figure 35, a first vertical supply air passage 2040 is provided in communication with the 轴承 bearing pocket 2034. Similarly, a second vertical air supply passage 2050 is also provided in communication with the pivot bearing pocket 2034 as shown in FIG. A third air supply line 2042 extending from a switch assembly 21 of the handle assembly 300 communicates with the wrong air supply passage 2040, and a fourth air supply extending from the switch assembly 21 (9) The line 2052 is in communication with the second vertical channel 2〇5〇. To assemble the joint assembly 2002, the pivot member 2014 is inserted into the shank housing 2034 and a cover 2060 is attached to the proximal ridge 2030 with screws 2 〇 62 or other suitable tying members as shown. Therefore, the pressurized gas entering the first vertical supply passage 2040 from the third gas supply line 2 2, 10 causes the distal ridge segment 2010 to pivot in the direction of the pivot axis E_E, and from the fourth supply The pressurized gas of the 10 gas line 2052 entering the second vertical gas supply 槔2〇5〇 causes the distal ridge segment 2010 to pivot with respect to the proximal ridge segment 2〇3〇 with the pivot axis E_E as the center and in the G〃 direction. . See Figure 34. Referring to Figures 37-45, the construction and operation of the switch assembly 21A of each embodiment will be described below. In various non-limiting embodiments, switch assembly 2100 includes a switch block 2110 having a supply port 2112 therein. The gas supply port 2112 is coupled to the gas supply line 051 for receiving pressurized gas from the pressurized gas source 62 (Fig. 44) or 618 (Fig. 45). In particular, a gas supply line 651 can extend from the gas supply line 650 to the cornice 2112. A switch cavity 2114 is provided in the switch block 2110 and is sized to pivotally receive a body portion 215A of a selector member assembly 2130 therein. A pivot rod 2151 protrudes from the bottom of the main body portion 2150 and is pivotally mounted in the pivot hole 2111 of the switch block 211''. See Figure 39. This configuration permit selector member assembly 213 is selectively rotated about the switch axis H-H. See Figure 38. A pair of tamper seals 2152, 2154 or other suitable sealing members may be provided as shown in Figures 38 and 39, 96422 44 200814963 5 to provide a substantially airtight relationship between the body portion (10) of the selector member assembly 213 and the switch block 2110. seal. A short rod 2156 projects from the body portion 2150 to receive a selector handle 2158. Rotation of the selector handle (1) $ causes the body portion 2150 to rotate within the switch cavity 2114. As shown in Fig. 39, the air supply port 2112 is connected to one of the air supply passages 2116 of the switch block 211, and the air supply passage communicates with a tube 2118 which is also formed in the switch block 211A. The main body portion 2150 of the selector member assembly 2130 has a penetrating central air supply port 2160 that communicates with the header region 2118. The third air supply passage 2〇45 1〇 is provided in the switch block 2110. See Figure 40. The third air supply passage 2〇45 extends between the switching chamber 2114 and a third air supply port 2〇44, and the third air supply line 204曰2 is attached to the third air supply port. Similarly, a fourth air supply passage 2055 is provided in the switch block 211A and extends between the switch chamber 2114 and a fourth air supply port 2054, and the fourth air supply line 2〇52 is attached to the fourth supply unit 1 15埠. When the selector member assembly 213 is positioned as shown in FIG. 4A, the pressurized gas entering the switch block 211 via the air supply_2112 into the air supply passage 2116 enters the official tank area 2118 and may flow into the central air supply. Channel 216〇. However, the pressurized gas will be blocked at the end of the central air supply passage 216. Thus, the switch is in the "off" position in Figure 4. 20 To pivot the distal spine section 2010 to the right (as opposed to the position shown in Figure 34), pivot the selector member assembly 2130 to the map. 41. As shown in the figure, the pressurized gas that enters the switch block 2110 through the air supply passage 2116 through the air supply passage 2112 and enters the header box region 2118 is transferred to the third air supply passage through the central air supply port 2160. Within 2〇45 and the third gas supply line 2(10)2 96422 45 , 200814963 then the helium gas flows into the first staggered gas supply passage 2040 and contacts the driver piece 2〇16 on the pivot member 2014 to force the pivot member 2〇 14 moves in the direction of 10 15 20. The pressurized gas on the opposite side of the driver chip 2〇16 enters the first staggered passage 2050 and flows into the fourth gas supply line 2〇52. As the pressurized gas enters the switch block 211G The fourth port 2054 flows into the fourth gas supply passage 2055 and flows into one of the main portion 215, the fourth exhaust passage = 7^0. The fourth exhaust passage 217 is connected to the main body of the selector member assembly 213 One of the shovel 215 turns into an undercut venting zone 2155. See Figure 43. Therefore, The pressurized gas in the four gas supply line 2052 is discharged through the fourth exhaust passage 217q and is discharged outside the switch via the undercut exhaust region 2155. To pivot the transport side ridge to the position shown in Fig. 34, the clinical The physician rotates the selector member assembly 213G such that the central air supply passage 216 () extends between the official, tank region 2118 and the fourth air supply passage 2〇55. Therefore, the water supply passage 651 flows into the air supply passage 2116 and The pressurized gas flowing into the header tank region 2 ι 8 flows into the fourth gas supply passage through the central air supply passage 216. The pressure gas flows out of the fourth air supply port 2054 to the fourth gas supply line. Line 2052 transfers the pressurized gas to the second 妒 = gas passage 2050. As the pressurized gas enters the second misdirected supply, the driver plate 2 〇 16 causes the pivot member 2 〇 14 to The y-direction pivot = the gas gas on the opposite side of the drive plate passes through the first - ° (the gas passage 2040 flows into the third gas supply line 2042. The gas enters the third supply line 2G42 from the first view, leaving the Wo - The milk is transported within 2045 and flows into the supply; - one of the second exhaust passages 218 of the 2150 is divided into two. This 2180 is oriented to vent gas through the undercut venting zone 5. K 96422 46 200814963 Another unique novel feature of the present invention is an automatic neutral feature configuration that allows the clinician to simply select by releasing The switch handle 2158 locks the distal ridge segment 2〇1〇 (and the end effector 12) in a phase. It is intended to move the position of the joint. More specifically, a recursive Bo 2 5190 constructed as shown in the figure The ampules shown in Figures 40, 41 and 43 are in the switch block 211A. In order to hold the spring 219 〇 in the switch block 2110, a pair of opposing knobs 2192 2194 底部 the bottom surface 2113 of the switch block 2110 protrude. The spring 2190 • is not held in the slots Μ%, 94% of the knobs Μ%, ^94. The kite is shown in Figure 43. As shown in Fig. 43, a return lever 2153 protrudes from the main body portion 2150 of the selector member 10 to 2130. The return lever 2153 is received between the free ends 2196, 2198 of the returning boar 2190. Figure 43 illustrates the body portion 2150 in a neutral or closed position. Thus, when the clinician wants to cause the end effector 12 to perform a joint motion, he or she rotates the selector knob 2158 to cause the body portion 2150 of the selector member assembly 213〇15 to move in a rotational direction corresponding to the desired joint motion. Spring is moving. When the clinician rotates the body portion 215, it is rotated against the force generated by one of the free ends 2196, 2198 of the return 箬 2190. Once the clinician has turned the end effector 12 to the desired position, he or she releases the selector handle 2158 and the return spring 219 〇 moves the body portion 215 to the closed position, which maintains the end effector 12 in that position. If the clinician wants to adjust the articulated position of the end effector U, he or she can rotate the selector handle 2158 in the desired direction to obtain the desired position and then release the handle 2158 to maintain the end effector 12 in that position. Figure 44 illustrates a non-limiting embodiment of the present invention with a switch 2100 96422 47 200814963 5
10 使用之控制系統組件的配置。如圖所示,使用一可移除的 加壓氣體源620。從源620流出的氣體通過供氣線路65〇 流到比例閥660並通過供氣線路651流到開關總成2100 中之埠口 2112。在圖44所示實施例中,源620包括一可 替換/可再充氣氣瓶622,該氣瓶被支承在殼體總成3〇〇之 握把部分342内。貯氣瓶622可為可再充氣的。但熟習此 技蟄者會理解到亦可有效地利用不可替換/再充氣加壓氣 體源(財氣瓶)。在其他實施例中,把手總成3〇〇可具備一 用以從一外界加壓氣體源618供應加壓氣體的璋口 616。 舉例來說,該器具可透過一可撓供氣線路617耦接於設施 之蜃縮空氣線路(圖中未示)。參見圖45。 1510 Configuration of the control system components used. As shown, a removable source of pressurized gas 620 is used. The gas flowing from the source 620 flows through the supply line 65 to the proportional valve 660 and through the supply line 651 to the port 2112 in the switch assembly 2100. In the embodiment of Figure 44, source 620 includes a replaceable/refillable gas cylinder 622 that is supported within grip portion 342 of housing assembly 3. The gas cylinder 622 can be refillable. However, those skilled in the art will appreciate that the non-replaceable/refillable pressurized gas source (gas cylinder) can also be effectively utilized. In other embodiments, the handle assembly 3 can be provided with a port 616 for supplying pressurized gas from an external pressurized gas source 618. For example, the appliance can be coupled to a collapsed air line (not shown) of the facility via a flexible supply line 617. See Figure 45. 15
20 圖46-48例示活節接頭總成2〇〇2配置搭配前文所述類 型及構造之快拆式接頭1000,的使用。但在此配置中,她 :使用四個埠口。如圖47所示’遠侧連接器部分⑴6; 有一耦接於第一供氣線路區段54〇,的第一遠側供氣埠 1U7。-第二遠侧供氣谭提供於遠側連接器部分⑴6 中且耗接於—第二供氣線路區段542,。 :1丨丨8如圖所示從第-遠侧供氣璋依近:二τ :二氣嗔嘴部分1122從第二供氣㈣。依近侧 运侧連接器部分1116更具有 祸接於一第 區段2042,的第三遠侧供氣埠 1120,裎徂户、土 ^ 土 弟四遠側供氣埠 〇棱仏在遂側連接器部分1116 十 線路區段2052,。_坌-视^ 且耦接於一弟四供氣 *二供氣喷嘴部分1118,如圖所示從第 供氣線路 96422 48 200814963 三遠側供氣埠1117,依近侧方向 一 分1122,從第四供氣璋112〇,依近側方向往外四突出乳噴嘴部 相似地,近側脊段1150之遠 — :分⑽,該第二連接器部分有一_有:第 == 的第一近側供氣埠1156。第二連接器部分: 近例^氣埠i =0胁另一第二供氣線路區段542,,的第二 :側供孔埠1160。弟一近側供氣埠1156經建構 盆 可移除地接收第一供氣喷嘴1118 埠、 1160經訂定大小用以A甘出_ A ^风仏乳埠 ίο ⑽。如圖47m移除地接收第二供氣嘴嘴 埴斗人 環封1158與第一近側供氣 内時在第。^在/—贺嘴1118插入第—近側供氣蟑1156 路區,540,與另一第一供氣線路區段 = 致軋岔(或液密)密封。當依該方式耦 接=:,時,第-供氣線路區段540,和54G” 3 '2氣線路540。同樣的,一第二。環封1162與第:近: =埠116G結合以在第二供氣喷嘴1122插人第二近侧供 :1160内蚪在第二供氣線路區段542,與 __ 、 間形成另一大致氣密(或液密)密封。者 20 广亥方式輕接在—起時,第二供氣線路區段542,和542” 形成一第二供氣線路542。 又則脊段115〇之遠端⑽具有一第二連接器部分 Ρμ ^第;連接器部分有一耦接於另一第三供氣線路區 又42”的第三近側供氣埠1156,。第二連接器部分1154 ;…内更有耦接於另一第四供氣線路區段2〇52,,的第四 96422 49 200814963 5 ίο 15 20 近侧供氣埠1160’。第三近侧供氣埠1156,經建構用以在其 内可移除地接收第三供氣喷嘴1118,,且第四近側供氣埠、 1160,經訂定大小用以在其内可移除地接收第四供氣喷嘴 ^122。如圖47所示,一第三0環封1158,與第三近側供 氣埠,1156’結合以在第三噴嘴1118,插入第三近侧供氣埠 内k在第二供氣線路區段2G42,與另—第三供氣線路 區段2042”之間形成一大致氣密(或液密)密封。當依該 方式麵接在—起時,第三供氣線路區段2G42,和2042”接人 形成-第三線路2042。同樣的,一第四〇環封ιΐ62,與; 供t埠1160,結合以在第四供氣喷嘴1122,插入第四 乳埠116G,㈣在第四供氣線路區段顧,盘另-第 四供氣線路區段2052,,之Pi形#。 密封。當依二成另一大致氣密(或液密) ^ 2052^. 1 1接在一起時,第四供氣線路區段2052, 之精神及範圍。置、快拆配置而不脫離本發明 得越來技術】段中所述,隨著内切割器系統變 度也變得越言開t…種可產生必要傳動力之氣動系統的難 轴而變得比:容易=題電動機帶動旋轉傳動 可活節運動的傳動==動可輕易地在長而可挽或 產生能力方面作出極大進二::已在電動機大小及扭矩 側長軸桿直徑的 糸統的有效性會受到遠 域中之馬達的大小限制了:以釘合機構之區 长峰夕虽今應用中,轴桿直徑之 96422 50 200814963 期望大小阻止電動機被定位在系統遠端同時能夠提供充分 能量帶動系統。 以下實施例解決與傳動電動機有關之此等問題和缺 點。如下文所將詳述,這些實施例利用一氣動馬達將旋轉 5 動力傳輸到一旋轉從動内切割器。氣動馬達通常產生與傳 • 送至該馬達之氣體之壓力及體積成比例的扭矩及每分鐘轉 數。在圖49-56所示非限制性實施例中,利用一活節傳動 _ 軸總成將旋轉運動從氣動馬達傳送到終端作用器。但熟習 此技藝者會理解到本發明這些實施例之獨特新穎觀點亦可 10 有效地搭配其他已知旋轉從動終端作用器及其他利用一可 撓傳動軸配置傳送旋轉傳動運動至内切割器之外科器具使 用。又,本發明這些實施例之獨特新穎觀點可有效地搭配 非活節式終端作用器配置使用。 圖49-56例示本發明之一外科切割及釘合器具15〇〇, 15 其利用一旋轉從動内切割器1512。頃存在多種旋轉從動内 ⑩切割器及其他外科器具。舉例來說,一種旋轉内切割器配 置揭示於2006年1月31日申請之授證給Shelton, IV等人 之發明名稱為、、Motor Driven Surgical Cutting and Fastening Instrument With Adaptive User Feedback77 的美國 20 專利申請案序號第ll/343,447號中提及,該專利申請案之 相關部分以引用的方式併入本文中。其他實例揭示於2006 年6月27日申請之授證給Shelton,IV等人之發明名稱為 vv Manually Driven Surgical Cutting and Fastening Instrument〃的美國專利申請案(KLNG No· 96422 51 200814963 050704/END5779USNP),該專利申請案之相關部分以引用 的方式併入本文中。 圖50是-依據多個非限制性實施例的終端作用器i5i2 的分解圖。如該範例實施例所示,終端作用器m2可包含 -經訂定大小用以接收-氣力操作工具的長槽道i,。各 非限制性實施例之氣力操作工具包括一於内部可操作地支 ίο 15 20 = 料機構㈣g 50。此實施例包含—楔形滑橇總 ㈣^,在該滑橇總成上有—刀部分1538。楔形滑樣總成 ⑽㈣一螺旋傳動螺桿156〇上。一位於長槽道⑽之 ^端1521的軸承1522接收螺旋傳動螺桿156〇,允許螺 旋傳動螺桿156〇相對於長槽道⑽自由轉動。螺旋傳動 螺桿⑽可與楔形滑橇總成⑽之―有螺紋開口(圖中 ^了)父界’致使傳動螺桿156G之轉動會導致楔形滑橋總 30在&全伸長或已作動位置與—完全縮回或未作 動位置之間往遠側或近側平移(視旋轉方向而〇通過長 槽運1520’其令在該完全伸長或已作動位置中被支承在釘 £内的肘釘已全部被擊發。據此’ #螺旋傳動螺桿WO 被依一方向轉動時,楔形滑橇總成153〇被往遠側帶動通過 釘匣50切斷終端作用器1512内夹緊之組織且擊發釘匣% 内之肘釘使肘釘與可枢轉地耦合於長槽道1之一砧4〇 之底部表面發生成形接觸。楔形滑橇總成1530之滑橇部分 1532舉例來說可由塑膠製成,且可有一傾斜遠侧表面 1534。隨著楔形滑橇總成153〇橫越長槽道152〇,傾斜前 w表面1534可將釘匣5〇内之肘釘往上推或帶動穿過被夾 96422 52 200814963 緊的組織並抵住站40。站40翻轉肘釘,從而釘合被切斷 的組織。當模形滑樣總成15 3 0縮回時,刀部分1 $ 3 §及、、骨 橇部分1532可變成分開,從而將滑橇部分1532留在長槽 道1520之遠端。熟習此技藝者會理解到可使用其他氣力操 5 作工具與其他擊發機構。 圖51和52例示一種用以從把手總成3⑽中一氣動馬達 傳輸旋轉運動到螺旋傳動螺桿1560的傳動轴配置。如參照 •圖51所見,此實施例可運用前文詳述之閉合管總成 閉合官總成170可滑動地套在一脊總成i 54〇上,該脊總成 10包括一可旋轉地支承一主旋轉(或近侧)傳動軸1544的近 側脊段1542,該主傳動軸經由一包含齒輪1552、1554、1556 之斜齒輪總成1550與一次級(或遠侧)傳動軸1546聯繫。 次級傳動軸1546連接到一傳動齒輪1548,該傳動齒輪接 合於螺旋傳動螺桿1560之一近侧傳動齒輪1562。鉛直斜 5齒輪1552被可樞轉地支承於近侧脊段1542遠端中之一開 戀 1内可利用一达侧脊段1570封閉次級傳動軸1546 及傳動齒輪1548、1554。總括而言,主傳動軸〗544、次級 傳動軸1546、及活節總成(譬如斜齒輪總成1550)在本說 明書中有時稱為、、主傳動轴總成"。 2〇 如圖53和54所示,器具1500各實施例係由一呈加壓 氣體源620形式之氣動力源供能。在這些圖式所示之實施 例中,源620包括一可替換/可再充氣氣瓶622,該氣瓶被 支承在殼體總成3〇〇之握把部分642内。貯氣瓶622可為 可再充氣的。但熟習此技藝者會理解到亦可有效地利用不 96422 53 200814963 可替換/再充氣加壓氣體源( 把手總成300可具備一用、米开。在一他實施例中, 加壓氣體的谭口 外界&加壓氣體源肩供應 新穎 1下點更==可移除/可再充氣貯氣瓶⑵之獨特 作用器1512,圖中傳動ΐ統如何提供旋轉運動給終端 °° ㈤W見加壓氣體在壓力下從貯氣瓶622 1 外界壓力源618通過一供衰妗枚+攸丁孔瓶622或 10 15 20 _内。比例閥_耦接:::接, ^ .. ,θ ... 、附接於一啟動扳機070的供 二二1c/圖53和58 °在各實施例中’啟動板機 J f/ 310^# 彻j機由&伸於右邊機殼構件32G與左邊機殼構件 330之間的樞軸銷37〇可樞轉地輕合至把手總成綱。相對 位置扳機310,可由塑朦或其他適當材料製成且有一部分具 備大致U形松截面藉以如圖所示容納啟動扳機㈣。臨 床西師可將他或她的手放到殼體總成3〇〇之握把部分Μ〕 上致使下三根手指位在相對位置扳機31〇,上且食指位在啟 ,扳機670上。將啟動扳機67〇往内朝相對位置扳機η〇, 扎壓冒V致比例閥660允許氣體在壓力下從源62〇 (或圖 53Α之618)通過該閥到一供氣線路68〇流入定向控制閥 1610 内。 如圖56所示,定向控制閥161〇具有一前進位置區段 1620、一停止區段163〇、及一倒轉區段164〇。控制閥區段 96422 54 200814963 1620、1630、164〇可藉由穿過把手殼體300突出之按鈕1612 ,1614手動切換。參見圖則口 56。二個供氣/排氣線路 00、1710從定向控制閥161〇延伸到一傳統氣動馬達 173 〇因此,當臨床醫師將控制閥1610切換到前進位置, 刖進通遏1622允許加壓氣體從供氣線路68〇 氣線路⑽内導致氣動馬達1730以一第一方向 dn(r進-步於下文詳述),這會導致旋轉運動 '月ί ♦動軸1544,在一擊發行程中驅使模形滑槪總 ίο 15 20 532及刀部分1538往遠侧通過終端作用器Μι]。姐由 ^路mo離開氣動馬達⑽的氣體透過一排氣璋工咖 680的當161G被切換至倒轉位置時,通過供氣線路 勺乳體被允許通過供氣線路171〇流入氣動馬達 經由供氣/排氣線路17〇〇離開氣動馬S 過排氣埠⑹2排放。當控制闕處於停止位’:體透 =及供氣/排氣料1710被關閉且供氣線路17〇;^路 排氣埠1632。參見圖56。 逆强主 如圖56更進一步顯示’氣動馬達WO之輸出轴⑺2 有Γ第一傳動齒輪1734,該第一傳動齒輪喷合於 動去二4丁生齒輪總成1740之一輸入軸1738的第二傳 出二二7!6·。行星齒輪總成1740有一輸出軸1742,該輸 1545 傳統聯軸構件1743耦接於傳動軸1544之近端 轉Ϊ動傳送到該傳動軸近端。因此,當控制閥 1732 ^ 行生齒輪總成1740將一旋轉運動加 96422 55 200814963 諸於傳動軸1544藉以導致楔形滑橇總成153〇及刀部分 1538通過釘匣50切斷終端作用器1512中夾緊之組織並驅 使釘匣50内之肘釘與砧40發生成形接觸。當控制闕161〇 切換到倒轉位置,氣動馬達1730之輸出軸1732將一反向 5旋轉運動加諸於傳動軸1544使楔形滑橇總成153〇及刀部 分1538依一近侧方向回縮通過釘匣5〇。 圖49-56所示實施例亦具有增進儀器之可操作性且向 •臨,醫師提供多種形式之回饋的更進一步獨特新顆特徵, 使得臨床醫師能夠監測楔形滑橇總成153〇及刀部分Μ% 10在釘匣5 0内在运側推進及縮回時的釘匣内位置。再次參照 圖56可看到一回饋齒輪提供在傳動軸上或行 星總成1740之輸出轴1742上。回饋齒輪175〇嚙合於 一安裝在一有螺紋刀位置軸1754上的刀位置齒輪η%。 刀位置軸1754可由有助於其自由旋轉的適#軸承配置(圖 15中未示)支承。一近側限制開關176〇與軸1754之近端η% _結合,且一遠侧限制開關1770與軸1754之遠端1758結 合。一刀指示器1780旋到刀位置軸1754上以供在該刀位 置軸上往遠側和近側行動。當傳動軸1544依會導致楔形滑 ,總成1530及刀部分1538往遠侧通過釘匣5〇的方向轉動 20 %,刀指不器178〇亦往近侧朝遠側限制開關口移動 遠侧限制開關177〇經定向致使當楔形滑橇1530及刀部1 1Γ二ί於最遠側位置時,刀指示器_作動遠側限制‘ ^ 一窗提供於左邊機殼構件330 (或右邊機殼構件 320,這取決於刀位置軸1754在殼體總成300内的位置) 96422 56 200814963 ,得臨床醫師㈣相刀指w⑽之位錢以判 ㈣構(楔形總成1530及刀部分1538)在其擊發行程内 之,置且為臨床醫師提供用以在回縮行程中監測楔形 1530之位置的器件。 5 10 15 20 又’在各實施例中,可提供—從供氣線路㈣延伸 ::制開關1770的遠侧輔助線路1772。一遠側限制開關 774可提供在遠侧限制開關㈣與定向控制閥161〇 ^間三因此’當楔形滑橇總成⑽及刀部分1538已完成 手發行程且刀指示器178〇作動遠侧限制開關㈣,遠侧 限制開關Π70許可氣體在壓力下從供氣線路㈣流到遠側 限制開關線路1774並流入定向控制閥161〇内,這在夂* 施例中會導致定向控制閥1610自動切換至倒轉位置並口因貝 2致氣動馬達1730反轉且最終將一反向旋轉運動加諸 於傳動軸1544。當氣動馬達173〇反轉傳動軸⑽時,反 向旋轉運動傳輸到刀位置軸1754藉以驅使刀位置指示器 =80朝近侧限制開關1往回移動。—近侧輔助線路麗 =可在近側限制開關! 6 6 〇與供氣線路6 5 〇之間延伸,致使 當刀位置指示器1780作動近側限制開關166〇 (意味著楔 形滑橇1530及刀部分1538已移到其完全縮回位置)時二 近側限制開關!660因此許可氣體流入一近侧限制開關線 路1664且流入定向控制目161〇 π藉以導致定向控制閥 1610自動切換成停止位置。 在各實施例中’一第一氣笛1790或其他適當發聲裝置 可與遠側限制開關線路1774 (或遠側限制開關177〇)連 96422 57 200814963 ,,致使當遠側限制開關1770在擊發行程之末端被作動 叫’通過遠側限制開關線路丨774的空氣致使第一氣笛179〇 向臨床醫師提供一聲音信號表示楔形滑橇/刀具已抵達擊 發行程之末端。同樣的,一第二氣笛1792或其他適當發聲 裝置可與近側限制關1760連通,致使當近側限制開關 ' 1760在回鈿行私之末端被作動時,通過近側限制開關線路 1764的空氣致使第二氣笛1792向臨床醫師提供另一聲音 信號表示楔形滑橇/刀具已抵達_行程之末端。在立他^ 施例中二舉例來說,電池供電的發光二極體或其他發信裝 置可與遠側和近側限制開關177〇、176〇聯繫以向使用者提 供楔形滑橇/刀具已抵達擊發行程及/或回縮行程之末端時 的另一指示。在替代實施例中,氣笛1790、1792可換成壓 力感測H或壓力相指出裝置何㈣達擊發行程及/或回 縮行程之末端。 ^ 在圖49-56所示各實施例中,氣動馬達被支 •成^内。在圖52A和52B所示實施例中,氣動馬達^, =於逡側脊段110内。馬達傳動軸1546,在其上有一傳動 齒輪1548’,該傳動齒輪嚙合於螺旋傳動螺桿1560之近侧 =動齒輪1562。圖52A例示此遠侧安裝氣動馬達搭配一如 =所述之活節接頭1〇4使用。圖52B所示實施例使用一如 前所述之氣動活節接頭總成2〇〇2。此等遠侧安裝空氣馬達 配置亦可搭配採用其他活節接頭配置的器具使用,或是搭 =終j作用器不相對於把手總成或其所附接長軸桿總成部 分進仃活節運動的器具使用。熟習此技藝者會理解到此等 96422 58 200814963 遂侧安裝氣動馬達配置使得可能在實施例中透過長形傳 軸配置所遭遇到的動力損失最小化,其中馬達係支承於把 手總成内且擊發和回縮運動必須透過活節接頭傳輪到終= 作用器。諸如圖52A和52B所示之實施例僅要求二條線路 5 Π10和1760穿過活節接頭以向馬達173〇,供能。線路 ’和1760可包括可撓管路或類似物且相較於需要一或多個 傳動構件穿過接頭的其他實施例比較不會限制活節接頭。 _ 又’本發明各實施例可被建構成向使用者提供一有關器 具之擊發組件之相對位置的觸覺回饋。在一些實施例中, 10此係藉由將行程監測構件或相對位置扳機31〇,連結到施加 於I置之傳動軸或擊發機構之前進和回縮運動的方式達 成更特疋έ之且參照圖53-55,此實施例可包含一回饋 連桿總成1800,該回饋連桿總成在各非限制性實施例中可 ,括一有螺紋手動回饋軸18〇1,該軸可依螺紋附接於_可 旋轉地安裝在相對位置扳機31〇,之一上附接板部分Μ] •螺母構件334。手動回饋軸18〇1之遠端有一支承一手動回 饋齒輪1804的萬向接頭部分觀,該手動回讀齒輪嗜合 二刀位置间輪1752。當定向控制閥16〖〇處於前進位置, 氣動馬it 1730驅動傳動軸1544致使呈一楔形滑橇153〇 =邛刀1538之形式的擊發機構被帶動往遠侧通過氣缸 (擊發行程)。回饋齒輪175〇帶動刀位置齒輪1752,而該 騎置窗輪帶動手動回饋齒輪18〇4。然後手動回饋齒輪 8〇4轉動手動回饋軸,該手動回饋軸因其與螺母之螺 紋接合而將相對位置扳機31〇,拉往把手總& 3〇〇之握把部 96422 59 200814963 =342 ’從而向臨床醫師提供一代表楔形滑橇1530及刀部 分1538推進的、、觸覺1示。熟習此技藝者會理解到 ίο 15 20 ^醫師嘗試使相對位置扳機31〇,朝把手總成300之握把 =分342樞轉’手動回饋轴1801和螺母334會阻止其任何 移動,是,相對位置扳機31〇,會相關於模形滑橇153〇 =刀部分1538之推進和回縮自動樞轉。此配置向臨床醫 二供-僅需在外科程序全程巾抓住相對位置扳機训,就能 传到的楔形滑橇總成153〇及刀部分1538 (擊發機構)之 :進和回縮之自動觸覺指示。因*匕’臨床醫師不用看任何 f西就能得到此回饋。此配置向臨床醫師提供擊發機構在 作動位置與已作動位置間之進程及擊發機構何時從已作 動位置回到未作動位置的單手非視覺回饋。 各實施例可更進-步具備整體標示為333的另 回饋配置。