WO2019192068A1 - 一种手术器械 - Google Patents

一种手术器械 Download PDF

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Publication number
WO2019192068A1
WO2019192068A1 PCT/CN2018/089200 CN2018089200W WO2019192068A1 WO 2019192068 A1 WO2019192068 A1 WO 2019192068A1 CN 2018089200 W CN2018089200 W CN 2018089200W WO 2019192068 A1 WO2019192068 A1 WO 2019192068A1
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WO
WIPO (PCT)
Prior art keywords
handle
button
trigger
locking
finger
Prior art date
Application number
PCT/CN2018/089200
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English (en)
French (fr)
Inventor
朱莫恕
Original Assignee
成都五义医疗科技有限公司
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from CN201810284395.0A external-priority patent/CN108338810B/zh
Priority claimed from CN201810283533.3A external-priority patent/CN108451554B/zh
Application filed by 成都五义医疗科技有限公司 filed Critical 成都五义医疗科技有限公司
Publication of WO2019192068A1 publication Critical patent/WO2019192068A1/zh

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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

Definitions

  • the present invention relates to a minimally invasive surgical instrument, and more particularly to a laparoscopic surgical instrument including a locking mechanism.
  • Surgical instruments have been around for hundreds of years. During surgery, doctors use different surgical instruments to perform tissue grasping, shearing, separation, coagulation, suture closure, etc. The surgical instruments have matured over hundreds of years. Laparoscopic surgery has been clinically carried out for more than 30 years and is progressing rapidly. Simply put, laparoscopic surgery, that is, the surgeon uses an extended laparoscopic hand-held instrument to enter the patient through a natural cavity or a constructed puncture channel to complete tissue grasping, shearing, separation, coagulation, and suture closure.
  • laparoscopic surgery over traditional open surgery is reduced trauma and reduced pain and accelerated recovery.
  • the overall operation of laparoscopic surgery is difficult and takes a long time.
  • the surgeon needs 1 to 3 hours of continuous operation. Due to the limitations of the surgical space, surgeons often need to operate the device in difficult posture for a long time, the doctor is prone to fatigue, and even induce arthritis, shoulder inflammation and other risks.
  • Laparoscopic handheld instruments should be ergonomic and support a variety of gripping techniques to reduce extreme operating posture and reduce fatigue.
  • a scissors-type handle is usually used, which can support various holding techniques.
  • the existing surgical hand-held instrument with a scissors-type handle has been added with a corresponding locking mechanism.
  • the Chinese patent No. CN2014108503121 discloses a locking device with a state switching function and a surgical instrument.
  • surgeons have different hand sizes, and different surgeons have different hand habits.
  • the existing surgical instruments can generally satisfy the operation of most surgeons' fingers while operating, but very Less consideration of how to make the surgeon's fingers comfortable to operate, not to mention the needs of a few surgeons with special requirements, such as: surgeons who are used to the left axilla and matching the finger action area according to the different habits of the surgeon's fingers;
  • the surgeon uses the same hand to conveniently switch between different methods, such as finger grip and hand control, or in different methods. Switching between different states makes it easy for the surgeon to perform various precise operations with the best hand posture and reduce fatigue during long hours of operation;
  • the prior art mainly uses a surgical device to increase the surgical channel, a combination of different functional surgical instruments, or a multi-person assisted manner: for example, a hand-held device with a locking mechanism is used in one surgical channel, and a common hand-held device is used in another surgical channel. Or switching the surgical instruments of different functions into and out of the abdomen in the same surgical channel. Even so, only partially meet the surgeon's implementation requirements, but it increases the patient's pain, increases the operation time and the resulting surgical risks.
  • a surgical instrument comprising a distal working head, a proximal handle and an elongated rod extending therebetween;
  • the handle comprising a front handle, rear a handle and a handle rotating shaft coupled thereto, and the front handle and the rear handle are rotatable relative to the handle shaft;
  • the working head includes a pair of jaws and a driving mechanism connected thereto;
  • the elongated rod portion The utility model comprises a runner, an outer rod portion and an inner rod, wherein the outer rod portion and the rotating wheel are fixed together and installed in the front handle, the inner rod is connected at one end to the driving mechanism and the other end is connected to the rear handle, wherein
  • the handle further includes a lock mechanism including an active mode and an invalid mode;
  • the lock mechanism includes a trigger, a button and a resilient member mounted in the front handle; the button interacts with the trigger to drive the Rotating the trigger to realize that the lock mechanism switches between the active mode and the invalid mode;
  • buttons are disposed in the front handle A1 area, and meets the following requirements: when the left hand or the right hand operates the handle by the finger holding method, the index finger of the operating hand can conveniently move the button A button; when the handle is operated by the left or right hand using the hand, the thumb of the operating hand can conveniently push one of the buttons.
  • the A1 region satisfies the following condition: a length of the center of the thumb circle defining the handle shaft to the rear handle is D; the lengthening rod portion includes a first axis, the handle shaft and the first axis a second axis is disposed in a vertical direction; the first axis and the second axis intersect at an intersection point, the A1 region is extended from the intersection point along the first axis proximal end to the distal end direction D/2 length and along the second axis from the intersection point to The handle shaft extends in the direction of the D/3 length defined area.
  • the front handle comprises an elongated slot or an arc chute extending through two sides thereof, and the first button and the second button are slidable in the elongated slot or curved Slide in the slot.
  • the trigger comprises a trigger shaft, a first cam surface; the button interacts with the first cam surface to drive the trigger to rotate around a trigger shaft, so that the lock mechanism is in an effective mode Switch between and invalid mode.
  • the lock mechanism comprises a lock bolt and a cantilever integrally connected with the rear handle
  • the suspension arm includes a plurality of first lock teeth
  • the lock bolt includes the first lock tooth a matching second locking tooth
  • the trigger further comprising a second cam surface and a finger buckle
  • the locking mechanism when the locking mechanism is in an active mode, the first locking tooth and the second locking tooth mesh with each other, allowing the rear handle to face forward
  • the handle is closed to limit the rearward opening of the handle away from the front handle, that is, the locking function
  • the external force is applied to drive the finger buckle to rotate the trigger about the trigger shaft, and the second cam surface presses the lock bolt, so that the first The two locking teeth are disengaged from the first locking teeth, and the rear handle is allowed to open away from the front handle, which is an unlocking function.
  • the cantilever comprises a flexible locking band
  • the plurality of first locking teeth are disposed on a flexible locking band
  • the flexible locking band comprises a limiting rib disposed on both sides
  • the front The handle includes a guide slot that mates with the limit rib and defines movement of the flexible lock band along the guide slot.
  • a surgical instrument including an electrodeless locking mechanism comprising a distal working head, a proximal handle and an elongated stem extending therebetween;
  • the handle comprising a front handle, a rear handle and a connecting handle thereof a handle shaft, and the front handle and the rear handle are rotatable relative to the handle shaft;
  • the work head includes a pair of jaws and a drive mechanism coupled thereto;
  • the extension rod portion includes a runner An outer rod portion and an inner rod, the outer rod portion and the rotating wheel are fixed together and mounted in the front handle, the inner rod is connected at one end to the driving mechanism and the other end is connected to the rear handle, the handle further comprises a lock mechanism, the lock mechanism including an active mode and an invalid mode;
  • the lock mechanism includes a toothless cantilever that is integral with the rear handle; the lock mechanism further includes a locking tab, wherein the locking tab includes a keyhole that matches the shape and size of the toothless cantilever, the toothless a cantilever penetrating the lock hole; the lock mechanism further includes a trigger, a button and a resilient member mounted in the front handle; the trigger includes a trigger shaft, a first cam surface, a second cam surface and a finger clasp; Interacting with the first cam surface, driving the trigger to rotate about a trigger shaft, realizing that the lock mechanism switches between an active mode and an inactive mode; when the lock mechanism is in an active mode, the elastic element drives the lock The sheet is tightly engaged with the toothless cantilever, allowing the rear handle to be folded toward the front handle to restrict the rear handle from opening away from the front handle, which is a locking function; the second cam surface can be selectively contacted with the locking piece, applying The external force drives the finger buckle to rotate the trigger about the trigger shaft, and the second cam surface drives the
  • FIG. 1 is a schematic diagram of a prior art surgical instrument simulation
  • Figure 2 is a schematic view of the finger holding method shown in Figure 1;
  • Figure 3 is a schematic view of the hand holding method shown in Figure 2;
  • Figure 4 is a perspective view of the surgical instrument of the present invention.
  • Figure 5 is a schematic view showing the finger control division of the surgical instrument of Figure 4.
