TWI454243B - 活節式彎曲刀具釘合器 - Google Patents

活節式彎曲刀具釘合器 Download PDF

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TWI454243B
TWI454243B TW096131751A TW96131751A TWI454243B TW I454243 B TWI454243 B TW I454243B TW 096131751 A TW096131751 A TW 096131751A TW 96131751 A TW96131751 A TW 96131751A TW I454243 B TWI454243 B TW I454243B
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end effector
surgical stapler
ball
support shaft
cassette
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TW200822899A (en
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Michael T Mather
Michael L Kruszynski
Richard F Schwemberger
Michael A Parker
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Ethicon Endo Surgery Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis in a single operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/122—Clamps or clips, e.g. for the umbilical cord
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A61B2017/00473—Distal part, e.g. tip or head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B2017/0688—Packages or dispensers for surgical staplers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07221—Stapler heads curved
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2943—Toothed members, e.g. rack and pinion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320052—Guides for cutting instruments
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T403/00—Joints and connections
    • Y10T403/32—Articulated members
    • Y10T403/32008—Plural distinct articulation axes
    • Y10T403/32024—Single adjustment for plural axes
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T403/00—Joints and connections
    • Y10T403/32—Articulated members
    • Y10T403/32008—Plural distinct articulation axes
    • Y10T403/32032—Plural ball and socket
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T403/00—Joints and connections
    • Y10T403/32—Articulated members