舉例來說,如圖53_56所示,相對位置扳機仙, ^附接板部分332可具備—系列經設計#擊發及回縮行 程期間相對位置扳機31〇’以銷37〇為中心插轉時鱼安 把手總成·内之一彈簧臂337交界的槽孔335、以、 ^絲及士類似义當上附接板部分332隨著相對位置扳機31〇, =% U 337之末端掉入每一順序槽孔奶内且用 來(依序)將-力加諸於上附接板部分332,此力在臨床 醫師抓住相對位置扳機31〇,時_感覺到。因此,隨著相 =置扳機則’推進,臨床料會得到—㈣對應於擊發 機構之移動的額外觸覺回饋運動藉以確認相對位置板機 310,(及最終擊發機構)在擊發行程期間推進或在回缩行 96422 60 200814963 程期=縮回,無論是在何種情況之下。又,隨著彈簧臂337 =士端掉入每一每一順序槽孔内,此可能產生一聲音、喀 =耸等以向臨床醫師提供關於擊發機構通過擊發行程及回 ,仃程之移動的聲音回饋。因此,此實施例提供一系列(至 ’夕—個)關於擊發機構在未作動位置與已作動位置間之移 \ 動的聲音。 热習此技藝者會理解到器具1500呈現一遠優於習知氣 動内切副态配置的改良。舉例來說,各實施例提供一供臨 10床醫=監測擊發機構(楔形滑橇/刀具)被帶動通過其擊發 行私B守^位置的器件。在一些實施例中,當楔形滑橇/刀具 抵達其辜發行程之末端時會自動縮回。一旦處於完全縮回 t置,控,閥可自動切換到一停止位置藉以中斷從源618 =62=到氣動馬達173〇的空氣供應。但如果在啟動過程中 b臨床醫師想要停止楔形滑橇/刀具在氣缸内往遠側之推 他或她可簡單地將控制閥161〇手動切換至倒轉位置並 f續作動啟動扳機670向氣動馬達Π30供應加壓氣體直到 縣滑橇/刀具移動至期望回縮位置為止。此外,獨特新賴 勺=對位置扳機3 1〇’在臨床醫師抓住相對位置扳機Η。, 20二日:,臨床·師提供可感受到的手動或觸覺回饋。又,臨 西巾可在楔形滑橇/刀具已抵達擊發行程末端及/或已 全縮回時得到聲音信號。 ^習此技藝者亦會理解到行程監測裝置所提供的獨特 在使用傳動構件漏、_或波紋管總成_時亦 可错由以一推/拉可撓纜索(圖中未示)或剛性構件(用於 96422 200814963 非活節之實施例)將這些傳動構件之每一者連接到上 板部分332或相對位置扳機31〇,之其他部分致使此等傳動 構件之推進和回縮直接或間接地連結到相對位置板機⑽, •5 的方式獲得。此獨特新穎配置亦可搭配下文參照圖7㈣ 說明之實施例使用。 10 15 20 如前所述,回饋連桿總成则不僅以一對應於擊 籌二動速率的速率自動地移動相對位置扳_〇,以便向 師提供-用以監測擊發機構之進程的器件,回饋連 用螺紋或是會有效地阻止或大幅限制臨 手動樞轉相對位置扳機3!〇,之能力的其他器件。在 生實靖,相對位置扳機仙,會移動的時間 =桿總成使其移動之時。在更其他實施例中,可 任何樞轉行= = 在被作動時發生 示)來阻止相斜办)或另一貯氣瓶(圖中未 動扳機670上之力旦^ 310’之手動移動。舉例來說,啟 構紅 力里的出現會引起氣體釋放,但在擊發機 動之前,相對位置扳機 匕= 也會隨之停Γ 移動,相對位置板機3ΐ0,的運動 但在其他多個實施例中, 構為使臨床醫師 =饋連U 1_亦可被建 之形式協助傳動構:=仃程期間:一氣動馬達1730 動構件增添力旦式Β 、此 以便在臨床醫師想要時對傳 兴仓丨十_ 里或阻止擊發機構推進。在此等给妳如由 二…說’回饋轴1801可被形成為具備一梯形ί紋或其他 62 200814963 螺紋配置或組態,此箄螺好締里a成_ 哥螺紋配置會實際許可臨床醫師對相 ίο 15 20 對位置錢31G,絲壓力並藉此藉由其與料334之接人 而對軸臟施加-旋轉力。由於將一旋轉運動加諸於轴 議’臨床鲁師亦對齒輪18G4施加—旋轉力,該齒輪嗜合 於套在傳動轴1544上之齒輪175()。因此,如果擊發機構 遭遇阻力’臨床醫師可藉由擠壓相對位置扳機mg,而對傳 動軸1M4施加機械產生的動力。如果臨床醫師想要減缓或 ^止-手^機構之移動,臨床醫師可對相對位置扳機310,施 力,該扳機隨後抗拒/減緩軸18〇1及齒輪18〇4之旋轉且 終抗拒/減緩傳動軸1544之旋轉。 所述各實施例係搭配一用以在壓力下供應氣體以 #作衣置的-材料儲存構件以可移除貯氣瓶⑵的形式使 =°,數個實施例中’可移除貯氣瓶622可為—開始就裝 …了尚Μ氣體且可再填充。在其他實施例中,可移除貯氣 :瓦622可f不可再填充。舉例來說,貯氣瓶622可包括一 裝填了二A化碳的傳統拋棄切氣瓶。—旦貯氣瓶用盡, 使用者將其移離把手總成並用—新的滿載貯氣瓶替換。其 他y用氣體舉例來說為壓縮空氣,二氧化碳(c〇2),氮氣、, 乳氣,氯氣,氦氣,氫化鈉,丙院,異丁烷,丁燒 ,二:類’二甲基醚,甲基乙基醚,氧化亞氮,氫氟烷類 )· HFA 134a ( 1,1,1,2,-四氟乙烷)或 jjFA 227 i ϋ,2,3,3,3·七氟丙烷)。此配置提供一遠優於習知氣動 笙^二/、配置的改良。但該器具可供使用的次數取決於此 寺貝了氣瓶内可儲存之氣體體積以及有效地維持裝置無菌性 96422 63 200814963 之需求。 本發明其他實施例使用之貯氣瓶622儲存了在一儲存 壓力下呈非氣態、液態且至少部分液體當裝置作動後處於 一較低壓力下時會蒸發的材料。可用在這些實施例中之液 5體的實例包括氧化亞氮,二甲基醚,曱基乙基醚,氫化鈉, 丙烧,異丁烧,丁烧,氫氟燒類(HFA) : UFA 134a( 1,1,1 2 _ 四氟乙燒)或 ⑩壓下的二氧化碳(c〇2)。 10 15 20 圖57例不一貯氣瓶622之非限制性實例,其内裝有前 文所述液態物624之一者。貝宁氣瓶622可由鋼、紹或1他 相容於其⑽存之液體/蒸氣且能夠承受其内產生之内部 壓力的材料製成。當使用本說明書戶^ ^ ^ ^ ^ ^ ^ ^ 時,臨床醫師經常要以多種位置(包括上下颠隹=;置 翻轉把2總成300以達成終端作用器12之期望位置。因 此在k些實施例中,為防止液體在此類操縱過程中不人 槪622移到控制系統内,-膜片626提: 於貝丁乳开瓦622内。膜片& 7丄# , ^ »、 胰月626可由阻止液態物通過但許可由 :二if成之瘵氣628通過膜片626的材料製成。因此, 可自由操縱把手總成_而不會有液態物624進 制閥1610及/或氣動馬達謂㈣ 二,被㈣—體式構造’貯氣瓶⑵可用二或 1衣成以利液態物624和膜片咖安裝於其内。 昌密封構件建立此實施例中 ^ 用適 封。又,可提供-裏殖埠(二?各W之間的液密密 衣八旱(圖中未不)以填充貯氣瓶622。 96422 64 200814963 在圖57所示實施例中,當臨床醫師將定向控制閥i6i〇 切換到前進位置並作動比例閥660時,貯氣瓶622内之壓 力減小。此種壓力減小會導致液態物624開始氣化,且蒸 氣628通過膜片626並用來向前文所述各種控制系統供 5能。因此,藉由減小貯氣瓶622内之壓力,液態物624開 •始氣化且利用加壓蒸氣628向裝置供能。 其他實施例可使用需要燃燒作用使液態物轉變成其氣 •態的液態物。此等液態物的實例為丙烷、丁烷及其他石化 產物。可利用一傳統按鈕點火器或其他點火器系統來點燃 10该液悲物。在此等應用中,裝置之其他組件會由能夠安全 地發散因此產生之任何熱能/煙的材料及方式製造。更其他 實施例可使用經特殊設計在一低壓和低溫下經由熱之輸入 而從固態轉變成液態、從固態轉變成氣態或從液態轉變成 氣怨的相變材料。此等材料之實例為石蠟以及鈉之各種混 15合物。這些相變材料可能隨熱輸入到系統而有大量體積變 _化。此等裝置會使用一器件譬如燃燒器以向該材料提供必 要熱能。又,這些裝置可能暴露於此熱的組件會被設計成 在使用期間安全地散熱並保護臨床醫師並由達成此目標的 材料建構。 Λ 20 圖57所示實施例可用在前文所述各種不同類型之貯氣 瓶且提供許多優於貯氣瓶係永久性安裝在把手總成3〇〇内 之其他實施例的優點。更特定言之且參照圖57,貯氣瓶622 可收納在一形成於把手總成3〇〇之握把部分342中的腔穴 671内。為能進出腔穴671,握把部分342可為由二個可輕 96422 65 200814963 易刀開的。卩件袅成或疋具備一與其扣接或經其他方式可移 除地附接的可移除蓋板(圖中未示)。在各實施例中,貯氣 瓶622之排洩端63〇旋入一管集箱塊632之一有螺紋埠口 634内。有螺紋槔口 634與一供氣通道6%連通,該供氣 5通道由一針閥638開啟及關閉。特定言之,在各實施例十, 針閥638疑入官集箱塊632内致使供氣通道636可因轉動 針闊638而被開啟和關閉。但亦可採用其他閥或流量控制 馨配置。 為了在使用期間向臨床醫師提供貯氣瓶壓力之一指 1〇不,可將—傳統壓力計640安裝為與供氣通道630流體連 通。=壓力計窺視窗642可提供在握把部分342中以讓使 用者能在使用中觀看壓力計040。參見圖49。 、 久圖57# 58所示,貯氣弃瓦622可被支承在一可卸式握 把部分342内,該握把部分可移除地附接於一從主要把手 !5部分340向下突出的主要附著部分⑷。 •⑷可藉由任何適當配置與主要附著部分344接合。:: ^况,依據各實施例,可卸式握把部分342與主要附著部 分344之接合可藉由一如圖所示之直線性滑動配置實現。 如圖所不,例如在圖57_59及61中,可釋握把部分Μ] 20包括第一和第二上部滑軌367及第一和第二下部滑軌更 368 °亦如這些圖式所示’第一上部滑幸九367界定一斜面 369、°上部滑轨367被設計成欲收納在由鑲板380和382 界定於主要把手部分340中之對應區域384内。 外科器具可更進一步包括一閉鎖系統1_。例如在圖 96422 66 200814963 2及64 69中更詳細示出的閉鎖系統】9〇〇經 在可卸式握把部分342與主要附著部分344 成 擋主要附著部分344與可卸式握把部分數 駭次數可為任何次數。此配置可能特於 由限制一裝置可使用之次數來確保 j於猎 維持。舉例來說,栌每 ^ …、园性传到有效 ,4 來依據口貝施例,閉鎖系統1900可在可釦 =…2拆離主要附著部分344兩次之後阻擋心 者部分344連接到可卸式握把部分342。儘管 ίο ==统_大部分位在主要殼體部分34〇内,應理解到 又據八他貫施例閉鎖系統1900可為大部分位在可 把部分342内。 飞握 如圖59所示,閉鎖系統boo包括一計數器19〇2,及 一耦接於計數器1902的阻隔總成1904。計數器1902經建 構配置成在可卸式握把部分342拆離把手總成3〇〇之主要 ==著部分344時推進。如圖59所示,計數器19〇2連接到 馨一軸1906,該轴被一連接到右邊機殼構件32〇的轂19〇8 支承。计數益1902包括一躺接於軸19〇6的分度輪191 〇, 及一耦接於分度輪1910的偏動構件1912。偏動構件1912 舉例來說可包括一經建構用以使分度輪丨9丨〇依一逆時針 20 方向偏動的扭轉彈簧。參見圖59。 分度輪1910界定突出部1914、1914’、1914,,,該等突 出部與阻隔總成1904合作以限制分度輪ι91〇之推進。突 出部之一者1914”經建構配置用以與阻隔總成19〇4合作以 在握把部分342拆離主要附著部分344預定次數之後阻擔 96422 67 200814963 可卸式握把部分342連接到主要附著部分344。儘管分声 輪1910被不為界定突出部1914、1914,、1914”,應理魅 =據其他實施例’分度輪191()可界定與阻隔總成胸 己作以限制分度輪1910推進的缺口,且該等缺口之一者可 ΪΪ:::43人42拆離主要附著部分344預定次數之後與阻 Γ成 合作藉以阻擋可卸式握把部分342連接到主要 附著部分344。 ίο 15 20 軸1906經建構配置用以許可分度輪191〇重設到一 ^。舉例來說,軸1906可界定一六角形開口 1916,且 八角形工具可穿過左邊機殼構件330之一開口 1918(示 細,60)插入,、角形開口 1916内然後依順時針方向轉 動糟以將分度輪1910重設到一先前位置。 如圖59所示,阻隔總成19〇4包括一阻隔構件192〇、 「阻隔構件導件1922、一問構件1924、及一偏動構件 26。閘構件1924與阻隔構件192〇接觸,可扼轉地連接 到阻隔構件導件1922,且與突出部i9i4、MM,、⑼4” =限制分度輪1910推進。偏動構件1926輕接於閘構 門堪生4。偏動構件1926舉例來說可包括一經建構用以使 甲件1924依一順時針方向偏動的扭轉彈簧。以下來昭圖 64·69更詳細地說明閉鎖系統1900之操作。 如圖所示,例如圖59_63所示,把手總成3〇〇包括一經 建構配置用以起始可卸式握把部分⑷脫離主要附著部分 344之作用的釋放系統193〇。釋放系統193〇位於主要附著 部分344内且包括-釋放幻932,及連接或整合於釋放紐 96422 68 200814963 1932的第一和第二釋放構件1934。第一和第二釋放構件 1934各自界定一釋放斜面1936。釋放系統193〇更包括與 相應釋放斜面1936接觸的第一和第二釋放銷1938,與第 一和第二釋放銷1938接觸的第一和第二鎖簧194〇,及與 5第一和第一下部滑軌368接觸的第一和第二頂出簧丨942。 •參見圖62。如圖59所示,彈簧1940之自由端1941穿過 右邊機殼構件320中之一對應孔321及左邊機殼構件33〇 φ中之對應孔331伸入上部滑軌367中之對應孔3 72内藉 以使可卸式握把部分342保持與主要附著部分344接合。 10 要起始可卸式握把部分342脫離握把附著部分344之作 用時,使釋放鈕1932推進,導致第一和第二釋放構件1934 及相應釋放斜面1936亦推進。隨著釋放斜面1936推進, 釋放斜面1936導致第一和第二釋放銷1938改變位置。第 一和第二釋放銷1938之相應位置的改變會導致第一 15二鎖,m。往上移出上部滑轨367之孔二致二二 ⑩允許第一和第二上部滑軌367脫離其與鎖簧之接合。隨著 可卸式握把部分342從主要握把附著部分344移開,第一 和第二頂出簧1942每一者釋放其儲存的能量,從而分別對 第一和第二下部滑軌368施予一力。此力協助可卸式握把 20 。卩刀342脫離主要握把附著部分344。應理解到依據豆他 實施例,釋放系統B30可包括適於起始可卸式握把部分 342釋_主要握把附著部& 344之作用的其他組件及组 態。 、 芩妝圖57和58,供氣通道636之遠端637有一點639 96422 69 200814963 形成於其上以讓遠端637能夠刺穿安裝在主要附著部分 344中之一封閉管集室644内之無菌密封膜片646。特定言 之,供氣通道636之遠端637插穿過管集室644之一埠口 645。無菌膜片646可由能被消毒的任何適當可刺破材料製 *5 成,在供氣通道636之遠端637插穿過時於其間達成一大 \ 致液密或氣密密封,且在供氣通道636之遠端637移開時 仍維持管集室644内之區域的無菌性。 • 亦如圖57和58所示,供氣線路650流體耦合於管集室 644致使從供氣線路636進入管集室644之加壓氣體流入 10 供氣線路650内。圖57例示附接於主要附著部分644之前 的可卸式握把部分342。圖58例示附接於主要附著部分344 的握把部分342。如圖58所示,供氣通道636之遠端637 已刺穿無菌膜片646。為協助供氣通道636之遠端637插 穿過無菌膜片,一壓縮彈簧649提供在可卸式握把部分342 15 之壁與管集箱塊632之間。此配置在供氣通道636之遠端 • 637插穿過膜片646之時向管集箱塊632提供一些、彈性〃。 圖64-69例示閉鎖系統1900在附接/分開程序期間不同 時間其組件之相對位置。圖64例示握把部分342首次完全 接合於主要附著部分344之前的相對位置。閘構件1924 20 與突出部1914接觸藉以阻止分度輪1910推進。 握把部分342藉由滑執637推入對應通道384内而附接 於附著部分344。阻隔構件1920穿過鑲板380之一孔381 伸入通道384之一者内。參見圖59。隨著第一和第二上部 滑執367推進,第一上部滑執367之一者上的斜面369觸 96422 70 200814963 碰阻隔構件1920且導致該阻隔構件往上朝分度輪”⑺移 動。隨著阻隔構件192〇朝分度輪1910推進,阻隔構件192〇 導致閘構件1924從分度輪1910移開。參見圖65。隨著第 一上部滑執367及斜面369持續推進,阻隔構件192〇持續 5朝分度輪1910推進。當握把部分352完全接合於主要部分 \ 35^時,阻隔構件192〇觸碰原本與閘構件1924接觸的^ 出部1914,從而如圖66所示阻止分度輪191〇推進。 _ 在握把部分342開始脫離主要附著部分344後,第一和 第二上部滑軌367以相反方向推進,第一上部滑軌撕界 =的斜面369允許阻隔構件192〇從分度輪191〇移開。隨 著阻隔構件1920從分度輪191〇移開,阻隔構件192〇允許 閘構件1924朝分度輪191〇推進且如圖67所示跳過突出部 1914。隨著握把部分342拆離主要附接部分,阻隔構 件1920從分度輪191〇移開夠遠以鬆開其與突出部i9i4 =之接觸且允許分度輪1910轉動直到一第二突出部1914,如 攀圖68所示與閘構件1924發生接觸為止。 此蚪计數益1902已推進一個位置,且握把部分能 夠再次附接於主要附著部分344。附接/分開循環可重複進 行。圖68例示第二次再附接程序。當 如= 主要附著部分344,阻隔構件觸如圖的所;;碰接 =出=19U”藉此阻止分度輪191()推進。在第二循環之末 鳊,备握把部分342脫離主要附著部分344時,閉構件〗%々 如圖69所示觸碰一第三突出部1914”。第三突出部⑼ 經建構配置用以藉由阻隔構件192〇阻止閘構件MM從分 96422 200814963 度輪1910移關,你而^ 1立 把邱八342d 要附著部分344再次附接於握 二/ i或附接於一替換握把部分)。因此,依據這些 二!?: ’该外科器具有效地為兩次使用型器具。但孰習此 技勢者會理解到如果分度輪㈣界定更多突出部或缺口 即可增加使用次數。在本發明其他實施例中 测,但經建構以致鑲板382、或把手總成遍㈣=先 部份或數部份分離或是以其他方式使失效,以防止握把邻 分342或其他握把部分再次附接至把手總成。 ίο —圖70_83例示依據本發明之另一獨特新賴氣動外科切 副及緊SJ裝置侧,其向臨床醫師提供監測擊發行程之 程的能力同時亦提供手動縮回該裳置之擊發組件的能力。 此實施例可搭配前文所述終端作用器12或其他終 器配置使用。 、 Ρβ ㈣施例之長形脊總成3102可包括一附接於— 5段遍的近侧脊段31〇4。在替代實施例中,s形脊 • 3102可包括-單一組件。長形脊總成31〇2大致中空且不 可動地耦接於殼體總成300。如圖79和8〇所示,$側脊 段之近端3105可藉由一從右邊機殼構件32〇突出之右附接 捲3110及-從左邊機殼構件33〇突出之左附接捲3ιΐ2附 2〇接於殼體總成。長形脊構件3102之遠端可依前文所述方 輕接於長槽道2 0。 又’在此實施例中,一長形閉合管3190從把手總成3〇〇 延伸到終端作用器Π。閉合管3190之遠端3192有一穿透 的馬蹄形孔3194且用來在閉合管319〇於脊構件31〇2上轴 96422 72 200814963 向地移動依前文所述方式與砧4〇上之開/關舌片46互動。 如圖71所不,一藉由連桿總成43〇耦接於閉合扳機 的梭總成3400被支承在主殼體部分34〇内。梭總成34〇〇 亦可由以一聚合物或其他適當材料模製或其他方式製造且 5經設計要配合在一起的二個部件34〇2、34〇4構成。部件 ' 3402、3404可由扣接構件及/或黏著劑及/或螺栓、螺釘、 夾子、及類似物固持在一起。梭總成34〇〇之右邊部分34〇2 _具有一右止動凸緣區段3405,該右止動凸緣區段適於與梭 總成3400左邊部分3404上之一左止動凸緣區段(圖中未 10示)合作形成一可依前文所述方式伸入長形閉合管3190 之近端3196之-止動溝(圖中未示)内的止動凸緣總成。 長形脊構件3102之近端3104伸入形成於梭總成34〇〇之遠 端中的開口 3403内,且藉由延伸穿過分別位在右邊部分 3402及左邊部分34〇4中之開口 3406的右止動樁311〇及 15開口 3408的左止動樁3112不可動地附接於右邊機殼構件 _ 320。此外,梭總成34〇〇具備侧向延伸的導執34ι〇、34ιι。 執這3410建構為可滑動地收納在右邊機殼構件32〇之一對 應執道$件内,且軌道3 411建構為可滑動地收納在左邊機 设構件330之一對應執道導件内。因此,梭總成μ⑽及閉 20合管3190可相對於附接於把手總成3〇〇之脊總成31〇2轴 向地移動。 梭總成3400及長形閉合管3190在遠侧方向(箭頭、、c/r ) 中之軸向移動係由閉合扳機302朝把手總成3〇〇之握把部 分342移動產生,且梭總成3400在近側方向(箭頭、、D") 96422 73 200814963 中之軸向移動係由閉合扳機302移離握把部分342產生。 在各實施例中,梭總成3400具備一讓閉合連桿總成3430 與其附接的連接器舌片3412。參見圖71和72。閉合連桿 總成3430包含一藉由一銷3414可樞轉地銷接於連接器舌 1 片3412的軛部分3432。閉合連桿總成3430更有一閉合臂 ' 3434,該閉合臂如圖71所示藉由一閉合銷436可樞轉地銷 接於一形成在閉合扳機302上之輛總成304。閉合扳機302 _ 藉由一延伸於右邊機殼構件320與左邊機殼部分330之間 的樞軸銷306可樞轉地安裝在把手總成300内。 10 當臨床醫師想要關閉砧40並將組織夾緊於終端作用器 12内時,臨床醫師將扳機302拉往握把部分342。隨著臨 床醫師將閉合扳機302拉往握把部分342,閉合連桿總成 3430依遠側'VC〃方向移動梭總成3400直到閉合連桿總成 3430移至圖71所示鎖定位置為止。當處於該位置時,連 15 桿總成3430會傾向於將梭總成3400保持在該鎖定位置。 • 隨著梭總成3400移到鎖定位置,閉合管3190在脊總成 3102上往遠侧移動,導致砧40上之關閉/開啟舌片46被 閉合管區段3190之遠端3192之馬蹄形孔3194之近端碰觸 從而將砧40樞轉至關閉(夾緊)位置。為更進一步使梭總 20 成3400保持在關閉位置,可使用一如前所述之鎖定機構 301。 如前所述,本發明各實施例利用一獨特新穎回縮桿總成 4000讓臨床醫師能夠監測擊發和回縮行程之進程並且提 供手動縮回一擊發桿4030之能力。如圖72所示,回縮桿 96422 74 200814963 總成4000包含一可滑動地銷接於一推桿4020的回縮桿 4010。特定言之,回縮桿4010有一穿透的長形槽孔4012, 該槽孔經訂定大小可滑動地接收二個銷4014以供將回縮 桿4010附接於推桿4020。一回縮握把4016可附接於回縮 5 桿4010之近端4011。 • 推桿4020有一經設計用以與一長形擊發桿4030之近端 交界的遠端4022。如圖72所示,擊發桿4030之近端4032 ⑩有一形成於其上的連接器部分4034,該連接器部分經訂定 大小用以接收推桿4020遠端4022中之一對應造型連接器 10 孔4024。因此,可利用推桿4020為一擊發行程依遠侧方 向軸向地推動擊發桿4030或是為一回縮行程依近側方向 拉動擊發桿4030。熟習此技藝者會理解到擊發桿4030延 伸通過脊總成3102。在替代實施例中,擊發桿4030可有 一矩形、方形或類似的橫截面形狀且如前所述附接於刀具 15 總成30之遠端31或是連接到不同類型之刀桿及其他需要 馨一軸向運動予以作動的終端作用器組件。 圖72-77包括梭總成3400之多個圖式。如這些圖中所 示,左邊梭部分3404包含二個間隔的鉛直支撐壁3416、 3418,該等支撐壁在其間界定一推桿開口 3420。推桿4020 20 之遠端4022延伸穿過推桿開口 3420欲耦接於擊發桿4030 之近端4032。如圖72所示,推桿4020之近端4026耦接 於一 V'Z〃形連接器部件4040。特定言之,推桿近端4026 有一自其突出的連接樁4028,該連接樁可收納於Z形連接 器部件4040之近端4041上之一附接舌片4042之一開口 96422 75 200814963 4049中。參見圖72。但推桿4020之近端4026可藉由一螺 釘或其他適當繫結件附接於附接舌片4042 〇Z形連接器部 件4040之遠端4045在其上有一遠側附接舌片4046,該遠 侧附接舌片適於連接到一從一氣動缸總成5000突出之活 5 塞缸5040。 * 如圖79所不’氣缸總成5000包括一第一氣缸殼體 5010,該第一氣缸殼體具有一第一封閉近端5012及一通入 ⑩第一氣缸殼體5010中之一第一軸向通道5016内的第一開 放遠端5014。氣缸總成5000亦包括一第二氣缸殼體5020, 10 該第二氣缸殼體具有一第二近端5022及一通入一第二軸 向通道5026内的第二開放遠端5024。第二近端5022有一 第一活塞頭5028形成於其上,該第一活塞頭經相對於第一 軸向通道5016訂定大小用以與第一氣缸殼體5010之第一 壁5011產生一大致氣密滑動密封藉以在第一近端5012之 15 遠侧與第一活塞頭5028之近側之間界定一第一氣缸區 _ 5015。第一氣缸殼體5010之第一遠端5014更有一形成於 其上的向内延伸第一凸緣5017,該第一凸緣用於與第二氣 缸殼體5020之外壁表面建立一大致氣密滑動密封藉以在 第一凸緣5017之近側與第一活塞頭5028之遠側之間界定 20 —第二氣缸區5018。 一第一通道5027穿透第一活塞頭5028。如圖79所示, 一活塞缸5040穿過第二氣缸殼體5020之第二開放遠端 5024伸入第二軸向通道5026内。活塞缸5040具有一近端 5042及一封閉遠端5044。一第二活塞頭5046形成於活塞 96422 76 200814963 缸5040之近端5042上。第二活塞頭5046經相對於第二軸 向通道5026訂定大小用以與第二氣缸殼體5020之一第二 壁5021產生一大致氣密滑動密封藉以界定一第三氣缸區 5032。第二氣缸殼體5020之第二遠端5024更有一形成於 ^ 其上的向内延伸第二凸緣5025,該第二凸緣用於與活塞缸 • 5040建立一大致氣密滑動密封以在第二凸緣5025之近侧 與第二活塞頭5030之遠侧之間界定一第四氣缸區5034。 ⑩一開口 5047穿過第二活塞頭5046通入活塞缸5040之一通 道5048内。 10 如圖79和80所示,氣缸總成5000安裝在殼體總成300 内。一第一供氣線路或供氣導管5050從把手總成300之一 定向控制閥610延伸欲耦接於第一氣缸殼體5010第一近端 5012藉以供給加壓氣體通過第一氣缸殼體5010第一近端 5012之一第一供氣璋5013或開口。此外,一第二供氣線 15 路或供氣導管5052從定向控制閥610延伸到第一氣缸殼體 _ 5010之遠端5014附近連接至第一氣缸殼體5010藉以經由 一第二埠5029將加壓氣體送入第二氣缸區5018内。參見 圖78。 參照圖78和79,今詳細說明擊發桿4030之伸長及回 20 縮。如圖78所示,供氣線路5050和5052耦接於一傳統定 向閥1610,該閥係為裝在把手總成300内之一驅動器系統 1600的一部分。定向控制閥1610具有一前進位置區段 1620、一停止區段1630、及一倒轉區段1640。控制閥區段 1620、1630、1640可藉由穿過把手殼體300突出之按鈕1612 96422 77 200814963 和⑹4手動切換。在各實施例中,使用一可移除的加壓氣 體源620。參見圖71及81-83。但熟習此技藝者會理解到 亦可有效地利用不可替換/再充氣的加壓氣體源(貯氣 瓶)。在更其他實施例中,把手總成3〇〇可具備一用以從一 5外界加壓氣體源618供給加壓氣體的埠口 616。舉例來說, '器具3010可透過一可撓供氣線路617耦接於設施中之壓縮 空氣供應器618。參見圖81A。 # a加壓氣體從貯氣瓶622 (或外界壓力源618)通過一供 氣線路650流入一傳統比例閥66〇。如圖78中特別顯示, 1〇比例閥660耦接於一附接至一啟動扳機67〇之供氣連桿 662。在各實施例中,啟動扳機670被支承在擊發扳機31〇 附近"亥虡务扳機藉由一在右邊機殼構件320與左邊機殼 構件330之間延伸的柩軸銷37()可樞轉地搞合於把手總成 300。將啟動板機67〇向内朝擊發扳機31〇擠壓會導致比例 15閥660許可更多加壓氣體通過一供氣線路副流入定向闕 •二1〇内。視定向閥161〇之位置而定,加壓氣體會流入供 氣、、泉路5050或5052内。舉例來說,當定向閥61〇被臨床 百師作動以伸長擊發桿3〇時,控制閥161〇切換到前進位 f致使4進通道1622許可加壓氣體從供氣線路68〇流入供 氣、泉路5050内。流過供氣線路5〇5〇的氣體透過封閉端 刈^之第一供氣埠5013進入第一氣缸區5015且通過第一 ^基,5〇28中之開口 5027並進入第三氣缸區5032。進入 第三氣缸區5032的加壓氣體亦通過第二活塞頭5046之開 5047進入中空活塞缸5〇4〇内且迫使活塞缸钧牝往遠側 96422 78 200814963 移動。位於第四氣缸區5034内的氣體透過第二氣缸殼體 5020之排氣口 5023排出。相似地,位於第二氣缸區5018 内的氣體被允許透過第二開口 5029排入第二供氣線路 5052内。第二供氣線路5052將排放的氣體送到定向閥1610 勹之通道1624,由此最終從排氣通道1632排出。持續向第 • 一氣缸區5015、第三氣缸區5032、及活塞缸5040之通道 5048施予加壓氣體會導致活塞缸5040如圖73及79所示 _ 往遠侧延伸。隨著活塞缸5040往遠侧延伸,Z形連接器 4040亦因其與活塞缸5040之遠端5044附接而往遠侧延 10 伸。Z形連接器4040迫使推桿4020往遠侧移動,從而迫 使擊發桿4030亦往遠侧移動。隨著擊發桿4030往遠侧移 動,附接於該擊發桿的刀具總成30遠端部分31推進通過 釘匣50以切斷終端作用器12夾緊之組織並擊發肘釘。一 旦刀具總成30已被推進到其在終端作用器12中之最遠側 15 位置,臨床醫師放開啟動扳機670以中斷加壓氣體之施加。 _ 本實施例亦可具備一用以在刀具總成30已抵達其在釘 匣50内之最遠侧位置時作出指示的器件。特定言之,可提 供一從供氣線路650延伸到遠側限制開關1770的遠側輔助 線路1772。一遠侧限制開關線路1774提供在遠侧限制開 20 關1770與定向控制閥1610之間。因此,當刀具總成30 已完成擊發行程,遠侧限制開關1770相對於氣缸總成5000 之一部分定向為使該氣缸總成被該遠側限制開關之一部分 作動。遠侧限制開關1770許可空氣在壓力下從供氣線路 650流到遠侧限制開關線路1774並流入定向控制閥1610 96422 79 200814963 5 10 15 20 内,這在各實施例中會導致定向控制閥161〇自動切換至倒 轉位置/這如下文所述導致擊發桿4030縮回。在各實施例 中’一第一氣笛1790或其他適當發聲裝置可與遠侧 (或遠侧限制開關17雨 声史立产味主 弟軋由1790向臨床醫師提供一 =曰L旒表不刀具總成3〇已抵達擊發行程之末端。在替 氣笛1790可換成壓力開關壓力計或類似物以向 L床百師k供刀具總成30何時抵達擊發行程末端之一 ⑹氣力縮回擊發桿侧時,臨床醫師可押下按紐 670 Λ 161G㈣到倒轉位置且開始擠壓啟動扳機 ΓΙ’Λ 氣體流入第二供氣線路5052内。流過第 -,“路5052的氣體進入第二氣缸區5〇18導致第 缸殼體5020往折彻綠入楚 ^ , 、 “ f广 弟一氣缸殼體5010内。第-氣缸 供μ二 被允許經由第一供氣開口 5013排入第- .ρ, ^1Λ 通過弟一供軋線路5040的氣體進入定 =1”此從排氣° 1632排出…旦進人第二氣紅 = 體已導致第二氣紅殼體5〇2〇縮入第一氣 Γ ΓΠ通過第二開口 5029的氣體此時能夠通過 喊體5_之排氣口湖流人第四氣缸區腦。 體進入第四氣紅區5034,第二活塞頭獅將 ^土缸5040在近侧拉入第二氣缸殼體5咖内。第三氣缸 £ 5032内的氣體诵禍笛 «η ; 孔體通過弟一開口助進入第-氣缸區5015 96422 80 200814963 Η娜=:==: 5 10 15 20 門闢1: Γ 近侧輔助線路1662亦在-近侧限制 二f則共氣線路65G之間延伸。近侧限制開關1660 相^聽總成5000或連接器购定向為當擊發桿侧 乂兀王、’'但回日守’近側限制開關丨76〇被作動然後許可空氣流 入近側限制開關線路1764並流入定向控制閥⑹〇 =定一向控制閥1610自動切換到停止位置。在替代實施例 二氣^ 1792或其他適當發聲裝置可與近側限制開 :〇連通,致使當近侧限制開關〗76〇在回縮行程之末 ,被作動時,通過近侧限制開關線路1764的空氣作動第二 乳笛1792向臨床醫師提供另一聲音信號表示擊發桿4⑽〇 和刀,分30已抵達回縮行程之末端。在其他實施例中,舉 例來說,電池供電的發光二極體或其他發信裝置可與遠側 和近侧限制開關1770、1760聯繫以向使用者提供楔^滑橇 /刀具已抵達擊發行程及/或回縮行程之末端時的另一指 不。熟習此技藝者會輕易理解到如果臨床醫師想要在擊發 行程期間停止擊發行程並縮回擊發桿和刀具,他或她必須 以手動地將控制閥1610切換到倒轉位置的方式進行。、 在以上所述實例中,臨床醫師並未使用本發明此實施例 之獨特新穎回縮桿總成4000。回縮桿具有多項優點。首 先’如果在擊發或回縮行程的過程中,氣動力譬如因為一 空的供氣瓶620或是因為加壓氣體供應之意外中斷而意外 96422 81 200814963 喪失,臨床醫師可簡單地藉由手動地將控制閥1610切換到 倒轉位置,抓住附接於回縮桿近端之握把4016並將該桿往 近侧方向拉動至擊發桿已完全縮回的方式手動縮回擊發桿 (及刀具總成30)。參見圖83。將控制閥1610切換到倒轉 ‘5 位置會讓氣缸總成内的氣體在刀桿縮回時排掉。 ; 本發明此實施例提供之另一優點是目視監測擊發桿及 刀部分在擊發行程期間往遠侧移動之擊發進程的能力。此 _ 優點可簡單地藉由在開始擊發行程之前將回縮桿拉到圖 83所示其最近侧位置的方式實現。當在該位置時,隨著氣 10 缸總成5000將連接器4040、推桿4020及擊發桿4030往 遠側推進,推桿4020藉由其與回縮桿4010之銷連接而將 回縮桿4010隨之往遠侧拉。在各實施例中,回縮桿4010 之長度被提供為當擊發桿4030完全伸長時,回縮桿4010 沒有任何部分從把手總成300突出。因此,臨床醫師可藉 15 由觀察回縮桿4010從把手部分300突出之部分來判斷擊發 # 桿4030及刀具總成30之進程。 在圖72A和83A所示替代實施例中,回縮桿4010可具 備至少一個、較佳至少二個凹口 4015以接收銷4014。熟 習此技藝者會理解到此配置會向臨床醫師提供在回縮行程 20 期間目視監測擊發桿4030及刀具總成30之進程的能力。 特定言之,隨著擊發桿4030被縮回,推桿4020導致回縮 桿4010因銷4014接合於凹口 4015而往近侧推進至殼體總 成300外。因此,臨床醫師可藉由觀察回縮桿4010突出把 手總成300外之距離而判斷出擊發桿4030在回縮行程期間 96422 82 200814963 已行進的距離。但當器具未在使用中時,回縮桿4〇ι〇可被 推入把手總成内如圖81所示位置。 一儘管以上已說明本發明數個實施例,但應理解到熟習此 技藝者可想出許多修改、變更及適應變化達成本發明之一 些或全部優點。舉例來說,依據各實施例,單一=件可換 成多個組件,且多個組件可換成單—組件,#以執行一或 多項已知機能。因此本中請案希望涵蓋所有此等修改、變 更及適應變化而不脫離隨附申請專利範圍項所界定 精神及範圍。 x20 Figures 46-48 illustrate the use of the articulated joint assembly 2〇〇2 with the quick-release joint 1000 of the type and construction described above. But in this configuration, she: uses four mouthwashes. As shown in Fig. 47, the 'distal connector portion (1) 6; has a first distal air supply port 1U7 coupled to the first air supply line portion 54A. - a second distal air supply tan is provided in the distal connector portion (1) 6 and is consuming - the second air supply line segment 542. :1丨丨8 as shown in the figure from the first-distal air supply 璋: two τ: two gas nozzle part 1122 from the second gas supply (four). The proximal side side connector portion 1116 further has a third distal air supply port 1120 that is in contact with a first section 2042, and the tenth side of the Seto, the soil The connector portion 1116 has ten line segments 2052. _ 坌 视 且 且 且 且 且 且 且 且 且 且 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视 视From the fourth air supply port 112〇, similarly to the outer four protruding milk nozzle portion in the proximal direction, the proximal ridge segment 1150 is far away from: - (10), the second connector portion has a _ there: the first == The gas supply near the side is 1156. The second connector portion: the second example: the second air supply line section 542, the second: the side supply aperture 1160. The first side of the gas supply 1156 is constructed to be removably received by the first gas supply nozzle 1118 埠, 1160 is sized to be used for A 甘 _ A ^ 仏 仏 仏 ί ίο (10). As shown in Fig. 47m, the second air supply nozzle is received to receive the ring seal 1158 and the first proximal air supply. ^ In the / - He mouth 1118 inserted into the first - proximal gas supply 1156 road area, 540, and another first gas supply line section = caused by rolling (or liquid tight) seal. When coupled in this manner =:, the first - gas supply line section 540, and 54G" 3 '2 gas line 540. Similarly, a second. The ring seal 1162 is combined with: near: = 埠 116G to The second air supply nozzle 1122 is inserted into the second proximal side of the supply: 1160, and is disposed in the second air supply line section 542 to form another substantially airtight (or liquid tight) seal with __. When the mode is lightly connected, the second gas supply line sections 542, and 542" form a second gas supply line 542. Further, the distal end (10) of the ridge section 115 has a second connector portion Ρμ^; the connector portion has a third proximal air supply port 1156 coupled to the other third gas supply line region 42". The second connector portion 1154; is further coupled to the other fourth gas supply line section 2〇52, the fourth 96422 49 200814963 5 ίο 15 20 proximal air supply port 1160'. The third proximal side An air supply port 1156 is configured to removably receive a third air supply nozzle 1118 therein, and a fourth proximal air supply port, 1160, is sized to be removably received therein a fourth air supply nozzle ^ 122. As shown in Figure 47, a third zero ring seal 1158 is combined with a third proximal air supply port, 1156' to be inserted into the third proximal air supply port at the third nozzle 1118. k forms a substantially airtight (or liquid tight) seal between the second supply line section 2G42 and the other third supply line section 2042". When the surface is connected in this manner, the third gas supply line sections 2G42, and 2042" are connected to form a third line 2042. Similarly, a fourth loop seal ΐ 62, and; for t 埠 1160, In combination with the fourth air supply nozzle 1122, the fourth nipple 116G is inserted, (4) in the fourth gas supply line section, the disk-fourth gas supply line section 2052, and the Pi-shaped #. 