  • FIG. 6 is a schematic diagram of switching from an effective mode to an invalid mode when the finger holding method is performed by using the right hand in FIG. 4;
  • FIG. 7 is a schematic diagram of switching from an invalid mode to an active mode when the finger holding method is performed with the right hand in FIG. 4;
  • FIG. 8 is a schematic diagram of the side of the effective mode switching to the invalid mode when the hand grasping method is performed by using the right hand in FIG. 4;
  • FIG. 8 is a schematic diagram of the side of the effective mode switching to the invalid mode when the hand grasping method is performed by using the right hand in FIG. 4;
  • FIG. 9 is a schematic diagram of the other side of the effective mode switching to the invalid mode when the hand grasping method is performed by using the right hand in FIG. 7; FIG.
  • Figure 10 is an exploded view of the surgical instrument of Figure 9;
  • Figure 11 is a perspective view of the button slider shown in Figure 10;
  • Figure 12 is another perspective view of the button slider shown in Figure 11;
  • Figure 13 is a perspective view of the trigger shown in Figure 10;
  • Figure 14 is a schematic view of the lock bolt of Figure 10;
  • Figure 15 is a schematic view of the interior of the front handle shown in Figure 10;
  • Figure 16 is a schematic internal view of the front handle cover shown in Figure 10;
  • Figure 17 is a schematic view showing the removal of the front handle cover in the invalid mode of the present invention.
  • Figure 18 is a sectional view taken along line 18-18 of Figure 17;
  • Figure 19 is a schematic view showing the removal of the front handle cover in the effective mode of the present invention.
  • Figure 20 is a cross-sectional view taken along line 20-20 of Figure 19;
  • Figure 21 is a schematic view showing the front handle cover removed when the unlocking function of the present invention is performed
  • Figure 22 is a cross-sectional view taken along line 22-22 of Figure 21;
  • Figure 23 is an exploded view of still another embodiment of the surgical instrument.
  • Figure 24 is a cross-sectional view of the Figure 23 in an invalid mode
  • Figure 25 is a cross-sectional view showing the effective mode of Figure 23;
  • one of the parties that is close to the operator is defined as the near end, and the party that is far from the operator is defined as the far end.
  • FIG. 1 is a prior art surgical handpiece 10 comprising a distal working head 106, a proximal handle 11 and an elongated stem 105 extending therebetween; the handle including a front handle 101 and a rear handle 102 And a handle shaft 103 connected thereto, the front handle 101 and the rear handle 102 are rotatable relative to the handle shaft 103; the front handle 101 includes a front finger loop 110, and the rear handle 102 includes a thumb loop 120, A support arm 112 is disposed at the bottom of the front finger ring 111. The upper side of the front finger ring 111 is provided with an unlock trigger 115 for locking and unlocking the front handle 101 and the rear handle 102.
  • FIG. 1 and 2 illustrate a state in which a surgeon uses a typical surgical hand-held instrument 10 to grasp an organ or grasp a tissue in a finger grip manner: the ring finger of a surgeon's hand passes through the front finger ring 111 , wherein the finger is attached to the position of the unlock trigger 115 on the upper side of the front finger ring 111, the inner side of the little finger is pressed over the support arm 112; the thumb is moved through the thumb circle 120 to move the thumb to surround the rear handle 102 The handle shaft 103 rotates back and forth, and the movement of the rear handle 102 is converted by the rod 105 into the movement of the distal working head 106.
  • FIG. 1 and 3 illustrate the state in which the surgeon uses a typical surgical hand-held instrument 10 to grasp the organ or grasp the tissue in a hand-held manner: the palm of one hand of the surgeon is in close contact with the side of the handle 11.
  • the thumb presses the opposite side of the handle 11 to clamp the rear handle 102 in the palm of the hand to form a U-shaped grip, the little finger of which is pressed over the support arm 112 of the front handle 101, and the ring finger passes through the front a finger loop 110, wherein the finger is attached to the unlock trigger 115 position on the upper side of the front finger loop 110, the movement causes the front handle 101 to rotate back and forth around the handle shaft 103, and the stem portion 105 will be rearward
  • the movement of the handle 102 translates into the movement of the distal working head.
  • the finger grip method is as important as the hand grip method and often requires frequent switching.
  • the surgeon holds the ultrasonic knife or the separation forceps in one hand and carefully peels the tissue.
  • the other hand usually has to hold the grasping force to manipulate the organ or tissue to form a synergistic effect.
  • the surgeon usually uses the finger grip method to operate the instrument, and the lock mechanism needs to be set to an inactive state.
  • the operating instrument when the finger grip method is used and the lock mechanism is in an inactive state, the operating instrument is most flexible, so that the instrument can be quickly opened and closed to grasp, clamp, drag organs or tissues, and move the organ flexibly or Organization, so that you can flexibly match organizational stripping.
  • the finger grip method when the finger grip method is used and there is no auxiliary lock, the surgeon's fingers are quite tired.
  • the surgeon usually wants to quickly switch to the effective state of the lock function, relying on the clamping force of the instrument itself to tightly clamp the organ or tissue, pull or dial An organ or tissue that blocks the line of sight.
  • the device When the lock function is in an effective state, the device is usually not operated for multiple quick opening and closing operations.
  • the surgeon or the surgical assistant When the organ or tissue that is grasped or pulled is large or heavy, the surgeon or the surgical assistant usually switches to the hand grasping method, because the hand grasping method is often easy to apply force and the posture is more free and relaxed, which is convenient for vigorous operation or Can reduce fatigue.
  • the lock mechanism of the prior art surgical instrument 10 described in FIG. 1 is inconvenient to switch between the active state and the inactive state, and in particular, it is extremely difficult to switch between the active state and the inactive state when using the hand grasping method.
  • the middle finger pressing position is exactly the position of the unlocking trigger 115 on the upper side of the front finger ring 111, when the operating instrument performs organ grasping, if the middle finger is slightly stressed, it is easy to cause the middle finger to press the trigger 115 to make the handle 11 unlocked. causes the lock mechanism to trigger the unlocking by mistake.
  • FIG. 4-9 illustrate in detail a surgical instrument 20 in accordance with an embodiment of the present invention, including a distal working head 23, a proximal scissors-type handle 21 and an elongated stem portion 22 extending therebetween;
  • the handle 21 includes a front handle 206, a rear handle 202 and a handle rotating shaft 261 connected thereto, and the front handle 206 and the rear handle 202 are rotatably movable relative to the handle rotating shaft 261;
  • the handle rotating shaft 261 is integrally molded with the front handle 206 and passes through the rotating shaft hole 222,
  • the front handle 206 and the rear handle 202 are movably connected.
  • the handle pivot 261 can also be provided as a separate component for movably connecting the front handle 206 and the rear handle 202.
  • the extension rod portion 22 includes a rotation wheel 214, an outer rod portion 213 and an inner rod 215, and the outer rod portion 213 and the rotation wheel 214 are fixed together and mounted in the front handle 206, the inner rod 215 is at one end and the The drive mechanism 211 is coupled and the other end thereof is coupled to the rear handle 202 and is fixed in the rear handle 202 fixing hole 221 by a fixing shaft 218.
  • the working head 23 includes a pair of jaws 210 and a drive mechanism coupled thereto.
  • the drive mechanism includes a first connection block 217, a second connection block 216, a slider 212, a drive arm 211, and a pin 219.
  • the first connecting block 217 and the second connecting block 216 are respectively vertically connected to the pair of jaws 210 and are mounted in the driving arm 211 together with the slider 212 and fixed by pins 219.
  • the distal end of the inner rod 215 is connected to the slider 212, and the movement of the inner rod 215 drives the slider 212 to move.
  • the first connecting block 217 is coupled with the slider 212, and the second connecting block 216 drives the pair of jaws 210.
  • the hand-held instrument 20 can be classified into a surgical scissors with a scissors head, a grasping forceps with a fine-toothed straight-clamp head, and a peeling forceps with a curved-clamp head, etc., depending on the configuration of the working head 23.
  • surgical hand-held devices in order to meet different surgical needs, more and more different types of working heads are within the scope of the present invention, and will not be enumerated one by one.
  • the front handle 206 includes a front finger loop 262 that includes a thumb loop 224.
  • the rotational movement of the front handle 206 and the rear handle 202 relative to the handle shaft 261 is converted into a linear motion of the inner rod 215, and the drive mechanism 211 drives the jaw 210 to close or release.
  • the handle 21 also includes a lock mechanism 24 that includes an active mode and an inactive mode.