    • Y10T403/32254—Lockable at fixed position
    • Y10T403/32262—At selected angle
    • Y10T403/32311—Ball and socket

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  • Health & Medical Sciences (AREA)
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  • Surgery (AREA)
  • Molecular Biology (AREA)
  • Engineering & Computer Science (AREA)
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  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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Description

活節式彎曲刀具釘合器
本發明係有關於一種設計成於以釘合切除術處理病理之診斷及治療時使用的手術釘合及切割器械。更特別的是，本發明係有關於一種可提供末端執行器活節操作的手術釘合及切割器械以改善手術部位之可近性。
手術釘合及切割器械通常是在以釘合切除術處理病理之診斷及治療的時候使用。手術釘合器械提供一種機構可經由肛管、口部、胃部及輔助引道引進來擴展機械縫合器的經腔(transluminal)利用性。雖然手術釘合及切割器械最常用於直腸病理學，手術釘合及切割器械仍可用於各種環境。
長期以來，已開發出多種手術釘合及切割器械。該等器械通常包含支架、附著於該支架的砧體、以及攜載多支U形釘的卡匣模組。該等器械也包含在該卡匣模組內的驅動器，該驅動器會同時把所有的U形釘推出進入該砧體以使該等U形釘大體呈B形而一起縫合組織。此外，該等器械包含逼近機構可用來使卡匣模組由相對於砧體為可接受組織的分開位置到移動到可把組織夾在砧體及卡匣模組之間的位置。最後，該等器械包含擊發構件可用來使U形釘驅動器向前移動以形成頂著砧體的U形釘。
一旦該器械位於人體腔內，末端執行器相對於需要切除的組織必須有適當的方位。一般而言，這是藉由重定整個器械，亦即，把手、軸桿及末端執行器的方位來達成，，因為彼等係剛性地沿著該器械的縱軸連接。然而，這會限制末端執行器重定方位的可能性，因為它的方位會受限於讓手術釘合及切割器械插進身體的進入開口。
因此，亟須一種手術釘合及切割器械有考慮到末端執行器的重定向而不需要重定伸出人體孔之把手及軸桿的方位。本發明係提供這種機構。
因此，本發明的目標是要提供一種有近端及遠端的活節式外科釘合器。該釘合器包含一在該近端的把手與一在該遠端供選擇性活節操作的末端執行器以改善需要治療之組織的可近性以及本線性外科釘合器的易用性。一使該把手連接至該末端執行器的支撐軸桿。有一活節機構位於該支撐軸桿與該末端執行器之間且允許該末端執行器相對於該支撐軸桿的選擇性移動。
本發明的另一目標是要提供一種外科釘合器，其中該活節機構包含一使該末端執行器耦合於該支撐軸桿的球形接頭。
本發明的另一目標是要提供一種外科釘合器，其係包含一與該球形接頭連繫的鎖緊機構供允許選擇性地鎖定該末端執行器於想要的方位以及選擇性地釋放該末端執行器以便在必要時控制它的移動。
本發明的另一目標是要提供一種外科釘合器，其中該鎖緊機構包含一球形鎖釋放管。
本發明的另一目標是要提供一種外科釘合器，其中該球形接頭包含一有造形(contoured)外表面的小球，該造形外表面的形狀及尺寸係經製作成可接合該球形鎖釋放管的遠端。
本發明的另一目標是要提供一種外科釘合器，其中該球形接頭包含一有造形外表面的小球，該造形外表面的形狀及尺寸係經製作成可鎖住該球形鎖釋放管的遠端，該小球的造型有助於保證在該小球與該球形鎖釋放管的遠端之間有磨擦式接合。
本發明的另一目標是要提供一種外科釘合器，其中該活節機構包含多個活節接頭。
本發明的另一目標是要提供一種外科釘合器，其中用一齒輪及皮帶旋轉機構啟動該等多個活節接頭。
本發明的另一目標是要提供一種外科釘合器，其中該齒輪及皮帶旋轉機構包含一連結至一齒輪的活節旋鈕，接著該齒輪連結至第一及第二控制桿，該第一及該第二控制桿均連結至一驅動一固定於該末端執行器之固定齒輪的旋轉齒輪。
本發明的另一目標是要提供一種外科釘合器，其中該等多個活節接頭均用一纜線啟動，該纜線係連結至一附著於該末端執行器的傳動結構。