20% of another substantially airtight (or liquid tight) ^ 2052^. The spirit and scope of the fourth gas supply line section 2052 when 1 1 is joined together. As described in the paragraph, as the internal cutter system becomes more variable, it becomes more difficult to change the difficult axis of the pneumatic system that generates the necessary transmission force.得比: Easy = The motor drives the rotary transmission to move the joint movement == The movement can easily make a great difference in terms of long and manageable or generating capacity:: The length of the shaft and the diameter of the shaft are 糸The effectiveness of the system will be limited by the size of the motor in the far field: the length of the pinning mechanism, although the application, the diameter of the shaft 96924 50 200814963, the expected size prevents the motor from being positioned at the far end of the system while providing Full energy drives the system. The following embodiments address these problems and deficiencies associated with drive motors. As will be described in more detail below, these embodiments utilize a pneumatic motor to transmit rotational 5 power to a rotary driven internal cutter. Air motors typically produce torque and revolutions per minute that are proportional to the pressure and volume of the gas delivered to the motor. In the non-limiting embodiment illustrated in Figures 49-56, a rotational motion is transmitted from the air motor to the end effector using a articulation _shaft assembly. However, those skilled in the art will appreciate that the unique novel aspects of these embodiments of the present invention can also be effectively combined with other known rotary driven end effectors and other rotational transmission motions to the inner cutter using a flexible drive shaft configuration. Use of surgical instruments. Moreover, the unique novel aspects of these embodiments of the present invention can be effectively used in conjunction with non-joint end effector configurations. Figures 49-56 illustrate a surgical cutting and stapling instrument 15 〇〇 15 of the present invention utilizing a rotary driven inner cutter 1512. There are a variety of rotary driven internal 10 cutters and other surgical instruments. For example, a rotary inner cutter configuration discloses a US 20 patent application filed on January 31, 2006, to Shelton, IV et al., entitled, Motor Driven Surgical Cutting and Fastening Instrument With Adaptive User Feedback 77 The relevant part of the patent application is incorporated herein by reference. Other examples are disclosed in U.S. Patent Application Serial No. (KLNG No. 96422 51 200814963 050704/END5779 USNP), filed on June 27, 2006, to Shelton, et al., entitled vv Manually Driven Surgical Cutting and Fastening Instrument. The relevant portions of this patent application are incorporated herein by reference. Figure 50 is an exploded view of a terminal effector i5i2 in accordance with various non-limiting embodiments. As shown in this exemplary embodiment, the end effector m2 can include a long slot i that is sized to receive a pneumatic operating tool. The pneumatic operating tool of each non-limiting embodiment includes an internally operatively operative member 15 (e) g 50 . This embodiment includes a wedge-shaped skid total (four)^ having a knife portion 1538 on the skid assembly. The wedge-shaped sliding sample assembly (10) (four) is a screw drive screw 156. A bearing 1522 at the end 1521 of the long channel (10) receives the screw drive screw 156, allowing the screw drive screw 156 to freely rotate relative to the long channel (10). The screw drive screw (10) can be coupled with the "threaded opening (in the figure) of the wedge slider assembly (10) to cause the rotation of the drive screw 156G to cause the wedge slide total 30 to be in the & fully extended or actuated position - Translating distally or proximally between fully retracted or unactuated positions (depending on the direction of rotation and passing through the long slot 1520', the elbows that are supported within the staples in the fully extended or actuated position are all According to this, when the # helical drive screw WO is rotated in one direction, the wedge-shaped skid assembly 153 is driven to the far side to cut the tissue clamped in the end effector 1512 and the nail is broken. The inner staples cause the staples to make a form contact with the bottom surface of the anvil 4 pivotally coupled to the long channel 1. The slider portion 1532 of the wedge slider assembly 1530 can be made, for example, of plastic, and There may be a slanted distal surface 1534. As the wedge sled assembly 153 traverses the long channel 152 〇, the slanted front w surface 1534 pushes or pushes the staple within the 匣5〇 through the clip 96422 52 200814963 Tight organization and resistance to station 40. Station 40 flips the elbow from The stapled tissue is stapled. When the modular slip assembly 15 350 is retracted, the knife portion 1 $ 3 § and the bone sled portion 1532 can be separated, thereby leaving the slider portion 1532 in the long slot. The distal end of the track 1520. Those skilled in the art will appreciate that other pneumatic motors can be used as tools and other firing mechanisms. Figures 51 and 52 illustrate a rotational motion of a pneumatic motor from a handle assembly 3 (10) to a screw drive screw. The drive shaft configuration of the 1560. As seen with reference to Figure 51, this embodiment can be slidably fitted over a ridge assembly i 54 运用 using the closure tube assembly closure official assembly 170 detailed above, the ridge assembly 10 A proximal ridge 1542 that rotatably supports a main rotating (or proximal) drive shaft 1544 that is coupled to the primary (or distal) via a helical gear assembly 1550 that includes gears 1552, 1554, 1556 The drive shaft 1546 is coupled. The secondary drive shaft 1546 is coupled to a drive gear 1548 that is coupled to one of the proximal drive gears 1562 of the screw drive screw 1560. The vertical oblique 5 gear 1552 is pivotally supported on the proximal ridge One of the distal ends of segment 1542 can be opened within 1 The secondary drive shaft 1546 and the drive gears 1548, 1554 are closed by a side ridge section 1570. In summary, the main drive shaft 544, the secondary drive shaft 1546, and the joint assembly (such as the helical gear assembly 1550) are As used herein, the main drive shaft assembly " is shown in Figures 53 and 54. Each embodiment of the appliance 1500 is powered by an aerodynamic source in the form of a pressurized gas source 620. In the embodiment shown in these figures, source 620 includes a replaceable/refillable gas cylinder 622 that is supported within grip portion 642 of housing assembly 3. The gas cylinder 622 can be refillable. However, those skilled in the art will appreciate that an alternative/re-inflatable pressurized gas source that does not utilize 96422 53 200814963 can be utilized effectively (handle assembly 300 can be provided with one meter, metered open. In one embodiment, pressurized gas Tankou outside & pressurized gas source shoulder supply novel 1 point more == removable / refillable gas cylinder (2) unique action device 1512, how the transmission system provides rotary motion to the terminal ° ° (5) W see The pressurized gas is passed under pressure from the external pressure source 618 of the gas cylinder 622 1 through a supply 妗 攸 攸 攸 622 622 622 622 622 622 。 。 。 。 。 。 。 。 比例 比例 比例 比例 比例 比例 比例 比例 比例. . , θ . . . , Attached to a start trigger 070 for two two 1c / Fig. 53 and 58 ° in each of the embodiments 'starting the trigger machine J f / 310 ^ # machine j by & A pivot pin 37 that extends between the right housing member 32G and the left housing member 330 is pivotally coupled to the handle assembly. Relative position trigger 310, It may be made of plastic or other suitable material and has a portion having a generally U-shaped loose cross section to accommodate the trigger (4) as shown. The clinical teacher can place his or her hand on the grip portion of the housing assembly 3, causing the next three fingers to trigger at the relative position 31〇. And the index finger is in the start, Trigger 670. Will trigger the trigger 67 〇 to the relative position trigger η〇, The V-proportional proportional valve 660 allows the gas to flow from the source 62 (or 618 of Figure 53) through the valve to a supply line 68 into the directional control valve 1610 under pressure. As shown in Figure 56, The directional control valve 161 has a forward position section 1620, a stop section 163〇, And an inversion section 164〇. Control valve section 96422 54 200814963 1620, 1630, 164 〇 can be by a button 1612 protruding through the handle housing 300, 1614 manual switching. See Figure 56. Two gas supply/exhaust lines 00, The 1710 extends from the directional control valve 161〇 to a conventional air motor 173. Therefore, When the clinician switches control valve 1610 to the advanced position, The intrusion 1622 allows pressurized gas to cause the air motor 1730 to pass from the gas supply line 68 to the first direction dn in the helium line (10), which is described in detail below. This causes a rotary motion 'month ί ♦ axis 1544, In a firing stroke, the mold slide is driven to total ίο 15 20 532 and the knife portion 1538 is distally passed through the end effector Μι]. The sister passes the gas leaving the air motor (10) from the road mo through the exhaust gas 680 when the 161G is switched to the reverse position. The milk body is allowed to flow through the gas supply line 171 into the air motor through the gas supply line 171, and exits the pneumatic horse S through the air supply/exhaust line 17 to discharge the exhaust gas (6) 2 . When the control is in the stop position’: Body penetration = and the gas supply/exhaust material 1710 is closed and the gas supply line 17 is closed; ^ Road Exhaust 埠 1632. See Figure 56. The inverse strong master as shown in Fig. 56 further shows that the output shaft (7) 2 of the air motor WO has the first transmission gear 1734, The first transmission gear is sprayed onto the second output of the input shaft 1738 of the two-four-spindle gear assembly 1740. 6·. The planetary gear assembly 1740 has an output shaft 1742, The 1545 conventional coupling member 1743 is coupled to the proximal end of the transmission shaft 1544 and is turbulently transmitted to the proximal end of the transmission shaft. therefore, When the control valve 1732 ^ the gear assembly 1740 adds a rotational motion to the 96422 55 200814963, the drive shaft 1544 causes the wedge sled assembly 153 and the knife portion 1538 to be clamped in the end effector 1512 by the staples 50. It organizes and drives the staples in the magazine 50 into forming contact with the anvil 40. When the control 阙161〇 switches to the reverse position, The output shaft 1732 of the air motor 1730 applies a reverse 5 rotational motion to the drive shaft 1544 to retract the wedge slider assembly 153 and the knife portion 1538 through the magazine 5 in a proximal direction. The embodiment shown in Figures 49-56 also has the operability of the instrument and is Physicians offer a variety of unique and unique features in a variety of forms of feedback. This allows the clinician to monitor the position of the wedge sled assembly 153 and the knife portion 10% 10 within the staple raft 50 as it advances and retracts on the transport side. Referring again to Figure 56, it can be seen that a feedback gear is provided on the drive shaft or on the output shaft 1742 of the planetary assembly 1740. The feedback gear 175 is engaged with a tool position gear η% mounted on a threaded knife position shaft 1754. The knife position axis 1754 can be supported by a suitable # bearing arrangement (not shown in Figure 15) that facilitates its free rotation. A proximal limit switch 176A is coupled to the proximal end η% _ of the shaft 1754, And a distal limit switch 1770 is coupled to the distal end 1758 of the shaft 1754. A knife indicator 1780 is threaded onto the knife position axis 1754 for distal and proximal movement on the knife position axis. When the drive shaft 1544 is caused to cause a wedge slip, The assembly 1530 and the knife portion 1538 are rotated 20% in the direction of the nail by 5〇, The knife finger 178 〇 also moves to the distal side to restrict the opening of the switch port. The distal limit switch 177 is oriented such that when the wedge slider 1530 and the blade portion 1 1 Γ are at the farthest position, Knife Indicator _ Actuating the distal limit ‘ ^ A window is provided to the left housing member 330 (or the right housing member 320, This depends on the position of the knife position axis 1754 within the housing assembly 300) 96422 56 200814963 , The clinician (4) phase cutter refers to the position of w(10) to determine (four) configuration (wedge assembly 1530 and knife portion 1538) within its firing stroke. The device is provided to the clinician to monitor the position of the wedge 1530 during the retraction stroke. 5 10 15 20 and in various embodiments, Available - extended from the gas supply line (4): : The distal auxiliary line 1772 of the switch 1770. A distal limit switch 774 can be provided between the distal limit switch (4) and the directional control valve 161, so that 'when the wedge sled assembly (10) and the knife portion 1538 have completed the hand stroke and the knife indicator 178 is actuated distally Limit switch (4), The distal limit switch Π70 allows the gas to flow under pressure from the supply line (4) to the distal limit switch line 1774 and into the directional control valve 161〇, This would cause the directional control valve 1610 to automatically switch to the inverted position and cause the air motor 1730 to reverse and eventually apply a reverse rotational motion to the drive shaft 1544. When the air motor 173 turns the drive shaft (10), The reverse rotational motion is transmitted to the knife position axis 1754 to drive the knife position indicator = 80 toward the proximal limit switch 1 to move back. - Near side auxiliary line 丽 = can limit the switch on the near side! 6 6 延伸 extends between the gas supply line 6 5 ,, The second proximal limit switch is actuated when the knife position indicator 1780 actuates the proximal limit switch 166 (meaning that the wedge slider 1530 and the knife portion 1538 have moved to their fully retracted position)! 