  • the front handle 206 and the rear handle 202 can be rotated relative to the handle shaft 261 to realize the opening and closing of the working head 23; in the effective mode, the front handle 206 and the rear handle 202 can be Rotational movement relative to the handle shaft 261 allows the rear handle 202 to be closed toward the front handle 206 to restrict the rear handle 202 from opening away from the front handle 206, which is a locking function; when an external force is applied to drive the trigger shaft to rotate, the rear handle 202 is allowed to deviate The front handle is opened to unlock the function.
  • Ergonomics is a very complex subject. According to the definition of the International Society of Ergonomics (IEA), ergonomics is a study of anatomy, physiology and psychology in a certain working environment. Various factors; the interaction between the researcher and the machine and the environment; the study of how to unify the issues of work efficiency, human health, safety and comfort at work, in family life and on vacation. There are few ergonomic application cases or related research disclosures on laparoscopic hand-held devices in the disclosed patent technology. The invention adopts ergonomic principles and uses experiments and statistics of comprehensive subjects such as anthropometry, biomechanics, time and work research. Research, proposed an ergonomic laparoscopic handheld device and its design method, use method.
  • the present invention generally partitions the surgical instrument 20 as shown in FIG. 5: the thumb shaft 224 defining the handle shaft 261 to the rear handle 202 has a center position length D, and the extension rod portion 22 includes a first axis 1000, which passes over the handle shaft.
  • a second axis 2000 is disposed perpendicular to the first axis 1000, the first axis 1000 and the second axis 2000 intersecting at an intersection 1001, the intersection 1001 being proximally distal to the first axis 1000 and along the second axis 2000
  • a square area of length D is disposed from the intersection point to the direction of the axis of the handle, and the square area is divided into two equal parts (D/2) along the first axis 1000, three equal parts (D/3) along the second axis, and is set to A1 area, A2. Area, A3 area, and B1 area, B2 area, and B3 area.
  • the optimal D value interval is obtained by experimental research and statistics, 60 ⁇ D ⁇ 70 (unit: mm).
  • a first button 237 for switching the state when the effective mode and the invalid mode are controlled is set in the A1 region, and the trigger 205 is set in the A2 region, and the A3 region is set.
  • the middle finger press zone is set inside, and the runner 214 is set in the B1 zone.
  • the first button 237 is disposed in a corresponding A1 region of the handle 21, and the second button 237a is disposed in a plane symmetry formed along the second axis 2000 and the first axis 1000 in the A1 region. In the position A1-1, the operation of the first button 237 or the second button 237a can control the handle 21 to switch between the active mode and the invalid mode.
  • the ring finger passes through the front finger ring 262, and the middle finger is attached to the A3 area on the upper side of the front finger ring 262, and the index finger thereof.
  • the A1 area, the A2 area, or the B1 area can be flexibly controlled.
  • the index finger mainly plays the role of pushing the first button 237 along the proximal end or the distal end to the proximal end in the A1 region, and mainly plays the pressing control trigger 205 in the A2 region, and mainly plays along the B1 region.
  • the direction of rotation of the runner 214 toggles the action of the rotary runner 214.
  • the index finger reaches the B1 region and is substantially in a straight state.
  • the index finger in the straight state is in the B1 region, and is pressed or moved forward and backward along the direction of the first axis 1000, which is inconvenient to exert force, so it is not appropriate to set the state button.
  • the index finger can be flexibly moved in the direction of rotation of the wheel 214 in the B1 area.
  • the finger is in a curved state, so that the pressing or pushing action can be performed comfortably.
  • the first button 237 is disposed in the A1 region, and the trigger 205 is disposed in the A2 region, and the runner 214 is disposed in the B1 region.
  • This arrangement allows the index finger to conveniently toggle and rotate the runner 214, and is convenient to push the first A button 237 realizes switching between the active mode and the inactive mode, and at the same time, the trigger 205 can be conveniently pressed or pulled to realize the switching between the locked state and the unlocked state.
  • the surgeon's index finger is often referred to as an index finger, and the index finger is generally not used as an output operating force to operate the handle.
  • the index finger is usually used to control the direction of the instrument or Switch status buttons, etc.
  • the surgeon's palm is in close contact with the side of the scissors-type handle 21, and the thumb holds the pair of the scissors-type handle 21
  • the side grip s the rear handle 202 in the palm of the hand to form a U-shaped grip.
  • the index finger can still conveniently rotate and rotate the reel 214, and at the same time, the trigger 205 can be conveniently pressed or pulled to realize the switching between the locked state and the unlocked state; at this time, the index finger cannot block the A1 region due to the clamping of the palm.
  • the first button 237 of the internal switching state however, the surgeon's thumb is just pressed in the A1-1 area, so that the second button 237a can be conveniently pushed to switch between the active mode and the inactive mode.
  • the first button 237 and the second button 237a are substantially symmetric with respect to a plane formed along the second axis 2000 and the first axis 1000, and those skilled in the art should readily understand that This symmetrical relationship allows the doctor to operate the surgical instrument 20 with the left hand finger grip or the hand grasping method, and the operation of the surgical instrument 20 of the present invention with the right hand is substantially identical, and therefore will not be described again.
  • the positional relationship between the first button, the second button, the trigger and the wheel of the present invention can simultaneously satisfy the right hand (left hand) finger gripping method, and the index finger can conveniently complete the rotation of the wheel, the effective mode and Invalid mode switch, lock state and unlock state switch. It can also satisfy the right hand (left hand) hand grasping the hand index, and the index finger can easily complete the rotation of the wheel, the lock state and the unlock state switch, and the thumb completes the switching between the effective mode and the invalid mode.
  • the setting of the positional relationship can simultaneously satisfy the convenient switching between the finger grip method and the finger grip method.
  • a common laparoscopic surgical instrument has its lock mechanism state switching button disposed in the B1 region (for example, the structure disclosed in U.S. Patent No. 5,626,608), which has been mass-produced and used in the abdominal cavity similar to this patented technology.
  • Mirror surgical instruments such as the laparoscopic grasping forceps series sold under the Auto Suture brand
  • the lock mechanism status button is set in the B1 area, and the effective mode and the invalid mode switching comfort are not enough when the device is operated by the finger grip method.
  • Another common laparoscopic surgical instrument has its locking/unlocking trigger set in the B2 region and contains only two states, a locked state and an inactive state (for example, the structure disclosed in U.S. Patent No. 6,117,158), which is mass produced similarly to this patented technology.
  • laparoscopic surgical instruments such as the laparoscopic grasping forceps series sold under the ENDOPATH brand
  • the locking/unlocking button is set in the B2 area, and it is inconvenient to perform the locking function when using the finger grip method or the hand grasping method.
  • the laparoscopic surgical instruments such as the laparoscopic grasping forceps series sold under the ENDOPATH brand
  • Another common laparoscopic surgical instrument has a locking/unlocking trigger in the A3 area and an active/inactive mode switching button in the A2 area (for example, the structure disclosed in US Pat. No. 8,551,077, US Patent Application No. US20060004406), and the patent Similar mass-produced, and used laparoscopic surgical instruments (such as the laparoscopic grasping forceps series sold under the CLICKline brand) have a locking/unlocking trigger set in the A3 area and an active/inactive mode switching button set in the A2 area.
  • This design usually requires the middle finger to operate the trigger for locking/unlocking switching, and the middle finger or index finger operating button for effective/invalid mode switching, which is uncomfortable for operation and switching.
  • the most common problems mainly include that when the instrument is in the locked state, the surgeon needs almost all the middle finger, whether it is the finger holding method or the hand grasping method, and the operating instrument (gripper) clamps the organ or tissue and pulls the movement. It is used to assist the force application. In this state, the trigger is easily accessible, resulting in false triggering, which causes the instrument to accidentally switch from the locked state to the unlocked state, causing the organ or tissue to slip, causing inconvenience in clinical use and even inducing medical accidents.
  • the surgical instrument 20 includes a lock mechanism 24, and Figures 10-18 depict the composition and construction of the lock mechanism 24.
  • the lock mechanism 24 includes a trigger 205, a locking tab 208, and a toothless cantilever 226 that is integral with the rear handle 202.
  • the toothless cantilever 226 includes a toothless cantilever body 223 that projects outwardly from the rear handle 202 and a toothless cantilever distal end 227.
  • the toothless cantilever body 223 is disposed in an arc shape, and includes a cantilever inner wall 229 and a cantilever outer wall 228.
  • the cantilever inner wall 229 and the cantilever outer wall 228 are generally concentrically formed from the joint of the handle 202 along the handle shaft 261 as a center.