本發明的另一目標是要提供一種外科釘合器，其中該末端執行器係可釋放地固定於該支撐軸桿。
本發明的另一目標是要提供一種外科釘合器，其中一在該末端執行器與該支撐軸桿之間的刺刀型鎖係允許選擇性釋放。
本發明的另一目標是要提供一種外科釘合器，其中該末端執行器為彎曲型。
本發明的另一目標是要提供一種外科釘合器，其中該末端執行器為一包含一卡匣模組與一支撐結構的手術夾緊總成。
本發明的另一目標是要提供一種外科釘合器，其中該卡匣模組包含一耦合至一砧體的卡匣外殼。
本發明的另一目標是要提供一種外科釘合器，其係包含一由該把手延伸至該末端執行器用以啟動該卡匣模組的驅動纜線。
本發明的另一目標是要提供一種外科釘合器，其中該卡匣外殼包含一形狀及尺寸經製作成可滑動地接受一推動軸環的凹座，該驅動纜線的帶螺紋遠端係於該推動軸環內嚙合成可使該卡匣外殼及該推動軸環向該砧體移動。
本發明的另一目標是要提供一種外科釘合器，其中該推動軸環係選擇性地由與該卡匣外殼的嚙合鬆開而以強迫刀片及U形釘與該卡匣外殼往該砧體移動的方式允許該推動軸環繼續向前移動。
本發明的另一目標是要提供一種外科釘合器，它更包含一防止該卡匣外殼不必要地向後移動的防後退機構。
本發明的另一目標是要提供一種外科釘合器，其係包含一啟動止動銷的撓性止動銷驅動纜線。
由以下提出一些本發明具體實施例及結合附圖的詳細說明可明白本發明的其他目標及優點。
本文詳細揭示本發明的具體實施例。然而，應瞭解該等具體實施例都可具體實作成不同的形式而只是用來示範本發明。因此，揭示於本文的細節不應被解釋成有限定性，而只是作為申請專利範圍和教導熟諳此藝者如何製作及/或使用本發明的基礎。
請參考第1圖至第10圖，其係圖示一手術釘合及切割器械(特別是，線性外科釘合器)10。該線性外科釘合器10係經設計成可釘合及切割組織。該線性外科釘合器10有一在近端14的把手12與一在相對遠端18的末端執行器16。如下文所詳述的，末端執行器16係經支撐成可選擇性地活節操作以改善需要治療之組織的可近性以及本線性外科釘合器10的易用性。
根據本發明之一較佳具體實施例，末端執行器16為彎曲型，然而熟諳此藝者會明白可使用不同形狀的末端執行器而不脫離本發明的精神。支撐軸桿20係使該器械的把手12連接至末端執行器16。根據本發明之一較佳具體實施例，把手12有右側及左側防護罩22、24。把手12也有可抓緊及操縱線性外科釘合器10的主體部份。
末端執行器16為一種包含一卡匣模組26與一C形支撐結構28的手術夾緊總成。本專利說明書所用的術語“C形”是描述支撐結構28及卡匣模組26的凹性。該C形結構係有利於增強機能，而且本專利說明書在使用術語C形這方面應被認為是涵蓋可同樣增強該手術釘合及切割器械之機能的各種形狀。末端執行器16的形狀及尺寸係經製作成可接受卡匣模組26。末端執行器16也包含一用於防止先前已擊發之卡匣模組擊發的安全鎖定機構。儘管下文將本末端執行器的設計揭示成可結合有各種組件的可置換卡匣模組供使用，本發明的概念可應用於各種的末端執行器及卡匣模組構造而不脫離本發明的精神。
基於以下的揭示內容可明白，本線性外科釘合器10係經設計成一有一可置換卡匣模組26的多次擊發式裝置。然而，應瞭解，本發明的概念中有許多同樣可應用於單次擊發式裝置而不脫離本發明的精神。
更特別的是，而且根據一較佳的具體實施例，卡匣模組26包含一與砧體32耦合的卡匣外殼30。卡匣模組26也包含止動銷34、刀片36、可卸除保持架38、組織接觸面40該組織接觸面40顯示含有多支U形釘之槽孔42在刀片36兩側以交錯方式排成一或更多列(亦即，U形釘排)。數支U形釘(未圖示)係由卡匣外殼30向砧體32面對著卡匣外殼30之組織接觸面40的的U形釘形成面44擊出。
如下文所詳述的，卡匣模組26是用以下方式操作。一旦適當地裝上卡匣模組26後，啟動安裝於把手12的曲柄48以旋轉會啟動線性外科釘合器10之末端執行器16的驅動纜線50。驅動纜線50的初始啟動最初會使卡匣模組26閉合。亦即，驅動纜線50會使卡匣外殼30由完全打開位置移動到在打開及閉合位置之間的中間位置。一旦使卡匣外殼30移到中間位置後，啟動止動銷驅動纜線52以使止動銷34由卡匣外殼30通過砧體32的開口向前移動。在此位置時，可正確地固定住已置於卡匣外殼30、砧體32之間的組織，且可確保組織會保持在卡匣外殼30、砧體32之間。在已啟動驅動纜線50來使卡匣外殼30移到中間位置時，卡匣外殼30及砧體32會處於可保持組織的對應位置。
當以驅動卡匣外殼30向前的方式進一步旋轉驅動纜線50時，卡匣外殼30的組織接觸面40與砧體32的U形釘形成面44會相互靠近，結果會完全夾住所保持之組織於適當的位置。之後，以擊發U形釘的方式進一步旋轉驅動纜線50而驅動U形釘驅動器54向前且使刀片36向前移動以切割該組織。