660 thus permits the gas to flow into a proximal limit switch line 1664 and flow into the directional control target 161 〇 π thereby causing the directional control valve 1610 to automatically switch to the stop position. In various embodiments, a first whistle 1790 or other suitable sounding device can be coupled to the distal limit switch line 1774 (or the distal limit switch 177 96) 96422 57 200814963 , , Having caused the distal limit switch 1770 to be actuated at the end of the firing stroke, the air passing through the distal limit switch circuit 774 causes the first air stag 179 to provide an audible signal to the clinician indicating that the wedge sled/tool has reached the firing stroke The end. same, A second whistle 1792 or other suitable audible device can be in communication with the proximal restriction switch 1760, Causing when the proximal limit switch '1760 is actuated at the end of the return line, The air passing through the proximal limit switch line 1764 causes the second whistle 1792 to provide the clinician with another audible signal indicating that the wedge sled/knife has reached the end of the _ stroke. In the case of Li He ^, for example, A battery powered light emitting diode or other signaling device can be associated with the distal and proximal limit switches 177, 176〇 contact to provide the user with another indication that the wedge sled/tool has reached the end of the firing stroke and/or the retraction stroke. In an alternate embodiment, Gas flute 1790, The 1792 can be replaced with a pressure sensing H or a pressure phase indicating which device (4) reaches the end of the firing stroke and/or the retraction stroke. ^ In the various embodiments shown in Figures 49-56, The air motor is supported. In the embodiment shown in Figures 52A and 52B, Air motor ^, = in the side ridge section 110. Motor drive shaft 1546, There is a transmission gear 1548' thereon, The drive gear meshes with the proximal side of the screw drive screw 1560 = the move gear 1562. Fig. 52A illustrates the use of the distally mounted air motor with a joint joint 1〇4 as described in Fig. The embodiment shown in Fig. 52B uses a pneumatic joint assembly 2 2 as previously described. These far-mounted air motor configurations can also be used with appliances that use other joint configurations. Or the rider is not used with respect to the handle assembly or the attached long shaft assembly. Those skilled in the art will appreciate that the 96422 58 200814963 side-mounted air motor configuration minimizes the power loss that may be encountered in the embodiment through the elongated axle configuration. The motor is supported in the handle assembly and the firing and retracting movement must be transmitted through the joint joint to the final actuator. Embodiments such as those illustrated in Figures 52A and 52B require only two lines 5 Π 10 and 1760 to pass through the joint to align with the motor 173. Energy Supply. Lines ' and 1760 may include flexible tubing or the like and do not limit the articulation joint as compared to other embodiments that require one or more transmission members to pass through the joint. The embodiments of the present invention can be constructed to provide the user with a tactile feedback regarding the relative position of the firing assembly of the device. In some embodiments, 10 This is by pulling the stroke monitoring member or relative position trigger 31, The manner in which the forward and retracting motions are applied to the drive shaft or firing mechanism applied to the I-set is more specific and is described with reference to Figures 53-55. This embodiment can include a feedback link assembly 1800, The feedback link assembly is available in various non-limiting embodiments, Include a threaded manual feedback shaft 18〇1, The shaft is attachable to the thread _ rotatably mounted at the relative position trigger 31〇, One of the upper attachment plate portions Μ] • a nut member 334. The distal end of the manual feedback shaft 18〇1 has a universal joint portion that supports a manual feedback gear 1804. The manual readback gear is incompatible with the second knife position wheel 1752. When the directional control valve 16 is in the forward position, The pneumatic horse 1730 drive shaft 1544 causes the firing mechanism in the form of a wedge slider 153 〇 = trowel 1538 to be driven distally through the cylinder (fire stroke). The feedback gear 175 〇 drives the knife position gear 1752, The riding window wheel drives the manual feedback gear 18〇4. Then manually return the gear 8〇4 to turn the manual feedback shaft. The manual feedback shaft triggers the relative position trigger 31 due to its engagement with the nut thread. Pull to the handle total & 3〇〇 grip 96422 59 200814963 =342 ' thus providing the clinician with a representative of the wedge sled 1530 and the knife portion 1538, , Tactile 1 shows. Those skilled in the art will understand that the physician at ίο 15 20 ^ attempts to trigger the relative position 31 〇, The handle of the handle assembly 300 is pivoted by 342. The manual feedback of the shaft 1801 and the nut 334 prevents any movement thereof. Yes, Relative position trigger 31, It will be related to the automatic sliding of the camber 153 〇 = the advancement and retraction of the knife portion 1538. This configuration is available to the clinician - only need to grasp the relative position trigger training in the surgical procedure. The wedge-shaped skid assembly 153 〇 and the knife portion 1538 (fire-fighting mechanism) that can be passed: Automatic tactile indication of advancement and retraction. Because the *匕' clinician can get this feedback without looking at any f West. This configuration provides the clinician with a one-handed non-visual feedback of the firing mechanism between the actuated position and the actuated position and when the firing mechanism returns from the activated position to the unactuated position. Embodiments may further have an additional feedback configuration, generally designated 333. for example, As shown in Figure 53_56, Relative position trigger, The attachment plate portion 332 can be provided with a slot that is at the junction of the fish spring handle 337 and the inner spring arm 337 when the pin 37 is centered on the pin 37 击 during the firing and retracting stroke. 335, With ^Sis and the similarity of the upper attachment plate portion 332 with the relative position trigger 31, The end of the =% U 337 falls into each of the sequential slot milks and is used (in order) to apply a force to the upper attachment plate portion 332. This force is triggered by the clinician grasping the relative position 31〇, Time _ feels. therefore, With the phase = trigger, then 'advance, The clinical material will receive - (d) an additional tactile feedback motion corresponding to the movement of the firing mechanism to confirm the relative position trigger 310, (and the final firing mechanism) advances during the firing stroke or retracts in the line 96422 60 200814963 Cheng = retracted, No matter what the circumstances. also, As the spring arm 337 = the tip falls into each of the sequential slots, This may produce a sound, 喀 = towering to provide the clinician with information about the firing mechanism through the firing trip and back, The voice feedback of the movement of the process. therefore, This embodiment provides a series of (to _ _ _) sounds about the movement of the firing mechanism between the unactuated position and the activated position. Those skilled in the art will appreciate that the appliance 1500 exhibits an improvement that is far superior to the conventional pneumatic incision misalignment configuration. for example, Embodiments provide a means for a 10-bed medical = monitoring firing mechanism (wedge sled/tool) to be driven through its firing line. In some embodiments, When the wedge sled/knife reaches the end of its burst stroke, it automatically retracts. Once in full retraction t, control, The valve can be automatically switched to a stop position to interrupt the supply of air from source 618 = 62 = to air motor 173 . However, if during the start-up process the clinician wants to stop the wedge sled/tool pushing it far inside the cylinder, he or she can simply switch the control valve 161〇 to the inverted position and continue to activate the trigger 670 to pneumatic The motor bore 30 supplies pressurized gas until the county skid/tool moves to the desired retracted position. In addition, The unique new spoon = the trigger on the position 3 1〇' in the clinician grabs the relative position trigger Η. , 20th day: , The clinician provides a perceptible manual or tactile feedback. also, The lining can get an audible signal when the wedge sled/knife has reached the end of the firing stroke and/or has been fully retracted. ^ This artist will also understand the uniqueness provided by the travel monitoring device. _ or the bellows assembly _ can also be connected by connecting each of these transmission members with a push/pull flexible cable (not shown) or a rigid member (for the embodiment of the 64422 200814963 non-job) To the upper plate portion 332 or the relative position trigger 31, The other portions cause the propulsion and retraction of the transmission members to be directly or indirectly coupled to the relative position trigger (10), • 5 ways to get. This unique and novel configuration can also be used in conjunction with the embodiments described below with reference to Figure 7 (d). 10 15 20 As mentioned earlier, The feedback link assembly automatically moves the relative position not only at a rate corresponding to the rate at which the second motion is struck, In order to provide the device to the division - to monitor the progress of the firing mechanism, Retrieving the coupling thread will effectively block or significantly limit the manual pivoting relative position trigger 3! Oh, Other devices of the ability. In Shengjing, Relative position trigger, The time that will move = the rod assembly makes it move. In still other embodiments, Manual movement of any pivoting line = = occurs when actuated to prevent the tilting) or another cylinder (the force of the trigger 670 on the trigger 670). for example, The appearance of the red force will cause the gas to release. But before the firing machine, Relative position trigger 匕 = will also stop moving, Relative position plate machine 3ΐ0, Motion, but in other embodiments, Constructed to enable the clinician = feed U 1_ can also be built to assist the drive: = during the course: A pneumatic motor 1730 adds dynamic force to the moving parts, This is to allow the clinician to advance the squatting or stop the firing mechanism when the clinician wants it. In this case, the feedback shaft 1801 can be formed to have a trapezoidal pattern or other 62 200814963 thread configuration or configuration, This 箄 screw is a good _ _ 哥 Thread configuration will actually permit the clinician to phase ίο 15 20 on the position of money 31G, The wire pressure thereby exerts a -rotational force on the shaft dirt by its connection with the material 334. Since a rotational motion is added to the axis, the clinical Lushi also applies a rotational force to the gear 18G4. The gear is fitted to a gear 175() that fits over the drive shaft 1544. therefore, If the firing mechanism encounters resistance, the clinician can squeeze the relative position trigger mg, Mechanically generated power is applied to the drive shaft 1M4. If the clinician wants to slow down or stop the movement of the hand mechanism, The clinician can trigger 310 on the relative position, Force, The trigger then resists/slows the rotation of the shaft 18〇1 and the gear 18〇4 and eventually resists/slows the rotation of the drive shaft 1544. Each of the embodiments is provided with a material storage member for supplying gas under pressure to be placed in the form of a removable gas cylinder (2), In several embodiments, the 'removable gas cylinder 622 can be - loaded with a gas and can be refilled. In other embodiments, Removable gas storage: Tile 622 can be refilled. for example, The gas cylinder 622 can include a conventional disposable gas cylinder filled with carbon dioxide. - Once the gas cylinder is exhausted, The user removes it from the handle assembly and replaces it with a new full load cylinder. Others use gas as compressed air, for example. Carbon dioxide (c〇2), Nitrogen, , Milk, Chlorine gas, Helium, Sodium hydride, 丙院, Isobutane, Ding burning, two: Class dimethyl ether, Methyl ethyl ether, Nitrous oxide, Hydrofluorocarbons ) · HFA 134a ( 1, 1, 1, 2, -tetrafluoroethane) or jjFA 227 i ϋ, 2, 3, 3, 3. Heptafluoropropane). This configuration provides a far better than the conventional pneumatic 笙^二/, Improved configuration. However, the number of times the appliance is available depends on the volume of gas that can be stored in the gas cylinder and the need to maintain the sterility of the device 96422 63 200814963. The gas cylinder 622 used in other embodiments of the present invention stores a non-gaseous state under a storage pressure. A material that evaporates in a liquid state and at least partially liquid when the device is operated at a lower pressure. Examples of the liquid body which can be used in these examples include nitrous oxide, Dimethyl ether, Mercaptoethyl ether, Sodium hydride, Acrylic, Isobutyl, Ding burning, Hydrofluorocarbon (HFA): UFA 134a (1) 1, 1 2 _ tetrafluoroethylene bromide or carbon dioxide (c〇2) at 10 press. 10 15 20 Figure 57 illustrates a non-limiting example of a gas cylinder 622, It is provided with one of the liquid substances 624 described above. Benin cylinder 622 can be steel, Or a material that is compatible with the liquid/vapor of (10) and capable of withstanding the internal pressure generated therein. When using this manual ^ ^ ^ ^ ^ ^ ^ ^, Clinicians often have multiple locations (including bumps up and down =; The 2 assembly 300 is turned over to achieve the desired position of the end effector 12. Therefore, in some embodiments, To prevent liquid from moving into the control system during such maneuvers, - Diaphragm 626: Within the Bedding 720. Diaphragm &7丄# , ^ », The pancreatic month 626 can block the passage of liquids but is permitted by: The second yoke 628 is made of the material of the diaphragm 626. therefore, The handle assembly can be freely manipulated _ without the liquid material 624 entering the valve 1610 and/or the air motor (4) The (four)-body configuration 'gas cylinder (2) can be used in two or one to facilitate the liquid material 624 and the membrane coffee to be installed therein. The Chang seal member is constructed in this embodiment. also, Available - 里 埠 (二? The liquid-tight coat between the Ws is dry (not shown) to fill the gas cylinder 622. 96422 64 200814963 In the embodiment shown in FIG. 57, When the clinician switches the directional control valve i6i〇 to the advanced position and actuates the proportional valve 660, The pressure within the gas cylinder 622 is reduced. This pressure reduction causes the liquid material 624 to begin to vaporize. The vapor 628 passes through the membrane 626 and is used to supply the various control systems described above. therefore, By reducing the pressure in the gas cylinder 622, The liquid 624 is opened and gasified and the pressurized steam 628 is used to energize the device. Other embodiments may use liquids that require combustion to convert the liquid to its gaseous state. An example of such a liquid is propane, Butane and other petrochemical products. A conventional button igniter or other igniter system can be utilized to ignite the liquid stagnation. In these applications, Other components of the device may be fabricated from materials and means that are capable of safely dissipating any heat/smoke generated thereby. Still other embodiments may be specifically designed to convert from a solid to a liquid via a heat input at low pressure and low temperature, A phase change material that transforms from a solid to a gaseous or from a liquid to a gas. Examples of such materials are paraffin waxes and various blends of sodium. These phase change materials may have a large volume change with heat input to the system. Such devices use a device such as a burner to provide the necessary thermal energy to the material. also, Components that may be exposed to heat from these devices will be designed to safely dissipate heat during use and protect the clinician and be constructed from materials that achieve this goal. Λ 20 The embodiment shown in Fig. 57 can be used with the various types of gas cylinders described above and provides many advantages over other embodiments in which the gas cylinder is permanently mounted within the handle assembly 3〇〇. More specifically, and referring to FIG. 57, The gas cylinder 622 can be received in a cavity 671 formed in the grip portion 342 of the handle assembly 3. In order to get in and out of the cavity 671, The grip portion 342 can be easily opened by two light 96422 65 200814963. The jaws or jaws are provided with a removable cover (not shown) that is snapped or otherwise removably attached thereto. In various embodiments, The drain end 63 of the gas cylinder 622 is screwed into one of the tube header blocks 632 with a threaded opening 634. The threaded opening 634 is connected to a gas supply passage 6%. The air supply 5 passage is opened and closed by a needle valve 638. In particular, In each of the tenth embodiment, The needle valve 638 is suspected to enter the official compartment block 632 such that the air supply passage 636 can be opened and closed by rotating the needle width 638. However, other valves or flow control configurations are also possible. In order to provide the clinician with one of the cylinder pressures during use, The conventional pressure gauge 640 can be installed in fluid communication with the air supply passage 630. = Pressure gauge window 642 can be provided in grip portion 342 to allow the user to view pressure gauge 040 in use. See Figure 49. , Long figure 57#58, The air reservoir tile 622 can be supported in a detachable grip portion 342. The grip portion is removably attached to a main handle from the main! The main attachment portion (4) of the portion 5 340 that protrudes downward. • (4) can be engaged with the primary attachment portion 344 by any suitable configuration. : : ^ condition, According to various embodiments, The engagement of the removable grip portion 342 with the primary attachment portion 344 can be accomplished by a linear sliding configuration as shown. As shown in the picture, For example, in Figures 57_59 and 61, The releasable grip portion 20 includes the first and second upper rails 367 and the first and second lower rails 368 ° as shown in these figures. The first upper portion of the slippery nine 367 defines a slope 369. The upper rail 367 is designed to be received within a corresponding region 384 defined by the panels 380 and 382 in the main handle portion 340. The surgical instrument can further include a latching system 1_. For example, the latching system shown in more detail in Figures 96422 66 200814963 2 and 64 69 is the number of main attachment portions 344 and the removable grip portion that are blocked by the removable grip portion 342 and the primary attachment portion 344. The number of times can be any number of times. This configuration may be particularly limited by limiting the number of times a device can be used to ensure that it is maintained. for example, 栌 every ^ ..., The garden is effective, 4 to rely on the mouth, for example, The latching system 1900 can block the heart portion 344 from attaching to the detachable grip portion 342 after the primary attachment portion 344 is detached twice. Although ίο == _ most of the bits are in the main housing portion 34〇, It should be understood that the latching system 1900 can be mostly in the accessible portion 342. Flying grip, as shown in Figure 59, The locking system boo includes a counter 19〇2, And a blocking assembly 1904 coupled to the counter 1902. The counter 1902 is configured to advance as the detachable grip portion 342 is detached