  • the toothless cantilever body 223 material comprises a plastic material integrally molded with the rear handle 202, and may be made of other semi-rigid or rigid materials or even flexible materials.
  • the lock mechanism 24 also includes a button assembly 25 and a resilient member 250 in which the resilient member 250 and the button assembly 25 are mounted together.
  • the resilient element 250 drives the trigger 205 to effect a reset after pressing.
  • the trigger 205 controls the locking tab 208 to cooperate with the toothless cantilever 226 for locking and unlocking.
  • a toothed locking band is generally used, and the locking teeth of the locking band are easily exposed outside the handle, which may cause scratches on the surgeon's fingers or gloves.
  • the degree of density of the lock teeth determines the spacing of each lock tooth, and thus determines the degree of clamping of the tissue of the working head of the surgical instrument.
  • the toothless cantilever body 223 of the present invention cooperates with the locking piece 208 to realize locking at any position, and meets the clamping force to meet the clamping requirements of different operations and different tissue and organ positions, thereby achieving an infinite change, so that the surgical instrument 20 can be kept properly
  • the clamping force position and clamping force cooperates with the locking piece 208 to realize locking at any position, and meets the clamping force to meet the clamping requirements of different operations and different tissue and organ positions
  • the button assembly 25 includes a button slider 203 and a first button 237 and a second button 237a.
  • the button block 203 includes a slider body 230 with a limiting slot 231, and the slider body 230 includes a slider sidewall 234 (235) and a limiting stopper 233.
  • the slider sidewall 234 (235) and the limit stop 233 together define a limiting slot 231.
  • the slider sidewall 234 (235) extends outwardly from a button mounting post 232 that is fixedly coupled to the first button 237 and the second button 237a.
  • the push button 237 or the second button 237a can be used to drive the button to slide.
  • the block 203 slides from the distal end to the proximal end or from the proximal end to the distal end, thereby pushing the trigger 205 to rotate, enabling switching between the active mode and the inactive mode.
  • the first button 237 includes a friction strip 238 with a curved surface to facilitate the force of the fingers.
  • the trigger 205 includes a trigger shaft hole 258 and a trigger shaft 269, a first cam surface 251, a second cam surface 255 and a finger clasp 259 coupled to the front handle 206.
  • the trigger 205 includes a generally crescent-shaped trigger body 254, the first cam surface 251 being disposed on one side of the trigger body 254 and the finger clasp 259 being disposed on the other side of the trigger body 254.
  • the trigger body 254 is disposed adjacent to the first cam surface 251 to provide a hole 257 for mounting the elastic member 250.
  • the trigger shaft hole 258 is disposed between the first cam surface 251 and the finger buckle 259 through the trigger body 254.
  • the first cam surface 251 includes a cam arc segment 253 and a cam straight surface 252.
  • the limit stop 233 of the button assembly 25 is in contact with the cam arc segment 253 and the cam straight surface 252 of the first cam surface 251, respectively, thereby pushing the
  • the trigger 205 is rotated to implement an active mode to an invalid mode switch.
  • a second cam surface 255 extends outwardly along a side of the trigger body 254, and the second cam surface 255 rotates with the trigger 205 to urge the locking tab 208 and the toothless cantilever 226 to lock and unlock.
  • the locking tab 208 includes a keyhole 284 that matches the shape and size of the toothless cantilever 226, the toothless cantilever 226 penetrating the locking aperture 284.
  • the locking piece 208 includes a first piece 281, a second piece 283, and a transition section 282 connecting the two.
  • the first piece 281, the second piece 283 and the transition section are formed in a substantially "Z" shape.
  • a lock leaf spring 204 is disposed on a proximal end surface of the second sheet body 283.
  • the second body 283 and the lock leaf spring 204 may be connected by welding, or by a movable shaft or the like.
  • the locking hole 284 of the first piece 281 includes a first locking hole wall 285 and a second locking hole wall 286, and the first locking hole wall 285 and the second locking hole wall 286 and the cantilever inner wall 229 of the toothless cantilever 226
  • the cantilever outer wall 228 is substantially mated, and the distance between the first keyhole wall 285 and the second keyhole wall 286 is greater than the distance between the cantilever inner wall 229 and the cantilever outer wall 228.
  • the material of the locking piece 208 includes a rigid material such as a metal material, a thermosetting plastic material, and may also be made of a semi-rigid type.
  • the second cam surface 255 of the trigger 205 When the second cam surface 255 of the trigger 205 is selectively in contact with the locking tab 208, an external force is applied to drive the finger clasp 259 such that the trigger 205 rotates about the trigger shaft 269, and the second cam surface 255 drives the
  • the locking tab 208 is moved to cooperate with the toothless cantilever 226 to allow the rear handle 206 to open away from the front handle 202; in an alternative manner, the first body 281 is substantially perpendicular to the toothless cantilever 226
  • the first locking hole wall 285 is in clearance with the cantilever inner wall 229
  • the second locking hole wall 286 is in clearance with the cantilever outer wall 228, and the toothless cantilever 226 is rotated about the handle rotating shaft 261, and the toothless cantilever 226 can be free.
  • a front handle 206 for mounting the fixed lock mechanism 24 is depicted in Figures 5, 10 and 15-17.
  • the front handle 206 also includes a front handle cover 209 that mates therewith.
  • the front handle 206 removes the front finger ring 262 portion and has a substantially symmetrical structure with the front handle cover 209.
  • the front handle cover 209 and the front handle 206 are respectively symmetrically disposed with the first sliding slot 297 and the second sliding slot 267, and the first sliding slot 297 and the second sliding slot 267 define the
  • the button slider 203 moves back and forth in the direction of the chute.
  • first sliding slot 297 and the second sliding slot 267 are elongated slots, and the direction of the elongated sliding slot is substantially parallel to the elongated rod portion 22, as will be understood by those skilled in the art.
  • the first chute 297 and the second chute 267 may also be provided as arcuate chutes. As described above, when the index finger is in the A1 area and the A2 area, the finger is in a curved state, so that the pressing or pushing action can be performed comfortably, and the index finger is not as comfortable as the linear direction in the curved pushing experience. Therefore, the operation experience of the curved chute is not as good as the linear narrow chute substantially parallel to the direction of the rod.
  • the first sliding slot 297 and the second sliding slot 267 may have the same size of the proximal opening 297a (267a) and the distal opening 297b (267b).
  • the proximal opening size 297a (267a) is greater than The distal opening size 297b (267b), in this way can further enhance the operating experience when sliding, giving the surgeon a clear indication when the active mode and the invalid mode are switched.
  • the front handle 206 includes a handle shaft 261 and a trigger shaft 269 fixed thereto, and the handle shaft 261 and the trigger shaft 269 may be provided as separate parts to be mounted and fixed to the front handle 206,
  • the front handle 206 can be injection molded into one part.
  • the front handle cover 209 is provided with a fixing post 291 (299) corresponding to the handle rotating shaft 261 and the trigger rotating shaft 269.
  • the trigger shaft 269 is integrally formed with the trigger shaft hole 269 of the trigger 205, and the trigger 205 includes a trigger shaft 269.
  • the front handle cover 209 is provided with a shaft hole corresponding to the front handle 206.
  • the front handle 206 also includes a runner mounting slot 265 in a distal position, the front handle cover 209 including a runner mounting slot 295.
  • the runner mounting slots 265 (295) together define a rotational movement of the runner within the slot.
  • the front handle 206 and the front handle cover 209 include cantilever slots 263 (293) that receive the rear handle 202 without the toothed cantilever 226.
  • the cantilever slots 263 (293) form a complete cantilever opening that is larger than the toothless opening.
  • the cantilever 226 is of an outer dimension and the toothless cantilever 226 is not in contact with the cantilever slot 263 (293) when rotated about the handle axis.
  • the front handle 206 and front handle cover 209 also include a cantilever bin 266 (296) for escaping the toothless cantilever 226, which can accommodate the toothless cantilever 226 when the surgical instrument 20 is closed
  • the cantilever bin 266 (296) appears as a outwardly projecting hollow bin at the front handle 206 and the front handle cover 209.
  • the front handle 206 and the front handle cover 209 further include a support groove 264 (294) defining a locking movement of the locking piece 208.
  • the support groove 264 (294) is defined by ribs 260 (290) protruding from both sides. .
  • the rib 260 (290) of the support groove 264 (294) serves as a rotational support point when the locking piece 208 is rotated.
  • the front handle 206 and the front handle cover 209 also include a spring slot 268 (298) for defining a leaf spring 204, one end of which is coupled to the locking tab 208 and the other end is defined within the spring slot 268 (298) It is in a compressed state.