線性外科釘合器10的把手12包含外科醫生可用手掌握住的手柄56。手柄56係由右側防護罩24與左側防護罩22組成。使用者用線性外科釘合器10的把手12可使用前述曲柄48或其他用於驅動本手術釘合及切割器械10之擊發機構的使用者啟動機構。
由於末端執行器16與支撐軸桿20及把手12的活節操作會迫使擊發機構隨著末端執行器16的活節操作而能夠彎曲，而且如以上所簡述的，把手12係經由撓性驅動纜線50而連結於末端執行器16。更特別的是，本線性外科釘合器的擊發機構是用有近端58及遠端60的撓性驅動纜線50來啟動。驅動纜線50係以控制方式啟動卡匣外殼30、U形釘驅動器54及刀片36的運動。特別是，驅動纜線50係由線性外科釘合器10的把手12延伸到卡匣外殼30、U形釘驅動器54以及位於線性外科釘合器10之末端執行器16的刀片36。
在驅動纜線50的近端58裝設一使用者可接合界面48。例如，而且根據一較佳的具體實施例，該使用者可接合界面為一曲柄48，使用者可選擇性地旋轉動它以沿著驅動纜線50的長度施加扭矩最後再轉變成卡匣外殼30、U形釘驅動器54及刀片36的線性運動。
關於驅動纜線50的遠端60，它是用以下方式以螺紋嚙合卡匣外殼30、U形釘驅動器54及刀片36：在以控制方式轉動驅動纜線50時會使該等元件線性移動。因此，藉由旋轉驅動纜線50，使卡匣外殼30、U形釘驅動器54及刀片36能以控制方式向砧體32移動用來釘合及切割組織。
更特別的是，以及參考第4圖、第5圖、第6圖及第7圖，其係圖示卡匣外殼30驅動U形釘及刀片36的操作。根據一較佳的具體實施例，卡匣外殼30包含形狀及尺寸製作成可接受推動軸環142的凹座140，該推動軸環142之內則嚙合著驅動纜線50的帶螺紋遠端144用以移動推動軸環142(其方式在下文會有更詳細的說明)。如下文所詳述的，推動軸環142保持在凹座140內以便與它有受控制的相對運動。
當以預定方向旋轉驅動纜線50時，會使卡匣外殼30及推動軸環142向砧體32往前移動。U形釘及刀片36同樣被驅動向前往砧體32移動。連續旋轉驅動纜線50會使卡匣外殼30移動而更加靠近砧體32。一旦卡匣外殼30與砧體32相對靠近後，推動軸環142與卡匣外殼30的嚙合會鬆開而允許推動軸環142及驅動器54以強迫刀片36及U形釘接近砧體32的方式連續向前移動。
更特別的是，驅動器54是裝在形成於卡匣外殼30的凹座146內。用彈簧148偏壓驅動器54使它傾向離開砧體32而接近推動軸環142。因此，當推動軸環142鬆脫而且與卡匣外殼30可自由地相對移動時，會反抗彈簧148的偏壓，把驅動器54推向砧體32，直到驅動U形釘及刀片36穿過組織進入砧體32而在此以可固定於組織的方式弄彎U形釘。
顯然熟諳此藝者會明白，卡匣外殼30不會意外地後退是很重要的。因此，裝設一防後退機構。該防後退機構通常包含防後退棘爪150，其形狀及尺寸係經製作成以能夠防止卡匣外殼30向後移動的方式與沿著末端執行器16形成的齒狀物152嚙合。特別是，防後退棘爪150為一縱向延伸構件154，其係可樞轉地固定於卡匣外殼30且受偏壓而轉向末端執行器16的牆體。用彈簧(未圖示)偏壓防後退棘爪150使它傾向末端執行器16的牆體以致於它會與形成於其中的齒狀物152嚙合以防止它後退。
如以上所簡述的，實現驅動器54的移動係藉由在卡匣外殼30的凹座140內裝設推動軸環142。當推動軸環142與驅動纜線50及驅動棘爪156一起動作時，可讓人推動驅動器54向前而克服彈簧148向閉合位置偏壓驅動器54的阻力。更特別的是，驅動棘爪156是可樞轉地安裝於卡匣外殼30上而可在鎖緊位置(請參考第4圖)與放鬆位置(請參考第5圖及第6圖)之間移動。處於鎖緊位置時，驅動棘爪156有第一末端158，該第一末端158係與在卡匣外殼30凹座140內形成的推動軸環142嚙合。在嚙合著推動軸環142的時候，驅動棘爪156可防止推動軸環142與卡匣外殼30的相對移動。推動軸環142包含座落於驅動纜線50遠端144的內螺紋160。因此，在驅動棘爪156緊緊地夾著推動軸環142的時候，旋轉驅動纜線50會使整個卡匣外殼30向前移動。
當卡匣外殼30到達相對於砧體32的預定點時，驅動棘爪156的第二末端162會與末端執行器16的斜坡164嚙合使它在反時鐘方向旋轉而使驅動棘爪156的第一末端158移動離開與推動軸環142嚙合著的鎖緊位置。因此，當驅動纜線50在卡匣外殼30內旋轉時，允許推動軸環142向卡匣外殼30遠端移動。藉由加上由推動軸環伸出且進入卡匣外殼30的栓槽166來防止推動軸環142與驅動纜線50的相對旋轉。當驅動棘爪156脫離推動軸環142時，旋轉驅動纜線50，推動軸環142會被推向砧體32，從而克服彈簧148的阻力以強迫U形釘及刀片穿過組織的方式向砧體32推動驅動器54。