from the main == portion 344 of the handle assembly 3''. As shown in Figure 59, The counter 19〇2 is connected to the Xinyi axis 1906. The shaft is supported by a hub 19〇8 that is coupled to the right casing member 32〇. Counting benefit 1902 includes an indexing wheel 191 躺 lying on the shaft 19〇6, And a biasing member 1912 coupled to the indexing wheel 1910. The biasing member 1912 can include, for example, a torsion spring configured to bias the indexing rim 9 in a counterclockwise direction 20 . See Figure 59. The indexing wheel 1910 defines a protrusion 1914, 1914’, 1914, , , The projections cooperate with the blocking assembly 1904 to limit the advancement of the indexing wheel. One of the projections 1914" is configured to cooperate with the barrier assembly 19〇4 to resist the 9642 67 200814963 detachable grip portion 342 attached to the primary attachment after the grip portion 342 is detached from the primary attachment portion 344 a predetermined number of times Part 344. Although the sound wheel 1910 is not defined as the protrusion 1914, 1914, , 1914", According to other embodiments, the indexing wheel 191() can define a gap that is formed by the barrier assembly chest to limit the advancement of the indexing wheel 1910. And one of these gaps can be: : : The 43 person 42 is detached from the main attachment portion 344 a predetermined number of times to cooperate with the barrier to block the detachable grip portion 342 from being attached to the main attachment portion 344. Ίο 15 20 Axis 1906 is configured to permit the indexing wheel 191 to be reset to a ^. for example, The shaft 1906 can define a hexagonal opening 1916, And the octagonal tool can pass through one of the openings 1918 of the left casing member 330 (shown, 60) Insert, , The angular opening 1916 then rotates clockwise to reset the indexing wheel 1910 to a previous position. As shown in Figure 59, The barrier assembly 19〇4 includes a barrier member 192〇, "Barrier member guide 1922 A question member 1924, And a biasing member 26. The shutter member 1924 is in contact with the blocking member 192, Can be rotatably connected to the barrier member guide 1922, And with the protrusion i9i4, MM, , (9) 4" = limit the indexing wheel 1910 to advance. The biasing member 1926 is lightly connected to the gate. The biasing member 1926 can include, for example, a torsion spring configured to bias the jaw 1924 in a clockwise direction. The operation of the latching system 1900 is described in more detail below with reference to Figure 64.69. as the picture shows, For example, as shown in Figure 59_63, The handle assembly 3 includes a release system 193 that is configured to initiate the action of the removable grip portion (4) from the primary attachment portion 344. The release system 193 is located within the primary attachment portion 344 and includes a release illusion 932. And first and second release members 1934 that are attached or integrated to release button 96422 68 200814963 1932. The first and second release members 1934 each define a release ramp 1936. The release system 193 further includes first and second release pins 1938 in contact with the respective release ramps 1936, First and second lock springs 194, in contact with the first and second release pins 1938, And first and second ejection springs 942 in contact with the first and first lower rails 368. • See Figure 62. As shown in Figure 59, The free end 1941 of the spring 1940 extends through a corresponding hole 321 of the right casing member 320 and a corresponding hole 331 of the left casing member 33 〇 φ into the corresponding hole 3 72 in the upper rail 367 so as to be detachable The grip portion 342 remains engaged with the primary attachment portion 344. 10 to initiate the action of the detachable grip portion 342 from the grip attachment portion 344, Push the release button 1932, The first and second release members 1934 and the corresponding release ramp 1936 are also advanced. With the release ramp 1936 advanced, The release ramp 1936 causes the first and second release pins 1938 to change position. A change in the corresponding position of the first and second release pins 1938 results in the first 15 two locks, m. Moving the upper rails 367 up to the second rails 10 allows the first and second upper rails 367 to disengage from their engagement with the lock springs. As the detachable grip portion 342 is removed from the main grip attachment portion 344, The first and second ejection springs 1942 each release their stored energy, Thereby, a force is applied to the first and second lower rails 368, respectively. This force assists the detachable grip 20 . The file 342 is separated from the main grip attachment portion 344. It should be understood that according to the bean embodiment, The release system B30 can include an initial detachable grip portion 342 adapted to release the primary grip attachment portion & Other components and configurations of the role of 344. , 芩 Makeup Figures 57 and 58, The distal end 637 of the air supply passage 636 has a point 639 96422 69 200814963 formed thereon to enable the distal end 637 to pierce the sterile sealing membrane 646 mounted in one of the primary attachment portions 344 in the closed tube collection chamber 644. In particular, The distal end 637 of the air supply passage 636 is inserted through a port 645 of the manifold 644. The sterile membrane 646 can be made of any suitable puncturable material that can be sterilized. When the distal end 637 of the air supply passage 636 is inserted through, a large liquid-tight or hermetic seal is achieved therebetween. The sterility of the area within the tube collection chamber 644 is maintained while the distal end 637 of the air supply passage 636 is removed. • Also shown in Figures 57 and 58, The gas supply line 650 is fluidly coupled to the tube collection chamber 644 such that pressurized gas entering the collection chamber 644 from the supply line 636 flows into the supply line 650. Figure 57 illustrates the detachable grip portion 342 attached prior to the primary attachment portion 644. FIG. 58 illustrates the grip portion 342 attached to the main attachment portion 344. As shown in Figure 58, The distal end 637 of the air supply passage 636 has pierced the sterile diaphragm 646. To assist the distal end 637 of the air supply passage 636 to be inserted through the sterile diaphragm, A compression spring 649 is provided between the wall of the removable grip portion 342 15 and the header block 632. This configuration provides some to the tube header block 632 at the distal end of the air supply passage 636 when the 637 is inserted through the diaphragm 646. elasticity〃. Figures 64-69 illustrate the relative positions of the components of the latching system 1900 at different times during the attachment/separation procedure. Figure 64 illustrates the relative position of the grip portion 342 prior to first fully engaging the primary attachment portion 344. The shutter member 1924 20 is in contact with the projection 1914 to prevent the indexing wheel 1910 from advancing. The grip portion 342 is attached to the attachment portion 344 by pushing the slide 637 into the corresponding passage 384. The barrier member 1920 extends through one of the apertures 381 of the panel 380 into one of the channels 384. See Figure 59. As the first and second upper slides advance 367, The ramp 369 on one of the first upper slides 367 touches 96422 70 200814963 and strikes the barrier member 1920 and causes the barrier member to move upward toward the indexing wheel "7". As the blocking member 192 pushes toward the indexing wheel 1910, The blocking member 192 导致 causes the shutter member 1924 to move away from the indexing wheel 1910. See Figure 65. As the first upper slide 367 and the ramp 369 continue to advance, The blocking member 192 continues for 5 to advance toward the indexing wheel 1910. When the grip portion 352 is fully engaged to the main portion \ 35^, The blocking member 192 〇 touches the detecting portion 1914 that is originally in contact with the shutter member 1924, Thereby, the indexing wheel 191 is prevented from being advanced as shown in FIG. _ After the grip portion 342 begins to detach from the main attachment portion 344, The first and second upper rails 367 are advanced in opposite directions. The bevel 369 of the first upper rail tearing edge = allows the blocking member 192 to be removed from the indexing wheel 191. As the barrier member 1920 is removed from the indexing wheel 191, The blocking member 192A allows the shutter member 1924 to advance toward the indexing wheel 191 and skips the projection 1914 as shown in FIG. As the grip portion 342 is detached from the main attachment portion, The blocking member 1920 is moved far enough away from the indexing wheel 191 to release its contact with the projection i9i4 = and allows the indexing wheel 1910 to rotate until a second projection 1914, As shown in Fig. 68, contact with the shutter member 1924 occurs. This 蚪Counter benefit 1902 has advanced to a position, And the grip portion can be attached to the main attachment portion 344 again. The attach/separate loop can be repeated. Figure 68 illustrates a second reattachment procedure. When, for example, the main attachment portion 344, The barrier member touches the figure; ; The contact = out = 19U" thereby preventing the index wheel 191 () from advancing. At the end of the second cycle, When the grip portion 342 is disengaged from the main attachment portion 344, Closed member〗 々 A third protruding portion 1914" is touched as shown in FIG. The third protrusion (9) is configured to prevent the shutter member MM from being removed from the 96422 200814963 wheel 1910 by the blocking member 192. You and ^1 stand the Qiu Ba 342d to attach the part 344 to the grip two / i or attached to a replacement grip part). therefore, Based on these two! ? : The surgical instrument is effectively a two-use device. However, those who are accustomed to this skill will understand that if the index wheel (4) defines more protrusions or gaps, the number of uses can be increased. In other embodiments of the invention, But constructed so that the panels 382, Or the handle assembly is repeated (four) = the first part or parts are separated or otherwise invalidated, To prevent the grip portion 342 or other grip portion from being attached to the handle assembly again. Ίο - Figure 70_83 illustrates another unique new pneumatic surgical pair and tight SJ device side in accordance with the present invention, It provides the clinician with the ability to monitor the firing stroke while also providing the ability to manually retract the firing assembly of the skirt. This embodiment can be used in conjunction with the terminal effector 12 or other terminal configurations described above. , The elongated ridge assembly 3102 of the Ρβ (four) embodiment may include a proximal ridge segment 31〇4 attached to the 1-5 segment. In an alternate embodiment, S-shaped ridges • 3102 can include - a single component. The elongate ridge assembly 31〇2 is generally hollow and non-movably coupled to the housing assembly 300. As shown in Figures 79 and 8〇, The proximal end 3105 of the side ridge section can be attached to the housing by a right attachment roll 3110 projecting from the right side casing member 32 and a left attachment roll 3 ι 2 attached from the left casing member 33 to make. The distal end of the elongate ridge member 3102 can be attached to the long channel 20 as previously described. And in this embodiment, An elongate closure tube 3190 extends from the handle assembly 3'' to the end effector. The distal end 3192 of the closure tube 3190 has a penetrating horseshoe-shaped aperture 3194 and is used to move the shaft 964 against the ridge member 31 〇 2 on the shaft member 96422 72 200814963 to open to the ground as described above and on the anvil 4 The tongue 46 interacts. As shown in Figure 71, A shuttle assembly 3400 coupled to the closure trigger by a linkage assembly 43 is supported within the main housing portion 34A. The shuttle assembly 34 can also be fabricated from a polymer or other suitable material that is molded or otherwise fabricated and that is designed to fit together. 34〇4 constitutes. Part ' 3402, 3404 may be a fastening member and/or an adhesive and/or a bolt, Screw, Clip, And the likes are held together. The right portion 34〇2 of the shuttle assembly 34〇〇 has a right stop flange section 3405, The right stop flange section is adapted to cooperate with a left stop flange section (not shown in the figure) on the left portion 3404 of the shuttle assembly 3400 to form an elongated closure tube that can be extended as described above. A stop flange assembly in the proximal end 3196 of the 3190 - a stop groove (not shown). The proximal end 3104 of the elongate ridge member 3102 extends into an opening 3403 formed in the distal end of the shuttle assembly 34〇〇, And the left stop member 3112 extending through the right stop pile 311 and the opening 3408 of the opening 3406 respectively located in the right portion 3402 and the left portion 34〇4 is non-movably attached to the right casing member_ 320. In addition, Shuttle assembly 34〇〇 has a laterally extended guide 34ι〇, 34 ιι. The 3410 is constructed to be slidably received in one of the right casing members 32, corresponding to the obedience, And the rail 3 411 is constructed to be slidably received in one of the left guide members 330 in the corresponding guide. therefore, The shuttle assembly μ (10) and the closed 20-joint tube 3190 are axially movable relative to the ridge assembly 31〇2 attached to the handle assembly 3〇〇. Shuttle assembly 3400 and elongated closure tube 3190 in the distal direction (arrow, , The axial movement in c/r) is generated by the closing trigger 302 moving toward the grip portion 342 of the handle assembly 3〇〇, And the shuttle assembly 3400 is in the proximal direction (arrow, , D" The axial movement in 96422 73 200814963 is generated by the closure trigger 302 moving away from the grip portion 342. In various embodiments, The shuttle assembly 3400 has a connector tab 3412 to which the closure link assembly 3430 is attached. See Figures 71 and 72. The closure link assembly 3430 includes a yoke portion 3432 that is pivotally pinned to the connector tab 1 34 by a pin 3414. The closed link assembly 3430 has a closing arm ' 3434, The closure arm is pivotally pinned to a vehicle assembly 304 formed on the closure trigger 302 by a closure pin 436 as shown in FIG. The closure trigger 302 is pivotally mounted within the handle assembly 300 by a pivot pin 306 extending between the right housing member 320 and the left housing portion 330. 10 When the clinician wants to close the anvil 40 and clamp the tissue within the end effector 12, The clinician pulls the trigger 302 to the grip portion 342. As the clinician pulls the closure trigger 302 to the grip portion 342, The closed link assembly 3430 moves the shuttle assembly 3400 in the distal 'VC〃 direction until the closed link assembly 3430 moves to the locked position shown in FIG. When in this position, Even the 15 bar assembly 3430 would tend to hold the shuttle assembly 3400 in the locked position. • As the shuttle assembly 3400 moves to the locked position, The closure tube 3190 moves distally over the ridge assembly 3102, The closing/opening tab 46 on the anvil 40 is brought into contact by the proximal end of the horseshoe shaped hole 3194 of the distal end 3192 of the closure tube section 3190 to pivot the anvil 40 to the closed (clamped) position. To further keep the shuttle 20 to 3400 in the closed position, A locking mechanism 301 as described above can be used. As mentioned earlier, Embodiments of the present invention utilize a unique novel retraction bar assembly 4000 to enable a clinician to monitor the progress of the firing and retraction strokes and provide the ability to manually retract a firing bar 4030. As shown in Figure 72, Retraction rod 96422 74 200814963 Assembly 4000 includes a retraction rod 4010 that is slidably pinned to a push rod 4020. In particular, The retracting rod 4010 has a penetrating elongated slot 4012, The slot slidably receives two pins 4014 of a predetermined size for attaching the retracting rod 4010 to the push rod 4020. A retracting grip 4016 can be attached to the proximal end 4011 of the retracting 5 rod 4010. • The push rod 4020 has a distal end 4022 designed to interface with the proximal end of an elongate firing rod 4030. As shown in Figure 72, The proximal end 4032 10 of the firing bar 4030 has a connector portion 4034 formed thereon. The connector portion is sized to receive one of the distal ends 4022 of the push rod 4020 corresponding to the molded connector 10 aperture 4024. therefore, The push rod 4020 can be used to push the firing rod 4030 axially in a distal direction for a firing stroke or to pull the firing rod 4030 in a proximal direction for a retracting stroke. Those skilled in the art will appreciate that the firing bar 4030 extends through the ridge assembly 3102. In an alternate embodiment, The firing bar 4030 can have a rectangle, The square or similar cross-sectional shape is attached to the distal end 31 of the cutter 15 assembly 30 as previously described or to a different type of arbor and other end effector assemblies that require a sinuous axial movement to actuate. 