  • the lock mechanism 24 is shown to switch between an active mode and an inactive mode.
  • the finger grip method the surgeon's right hand operation is taken as an example, and the ring finger passes through the front finger ring 262, wherein the finger is attached to the A3 area on the upper side of the front finger ring 262, and the index finger can flexibly control the A1 area and the A2 area. Area or B1 area.
  • the surgical instrument 20 requires rapid closing and opening operations, such as when a gallbladder procedure is performed for vascular detachment, it is then necessary to switch the surgical instrument 20 from an active mode to an inactive mode.
  • the index finger moves in the A1 region by a first button 237 that pushes the button assembly 25 distally, the first button 237 driving the button block 203 to move along the first and second chutes 297, 267.
  • the button block 203 of the button block 203 interacts with the first cam surface 251 to drive the trigger 205 to rotate clockwise around the trigger shaft 269.
  • the second cam surface 255 of the trigger 205 follows The trigger 205 rotates clockwise to rotate the second piece 283 of the locking tab 208 to rotate counterclockwise, and the first piece 281 is pivotally lifted to cooperate with the lock hole 284 and the toothless cantilever 226.
  • the lock mechanism 24 is switched from the active mode to the inactive mode, and those skilled in the art should understand that in the invalid mode, since the lock hole 284 and the toothless cantilever 226 are always in a clearance fit state, the front of the handle 21
  • the handle 206 and the rear handle 202 can be conveniently closed and opened to meet the needs of tissue that is peeled and sheared during finger grip.
  • the surgeon uses the right hand to hold the hand to grasp the grasping method to vigorously pull the organ or tissue and achieve the occlusion, it is necessary to switch the surgical instrument 20 from the invalid mode to the effective mode.
  • the surgical doctor's palm is in close contact with the side of the scissor-type handle 21, and the thumb holds the opposite side of the scissor-type handle 21 to clamp the rear handle 202 in the palm of the hand to form a U-shaped grip. Due to the grip blocking of the palm, the index finger cannot control the first button 237 in the switching state in the A1 region, and at this time, the thumb is pressed in the A1-1 region, so that the second button 237a can be conveniently pushed forward by the thumb.
  • the button block 203 of the button block 203 interacts with the first cam surface 251 to drive the trigger 205 to rotate counterclockwise about the trigger shaft 269.
  • the trigger 205 is under the action of the elastic member 250.
  • the second cam surface 255 rotates counterclockwise with the trigger 205 to drive the second piece 283 and drives the first piece 281 of the locking piece to rotate in a clockwise rotation.
  • the first piece 281 In oblique contact with the toothless cantilever 226, the lock leaf spring 204 drives the locking tab 208 to tightly engage the toothless cantilever 226, the first keyhole wall 285 is in compressive contact with the cantilever inner wall 229, and second The keyhole wall 286 is in compressive contact with the cantilever outer wall 228, which rotates about the handle pivot 261, allowing the rear handle 202 to be folded toward the front handle 206 to limit the rear handle 202 from opening away from the front handle 206.
  • the surgeon can engage and lock the working head 23 by the compression of the locking piece 208 with the toothless cantilever 226, thereby avoiding the fatigue of the palm caused by the long-term clamping force.
  • the above-mentioned effective mode and invalid mode can be switched to each other, and can be freely operated with one hand, whether using the finger holding method or the hand grasping method.
  • the whole operation process is similar, and the difference is mainly when the finger grip method is performed in the right hand, the first button is toggled by the index finger. 237, when the hand grasps the holding method, the thumb pushes the second button 237a; and when the left hand performs the finger holding method, the index finger moves the second button 237a, and when the hand grasps the holding method, the thumb is moved The first button 237.
  • the surgeon can be in a different surgical environment, such as requiring a quick closure and Open peeling operation or long-term pulling organ operation, etc., the same hand can be used to easily switch between the effective mode and the invalid mode, without the need for another hand to cooperate or others to complete the operation;
  • the aspect also satisfies that the surgeon who operates in either the right hand habit or the left hand habit can switch between the active mode and the inactive mode with one hand.
  • FIG. 17-18 when it is necessary to vigorously pull the organ for a long time, the surgeon uses the hand to grasp the holding method as an example for brief description. The surgeon's palm is in close contact with the side of the scissors-type handle 21, and the thumb holds the opposite side of the scissors-type handle 21 to clamp the rear handle 202 in the palm to form a U-shaped grip, and the rear handle 202 is fixed.
  • the front handle 206 is rotated to achieve the closing of the handle 21, thereby achieving the working head 23 and the closed clamping.
  • the front handle 206 is rotated clockwise from the distal end to the proximal end, the rear handle 202 is rotated counterclockwise relative to the front handle 206, and the toothless cantilever 226 is rotated about the handle shaft 261.
  • the first piece 281 is pushed to move counterclockwise, and the second piece 283 pushes the compression locking leaf spring 204.
  • the first locking hole wall 285 is in contact with the cantilever inner wall 229, and the second locking hole wall 286 and the cantilever
  • the outer wall 228 is in contact but does not affect the rear handle 202 being closed toward the front handle 206.
  • the locking piece 208 is caused to be tightly engaged with the toothless cantilever 226 due to the reaction force of the compression of the locking leaf spring 204, and the first piece 281 is in oblique contact with the toothless cantilever 226,
  • the first keyhole wall 285 is in compressive contact with the cantilever inner wall 229
  • the second keyhole wall 286 is in compressive contact with the cantilever outer wall 228 to restrict the rear handle 202 from opening away from the front handle 206.
  • the surgeon can engage and lock the working head 23 by the compression of the locking piece 208 with the toothless cantilever 226, thereby avoiding the fatigue of the palm caused by the long-term clamping force.
  • the surgeon grasps the holding method as an example for brief description.
  • the surgeon's palm is in close contact with the side of the scissors-type handle 21, and the thumb holds the opposite side of the scissors-type handle 21 to clamp the rear handle 202 in the palm to form a U-shaped grip, and the rear handle 202 is fixed.
  • the finger clasp 259 rotates clockwise to drive the second cam surface 255 to rotate with the trigger 205, and the second cam surface 255 of the trigger 205 rotates clockwise with the trigger 205 to push the second piece of the locking piece 208.
  • the body 283 is rotated counterclockwise, and the first piece 281 is pivotally lifted to fit the lock hole 284 and the toothless cantilever 226. The second piece 283 pushes the compression locking leaf spring 204.
  • the first locking hole wall 285 does not contact the cantilever inner wall 229, and the second locking hole wall 286 does not contact the cantilever outer wall 228, allowing the rear handle 202 to face away from the rear.
  • the front handle 206 is opened to unlock the function.
  • the handle 202 and the front handle 206 can be freely closed and opened while the index finger is pressed against the trigger 205.
  • the trigger 205 is automatically reset by the action of the elastic member 250, the second cam surface 255 is separated from the second piece 283, and the locking piece 208 is at the lock leaf spring 204.
  • the rebound is automatically reset, and the locking tab 208 is pressed against the toothless cantilever 226.
  • the present invention uses the toothless cantilever 226 and the locking piece 208 to realize the unlocking function and the locking function of the surgical instrument 20.
  • the locking can be realized at any position, and the clamping force is exactly matched.
  • the clamping requirements of different operations and different tissue and organ positions enable infinite changes, overcome the drawbacks caused by the toothed lock, and enable the surgical instrument 20 to maintain a proper clamping force position and clamping force.
  • the surgical instrument 30 is substantially identical to the surgical instrument 20, primarily for the replacement of the toothless cantilever 226 and the locking tab 208 for locking by the locking mechanism 24, using a toothed cantilever 326
  • the trigger function and the unlock function are implemented in cooperation with the trigger 305.
  • the surgical instrument 30 includes a distal working head 23, a proximal scissors-type handle 31 and an elongated rod portion 22 extending therebetween; the handle 31 includes a front handle 206, a rear handle 202 and a handle shaft 261 connected thereto, And the front handle 206 and the rear handle 202 are rotatable relative to the handle shaft 261.
  • the handle 31 includes a lock mechanism 34. Both the lock mechanism 34 and the lock mechanism 24 include an active mode and an invalid mode. The switching modes of the two are substantially the same, and are not described herein.
  • the lock mechanism 34 includes a cantilever 326 extending from the rear handle 202 and a trigger 305 for locking.