根據本發明之一較佳具體實施例，繩股與纜線為構造驅動纜線的理想物。這種結構能提供比單線細絲高的強度及撓性。這些高度受操縱的產品常使用複雜的結構或方法來增強疲勞壽命、強度、撓性、扭矩、勁度及平滑度。該驅動纜線的範圍可從有約0.003”以下之直徑的超細或迷你繩股到有約達0.125”之直徑的纜線。
更特別的是，以及參考第8圖、第9圖及第10圖，用來轉動驅動纜線50的曲柄48係耦合於傳動器62。更特別的是，傳動器62包含與曲柄48耦合的輸入正齒輪66、與輸入正齒輪66耦合的步進正齒輪68、以及與步進正齒輪68耦合的冠狀齒輪70。冠狀齒輪70係與耦合於驅動纜線50而使其旋轉的小齒輪72嚙合。
根據本較佳具體實施例，儲能飛輪74係耦合於驅動纜線50。替換地，飛輪74與驅動纜線50可為單一模製品。飛輪74能使曲柄48平滑地操作，否則在旋轉時需要加力，因為在開始旋轉時，驅動纜線48要使擊發機構前進。熟諳此藝者會明白，為了有效儲存能量，飛輪74設有相對大的質量為較佳。當藉由曲柄48的旋轉而使飛輪74旋轉(轉動)時，會留存某一數量的能量會而增加飛輪74的動能。有些能量會隨著時間因磨擦而損失。不過，有些用於旋轉飛輪74的能量會以動能的形式儲存下來。稍後，有可能通過直接的機械轉換來取回能量。在本發明的情形下，當首先旋轉曲柄48時，驅動纜線50幾乎沒有阻力而且施加於曲柄48的大部份能量都用來使飛輪74旋轉。在曲柄的旋轉快要結束時，由於驅動纜線50快要結束循環而累積扭轉阻力。在此時，會釋出飛輪74的動能而且減輕曲柄循環的其餘部份。較佳地，根據本發明，飛輪74的選定使得曲柄48在夾箝一次的運動期間施加於曲柄48的力大體相等(例如，相差不超過25%)。
由第9圖及第10圖可見，曲柄48設有棘爪鎖76使得在曲柄48可旋轉之前必須鬆開棘爪鎖76而且曲柄48轉一圈後會自動鎖住。曲柄48也設有可防止它向後轉動的棘輪機構(未圖示)為較佳。曲柄48設有可防止它轉動直到夾爪閉合的鎖(未圖示)為較佳。曲柄48也可設有轉數計(未圖示)用來耦合於輸入正齒輪66以及計數曲柄48已轉幾次來表示卡匣外殼30、U形釘驅動器54及刀片36的位置。該轉數計也可用來阻止曲柄48在擊發循環已完成後不再轉動。
根據圖示於第9圖的具體實施例，曲柄48有多個隔開的外圍指套78與滾花外周80。手搖柄82可視需要卸下藉此在必要時可像旋鈕那樣旋轉曲柄48。棘爪鎖76包含有凸緣86的按鈕84、有凸緣90的鎖銷88、以及彈簧92。在曲柄48中，鎖銷88係經配置成是在級形孔(stepped bore)94中且用級形孔94內的彈簧92偏壓。當按下按鈕84時，以克服彈簧92來移動鎖銷88離開鑽孔96而使曲柄48可轉動。
根據一示範具體實施例，傳動器62使得驅動纜線50在曲柄48轉一圈時會旋轉預定的轉數。在驅動纜線50遠端60之螺紋98的螺距導致卡匣外殼30、U形釘驅動器54及刀片36在曲柄48轉一圈時會前進一段預定距離。根據特定的夾箝長度(clip length)來選定齒輪及螺距。根據本較佳具體實施例，只需要改變冠狀齒輪(藉由增減齒數)即可適應不同長度的夾箝。
本外科釘合器10更設有止動銷啟動機構102。不過，而且考慮到本發明沿著活節接頭(articulation joint)需要可撓性，因此通過具體實作撓性止動銷驅動纜線52來實現止動銷34的啟動。撓性止動銷驅動纜線52包含近端104與遠端106。止動銷驅動纜線52係促使止動銷34移動。特別是，止動銷驅動纜線52由線性外科釘合器10的把手12延伸到位於線性外科釘合器10之末端執行器16的止動銷34。使用者可接合界面108設在止動銷驅動纜線52的近端104。例如，而且根據一較佳的具體實施例，該使用者可接合界面為一曲柄108，使用者可選擇性地旋轉動它以沿著止動銷驅動纜線52的長度施加扭矩。
關於止動銷驅動纜線52的遠端106，它是用以下方式以螺紋嚙合止動銷34：在以控制方式轉動止動銷驅動纜線52時會使止動銷34移動。因此，藉由旋轉止動銷驅動纜線52，以止動銷34能延伸越過末端執行器16的控制方式使止動銷34向砧體32移動。止動銷驅動纜線52的運動與上述驅動纜線50的相同。