72-77 include various figures of the shuttle assembly 3400. As shown in these figures, The left shuttle portion 3404 includes two spaced vertical support walls 3416, 3418, The support walls define a pusher opening 3420 therebetween. The distal end 4022 of the push rod 4020 20 extends through the push rod opening 3420 to be coupled to the proximal end 4032 of the firing rod 4030. As shown in Figure 72, The proximal end 4026 of the push rod 4020 is coupled to a V'Z-shaped connector member 4040. In particular, The proximal end 4026 of the push rod has a connecting post 4028 protruding therefrom, The connecting post can be received in an opening 96422 75 200814963 4049 of one of the attachment tabs 4042 on the proximal end 4041 of the Z-shaped connector component 4040. See Figure 72. However, the proximal end 4026 of the push rod 4020 can be attached to the attachment tab 4042 by a screw or other suitable tie member. The distal end 4045 of the Z-connector member 4040 has a distal attachment tab 4046 thereon. The distal attachment tab is adapted to be coupled to a live cylinder 5040 that protrudes from a pneumatic cylinder assembly 5000. * As shown in Figure 79, the cylinder assembly 5000 includes a first cylinder housing 5010. The first cylinder housing has a first closed proximal end 5012 and a first open distal end 5014 that opens into one of the first axial passages 5016 of the first cylinder housing 5010. The cylinder assembly 5000 also includes a second cylinder housing 5020. The second cylinder housing has a second proximal end 5022 and a second open distal end 5024 that opens into a second axial passage 5026. The second proximal end 5022 has a first piston head 5028 formed thereon. The first piston head is sized relative to the first axial passage 5016 for producing a substantially airtight sliding seal with the first wall 5011 of the first cylinder housing 5010 for distally of the first proximal end 5012 A first cylinder region _ 5015 is defined between the proximal sides of the first piston head 5028. The first distal end 5014 of the first cylinder housing 5010 further has an inwardly extending first flange 5017 formed thereon. The first flange is configured to establish a substantially airtight sliding seal with the outer wall surface of the second cylinder housing 5020 to define 20 - second between the proximal side of the first flange 5017 and the distal side of the first piston head 5028 Cylinder block 5018. A first passage 5027 penetrates the first piston head 5028. As shown in Figure 79, A piston cylinder 5040 extends through the second open distal end 5024 of the second cylinder housing 5020 into the second axial passage 5026. Piston cylinder 5040 has a proximal end 5042 and a closed distal end 5044. A second piston head 5046 is formed on the proximal end 5042 of the cylinder 9640 76 200814963 cylinder 5040. The second piston head 5046 is sized relative to the second axial passage 5026 for creating a substantially airtight sliding seal with the second wall 5021 of the second cylinder housing 5020 to define a third cylinder region 5032. The second distal end 5024 of the second cylinder housing 5020 further has an inwardly extending second flange 5025 formed thereon. The second flange is for establishing a substantially airtight sliding seal with the piston cylinder 5040 to define a fourth cylinder region 5034 between the proximal side of the second flange 5025 and the distal side of the second piston head 5030. A 10 opening 5047 extends through the second piston head 5046 into a passage 5048 of the piston cylinder 5040. 10 As shown in Figures 79 and 80, The cylinder assembly 5000 is mounted within the housing assembly 300. A first air supply line or air supply conduit 5050 extends from one of the handle assembly 300 directional control valves 610 to be coupled to the first proximal end 5012 of the first cylinder housing 5010 for supplying pressurized gas through the first cylinder housing 5010 One of the first proximal ends 5012 is a first air supply port 5013 or an opening. In addition, A second air supply line 15 or air supply conduit 5052 extends from the directional control valve 610 to the distal end 5014 of the first cylinder housing _ 5010 and is coupled to the first cylinder housing 5010 for pressurization via a second cymbal 5029 Gas is fed into the second cylinder region 5018. See Figure 78. Referring to Figures 78 and 79, The elongation and retraction of the firing bar 4030 will now be described in detail. As shown in Figure 78, The gas supply lines 5050 and 5052 are coupled to a conventional directional valve 1610. The valve is part of a drive system 1600 that is housed within the handle assembly 300. The directional control valve 1610 has a forward position section 1620, a stop section 1630, And an inversion section 1640. Control valve section 1620, 1630, The 1640 can be manually switched by buttons 1612 96422 77 200814963 and (6) 4 protruding through the handle housing 300. In various embodiments, A removable pressurized gas source 620 is used. See Figures 71 and 81-83. However, those skilled in the art will appreciate that a non-replaceable/re-inflatable pressurized gas source (a gas cylinder) can also be utilized effectively. In still other embodiments, The handle assembly 3 can have a port 616 for supplying pressurized gas from a source of external pressurized gas 618. for example, The appliance 3010 can be coupled to a compressed air supply 618 in the facility via a flexible supply line 617. See Figure 81A. # a Pressurized gas flows from a gas cylinder 622 (or external pressure source 618) through a gas supply line 650 into a conventional proportional valve 66. As shown in Figure 78, The 1-inch proportional valve 660 is coupled to a supply air link 662 attached to a start trigger 67A. In various embodiments, The start trigger 670 is supported near the firing trigger 31〇" The trigger trigger is pivotally engaged with the handle assembly 300 by a cymbal pin 37 () extending between the right housing member 320 and the left housing member 330. Squeezing the start trigger 67 〇 inwardly toward the firing trigger 31 causes the proportional 15 valve 660 to permit more pressurized gas to flow through the supply line pair into the directional 阙 • 2 〇. Depending on the position of the directional valve 161, Pressurized gas will flow into the gas supply, , Within the road 5050 or 5052. for example, When the directional valve 61 is actuated by the clinical master to extend the firing rod 3〇, The control valve 161 〇 is switched to the forward position f such that the 4-inlet passage 1622 permits the pressurized gas to flow from the supply line 68 into the air supply, Within the road 5050. The gas flowing through the gas supply line 5〇5〇 passes through the first gas supply port 5013 of the closed end 进入^ into the first cylinder area 5015 and passes through the first base, The opening 5027 of the 5 〇 28 enters the third cylinder zone 5032. Pressurized gas entering the third cylinder region 5032 also enters the hollow piston cylinder 5〇4〇 through the opening 5047 of the second piston head 5046 and forces the piston cylinder to move distally 96422 78 200814963. The gas located in the fourth cylinder region 5034 is exhausted through the exhaust port 5023 of the second cylinder housing 5020. Similarly, Gas located in the second cylinder region 5018 is allowed to escape into the second gas supply line 5052 through the second opening 5029. The second gas supply line 5052 sends the discharged gas to the passage 1624 of the directional valve 1610, This is finally discharged from the exhaust passage 1632. Continue to the first cylinder area 5015, Third cylinder zone 5032 The application of pressurized gas to the passage 5048 of the piston cylinder 5040 causes the piston cylinder 5040 to extend distally as shown in Figures 73 and 79. As the piston cylinder 5040 extends distally, The Z-connector 4040 is also extended distally by its attachment to the distal end 5044 of the piston cylinder 5040. The Z-shaped connector 4040 forces the push rod 4020 to move distally. Thus, the firing rod 4030 is forced to move also distally. As the firing bar 4030 moves distally, The distal end portion 31 of the cutter assembly 30 attached to the firing rod is advanced through the magazine 50 to sever the tissue clamped by the end effector 12 and fire the staple. Once the tool assembly 30 has been advanced to its farthest side 15 position in the end effector 12, The clinician releases the trigger 670 to interrupt the application of pressurized gas. The present embodiment may also be provided with means for indicating when the tool assembly 30 has reached its most distal position within the staple cartridge 50. In particular, A distal auxiliary line 1772 extending from the gas supply line 650 to the distal limit switch 1770 can be provided. A distal limit switch line 1774 is provided between the distal limit switch 2770 and the directional control valve 1610. therefore, When the tool assembly 30 has completed the firing stroke, The distal limit switch 1770 is oriented relative to a portion of the cylinder assembly 5000 such that the cylinder assembly is partially actuated by one of the distal limit switches. The distal limit switch 1770 permits air to flow under pressure from the supply line 650 to the distal limit switch line 1774 and into the directional control valve 1610 96422 79 200814963 5 10 15 20, This, in various embodiments, causes the directional control valve 161 to automatically switch to the inverted position/this causes the firing rod 4030 to retract as described below. In each of the embodiments, a first whistle 1790 or other suitable vocal device can be provided with the distal side (or the distal limit switch 17 is provided by the 1790 to the clinician) The tool assembly 3〇 has reached the end of the firing stroke. The gas flute 1790 can be replaced with a pressure switch pressure gauge or the like to provide the L-bed master with a time when the tool assembly 30 reaches one of the end of the firing stroke (6) when the pneumatic force is retracted to the firing rod side. The clinician can press the button 670 Λ 161G (4) to the inverted position and start squeezing the trigger ΓΙ'Λ gas into the second gas supply line 5052. Flow through the first -, "The gas entering the second cylinder zone 5〇18 of the road 5052 causes the first cylinder housing 5020 to be broken into green. , " f wide brother inside a cylinder housing 5010. The first cylinder is supplied to the first through the first air supply opening 5013. ρ, ^1Λ The gas entering the rolling line 5040 is set to =1”. This is discharged from the exhaust gas 1632. The second gas red is red. The body has caused the second gas red shell to smash into the first One gas ΓΠ The gas passing through the second opening 5029 can now flow through the fourth cylinder area of the human body through the venting port 5_. The body enters the fourth gas red zone 5034, and the second piston lion will The 5040 is pulled into the second cylinder housing 5 in the near side. The gas in the third cylinder £5032 is « « η η; 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔 孔=: 5 10 15 20 门门1: Γ The proximal auxiliary line 1662 is also extended between the proximal-side limit two f and the common-gas line 65G. The proximal limit switch 1660 is connected to the assembly 5000 or the connector is oriented. When the firing rod side 乂兀 king, ''but back to the day' proximal limit switch 丨 76 〇 is actuated then permits air to flow into the proximal limit switch line 1764 and into the directional control valve (6) 〇 = fixed one way control valve 1610 automatically switches to Stop position. In an alternative embodiment 2 gas 1792 or other suitable sounding device can be connected to the proximal side: 〇 connected, resulting in The proximal restriction switch 76 〇 at the end of the retraction stroke, when actuated, the second edema 1792 is actuated by the air of the proximal restriction switch line 1764 to provide the clinician with another audible signal indicating the firing bar 4 (10) 〇 and the knife, 30 has reached the end of the retraction stroke. In other embodiments, for example, a battery powered light emitting diode or other signaling device can be associated with the distal and proximal restriction switches 1770, 1760 to provide a wedge to the user. ^ Another indication when the skid/tool has reached the end of the firing stroke and/or the retraction stroke. It will be readily understood by those skilled in the art that if the clinician wants to stop the firing stroke and retract the firing rod during the firing stroke and The cutter, he or she must do so by manually switching the control valve 1610 to the inverted position. In the example described above, the clinician did not use the unique novel retraction rod assembly 4000 of this embodiment of the invention. The reduction of the rod has several advantages. First of all, if during the firing or retracting stroke, the aerodynamic force is caused by an empty gas supply bottle 620 or because of an unexpected interruption of the supply of pressurized gas. 96422 81 200814963 Loss, the clinician can simply grasp the grip 4016 attached to the proximal end of the retraction rod and manually pull the rod proximally to the firing rod by manually switching the control valve 1610 to the inverted position Manually retract the firing bar (and tool assembly 30) in a fully retracted manner. See Figure 83. Switching the control valve 1610 to the inverted '5 position will cause the gas in the cylinder assembly to drain when the shank is retracted. Another advantage provided by this embodiment of the present invention is the ability to visually monitor the firing process of the firing rod and knife portion moving distally during the firing stroke. This advantage can be achieved simply by pulling the retraction rod to its most proximal position as shown in Figure 83 before initiating the firing stroke. When in this position, as the gas 10 cylinder assembly 5000 pushes the connector 4040, the push rod 4020 and the firing rod 4030 distally, the push rod 4020 will retract the rod by its pin connection with the retraction rod 4010. The 4010 is then pulled to the far side. In various embodiments, the length of the retraction rod 4010 is provided such that when the firing rod 4030 is fully extended, no portion of the retraction rod 4010 protrudes from the handle assembly 300. Therefore, the clinician can judge the progress of the firing stick 4030 and the cutter assembly 30 by observing the portion of the retracting rod 4010 protruding from the handle portion 300. In an alternate embodiment shown in Figures 72A and 83A, the retraction rod 4010 can have at least one, and preferably at least two notches 4015 to receive the pin 4014. Those skilled in the art will appreciate that this configuration provides the clinician with the ability to visually monitor the progress of the firing bar 4030 and the tool assembly 30 during the retraction stroke 20. In particular, as the firing bar 4030 is retracted, the pusher 4020 causes the retraction bar 4010 to advance proximally beyond the housing assembly 300 as the pin 4014 engages the notch 4015. Accordingly, the clinician can determine the distance traveled by the firing bar 4030 during the retraction stroke 96422 82 200814963 by observing the retraction rod 4010 to highlight the distance outside the handle assembly 300. However, when the appliance is not in use, the retraction lever 4〇ι can be pushed into the handle assembly as shown in Figure 81. Although several embodiments of the invention have been described, it will be understood by those skilled in the art For example, in accordance with various embodiments, a single component can be replaced with multiple components, and multiple components can be replaced with a single component, # to perform one or more known functions. Therefore, the present application is intended to cover all such modifications, changes, and adaptations without departing from the spirit and scope of the scope of the accompanying claims. x
1515