  • the cantilever 326 includes a plurality of first locking teeth 325, and the trigger 305 includes a second locking tooth 342 that matches the serration; when the locking mechanism 34 is in an active mode, the elastic element 350 drives the The trigger 305 causes the first locking tooth 325 and the second locking tooth 342 to engage with each other, allowing the rear handle 202 to be closed toward the front handle 206 to restrict the rear handle from opening away from the front handle, that is, a locking function; applying an external force to drive the finger buckle 259 The trigger 305 is caused to rotate about the trigger shaft to disengage the first lock tooth 325 and the second lock tooth 342 from each other, allowing the rear handle to be opened away from the front handle, that is, the unlocking function.

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Abstract

本发明公开了一种手术器械，包含远端工作头部，近端手柄及在其间延伸的加长杆部；所述手柄还包含锁机构，所述锁机构包含有效模式和无效模式；所述锁机构包含安装在前把手中的扳机，按钮和弹性元件；所述按钮与所述扳机相互作用，驱动所述扳机旋转，实现锁机构在有效模式和无效模式之间切换；所述按钮包含第一按钮和第二按钮，所述第一按钮和第二按钮分别安装在所述前把手的两个侧面。

Description

一种手术器械 技术领域
本发明涉及微创手术器械，尤其涉及一种含锁机构的腹腔镜手术器械。
背景技术
外科手术器械已经有几百年历史，外科手术中医生运用不同的手术器械完成组织抓取，剪切，分离，凝血，缝合闭合等操作，外科手术器械经过数百年发展已经成熟。腹腔镜手术的已经临床开展30多年了，正在快速进步。简单的说，腹腔镜手术即手术医生采用加长的腹腔镜手持器械，经由自然腔道或构建的穿刺通道进入患者体内，完成组织抓取，剪切，分离，凝血，缝合闭合等操作。
腹腔镜手术相对于传统开腹手术，主要优势在于减小创伤和减轻病痛和加速恢复。腔镜手术的整体的操作难度较大，用时较长，手术医生在持续的手术操作需1～3小时。由于手术空间的限制，手术医生经常需要长时间的以困难姿势操作器械，医生容易疲劳，甚至诱发关节炎，肩周炎等风险。腹腔镜手持器械应符合人机工程学原理，支持多种握持手法，减少极端操作姿势和减轻疲劳感。
操作同一把器械时，不同手术医生，或同一手术医生在不同手术中，或者同一手术中具体的某项操作过程中，医生握持手术器械的手法各有不同。研究表明，腔镜手术中，如图2所示的手指握持法pinch grip(或称为精确握持法precision grip)和如图3所示的手掌握持手法pam grip(或称为大力握持法force grip)为最常用的两种手法。
现有的腔镜手持器械中，例如腔镜手术剪刀，腔镜手术分离钳，腔镜手术抓钳等，如图1所示，通常采用剪刀型手柄，可以支持多种握持手法。为了持续实现夹持器官或组织，现有的采用剪刀型手柄的外科手持器械增加了相应的锁定机构，如专利号为CN2014108503121的中国专利公开了一种带状态切换功能的锁卡装置及手术器械，然而现有的专利虽然实现了组织或器官的夹持以及解锁使用，但是由于手术医生的个体差异和手术环境的复杂性，主要有以下问题亟待解决:
一方面，不同的手术医生的手型大小不同，不同手术医生的手术用手习惯也不尽相同，现有的手术器械一般可以满足多数手术医生的手指在操作时能进行正常进行操作，但很少考虑如何使手术医生的手指舒适的操作，更不用说满足少数有特殊要求的手术医生的需求，比如：习惯左撇的手术医生以及根据手术医生各个手指不同的用力习惯进行匹配手指作用区域；
另一个方面，手术医生在连续的手术过程中，如何使用同一只手，方便的进行多种不同手法进行切换，比如手指握持法和手掌握持手法之间的切换，又或者在不同手法状态下进行不同状态的切换，方便手术医生可以采用最佳的手持姿态进行各种精确的操作，并减少长时间操作的疲劳；
此外，如何针对组织或器官需要连续的夹持和松开的操作与无需锁定机构参与进行的快速的牵拉和剥离操作之间的快速切换操作等。
现有技术主要通过增加手术通道，采用不同功能的手术器械进行组合使用，或者采用多人辅助等方式：比如在一个手术通道中采用带锁定机构的手持器械，另一个手术通道中采用普通手持器械；又或者在同一个手术通道中将不同功能的手术器械进行进出腹的切换。即便如此，也仅仅部分能满足手术医生的实现要求，但却增大了病人的痛苦，增加了手术时间以及由此带来的各种手术风险。
发明内容
因此，为了解决现有技术的问题，在本发明的一个方面，提出一种手术器械，包含远端工作头部，近端手柄及在其间延伸的加长杆部；所述手柄包含前把手，后把手及连接其的手柄转轴，且所述前把手和后把手可相对于所述手柄转轴作旋转运动；所述工作头部包含一对钳头及与之相连的驱动机构；所述加长杆部包括转轮，外杆部和内拉杆，所述外杆部和转轮固定在一起并安装在前把手中，所述内拉杆一端与所述驱动机构连接而其另一端与后把手连接，其中，所述手柄还包含锁机构，所述锁机构包含有效模式和无效模式；所述锁机构包含安装在前把手中的扳机，按钮和弹性元件；所述按钮与所述扳机相互作用，驱动所述扳机旋转，实现锁机构在有效模式和无效模式之间切换；所述按钮包含第一按钮和第二按钮，所述第一按钮和第二按钮分别安装在所述前把手的两个侧面。
一种可选的技术方案，其中，所述按钮设置在前把手A1区域，且满足如下要求：左手或右手采用手指握持法操作所述手柄时，操作之手的食指可以方便的拨动其中一个按钮；左手或右手采用手掌握持法操作所述手柄时，操作之手的拇指可以方便的拨动其中一个按钮。
一种可选的技术方案，其中，所述A1区域满足以下条件：定义手柄转轴到后把手的拇指圈中心位置长度为D；所述加长杆部包含第一轴线，过手柄转轴与第一轴线垂直方向设置第二轴线；所述第一轴线和第二轴线相交于交点，所述A1区域由从交点沿第一轴线近端向远端方向延伸D/2长度与沿第二轴线由交点到手柄转轴方向延伸D/3长度限定的区域组成。
一种可选的技术方案，其中，所述前把手包含贯穿其两个侧面的狭长滑槽或弧形滑槽，所述第一按钮和第二按钮可在所述狭长滑槽或弧形滑槽中滑动。
一种可选的技术方案，其中，所述狭长滑槽的方向基本平行于所述加长杆部。
一种可选的技术方案，其中，所述扳机包含扳机转轴，第一凸轮面；所述按钮与所述第一凸轮面相互作用，驱动所述扳机围绕扳机转轴旋转，实现锁机构在有效模式和无效模式之间切换。
一种可选的技术方案，其中，所述锁机构包含锁栓和与后把手连为一体的悬臂，所述悬臂包含多个第一锁齿；所述锁栓包括与所述第一锁齿相匹配的第二锁齿，所述扳机还包括第二凸轮面和手指扣；当所述锁机构为有效模式时，所述第一锁齿和第二锁齿相互咬合，允许后把手朝向前把手合拢而限制后把手背离前把手张开，即为锁定功能；施加外力驱动所述手指扣使得所述扳机围绕扳机转轴旋转，所述第二凸轮面挤压所述锁栓，使得所述第二锁齿与第一锁齿脱开，允许后把手背离前把手张开，即为解锁功能。
一种可选的技术方案，其中，所述悬臂包含柔性锁带，所述多个第一锁齿设置在柔性锁带上，所述柔性锁带包括两侧设置的限位筋，所述前把手包含与所述限位筋匹配的导向槽并限定所述柔性锁带沿导向槽运动。