如第11圖、第12圖、第13圖及第14圖所示，末端執行器16的支撐結構28係經由位於支撐軸桿20遠端112的球形接頭110而附著於支撐軸桿20，下文會有更詳細的說明。球形接頭110的組成有保留用以在位於支撐軸桿20遠端112之凹座116內移動的小球114而且該小球114係不動地固定於末端執行器16而與它一起移動。
根據本發明之一較佳具體實施例，支撐結構28係以單件結構形成。更特別的是，支撐結構28是用擠壓例如鋁來形成，然後加工製成如本發明所揭示的支撐結構28。藉由以此方式構造支撐結構28，不需要多個部件而且可實質減少與製造及組裝有關的成本。此外，吾等相信單件結構的支撐結構28可提高本線性外科釘合器10的整體穩定性。此外，擠製成單件之結構的支撐結構28可考慮到減少重量，由於鈷照射會有效穿透擠製鋁而比較容易消毒，以及由擠壓形成之平滑外表面對於組織會造成較少外傷。
更特別的是，末端執行器16固定於支撐軸桿20的方式是：允許末端執行器16相對於它的多條軸線可選擇性地移動。如下文所詳述的，當外科釘合器10位於患者體內時，末端執行器16是以可卸下末端執行器16以及再組裝它的方式選擇性地固定於支撐軸桿20。
更特別的是，而且如以上所簡述的，球形接頭110使末端執行器16與支撐軸桿20連結。球形接頭110用凹座或插座116固定於支撐軸桿20的遠端112，該凹座或插座116的形狀及尺寸係經製作成可保持在支撐軸桿20遠端112的小球114同時允許小球114與它相對旋轉。以此方式，小球114與形成於支撐軸桿20遠端112的插座116可相對運動，因而可控制小球114所固定之末端執行器16的運動。
根據一較佳的具體實施例，以及參考第13圖及第14圖，球形接頭110設有鎖緊機構118，外科醫生可用來選擇性地鎖定末端執行器16於想要的方位且選擇性地釋放末端執行器16以便在必要時控制它的移動。特別是，球形鎖釋放管120係由把手12延伸到球形接頭110。球形鎖釋放管120係經配置成可沿著支撐軸桿20的長度軸向移動。因此，它可由與球形接頭110嚙合的鎖定位置移動到離開球形接頭110一段短距離的解鎖位置。
彈簧122係連接至球形鎖釋放管120用來使它偏壓到鎖定位置。然而，當想要移動球形鎖釋放管120時，啟動固定於球形鎖釋放管120的釋放臂體124以拖拉球形鎖釋放管120離開球形接頭110。當以此方式撤退球形鎖釋放管120時，球形接頭110可自由旋轉以便以想要的方式活節末端執行器16。
藉由提供有造形外表面的小球114可進一步加強球形接頭110的鎖定，該造形外表面的形狀及尺寸係經製作成可“鎖住”球形鎖釋放管120的遠端126。小球114的造型有助於保證在小球114與球形鎖釋放管120遠端126之間有磨擦式接合。
如前述，釋放管120與小球114允許末端執行器16的相對定向。不過，以及根據本發明之一較佳具體實施例，在使用器具之前，必須事先調整此一活節。然而，預期，藉由釋放釋放管120及施加適當的力於末端執行器16以調整它的位置，可在人體腔中調整末端執行器16的方位。之後，使釋放管120向後移動以嚙合小球114來鎖住末端執行器16回到想要的位置。
根據一替代具體實施例，以及參考第15圖及第16圖，末端執行器216的活節操作是用多個活節接頭來控制。藉由使末端執行器216耦合於支撐軸桿220且讓支撐軸桿220可與把手212相對旋轉可實現末端執行器216繞著大體與線性外科釘合器210縱軸一致之軸線的旋轉。支撐軸桿220包含不動地固定於末端執行器216的遠端222使得末端執行器216會與支撐軸桿220一起移動。支撐軸桿220的近端224固定於把手212而與它可相對旋轉。
用遠端活節構件226可促進控制支撐軸桿220與把手212的相對運動，該遠端活節構件226作用於支撐軸桿220的方式是使它繞著線性外科釘合器210的縱軸旋轉從而使末端執行器216繞著同一個軸線旋轉。
關於末端執行器216繞著與線性外科釘合器210縱軸垂直之軸線的旋轉，可用齒輪及皮帶旋轉機構228來控制。特別是，把手212設有連結至齒輪232的活節旋鈕230，該齒輪232係接著連結至第一及第二控制桿234a、234b。同樣，末端執行器216包含固定齒輪236，其係經由在支撐軸桿220遠端222的旋轉齒輪238連結至控制桿234a、234b的另一端。末端執行器216的固定齒輪236係不動地固定於末端執行器216，但安裝成可旋轉使得末端執行器216會隨著旋轉齒輪238旋轉而旋轉。因此，而且在實務上，當旋鈕230旋轉時，把手212的齒輪232同樣也會旋轉，導致控制桿234a、234b移動且旋轉旋轉齒輪238，接著它會旋轉末端執行器的固定齒輪236，最後旋轉末端執行器216。此一方式的旋轉可用來使末端執行器216在順時鐘及反時鐘方向旋轉以利於有大範圍的取向。