20 本發明揭示的裝置可設計成在單次使用後丟棄,或者其 可設計成欲多次使用。但不管是哪—種,裝置可在至少^ 人使用之後經再调整以供再次使用。再調整作業可包含下 列步驟之-組合:將裝置分解,然後清潔或替換特定部件, ㈣再組裝。特定言之,裝置可被分解m之任何數 里特定部件可依任何組合被選擇性地#換或移除。 部件清潔且/或替換之後,裝置可在—再調整設施或是由一 外科團隊在-外科程序之後立即進行再組裝以供後續使 用。熟習此技藝者會理解到裝置之再調整可運用分解 潔/替換、及再組裝之許多不同技術。此等技術的運用以及 得到的經再調整裝置全都在本申請案的範圍以内。 較佳來說’本說明書所述本發明會在外科手術之前經過 处理。百先要取得-全新或料的器具,且若有需要刊清 =該器具。然後可消毒該器具。在—種消毒技術中,將該 态具放在-封閉密封容器譬如一塑膠袋或τγν跋⑧袋 96422 83 200814963 ^然後將該谷器與器具放到_能夠穿透該容器之輕射 内’此輻射譬如是r輻射、x射線、或更高能量電子。此 f殺”具上及容器内的細菌。然後將該經消毒的器罝 :在热囷容器中。密封容器保持器具 : 在醫療設施中被打開為止。 在本。兄明書中被稱為以全部或部分内容併入本文中 ΓΓ專利、公開案、或任何公示部分係僅以所併入内容不 ίο 度併入本文中。因此,:明、或其他公示部分的程 的内容取代併入太々Φ古 度,本說明書明確提出 Φ 有任何抵觸的部分。據稱併入本文 =抵:士說明書中提出之定義、聲明、或其他 的任何内谷或其部分將僅以不致在所併人内容 公示内容部分之間引發衝突的程度併入。 〃无有 15 福;·本Λ明Λ望保護的内容不應被解釋成僅限於本說明書 限:眭、:貝、例。因此這些實施例應視為範例說明而非 【制二他人:不脫離本發明之精神作出變化及變更。因 y希望洛入申請專利範圍項所定義之發 _ 有等效物、變化及變更均在涵蓋範圍以:。& 【圖式間單說明】 20視圖圖1是一本發明之一外科切割及緊固器具實施例的透 置的圖分=; 裝可圖搭配本發明各實施例使用之终端作用器配 圖3疋一圖i和2之終端作用器的俯視圖,其中砧部分 96422 84 200814963 已自其移除且閉合管總成以虛線繪出; 0 疋囷3之終端作用器的侧視剖面圖,其中石占部分 與其附接且處於一開啟位置; 园5疋 了用在本發明各實施例之活節控制器之一部 5 分的俯視剖面圖; - 圖6是一圖1所示終端作用器之活節的俯視剖面圖; 圖7是一例示一閉合管總成及被支承在把手總成内之 •才复配置之-實施例的分解組裝圖,其中裝在殼體總成内的 其他組件經省略以求圖面簡潔; 圖8疋本發明各實施例之殼體總成配置的剖面圖; /圖8A是一可搭配本發明各實施例使用之閉合扳機鎖定 系統之一部分的局部剖面圖; 圖8B是一本發明之另一把手總成實施例的剖面圖,其 中加壓氣體源在把手總成以外; 15 圖8C是一本發明之另一把手總成實施例的剖面圖; • ® 9是-圖8把手總成的另-剖面圖; 圖1 〇是一本發明各實施例之一刀桿配置及包括一兩段 式氣缸總成之擊發傳動構件的側視圖,其中氣缸總成係以 剖面示出; 20 圖11是圖1 〇所示刀桿及兩段式氣缸配置的另一側視 圖’其中刀桿處於伸長位置; 圖12是一本發明之另一刀桿及擊發傳動構件配置的側 視圖’其中刀桿正在縮入一以剖面示出的氣缸總成内; 圖u是圖12所示刀桿及氣缸配置的另一侧視圖,其中 96422 85 200814963 刀桿處於伸長位置; 圖14是一容納圖12和13所示氣缸及刀桿配置之終端 乍用器及脊總成的俯視圖; 圖15是一圖14所示終端作用器及脊總成的侧視剖面 圖,其中砧部分與其附接且處於開啟位置; 圖16疋一可搭配圖12·15所示實施例使用之把手總成 的剖面圖;20 The device disclosed herein can be designed to be disposed of after a single use, or it can be designed to be used multiple times. But no matter what kind of device, the device can be re-adjusted for reuse after at least 2 people use it. The realignment job can include the following steps: combination: disassemble the device, then clean or replace specific parts, and (4) reassemble. In particular, the particular component of any number of devices that can be decomposed m can be selectively #changed or removed in any combination. After the components are cleaned and/or replaced, the device can be reassembled for later use at - after adjusting the facility or by a surgical team - after the surgical procedure. Those skilled in the art will appreciate that the re-adjustment of the device can employ many different techniques for decomposing/replacement, and reassembly. The use of such techniques and the resulting re-adjustment devices are all within the scope of this application. Preferably, the invention described herein will be processed prior to surgery. Hundreds of first to get - brand new or expected equipment, and if necessary, to publish = the appliance. The appliance can then be sterilized. In a disinfection technique, the device is placed in a closed-closed sealed container such as a plastic bag or a τγν跋8 bag 96422 83 200814963 ^ Then the barn and the device are placed in a light shot capable of penetrating the container This radiation is, for example, r radiation, x-rays, or higher energy electrons. This f kills the bacteria on the container and the container. The sterilized device is then placed in a hot container. The sealed container holds the device: it is opened in the medical facility. It is called in the book. In all or part of this document, the patents, publications, or any of the disclosures are incorporated herein by reference in their entirety. Too 々 Φ 古 古 , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , The extent to which conflicts arise between the content of the content of the human content is incorporated. 〃There is no such thing as 15 blessings; • The content of this Λ Λ Λ 保护 保护 保护 不应 不应 不应 不应 不应 不应 不应 不应 不应 不应 不应 不应 不应 不应 不应 不应 不应 不应 不应 不应 不应 不应 不应 不应The examples should be considered as examples and not in the spirit of the invention. Changes and modifications are made without departing from the spirit of the invention. The equivalents, changes and changes are included in the scope of the application. [FIG. 1] FIG. 1 is a perspective view of an embodiment of a surgical cutting and fastening device of one embodiment of the present invention; The top view of the end effector of Figure 3, Figure 1 and Figure 2, wherein the anvil portion 96422 84 200814963 has been removed from it and the closed tube assembly is drawn in dashed lines; the side view of the end effector of 0 疋囷3 a cross-sectional view in which the stone portion is attached and in an open position; the garden 5 is a top cross-sectional view of a portion of the joint controller used in various embodiments of the present invention; - Figure 6 is a Figure 1 A top cross-sectional view of the joint of the end effector; FIG. 7 is an exploded, isometric view of an embodiment of a closure tube assembly and a support assembly that is supported in a handle assembly, wherein the housing is assembled The other components are omitted for the sake of simplicity; Figure 8 is a cross-sectional view of the housing assembly configuration of various embodiments of the present invention; / Figure 8A is a closed trigger locking system that can be used with embodiments of the present invention. Partial partial cross-sectional view; Figure 8B is another embodiment of the present invention A cross-sectional view of a handle assembly embodiment in which a pressurized gas source is outside the handle assembly; 15 Figure 8C is a cross-sectional view of another handle assembly embodiment of the present invention; • ® 9 is - Figure 8 handle assembly - FIG. 1 is a side view of a shank arrangement and a firing transmission member including a two-stage cylinder assembly in accordance with one embodiment of the present invention, wherein the cylinder assembly is shown in cross section; 1 〇 another side view of the arbor and two-stage cylinder arrangement 'where the shank is in the extended position; FIG. 12 is a side view of another arbor and firing transmission member arrangement of the present invention, wherein the shank is retracting Figure 1 is a side view of the arbor and cylinder arrangement of Figure 12, wherein 96422 85 200814963 is in an extended position; Figure 14 is a housing shown in Figures 12 and 13 FIG. 15 is a side cross-sectional view of the end effector and ridge assembly of FIG. 14 with the anvil portion attached thereto and in an open position; FIG. 15 is a top plan view of the end effector and ridge assembly of the cylinder and arbor; FIG. 16疋一 can be combined with the embodiment shown in Figure 12·15 A cross-sectional view of the handle assembly;
ίο 15Ίο 15
圖16A是一可搭配圖12_15所示實施例使用之另一把 手總成的剖面圖,其中加壓氣體源在把手總成以外; 圖16B疋一本發明之另一把手總成實施例的剖面圖; 圖11疋一支承本發明另一實施例呈一波紋管總成形式 之另擊發傳動構件的另一刀桿及脊總成的俯視圖; 圖18疋一圖π所示實施例之終端作用器及脊總成配置 的侧視剖面圖; 圖19疋一圖17和18所示實施例之波紋管總成的局部 剖面組裝圖; 圖20是一圖19波紋管總成之一部分的放大圖; 圖21疋一可搭配圖17_2〇所示實施例使用之把手總成 實施例的剖面圖; 〇 圖21A疋一可搭配圖17-20所示實施例使用之另一把 手總成實施例的剖面圖,其中加壓氣體源在把手總成以外; S 1B疋本叙明之另一把手總成實施例的剖面圖; 圖22是一依據本發明其他實施例之另一外科切割及緊 固器具的透視圖; 96422 86 200814963 圖23是/圖22所示實施例之終端作用器及脊總成的側 視剖面圖, 圖24是一圖22和23之實施例之快拆式接頭配置在遠 侧軸桿總成耦接於近侧軸桿總成之前的剖面圖; ^ 5 圖25是/沿圖24之線25_25取得的近側軸桿總成的 面圖; 10 圖26是一附接於近側軸桿總成之遠側軸桿總成的局部 透視圖,其中遠側軸桿總成之一部分經省略以求圖面簡潔; 圖27是一圖24-26之實施例之接頭總成的侧視剖面 圖,其中遠側軸桿總成已耦接於近侧轴桿總成; 圖28是-遠側軸桿總成之一部分在附接於近側軸桿她 成之一部分之前的透視圖; 〜 圖29是一可用在圖12_16A所示實施例之另一快Figure 16A is a cross-sectional view of another handle assembly that can be used in conjunction with the embodiment of Figures 12-15, wherein the pressurized gas source is outside the handle assembly; Figure 16B is a cross-sectional view of another handle assembly embodiment of the present invention; Figure 11 is a top plan view of another shank and ridge assembly supporting another firing transmission member in the form of a bellows assembly in accordance with another embodiment of the present invention; Figure 18 is an end effector and ridge of the embodiment shown in Figure π Figure 19 is a partial cross-sectional view of the bellows assembly of the embodiment shown in Figures 19 and 18; Figure 20 is an enlarged view of a portion of the bellows assembly of Figure 19; BRIEF DESCRIPTION OF THE DRAWINGS FIG. 21A is a cross-sectional view of another embodiment of a handle assembly that can be used in conjunction with the embodiment of FIGS. 17-20, wherein The pressurized gas source is outside the handle assembly; S 1B is a cross-sectional view of another handle assembly embodiment; FIG. 22 is a perspective view of another surgical cutting and fastening device in accordance with other embodiments of the present invention; 86 200814963 Figure 23 is / Figure 22 2 is a side cross-sectional view of the end effector and ridge assembly of the embodiment, and FIG. 24 is a quick release joint configuration of the embodiment of FIGS. 22 and 23 before the distal shaft assembly is coupled to the proximal shaft assembly Sectional view; ^ 5 Figure 25 is a plan view of the proximal shaft assembly taken along line 25_25 of Figure 24; 10 Figure 26 is a distal shaft assembly attached to the proximal shaft assembly a partial perspective view in which a portion of the distal shaft assembly is omitted for simplicity; FIG. 27 is a side cross-sectional view of the joint assembly of the embodiment of FIGS. 24-26, wherein the distal shaft assembly has been Coupled to the proximal shaft assembly; Fig. 28 is a perspective view of a portion of the distal shaft assembly prior to attachment to the proximal shaft; a portion of Fig. 29 is shown in Fig. 12-16A Another fast of the embodiment
接頭配皇的局部剖面圖; A 15 圖.30是-沿圖29之線3(MG取得的近側軸桿總成 面圖, 圖3!是一可搭配圖22_30所示實施例使用 總成之一部分的透視圖; ^由才干 圖32是一本發明之另一外科切割及緊固器 20圖,其使用本發明各實施例之—氣力作動活節接頭. 圖33是-圖32所示實施例將—遠側脊 至 脊段之活節接頭之一部分的局部透視圖; 近侧 圖34是圖33活節接頭配置的另一。透視圖,其 除且例示遠側脊段相對於近側脊段進行活節運動;皿私 96422 87 200814963 圖35是一圖33和34之活節接頭配置的分解組裝圖; 圖36是一圖33·35之接頭總成的側剖面圖; 圖3 7是一本發明之開關總成實施例的透視圖; ^ 圖38是一圖37開關總成的側視圖; 5 圖39是一沿圖37之線39-39取得的圖37和38開關總 - 成的剖面圖; 圖40是一沿圖38之線40-40取得之處於關位置的開關 _總成的剖面圖; 圖41是處於一已作動位置之圖37_4〇開關總成的另一 1()剖面圖; 圖42是一沿圖41之線42_42取得的圖41開關總成的 剖面圖; 圖43是一圖37-42開關總成的仰視圖; 15Partial cross-sectional view of the joint with the emperor; A 15 Fig. 30 is - along the line 3 of Fig. 29 (the proximal shaft assembly surface view taken by the MG, Fig. 3! is an embodiment that can be used in conjunction with the embodiment shown in Fig. 22_30 A perspective view of a portion; Fig. 32 is a view of another surgical cutting and fastening device 20 of the present invention, which uses the pneumatic actuation joint of the various embodiments of the present invention. Fig. 33 is - Fig. 32 Embodiments will be a partial perspective view of a portion of the distal joint of the distal ridge to the spine; a close-up view of FIG. 33 is another perspective view of the joint joint configuration of FIG. 33, except that the distal spine is illustrated relative to the near The side ridge section performs the joint movement; the vessel private 96422 87 200814963 Fig. 35 is an exploded assembly view of the joint joint arrangement of Figs. 33 and 34; Fig. 36 is a side sectional view of the joint assembly of Fig. 33·35; Fig. 3 7 is a perspective view of an embodiment of the switch assembly of the present invention; ^ is a side view of a switch assembly of Fig. 37; and Fig. 39 is a view of the total of Figs. 37 and 38 taken along line 39-39 of Fig. 37. - a cutaway view; Fig. 40 is a cross-sectional view of the switch_assembly taken in the off position taken along line 40-40 of Fig. 38; Fig. 41 is in a Figure 37_4 is another sectional view of the switch assembly; Figure 42 is a cross-sectional view of the switch assembly of Figure 41 taken along line 42_42 of Figure 41; Figure 43 is a switch assembly of Figure 37-42 Bottom view; 15
20 、圖44是一具有圖37-43之開關總成且裴有一加壓氣體 源的把手總成的剖面圖; 圖45是一在内部具有圖37_43之開關總成的把手總成 的剖面圖’且其中加壓氣體源在把手總成以外; 圖46是一本發明之另一外科釘合及切割器具的透視 :抽::吏用圖33_36所示活節接頭實施例及圖2 快拆式接頭實施例; 總成:=:=;:=頭配置在遠侧軸桿 接頭V::::7之線48-48取得的圖-之實施例之 96422 88 20081496320, FIG. 44 is a cross-sectional view of a handle assembly having the switch assembly of FIGS. 37-43 and having a source of pressurized gas; and FIG. 45 is a cross-sectional view of the handle assembly having the switch assembly of FIGS. 37-43 therein; 'And wherein the pressurized gas source is outside the handle assembly; Figure 46 is a perspective view of another surgical stapling and cutting device of the present invention: pumping:: using the joint joint embodiment shown in Figure 33_36 and Figure 2 quick release Example of a joint; assembly: =:=;:= Figure taken at line 48-48 of the distal shaft joint V::::7 - Example 96422 88 200814963
圖49是一本發明之另一 外科切割及緊固 益具的透視 置的=一裝可圖搭配圖49所示實施例使用之终端作用器配 ® μ是-可搭配圖49所示實施例使用之終端 置、脊總成及閉合管總成的分解組裝圖; - 圖52是一圖51終端作用器、脊總成及閉合管 視剖面圖,其中砧部分經省略以求圖面簡潔; 、 10 圖5 2 A是一本發明之另一非限制性實施例之終端作用 ^、脊,成及閉合管總成的侧視剖面圖,纟中氣動馬達被 支承在遠離把手總成之處; 。。圖52B是一本發明之另一非限制性實施例之終端作用 為、脊總成及閉合管總成的側視剖面圖,其中氣動馬達被 支承在遠離把手總成之處; 圖53是一可搭配圖49之實施例使用的把手總成的剖面 圖; 圖53A是一可搭配圖49之實施例使用的另一把手總成 的剖面圖’其中加壓氣體源在把手總成以外; 圖54是圖53之把手總成的另一剖面圖; 圖55是一本發明各實施例之相對位置擊發扳機配置的 側視圖; 圖56是一可搭配本發明各實施例使用之本發明控制系 統實施例的簡圖; 圖57是一從本發明各把手總成實施例之一主要附著部 96422 89 200814963 分卸下之一可卸式握把部分的剖面圖; 圖58是一顯示可卸式握把部分耦接於本發明各實施例 之一把手部分之主要附著部分的局部剖面圖; 圖59是一圖58之可卸式握把部分及主要附著部分的局 部剖面圖’其中管集箱及氣紅相關組件經省略以求圖面簡 圖60是一沿圖59之線6〇_6〇取得的圖兄和59之可卸 _式握把部分及主要附著部分的剖面圖; 圖61是一沿圖59之線61_61取得的圖58、59和6〇之 可卸式握把部分及主要附著部分的剖面圖; 圖62是一沿圖59之線62_62取得的圖58 61之可卸式 握把部分及主要附著部分的剖面圖; 圖63是一沿圖59之線63_63取得的圖58_62之可卸式 握把部分及主要附著部分的另一局部剖面圖; =圖64是-處於一初始位置之本發明閉鎖系統實施例的 在r圖二=广之閉鎖系統的另—簡圖’其例示閉鎖系統 ^至把抑開始附接於把手總成之主要附著部分時的動 作, 20 圖66是圖64和65之閉继备从a , 4 ^ 闭鎖糸統在握把部分第二次卸離 把手總成之主要附著部分之前的另—簡圖; 圖67是圖64_66之閉鎖系絲沾v曰#门 ^ έΒ jh -IP 4 ^ίτ V '、、、、的另一簡圖,其例示系統 組件在握把部分㈣接於主要附著部分時的位置; 圖68是圖64-67之閉鎖丰絲沾v ^门 貝糸統的另一簡圖,其例示系統 96422 90 200814963 組件在握把部分第二次附接於主要附著部分期間的位置,· 圖69是例示在握把部分已第二次且最後_次附接於主 要附著部分之後的閉鎖系統另一簡圖; 圖70是-本發明之另一外科切割及緊固器具的透視 圖; 圖71是-可搭配圖70所示器具使用之把手總成實施 的剖面圖; ' 圖72疋一本發明各實施例之梭及回縮桿總成的分解袓 裝圖; ' ίο 圖72 A疋一本發明其他實施例之梭及回縮桿總成的 解組裝圖; 圖73是一圖72所示組件的組合圖,其中其氣缸總成處 於一完全伸長位置; 圖74是一本發明之梭總成的後視圖; 圖75疋圖74梭總成的另一後視圖,其中回縮桿及推桿 伸入推#開口内且推桿附接於連接器構件; 圖76是一梭總成之左邊部分的後視透視圖; 圖77疋梭總成之左邊部分的另一後視透視圖; 圖78疋一可用於圖7〇-77所示實施例之控制系統配置 2〇 的的簡圖; 圖79是一圖70-78所示實施例之把手總成配置的俯視 口 ij面圖,其中氣缸總成處於一伸長位置; 圖80疋圖70-79所示實施例之把手總成配置的另一俯 視剖面圖,其中氣缸總成處於一回縮位置; 96422 91 200814963 圖81是一圖70-80所示實施例之把手總成的剖面圖; 圖81A是一可用於圖7〇_8〇所示實施例之把手總成實 施例的剖面圖,其中加壓氣體源在把手總成以外;、 圖82是圖81之把手總成的另一剖面圖,其中氣紅總成 圖83是圖 縮回;且 81之把手總成的另 一剖面圖,其中氣缸總成49 is a perspective view of another surgical cutting and fastening utility of the present invention. FIG. 49 is a combination of the end effector used in the embodiment shown in FIG. 49. An exploded assembly view of the terminal, ridge assembly and closure tube assembly used; - Figure 52 is a cross-sectional view of the end effector, ridge assembly and closure tube of Figure 51, wherein the anvil portion is omitted for simplicity; 10A is a side cross-sectional view of a terminal action, ridge, and closure tube assembly of another non-limiting embodiment of the invention in which the air motor is supported away from the handle assembly ; . Figure 52B is a side cross-sectional view of the terminal, ridge assembly and closure tube assembly of another non-limiting embodiment of the present invention, wherein the air motor is supported away from the handle assembly; Figure 53 is a A cross-sectional view of a handle assembly that can be used with the embodiment of Figure 49; Figure 53A is a cross-sectional view of another handle assembly that can be used in conjunction with the embodiment of Figure 49, wherein the source of pressurized gas is outside the handle assembly; Figure 54 Figure 5 is a side elevational view of the handle assembly of the relative position of the embodiment of the present invention; Figure 56 is a side view of a control system of the present invention for use with embodiments of the present invention; BRIEF DESCRIPTION OF THE DRAWINGS Fig. 57 is a cross-sectional view showing a detachable grip portion of a main attachment portion 96422 89 200814963 of one embodiment of the handle assembly of the present invention; Fig. 58 is a view showing a detachable grip A partial cross-sectional view of a main attachment portion of a handle portion of one of the embodiments of the present invention; FIG. 59 is a partial cross-sectional view of the detachable grip portion and the main attachment portion of FIG. 58 Red related component Illustrated in FIG. 59 is a cross-sectional view of the detachable _ grip portion and the main attachment portion taken along line 6〇_6〇 of FIG. 59; FIG. 61 is a cross-sectional view along FIG. FIG. 62 is a cross-sectional view of the detachable grip portion and the main attachment portion of FIGS. 58, 59 and 6 taken from line 61_61; FIG. 62 is a detachable grip portion of Fig. 58 61 taken along line 62_62 of Fig. 59 and mainly Figure 63 is a partial cross-sectional view of the detachable grip portion and the main attachment portion of Figure 58_62 taken along line 63_63 of Figure 59; = Figure 64 - the present invention in an initial position In the second embodiment of the latching system embodiment, the second embodiment of the latching system exemplifies the action of the latching system to the attachment of the main attachment portion of the handle assembly, 20 Figure 66 is Figure 64 and The closure of 65 is from the a, 4 ^ lock system before the second part of the grip part is removed from the main attachment part of the handle assembly; Figure 67 is the lock line of Figure 64_66 ^ έΒ jh -IP 4 ^ίτ Another schematic diagram of V ', , , , , exemplifying the system components in the grip part (four) connected to the main attachment Figure 68 is another schematic view of the latching abundance of Figure 64-67, illustrating the system 96422 90 200814963 assembly during the second attachment of the grip portion to the primary attachment portion Position, FIG. 69 is another schematic diagram illustrating a latching system after the grip portion has been attached a second time and last time to the primary attachment portion; FIG. 70 is a perspective view of another surgical cutting and fastening device of the present invention. Figure 71 is a cross-sectional view of a handle assembly that can be used with the appliance of Figure 70; Figure 72 is an exploded view of the shuttle and retractor assembly of the various embodiments of the present invention; ' ίο 72A疋 is an unassembled view of the shuttle and retracting rod assembly of another embodiment of the present invention; and FIG. 73 is a combined view of the assembly shown in FIG. 72, wherein the cylinder assembly is in a fully extended position; Rear view of the shuttle assembly of the present invention; Figure 75 is another rear view of the shuttle assembly, wherein the retraction rod and the push rod extend into the push # opening and the push rod is attached to the connector member; a rear perspective view of the left part of the shuttle assembly; Figure 77 left part of the shuttle assembly Another rear perspective view; Fig. 78 is a simplified view of a control system configuration 2〇 of the embodiment shown in Figs. 7〇-77; Fig. 79 is a handle assembly configuration of the embodiment shown in Figs. 70-78. Figure 10 is a plan view of the handle assembly, wherein the cylinder assembly is in an extended position; Figure 80 is another top cross-sectional view of the handle assembly of the embodiment shown in Figures 70-79, wherein the cylinder assembly is in a retracted position; 91 200814963 FIG. 81 is a cross-sectional view of the handle assembly of the embodiment shown in FIGS. 70-80; FIG. 81A is a cross-sectional view of an embodiment of the handle assembly of the embodiment shown in FIG. 7A-8. The pressure gas source is outside the handle assembly; FIG. 82 is another cross-sectional view of the handle assembly of FIG. 81, wherein the gas red assembly FIG. 83 is a retracted view; and another sectional view of the handle assembly of 81, wherein Cylinder assembly
10 1510 15