在本发明的另一个方面，提出一种含无极锁机构的手术器械，包含远端工作头部，近端手柄及在其间延伸的加长杆部；所述手柄包含前把手，后把手及连接其的手柄转轴，且所述前把手和后把手可相对于所述手柄转轴作旋转运动；所述工作头部包含一对钳头及与之相连的驱动机构；所述加长杆部包括转轮，外杆部和内拉杆，所述外杆部和转轮固定在一起并安装在前把手中，所述内拉杆一端与所述驱动机构连接而其另一端与后把手连接，所述手柄还包含锁机构，所述锁机构包含有效模式和无效模式；
所述锁机构包含与后把手连为一体的无齿悬臂；所述锁机构还包含锁片，其中所述锁片包含与所述无齿悬臂外形和尺寸相匹配的锁孔，所述无齿悬臂穿透所述锁孔；所述锁机构还包含安装在前把手中的扳机，按钮和弹性元件；所述扳机包含扳机转轴，第一凸轮面，第二凸轮面和手指扣；所述按钮与所述第一凸轮面相互作用，驱动所述扳机围绕扳机转轴旋转，实现锁机构在有效模式和无效模式之间切换；当所述锁机构为有效模式时，所述弹性元件驱动所述锁片使之与无齿悬臂紧配合，允许后把手朝向前把手合拢而限制后把手背离前把手张开，即为锁定功能；所述第二凸轮面可以选择性的与所述锁片接触，施加外力驱动所述手指扣使得所述扳机围绕扳机转轴旋转，而第二凸轮面驱动所述锁片运动，使之与无齿悬臂间隙配合，允许后把手背离前把手张开，即为解锁功能。
附图说明
为了更充分的了解本发明的实质，下面将结合附图进行详细的描述，其中：
图1是一种现有技术的外科手术器械模拟示意图；
图2是图1所示采用手指握持法示意图；
图3是图2所示采用手掌握持手法示意图；
图4是本发明的外科手术器械立体示意图；
图5是图4所述手术器械手指控制分区示意图；
图6是图4采用右手进行手指握持法时有效模式向无效模式切换示意图；
图7是图4采用右手进行手指握持法时无效模式向有效模式切换示意图；
图8是图4采用右手进行手掌握持手法时有效模式向无效模式切换一侧示意图；
图9是图7采用右手进行手掌握持手法时有效模式向无效模式切换另一侧示意图；
图10是图9所述手术器械的分解图；
图11是图10所示按钮滑块立体图；
图12是图11所示按钮滑块又一立体视图；
图13是图10所示扳机的立体图；
图14是图10所述锁栓示意图；
图15是图10所示前把手内部示意图；
图16是图10所示的前把手盖的内部示意图；
图17是本发明无效模式下的去掉前把手盖的示意图；
图18是图17所示18-18剖切图；
图19是本发明有效模式下的去掉前把手盖的示意图；
图20是图19所示20-20剖切图；
图21是是本发明解锁功能时去掉前把手盖的示意图；
图22是图21所示22-22剖切图；
图23是所述手术器械又一实施例的分解图；
图24是图23无效模式下的剖切示意图；
图25是图23有效模式下的剖切示意图；
在所有的视图中，相同的标号表示等同的零件或部件。
具体实施方式
这里公开了本发明的实施方案，但是，应该理解所公开的实施方案仅是本发明的 示例，本发明可以通过不同的方式实现。因此，这里公开的内容不是被解释为限制性的，而是仅作为权利要求的基础，以及作为教导本领域技术人员如何使用本发明的基础。
参考图1-4，为方便表述，后续凡接近操作者的一方定义为近端，而远离操作者的一方定义为远端。
如图1-3所示，结合前述背景所述，在进行外科手术，特别是在腔镜手术时，当套管组件(未示出)插入到位，各种微创手术器械，比如外科手持器械10就可以通过套管组件形成的通道插入到体腔。手术过程中可能需要同时使用一个或多个套管组件，而外科手持器械10也根据手术需要配置一个或多个进行同时操作。图1是现有技术的一种典型的外科手持器械10，包括远端的工作头部106，近端手柄11及在其间延伸的加长杆部105；所述手柄包含前把手101，后把手102及连接其的手柄转轴103，所述前把手101和后把手102可相对于所述手柄转轴103作旋转运动；所述前把手101包含前手指圈110，所述后把手102包括拇指圈120，所述前手指圈111底部设置有支撑臂112。所述前手指圈111的上侧设置解锁扳机115用于实现所述前把手101和后把手102的锁定和解锁。
目前的腔镜手术通常包括胆囊手术，腹腔镜腹股沟疝修补术，腹腔镜胃底折叠手术，腹腔镜脾切除手术，腹腔镜阑尾切除手术等手术。腔镜手术的整体的操作难度较大，用时较长，手术医生在持续的手术操作需1～3小时。为了减轻手术中医生长时间以困难姿势操作器械，现有的外科手持器械一定程度的考虑了人机工程学原理，通常可以支持多种握持手法，一定程度的减少极端操作姿势和减轻疲劳感。如图2所示的手指握持手法和如图3所示的手掌握持手法为最常用的两种手法。
如图1和图2展示了手术医生使用典型外科手持器械10以手指握持手法进行牵拉器官或抓取组织的握持状态：手术医生某一只手的无名指穿过所述前手指圈111，其中指贴在前手指圈111的上侧的解锁扳机115位置，其小指内侧面按压在所述支撑臂112之上；其拇指穿过所述拇指圈120运动拇指使所述后把手102围绕所述手柄转轴103来回旋转，并由所述杆部105将所述后把手102的运动转换成所述远端工作头部106的运动。
如图1和图3展示了手术医生使用典型外科手持器械10以手掌握持手法进行牵拉器官或抓取组织的握持状态：手术医生某一只手的手掌贴紧所述手柄11的侧面，其拇指按住手柄11的对侧面将后把手102夹紧在手掌中，形成一个U型的夹持，其小指按压在所述前把手101的支撑臂112之上，无名指穿过所述前手指圈110，其中指贴在所述前手指圈110的上侧的解锁扳机115位置，运动使所述前把手101围绕所述手柄转轴103来回旋转，并由所述杆部105将所述后把手102的运动转换成所述远端工作头部的运动。
在临床应用中，所述手指握持法和手掌握持法同等重要，且通常需要频繁的切换。例如临床手术中需要进行组织剥离而显露血管时，主刀医生一只手握持超声刀或分离钳小心翼翼的进行组织剥离，其另一只手通常必须握持抓钳操作器官或组织，形成协同效应，方能准确无误的完成组织剥离操作。当手术部位没有充分显露时，或者进行组织剥离部位短时间内的变动空间跨度较大时，手术医生通常采用手指握持法来操作器械，并需要将锁机构设定为无效状态。本领域的技术人员应该可以理解，采用手指握持法且锁机构无效状态时，操作器械最为灵活，因此可以快速的开合器械从而抓取，钳夹，拖拉器官或组织，灵活的移动器官或组织，从而能灵活自如的匹配组织剥离。然而采用手指握持法且没有辅助锁定时，手术医生的手指相当疲劳。当手术部位充分显露或进行组织剥离的部位短时间不移动时，手术医生通常希望快速的切换为锁功能有效状态，依靠器械本身的锁紧力紧紧的钳夹器官或组织，牵拉或拨动阻挡视线的器官或组织。锁功能有效状态下，通常不操作器械进行多次的快速开合动作。当抓取或牵拉的器官或组织较大或较重时，手术医生或手术助手通常切换为手掌握持法，因为手掌握持法往往容易施力且姿势更自由舒张，方便进行大力操作或可减轻疲劳。
图1所述的现有技术的手术器械10的锁机构有效状态和无效状态切换不便，尤其是采用手掌握持法时极难进行有效状态和无效状态的切换。此外，由于中指用力位置正好是前手指圈111的上侧的解锁扳机115位置，当操作器械进行器官抓取时，若中指稍用力，容易造成中指按压扳机115使手柄11处于解锁状态，即容易导致锁机构误触发解锁。
图4-9详细描绘了本发明实施例一种手术器械20，包含远端工作头部23，近端剪刀型手柄21及在其间延伸的加长杆部22；所述手柄21包含前把手206，后把手202及连接其的手柄转轴261，且所述前把手206和后把手202可相对于所述手柄转轴261作旋转运动；所述手柄转轴261与前把手206一体注塑并通过转轴孔222，将前把手206和后把手202活动连接。所述手柄转轴261也可以设置为单独零件用于活动连接前把手206和后把手202。所述加长杆部22包括转轮214，外杆部213和内拉杆215，所述外杆部213和转轮214固定在一起并安装在前把手206中，所述内拉杆215一端与所述驱动机构211连接而其另一端与后把手202连接并通过固定轴218固定在后把手202固定孔221中。
所述工作头部23包含一对钳头210及与之相连的驱动机构，所述驱动机构包括第一连接块217，第二连接块216，滑块212，驱动臂211，以及销钉219。所述第一连接块217，第二连接块216分别与一对钳头210上下对称连接并与滑块212一起装入驱动臂211中用销钉219固定。内拉杆215远端与滑块212连接，驱动所述内拉杆215运动带动滑块 212运动，与滑块212配合连接的所述第一连接块217，第二连接块216驱动一对钳头210实现张合。本领域的技术人员很容易想到，其他已经披露的连杆机构，滑槽机构或基于现有技术做简单适应性修改，都可以用于替代发明所述的工作头部23实现相同或相似的功能。手持器械20根据所述工作头部23配置不同，可以分为带剪刀头部的手术剪，带细齿直钳头部的抓钳，带弯钳头部的剥离钳等。随着外科手持器械的发展，为了配合不同手术需要，出现了越来越多的不同类型的工作头部均在本发明的保护范围内，在此不再逐一列举。