同樣，以及參考第17圖及第18圖，該等控制桿可換成纜線234’，它可啟動附屬於末端執行器216’的傳動結構232’。
請參考第19圖、第20圖及第21圖，以及關於上述活節機構中之任一，末端執行器316係以允許本線性外科釘合器310有更多用途性能的方式而可釋放地固定於支撐軸桿320。根據一較佳的具體實施例，支撐軸桿320設有刺刀型鎖334，該刺刀型鎖334的形狀及尺寸係經製作成可經由帶螺紋軸桿332來嚙合固定於末端執行器316近端338的可拆卸鎖頭330。熟諳此藝者會明白，為了嚙合刺刀型鎖334，只需要把鎖頭330插上刺刀型鎖334並且旋轉鎖頭330以嚙合刺刀槽338。刺刀型鎖334內與鎖頭330設有配合栓槽336以確保該等元件可適當地就定位。熟諳此藝者會明白，上述連接會設有中央通道讓控制纜線以及啟動末端執行器所需要的其他機構通過。
根據前述具體實施例的替代例，以及參考第22圖，在說明第11圖、第12圖、第13圖及第14圖時提及的球形接頭可結合旋轉軸桿480，該旋轉軸桿480係延伸通過形成於球形接頭410的通道482而且延伸到末端執行器416。藉由不動地固定於末端執行器416內的旋轉軸桿480，旋轉軸桿480的旋轉會導致末端執行器416繞著支撐軸桿420的縱軸做旋轉運動。藉由在球形接頭410與支撐軸桿420之間裝設軸承484有助於此一方式的旋轉，藉此在旋轉軸桿480啟動時球形接頭410可同樣地旋轉。
根據另一具體實施例，以及參考第23圖，當想要提供末端執行器516以支撐軸桿520縱軸為中心的旋轉調整時，可將以上所揭示的具體實施例簡化為可卸下球形接頭510。在末端執行器516的近端軸桿586與支撐軸桿520的遠端588之間裝設軸承584有助於末端執行器516相對於支撐軸桿520的運動，其中末端執行器516之近端軸桿586的形狀及尺寸係經製作成安裝於支撐軸桿520內。
儘管已圖示及描述該等較佳具體實施例，應瞭解，不希望本發明受限於揭示內容，反而是，希望涵蓋落入本發明精神及範疇內的所有修改與替代性構造。
10．．．線性外科釘合器
12．．．把手
14．．．近端
16．．．末端執行器
18．．．相對遠端
20．．．軸桿
22,24．．．防護罩
26．．．卡匣模組
28．．．支撐結構
30．．．卡匣外殼
32．．．砧體
34．．．止動銷
36．．．刀片
38．．．可卸除保持架
40．．．組織接觸面
42．．．槽孔
44．．．U形釘形成面
48．．．曲柄
50．．．驅動纜線
52．．．止動銷驅動纜線
54．．．U形釘驅動器
56．．．手柄
58．．．近端
60．．．遠端
62．．．傳動器
66．．．輸入正齒輪
68．．．步進正齒輪
70．．．冠狀齒輪
72．．．小齒輪
74．．．儲能飛輪
76．．．棘爪鎖
78．．．指套
80．．．滾花外周
82．．．手搖柄
84．．．按鈕
86．．．凸緣
88．．．鎖銷
90．．．凸緣
92．．．彈簧
94．．．級形孔
96．．．鑽孔
98．．．螺紋
102．．．止動銷啟動機構
104．．．近端
106．．．遠端
108．．．使用者可接合界面
110．．．球形接頭
112．．．遠端
114．．．小球
116．．．凹座
118．．．鎖緊機構
120．．．球形鎖釋放管
122．．．彈簧
124．．．釋放臂體
126．．．遠端
140．．．凹座
142．．．推動軸環
144．．．帶螺紋遠端
146．．．凹座
148．．．彈簧
150．．．防後退棘爪
152．．．齒狀物
154．．．縱向延伸構件
156．．．驅動棘爪
158．．．第一末端
160．．．內螺紋
162．．．第二末端
164．．．斜坡
166．．．栓槽
210．．．線性外科釘合器
212．．．把手
216,216’．．．末端執行器
220．．．支撐軸桿
222．．．遠端
224．．．近端
226．．．遠端活節構件
228．．．齒輪及皮帶旋轉機構
230．．．活節旋鈕
232．．．齒輪
232’．．．傳動結構
234a,234b．．．控制桿
234’．．．纜線
236．．．固定齒輪
238．．．旋轉齒輪
310．．．線性外科釘合器
316．．．末端執行器
320．．．支撐軸桿
330．．．可拆卸鎖頭
332．．．帶螺紋軸桿
334．．．刺刀型鎖
336．．．栓槽
338．．．刺刀槽
410．．．球形接頭
416．．．末端執行器
420．．．支撐軸桿
480．．．旋轉軸桿
482．．．通道
484．．．軸承
516．．．末端執行器
520．．．支撐軸桿
584．．．軸承
586．．．近端軸桿
588．．．遠端
第1圖為圖示本發明之一外科釘合器的詳細透視圖。