圖83A是-@ 72B所^施例之把手總成 其中氣缸總成縮回且擊發桿處於其最近侧位置。面圖 【主要元件符號說明】 10外科釘合及切斷器具 12終端作用器 20長槽道 21鎖定開口 22附著穴 23槽道槽孔 24凹處 26凹處 28砧凸輪槽孔 20 30刀具總成 31遠侧部分 32上部銷 33孔 3 4刀棒帽 96422 92 200814963 35活塞桿 35’階梯狀部分 36中間銷 37突出部 、 38切割刃 \ 39鎖定突出部 39’近側斜面 _ 39”遠側斜面 40砧 10 42砧穴 43砧樞轴 44縱向砧槽孔 46砧開/關舌片 50釘匣 15 51匣主體 、 • 54鉛直槽孔 56釘匣上表面 58釘孔 60釘匣之加長特徵部 20 62釘匣之加長特徵部 64楔形滑橇 66肘釘傳動器 68匣托板 70肘釘 96422 93 200814963 100長軸桿總成 102脊總成 104樞軸 110遠侧脊段 5 111遠侧方形孔 ' 112鎖簧 113近側方形孔 馨 114槽道錨定構件 Π5夾桿 10 116鎖簧上臂 117波紋管通道 118鎖簧下臂 122轂 123連接點 15 124 孔 _ 125連接點 130近侧脊段 134柄腳 136孔 20 138樞轴銷 140銷 142銷 150帶構件 160帶構件 96422 94 200814963 170 閉合管總成 172 雙柩軸閉合接頭 174 上部雙樞軸連桿 175 遠侧樞軸銷 •5 176 近側樞軸鎖 177 下部雙樞軸連桿 178 遠側樞軸銷 • 179 近側樞軸銷 180 遠側閉合管區段 10 182 上柄腳 183 插銷孔 184 下柄腳 185 馬蹄形孔 186 舌片 15 187 插銷孔 • 190 近侧閉合管區段 191 轴向通道 192 上柄腳 193 插銷孔 20 194 下柄腳 195 插銷孔 196 止動溝 200 活節控制器 202 活節滑件 96422 95 200814963Figure 83A is a handle assembly of the embodiment of -@72B wherein the cylinder assembly is retracted and the firing rod is in its proximal most position. Fig. [Major component symbol description] 10 Surgical stapling and cutting device 12 End effector 20 Long channel 21 Locking opening 22 Attachment hole 23 Channel groove 24 Recession 26 Recession 28 Anvil cam slot 20 30 Total cutter 31 distal part 32 upper pin 33 hole 3 4 knife bar 96422 92 200814963 35 piston rod 35' stepped portion 36 intermediate pin 37 protrusion, 38 cutting edge \ 39 locking protrusion 39' proximal slope _ 39" far Side bevel 40 anvil 10 42 anvil 43 anvil pivot 44 longitudinal anvil slot 46 anvil open / close tongue 50 nail 匣 15 51 匣 main body, • 54 vertical slot hole 56 nail 匣 upper surface 58 nail hole 60 nail lengthening Feature portion 20 62 staple extension feature 64 wedge slider 66 staple driver 68 匣 plate 70 elbow 96422 93 200814963 100 long shaft assembly 102 ridge assembly 104 pivot 110 distal ridge segment 5 111 far Side square hole '112 lock spring 113 proximal square hole Xin 114 channel anchoring member Π 5 clamp rod 10 116 lock spring upper arm 117 bellows passage 118 lock spring lower arm 122 hub 123 connection point 15 124 hole _ 125 connection point 130 Side ridge section 134 tang 136 hole 20 138 pivot pin 140 pin 142 pin 150 belt member 160 belt member 9642 2 94 200814963 170 Closed tube assembly 172 Double 闭合 shaft closed joint 174 Upper double pivot link 175 Far pivot pin • 5 176 Proximate pivot lock 177 Lower double pivot link 178 Distal pivot pin • 179 Proximal pivot pin 180 distal closure tube segment 10 182 upper tang 183 pin hole 184 lower tang 185 horseshoe hole 186 tongue 15 187 pin hole 190 proximal closed tube section 191 axial channel 192 upper tang 193 pin Hole 20 194 Lower tang 195 Pin hole 196 Stop groove 200 Joint controller 202 Joint slide 96422 95 200814963
ίο 15Ίο 15
204框架 206封閉件 208槽孔 210連接點 212連接點 300把手總成 301可釋鎖定機構 302閉合扳機 303可撓縱向臂 304輛總成 305銷 3 0 6柩轴銷 310擊發扳機 310’相對位置扳機 320右邊機殼構件 321孔 322右邊機殼構件之上部部分 323左邊機殼構件之上部部分 324右邊機殼構件之下部握把部分 326右脊總成止動樁 328執道導件 330左邊機殼構件 331孔 332上附接板部分 96422 96 20 200814963 333觸覺回饋配置 334左邊機殼構件之下部握把部分;螺母部分(圖55) 335槽孔 337彈簧臂 、 340主殼體部分 ' 342握把部分 344主要附著部分 • 350 開口 352楔 10 354楔之下表面 356 凹口 358可撓擋止 359開口 350之傾斜後壁 360 開口 15 367上部滑執 馨 368下部滑執 3 69斜面 370樞軸銷 372孔 20 380鑲板 382鑲板 384上部滑執之收納通道 400閉合梭 402梭之右邊部分 96422 97 200814963 403 緊固 栓 404 梭之左邊部分 405 右止 動凸緣區段 406 槽孔 408 槽孔 410 導執 411 導執 • 412 連接 器舌片 414 銷 10 430 閉合連桿總成 432 輛部分 434 閉合臂 436 閉合銷 500 傳動構件 15 501 氣缸 總成 • 510 第一 氣缸殼體 511 第一 壁 512 第一 近端 513 第一 供氣埠 20 514 第一 遠端 515 第一 氣缸區 516 第一 轴向通道 517 第一 凸緣 518 第二 氣缸區 96422 98 200814963 519耳軸 520第二氣缸殼體 521第二壁 522第二近端 _5 523排氣口 ' 524第二遠端 525第二凸緣 _ 526第二轴向通道 527第一通道 10 528第一活塞頭 529第二供氣埠 530第二活塞頭 532第三氣缸區 534第四氣缸區 15 540第一供氣線路 ⑩ 540’第一供氣線路區段 540”第一供氣線路區段 541壓力計 542第二供氣線路 20 542’第二供氣線路區段 542”第二供氣線路區段 543窗 545聲音出口 546限制開關 96422 99 200814963 547啟動構件 549指示構件 600驅動器系統 610定向控制閥 *5 612選擇開關 ^ 616 埠口 617可撓供氣線路 H 618外界加壓氣體源 620可移除/可再充氣加壓氣體源 10 622貯氣瓶 624液態物 626膜片 628蒸氣 630真空源;貯氣瓶排洩端(圖57-58 ) 15 632可撓真空線路;管集箱塊(圖57-58 ) _ 634有螺紋槔口 636供氣通道 637遠端 638針閥 20 639 點 640壓力計 642壓力計窺視窗 644封閉管集室 645 埠口 96422 100 200814963204 frame 206 closure 208 slot 210 connection point 212 connection point 300 handle assembly 301 releasable locking mechanism 302 closure trigger 303 flexible longitudinal arm 304 assembly 305 pin 3 0 6 axis pin 310 firing trigger 310 'relative position Trigger 320 right side casing member 321 hole 322 right side casing member upper portion 323 left casing member upper portion 324 right casing member lower portion grip portion 326 right ridge assembly stop pile 328 obstruction guide 330 left machine Shell member 331 hole 332 upper attachment plate portion 96422 96 20 200814963 333 haptic feedback configuration 334 left side casing member lower grip portion; nut portion (Fig. 55) 335 slot 337 spring arm, 340 main housing portion '342 grip Part 344 main attachment part • 350 opening 352 wedge 10 354 wedge lower surface 356 notch 358 can be flexed 359 opening 350 inclined rear wall 360 opening 15 367 upper sliding 368 lower sliding 3 69 inclined 370 pivot Pin 372 hole 20 380 panel 382 panel 384 upper sliding storage channel 400 closing shuttle 402 shuttle right part 96422 97 200814963 403 fastening bolt 404 shuttle left part 405 right stop flange section 406 Slot 408 Slot 410 Guide 411 Guide • 412 Connector Tab 414 Pin 10 430 Closed Link Assembly 432 Vehicle Section 434 Closing Arm 436 Closing Pin 500 Transmission Member 15 501 Cylinder Assembly • 510 First Cylinder Housing Body 511 first wall 512 first proximal end 513 first air supply port 20 514 first distal end 515 first cylinder region 516 first axial passage 517 first flange 518 second cylinder region 96422 98 200814963 519 trunnion 520 Second cylinder housing 521 second wall 522 second proximal end _5 523 exhaust port ' 524 second distal end 525 second flange _ 526 second axial passage 527 first passage 10 528 first piston head 529 Second air supply port 530 second piston head 532 third cylinder area 534 fourth cylinder area 15 540 first gas supply line 10 540 'first gas supply line section 540" first gas supply line section 541 pressure gauge 542 Two gas supply line 20 542' second gas supply line section 542" second gas supply line section 543 window 545 sound outlet 546 limit switch 96422 99 200814963 547 activation member 549 indicator member 600 drive system 610 directional control valve *5 612 selector switch ^ 616 埠 617 flexible supply line H 618 external pressurized gas source 620 removable / refillable pressurized gas source 10 622 gas cylinder 624 liquid 626 diaphragm 628 vapor 630 vacuum source ; gas cylinder drain end (Figure 57-58) 15 632 flexible vacuum line; tube set box block (Figure 57-58) _ 634 threaded port 636 gas supply channel 637 distal end 638 needle valve 20 639 points 640 pressure 642 pressure gauge peep window 644 closed tube set room 645 埠 mouth 96422 100 200814963
ίο 15Ίο 15
646 無菌 膜片 649 壓縮 彈簧 650 供氣線路 651 供氣線路 660 比例 閥 662 供氣連桿臂 670 啟動扳機 671 腔穴 680 供氣線路 800 氣缸 總成 810 第一 氣缸殼體 812 第一 封閉端 813 第一 供氣埠 815 第一 氣缸區 817 第一 凸緣 820 第二 氣缸殼體 822 第二 封閉近端 824 第二 遠端 825 第二 凸緣 827 第一 開口 828 第一 活塞頭 830 第二 活塞頭 832 第三 氣缸區 840 第一 供氣線路 96422 20 200814963 850第一回縮彈簧 852彈簧 900波紋管總成 902遠端 5 904突出部 • 910可擴張/縮回波紋管部分 912金屬絲約束環 B 912’啟動構件 914基座部分 10 916供氣槔 920真空埠 922真空線路 940供氣線路 940’供氣線路區段 15 940”供氣線路區段 _ 1000快拆式接頭 1000’快拆式接頭 1010遠侧軸桿總成 1012近端 20 1020近侧軸桿總成 1022遠端 1030脊總成 1110遠侧脊段 1111遠侧方形孔 96422 102 200814963 1113近側方形孔 1114近端 1115夾桿646 sterile diaphragm 649 compression spring 650 gas supply line 651 gas supply line 660 proportional valve 662 gas supply link arm 670 start trigger 671 cavity 680 gas supply line 800 cylinder assembly 810 first cylinder housing 812 first closed end 813 First air supply port 815 first cylinder region 817 first flange 820 second cylinder housing 822 second closed proximal end 824 second distal end 825 second flange 827 first opening 828 first piston head 830 second piston Head 832 third cylinder area 840 first gas supply line 96422 20 200814963 850 first retraction spring 852 spring 900 bellows assembly 902 distal end 5 904 projections 910 expandable/retractable bellows portion 912 wire confinement ring B 912 'starting member 914 base portion 10 916 air supply 920 vacuum 922 vacuum line 940 gas supply line 940 ' gas supply line section 15 940 " gas supply line section _ 1000 quick release joint 1000 ' quick release Connector 1010 distal shaft assembly 1012 proximal end 20 1020 proximal shaft assembly 1022 distal end 1030 ridge assembly 1110 distal ridge segment 1111 distal square hole 96422 102 200814963 1113 proximal square hole 1114 proximal 1115 clamp
ίο 15Ίο 15
1116遠侧連接器部分 1117第一遠侧供氣埠 1117’第三遠侧供氣埠 1118第一供氣喷嘴部分 1118’第三供氣喷嘴部分 1119凹口部分 1120第二遠側供氣埠 1120’第四遠侧供氣埠 1122第二供氣噴嘴部分 1122’第四供氣喷嘴部分 1124掣止構件 1126可撓舌片 1150近侧脊段 1152遠端 1154第二連接器部分 115 5凹口部分 1156第一近側供氣埠 1156’第三近側供氣埠 1158第一 Ο環封 1158’第三Ο環封 1160第二近側供氣埠 96422 103 20 200814963 1160’第四近侧供氣埠 1162第二Ο環封 1162’第四Ο環封 1170中空套筒部分 5 1172鎖定開口 - 1178閉合管總成 1180遠侧閉合管區段 • 1182近端 1184鎖定舌片 10 1186鎖定楔 1190近侧閉合管區段 1194鎖定開口 1195近端 1196槽孔 15 1200釋放套筒 ⑩ 1202遠端 1204釋放鈕 1206第二斜切内緣 1300第一遠侧供氣埠 20 1306近侧供氣埠 1308 Ο環封 1500外科切割及釘合器具 1512終端作用器 1520長槽道 96422 104 2008149631116 distal connector portion 1117 first distal air supply port 1117' third distal air supply port 1118 first air supply nozzle portion 1118' third air supply nozzle portion 1119 notch portion 1120 second distal air supply port 1120' fourth distal air supply port 1122 second air supply nozzle portion 1122' fourth air supply nozzle portion 1124 stop member 1126 flexible tongue 1150 proximal ridge segment 1152 distal end 1154 second connector portion 115 5 concave Port portion 1156 first proximal air supply 埠 1156' third proximal air supply 埠 1158 first Ο ring seal 1158 'third Ο ring seal 1160 second proximal air supply 埠 96422 103 20 200814963 1160 'fourth proximal side Air supply 埠 1162 second Ο ring seal 1162' fourth Ο ring seal 1170 hollow sleeve portion 5 1172 locking opening - 1178 closing tube assembly 1180 distal closing tube section • 1182 proximal end 1184 locking tongue 10 1186 locking wedge 1190 Proximal closed tube section 1194 locking opening 1195 proximal end 1196 slot 15 1200 release sleeve 10 1202 distal end 1204 release button 1206 second beveled inner edge 1300 first distal air supply port 20 1306 proximal air supply port 1308 Ο Ring seal 1500 surgical cutting and stapling instrument 1512 end effector 1520 long slot 96422104 200 814 963
ίο 15 1521遠端 1522軸承 1530楔形滑橇總成 1532滑橇部分 1538刀部分 1540脊總成 1542近侧脊段 1543 開口 1544主傳動軸 1545近端 1546次級傳動軸 1546’馬達傳動軸 1548傳動齒輪 1548’傳動齒輪 1550斜齒輪總成 1552斜齒輪 1554傳動齒輪 1556斜齒輪 1560傳動螺桿 1562近侧傳動齒輪 1570遠侧脊段 1600驅動器系統 1610定向控制閥 1612按鈕 96422 20 200814963 1614按鈕 1620前進位置區段 1622前進通道 1624通道 1630停止區段 1632排氣埠 1640倒轉區段Ίο 15 1521 distal 1522 bearing 1530 wedge sled assembly 1532 sled part 1538 knife part 1540 ridge assembly 1542 proximal ridge section 1543 opening 1544 main drive shaft 1545 proximal end 1546 secondary drive shaft 1546' motor drive shaft 1548 transmission Gear 1548' transmission gear 1550 helical gear assembly 1552 helical gear 1554 transmission gear 1556 helical gear 1560 transmission screw 1562 proximal transmission gear 1570 distal ridge segment 1600 drive system 1610 directional control valve 1612 button 96422 20 200814963 1614 button 1620 forward position area Segment 1622 forward passage 1624 passage 1630 stop section 1632 exhaust 埠 1640 reverse section
ίο 15Ίο 15
1660近側限制開關 1662近側辅助線路 1664近側限制開關線路 1700供氣/排氣線路 1710供氣/排氣線路 1730氣動馬達 1730’氣動馬達 1732輸出軸 1734第一傳動齒輪 1736第二傳動齒輪 1738輸入轴 1740行星齒輪總成 1742輸出軸 1743聯轴構件 1750回饋齒輪 1752刀位置齒輪 1754刀位置軸 96422 106 20 200814963 1756近端 1758遠端 1760近侧限制開關 1770遠側限制開關 5 1772遠侧辅助線路 ‘ 1774遠側限制開關線路 1780刀指示器 _ 1790第一氣笛 1792第二氣笛 10 1800回饋連桿總成 1801有螺紋手動回饋軸 1802萬向接頭部分 1804手動回饋齒輪 1900閉鎖系統 15 1902計數器 • 1904阻隔總成 1906 軸 1908 轂 1910分度輪 20 1912偏動構件 1914突出部 1914’突出部 1914”突出部 1916六角形開口 96422 107 200814963 1918 開口 1920 阻隔構件 1922 阻隔構件導件 1924 閘構件 5 1926 偏動構件 * 1930 釋放系統 1932 釋放鈕 • 1934 釋放構件 1936 釋放斜面 10 1938 釋放銷 1940 鎖簧 1942 頂出簧 2000 外科切割及釘合器具 2002 氣動活節接頭總成 15 2004 脊總成 • 2010 遠側脊段 2012 近端 2014 樞軸構件 2016 驅動片 20 2030 近侧脊段 2032 遠端 2034 樞轴承窩 2036 溝 2038 溝 96422 108 200814963 2040第一鉛直供氣通道 2042第三供氣線路 2042’第三供氣線路區段 2042” 第三供氣線路區段 5 2044 第三供氣埠 ^ 2045 第三供氣通道 2050 第二鉛直供氣通道 m 2052 第四供氣線路 2052’第四供氣線路區段 10 2052”第四供氣線路區段 2054 第四供氣埠 2055 第四供氣通道 2060 蓋 2062 螺釘 15 2100 開關總成 2110開關塊 2111樞軸孔 2112供氣埠 2113 開關塊之底部表面 20 2114 開關腔 2116 供氣通道 2118 管集箱區 2130選擇器構件總成 2150主體部分 96422 109 200814963 2151 框轴桿 2152 0環封 2153 回行桿 2154 0環封 5 2155 底切排氣區 - 2156 短桿 2158 選擇器把手 • 2160 中央供氣埠 2170 第四排氣通道 10 2180 第三排氣通道 2190 回動簧 2192 圓突部 2193 槽孔 2194 圓突部 15 2195 槽孔 • 2196 回動簧之自由端 2198 回動簧之自由端 3010 氣動外科切割及緊固裝置 3102 脊總成 20 3104 近侧脊段 3105 近端 3106 遠側脊段 3110 右止動樁 3112 左止動樁 96422 110 200814963 3190閉合管 3192遠端 3194馬蹄形孔 3196脊總成之近端 '5 3400梭總成 • 3402梭總成之右邊部分 3403 開口 • 3404梭總成之左邊部分 3405右止動凸緣區段 10 3406 開口 3408 開口 3410導執 3411導執 3412連接器片 15 3414 銷 φ 3416鉛直支撐壁 3418鉛直支撐壁 3420推桿開口 3430閉合連桿總成 20 3432輕部分 3434閉合臂 4000回縮桿總成 .4010回縮桿 4011近端 96422 111 200814963 4012槽孔 4014 銷1660 proximal limit switch 1662 proximal auxiliary line 1664 proximal limit switch line 1700 air supply/exhaust line 1710 air supply/exhaust line 1730 air motor 1730' air motor 1732 output shaft 1734 first transmission gear 1736 second transmission gear 1738 input shaft 1740 planetary gear assembly 1742 output shaft 1743 coupling member 1750 feedback gear 1752 knife position gear 1754 knife position shaft 96422 106 20 200814963 1756 proximal end 1758 distal 1760 proximal limit switch 1770 distal limit switch 5 1772 distal Auxiliary line '1774 far side limit switch line 1780 knife indicator _ 1790 first whistle 1792 second whistle 10 1800 feedback link assembly 1801 threaded manual feedback shaft 1802 universal joint part 1804 manual feedback gear 1900 locking system 15 1902 counter • 1904 barrier assembly 1906 shaft 1908 hub 1910 indexing wheel 20 1912 biasing member 1914 projection 1914 'protrusion 1914" projection 1916 hexagonal opening 96422 107 200814963 1918 opening 1920 barrier member 1922 barrier member guide 1924 Member 5 1926 Bias member * 1930 Release system 1932 Release button • 1934 Release member 1 936 release bevel 10 1938 release pin 1940 lock spring 1942 ejector spring 2000 surgical cutting and stapling instrument 2002 pneumatic joint assembly 15 2004 ridge assembly • 2010 distal ridge segment 2012 proximal 2014 pivot member 2016 drive plate 20 2030 proximal ridge section 2032 distal end 2034 pivot bearing socket 2036 groove 2038 groove 96422 108 200814963 2040 first vertical air supply passage 2042 third gas supply line 2042 'third gas supply line section 2042" third gas supply line section 5 2044 Third air supply 埠^ 2045 Third air supply channel 2050 Second vertical air supply channel m 2052 Fourth gas supply line 2052' Fourth gas supply line section 10 2052" Fourth gas supply line section 2054 Fourth Air supply 埠 2055 Fourth air supply passage 2060 Cover 2062 Screw 15 2100 Switch assembly 2110 Switch block 2111 Pivot hole 2112 Air supply 113 2113 Switch block bottom surface 20 2114 Switch chamber 2116 Air supply channel 2118 Pipe header box 2130 selection Member assembly 2150 body portion 96422 109 200814963 2151 frame shaft 2152 0 ring seal 2153 return rod 2154 0 ring seal 5 2155 undercut exhaust zone - 2156 short rod 2158 selector handle • 2160 central air supply 170 2170 fourth exhaust passage 10 2180 third exhaust passage 2190 return spring 2192 round projection 2193 slot 2194 round projection 15 2195 slot • 2196 free end of the return spring 2198 Reversing spring free end 3010 Pneumatic surgical cutting and fastening device 3102 Ridge assembly 20 3104 Proximal ridge segment 3105 Proximal end 3106 Distal ridge segment 3110 Right stop post 3112 Left stop post 96422 110 200814963 3190 Closed tube 3192 Distal end 3194 horseshoe hole 3196 ridge assembly proximal end '5 3400 shuttle assembly • 3402 shuttle assembly right part 3403 opening • 3404 shuttle assembly left part 3405 right stop flange section 10 3406 opening 3408 opening 3410 Guide 3411 guide 3412 connector piece 15 3414 pin φ 3416 vertical support wall 3418 vertical support wall 3420 push rod opening 3430 closed link assembly 20 3432 light part 3434 closed arm 4000 retracting rod assembly. 4010 retracting rod 4011 Proximal 96422 111 200814963 4012 slot 4014 pin
ίο 15 4015 凹口 4016回縮握把 4020推桿 4022遠端 4024連接器孔 4026推桿之近端 4028連接樁 4030擊發桿 4032近端 4034連接器部分 4040 Z形連接器部件 4041近端 4042附接舌片 4045 Z形連接器部件之遠端 4046遠侧附接舌片 4049 開口 5000氣動缸總成 5010第一氣缸殼體 5011第一壁 5012第一封閉近端 5013第一供氣埠 5014第一開放遠端 96422 112 20 200814963Ίο 15 4015 notch 4016 retracting grip 4020 push rod 4022 distal end 4024 connector hole 4026 push rod proximal end 4028 connection post 4030 firing rod 4032 proximal end 4034 connector portion 4040 Z-shaped connector part 4041 proximal end 4042 attached Tab 4045 Z-connector member distal end 4046 distal attachment tab 4049 opening 5000 pneumatic cylinder assembly 5010 first cylinder housing 5011 first wall 5012 first closed proximal end 5013 first air supply port 5014 An open distal 96422 112 20 200814963
ίο 15 5015第一氣缸區 5016第一軸向通道 5017第一凸緣 5018第二氣缸區 5020第二氣缸殼體 5021第二壁 5022第二近端 5023排氣口 5024第二開放遠端 5025第二凸緣 5026第二軸向通道 5027第一通道 5028第一活塞頭 5029第二埠 5032第三氣缸區 5034第四氣缸區 5040活塞缸 5042近端 5044封閉遠端 5046第二活塞頭 5047 開口 5048通道 5050第一供氣線路 5052第二供氣線路 96422 20Ίο 15 5015 first cylinder region 5016 first axial passage 5017 first flange 5018 second cylinder region 5020 second cylinder housing 5021 second wall 5022 second proximal end 5023 exhaust port 5024 second open distal end 5025 Second flange 5026 second axial passage 5027 first passage 5028 first piston head 5029 second 埠 5032 third cylinder region 5034 fourth cylinder region 5040 piston cylinder 5042 proximal end 5044 closed distal end 5046 second piston head 5047 opening 5048 Channel 5050 first gas supply line 5052 second gas supply line 96422 20
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US11/497,831 US20080029573A1 (en) | 2006-08-02 | 2006-08-02 | Pneumatically powered surgical cutting and fastening instrument with replaceable power sources |
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TW (1) | TW200814963A (en) |
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IL184589A0 (en) | 2008-01-20 |
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