第2圖的透視圖係圖示有已啟動之卡匣模組的第1圖外科釘合器。
第3圖的透視圖係圖示卡匣模組已卸下的第1圖外科釘合器。
第4圖、第5圖、第6圖及第7圖為末端執行器的橫截面圖，彼等係圖示卡匣模組的啟動。
第8圖的詳細圖係圖示本發明之一較佳具體實施例的傳動機構。
第9圖的透視圖圖示使用於第8圖具體實施例的曲柄。
第10圖為該傳動機構的橫截面圖。
第11圖、第12圖、第13圖及第14圖的不同視圖係圖示使用於第1圖具體實施例的球形接頭。
第15圖及第16圖圖示本發明之另一具體實施例。
第17圖及第18圖係根據本發明之一較佳具體實施例圖示另一實施例。
第19圖、第20圖及第21圖圖示可供本發明使用的拆卸機構。
第22圖及第23圖係根據本發明圖示一種提供末端執行器之旋轉的系統。
10．．．線性外科釘合器
12．．．把手
14．．．近端
16．．．末端執行器
18．．．相對遠端
20．．．軸桿
22,24．．．防護罩
26．．．卡匣模組
28．．．支撐結構
30．．．卡匣外殼
32．．．砧體
36．．．刀片
40．．．組織接觸面
42．．．槽孔
44．．．U形釘形成面
48．．．曲柄
50．．．驅動纜線
52．．．止動銷驅動纜線
54．．．U形釘驅動器
56．．．手柄
58．．．近端
60．．．遠端
102．．．止動銷啟動機構
104．．．近端
106．．．遠端
108．．．使用者可接合界面
110．．．球形接頭

Claims (6)

  1. 一種有近端及遠端的活節式外科釘合器，其係包含：一在該近端的把手與一在該遠端供選擇性活節操作的末端執行器以改善需要治療之組織的可近性以及該活節式外科釘合器的易用性，一使該把手連接至該末端執行器的支撐軸桿，其中該末端執行器係一手術夾緊總成，其包括一支撐結構及一卡匣模組，以及一使該把手連結至該末端執行器之旋轉驅動纜線，用以當該纜線繞該驅動纜線的一段長度旋轉時啟動該卡匣模組；以及一位於該支撐軸桿與該末端執行器之間、允許該末端執行器相對於該支撐軸桿之選擇性移動的活節機構，其中該活節機構包括一使該末端執行器耦合於該支撐軸桿的球形接頭以及一與該球形接頭連繫之鎖緊機構供允許選擇性地鎖定該末端執行器於想要的方位以及選擇性地釋放該末端執行器以便在必要時控制它的移動，其中該鎖緊機構包含一球形鎖釋放管，該球形鎖釋放管係經定位成可相對於該支撐軸桿作軸向移動，用以從一鎖定位置及一解鎖位置作選擇性移動，在該鎖定位置中該球形鎖釋放管與該球形接頭嚙合，在該解鎖位置中，該球形鎖釋放管離開該球形接頭。
  2. 如申請專利範圍第1項的外科釘合器，其中該球形接頭包含一有造形外表面的小球，該造形外表面的形狀及尺寸係經製作成可接合該球形鎖釋放管的遠端。
  3. 如申請專利範圍第1項的外科釘合器，其中該球形接頭包含一有造形外表面的小球，該造形外表面的形狀及尺寸係經製作成可鎖住該球形鎖釋放管的遠端，該小球的造形有助於保證在該小球與該球形鎖釋放管的遠端之間有磨擦式接合。
  4. 如申請專利範圍第1項的外科釘合器，其中該卡匣模組由一卡匣外殼及一砧體組成，且該旋轉驅動纜線使該把手連結至該末端執行器用以啟動該卡匣模組，造成該卡匣外殼往前移動朝向該砧體並且當該驅動纜線繞其長度旋轉時擊發該卡匣模組。
  5. 一種有近端及遠端的活節式外科釘合器，其係包含：一在該近端的把手與一在該遠端供選擇性活節操作的末端執行器以改善需要治療之組織的可近性以及該活節式外科釘合器的易用性，一使該把手連接至該末端執行器的支撐軸桿，其中該末端執行器係一手術夾緊總成，其包括一支撐結構及一由一卡匣外殼及一砧體組成之卡匣模組，以及一使該把手連結至該末端執行器之旋轉 驅動纜線，以啟動該卡匣模組造成該卡匣外殼往前移動朝向該砧體並且當該纜線繞該驅動纜線的一長度旋轉時擊發該卡匣模組；一位於該支撐軸桿與該末端執行器之間、允許該末端執行器相對於該支撐軸桿之選擇性移動的活節機構，其中該活節機構包括多個活節接頭，其致使末端執行器相對於該支撐軸桿繞著一大體與該線性外科釘合器的一縱軸一致的軸線之旋轉得以實現，並使該末端執行器相對於該支撐軸桿繞著一垂直於該外科釘合器的縱軸的軸線之旋轉得以實現；以及進一步包括一齒輪及皮帶旋轉機構，致使該末端執行器繞著一垂直於該外科釘合器的縱軸之軸線的旋轉得以實現。
  6. 如申請專利範圍第5項的外科釘合器，其中該齒輪及皮帶旋轉機構包含一連結至一齒輪的活節旋鈕，接著該齒輪連結至第一及第二控制桿，該第一及該第二控制桿均連結至一驅動一固定於該末端執行器之固定齒輪的旋轉齒輪。
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