一种实施案例中，所述前把手206包括前手指圈262，所述后把手202包括拇指圈224。操作所述前把手206和后把手202相对于所述手柄转轴261作旋转运动转化为内拉杆215的直线运动，并使驱动机构211驱动钳头210实现闭合或松开。所述手柄21还包含锁机构24，所述锁机构24包含有效模式和无效模式。在无效模式下，所述前把手206和后把手202可相对于所述手柄转轴261作旋转运动实现工作头部23的张开和闭合；有效模式下，所述前把手206和后把手202可相对于所述手柄转轴261作旋转运动，允许后把手202朝向前把手206合拢而限制后把手202背离前把手206张开，即为锁定功能；当施加外力驱动扳机转轴旋转，允许后把手202背离前把手张开，即为解锁功能。
本领域的技术人员应该可以理解，腹腔镜手术中，由于手术空间的限制，手术医生经常需要长时间的以困难姿势操作器械，医生容易疲劳，甚至诱发关节炎，肩周炎等风险。因此符合人体工程学或称为人类功效学(Ergonomics)的腹腔镜手持器械，能支持多种握持手法，减少极端操作姿势和减轻疲劳感，尤其重要。已公开的关于腹腔镜手术相关的人类功效学的相关研究很多：有代表性的研究包括发表于Journal of Healthcare Engineering的2012年第3卷第4号第587-603页的a review of the ergonomic issues in the laparoscopic operating rom，详述了腹腔镜手术器械的人类功效学危害，其他多份文献中也提到了腔镜器械的人类功效性缺陷及其危害，但没有给出解决措施。发表于Journal of laparoendoscopic&advanced surgical techniques的2001年第11卷第1号的Technical report,new ergonomic design criteria for handles of laparoscopic dissection forceps中列举了一些人体功效学评价措施，然而其评价措施局限于基于人体测量学统计得出的手柄长度尺寸，手指圈尺寸设计建议，以及粗略的给出了评价现有手柄不同握持体验的方法，然而没有给出对于功能性能相关的设计建议或暗示。
人体工程学是一个非常复杂的学科，根据国际人类工效学学会(IEA)所下的定义，人体工程学是一门“研究人在某种工作环境中的解剖学、生理学和心理学等方面的各种因 素；研究人和机器及环境的相互作用；研究人在工作中、家庭生活中和休假时怎样统一考虑工作效率、人的健康、安全和舒适等问题的学科。然而到目前为止，已披露的专利技术中少有关于腹腔镜手持器械人体工程学应用案例或相关研究披露。本发明采用人体工程学原理，利用人体测量学、生物力学、时间与工作研究学等综合学科的试验和统计研究，提出了一种符合人体工程学的腹腔镜手持器械及其设计方法，使用方法。
简要的说，本发明大致将手术器械20如图5所示进行分区：定义手柄转轴261到后把手202的拇指圈224中心位置长度为D，加长杆部22包含第一轴线1000，过手柄转轴261与第一轴线1000垂直方向设置第二轴线2000，所述第一轴线1000和第二轴线2000相交于交点1001，交点1001沿第一轴线1000近端向远端方向和沿第二轴线2000由交点到手柄转轴方向设置长度为D的正方形区域，将正方形区域沿第一轴线1000两等分(D/2)，沿第二轴线2000三等分(D/3)，设置为A1区域、A2区域、A3区域以及B1区域、B2区域、B3区域。需要更进一步指出的，前述“手柄转轴261到后把手202的拇指圈224中心位置长度为D”，D的具体数值不是定值，其数值在一个较小的区间变动。基于人体测量学和生物力学原理进行试验研究和统计获得最优D值区间为，60≤D≤70(单位：毫米)。
为了兼顾不同人群的手型和不同握持手法，一种可选的方案中，在A1区域内设置控制有效模式和无效模式时切换状态的第一按钮237，A2区域内设置扳机205，A3区域内设置中指按压区，同时在B1区域内设置转轮214。又一种优选的的技术方案中，所述第一按钮237设置在手柄21对应的A1区域，第二按钮237a设置在A1区域沿第二轴线2000和所述第一轴线1000形成的平面的对称位置A1-1位置，操作第一按钮237或第二按钮237a均可以控制手柄21实现有效模式和无效模式的切换。
下面更具体描述按钮、扳机及转轮位置设计的工作原理。如图6-8，当采用手指握持手法时，以手术医生的右手操作为例，其无名指穿过所述前手指圈262，中指贴在前手指圈262的上侧的A3区域，其食指可以灵活的控制A1区域、A2区域或B1区域。所述食指在A1区域主要是起到沿近端向远端，或远端向近端的推动第一按钮237的作用，在A2区域主要起到按压控制扳机205，在B1区域主要起到沿转轮214旋转方向来回拨动旋转转轮214的作用。
更进一步的，采用手指握持手法时，食指到达B1区域基本处于伸直状态。处于伸直状态的食指在B1区域中，做按压动作或沿第一轴线1000方向做前后推动动作，不方便施力发力，因此不宜设置状态按钮。食指在B1区域可以舒适的沿转轮214旋转方向做 旋转拨动运动。食指在所述A1区域和A2区域时，手指处于弯曲状态，所以可以舒适的进行按压或推动动作。将第一按钮237设置在A1区域，且扳机205设置在A2区域，且将转轮214设置在B1区域，这种设置使得食指可方便的拨动和旋转转轮214，同时可方便的推动第一按钮237实现有效模式和无效模式的切换，同时可方便的按压或扳动扳机205实现锁定状态和解锁状态的切换。本领域的技术人员应该可以理解，外科手术领域特别是腔镜手术领域，手术医生的食指通常被称为index finger，食指通常不作为输出操作力操作手柄的选择，食指通常用来控制器械方向或切换状态按钮等。前述多种状态，功能的切换或操作是相当频繁的，而且在腹腔镜手术中，由于手术医生的眼睛通常要密切的关注前方水平方向的监视器，而无暇低头观察自己的操控手或病人区域，因此此多种状态的切换操控方便性非常重要。
如图9所示，当手术医生的右手由手指握持法切换成手掌握持手法时，外科手术医生的手掌贴紧所述剪刀型手柄21的侧面，其拇指按住剪刀型手柄21的对侧面将后把手202夹紧在手掌中，形成一个U型的夹持。此时，其食指仍然可以方便的拨动和旋转转轮214，同时可方便的按压或扳动扳机205实现锁定状态和解锁状态的切换；此时由于手掌的夹持阻挡，食指无法操作A1区域内切换状态的第一按钮237，然而此时手术医生的拇指正好按压在A1-1区域，因此可方便的推动第二按钮237a实现有效模式和无效模式的切换。
本发明优选的的技术方案中，所述第一按钮237和第二按钮237a相对于沿第二轴线2000和所述第一轴线1000形成的平面的大致对称，本领域的技术人员应该容易理解，这种对称关系使得医生以左手手指握持法或手掌握持法操作手术器械20，与右手使用本发明的手术器械20的操作基本等同，因此不再赘述。
综上所述，本发明所述的第一按钮，第二按钮，扳机和转轮的位置关系设置，可同时满足右手(左手)手指握持手法时食指方便的完成转轮旋转，有效模式和无效模式切换，锁定状态和解锁状态切换。也可同时满足右手(左手)手掌握持手法时食指方便的完成转轮旋转，锁定状态和解锁状态切换，拇指完成有效模式和无效模式的切换。而且，这种位置关系的设置，还可同时满足手指握持法和手指握持法之间的方便切换。其有益效果可简单的概括的描述为：可仅凭借手术医生的触觉反馈，方便快捷进行手指握持法和手掌握持法变换，方便快捷的操作转轮旋转，有效模式和无效模式切换，锁定状态和解锁状态切换。
研究表明，到目前为止，还没有专利技术或文献披露本发明所述的腹腔镜器械及 其设计方法，使用方法。也没有任何企业，团体或个人披露，或生产，或销售本发明所述的腹腔镜器械。已披露的现有技术中，常见的腹腔镜手术器械将其锁机构状态切换按钮设置在B1区域(例如美国发明专利US5626608披露的结构)，与此专利技术类似的已大量生产，和使用的腹腔镜手术器械(例如以Auto Suture品牌销售的腹腔镜抓钳系列)，将锁机构状态按钮设置在B1区域，采用手指握持法操作这类器械时，其有效模式和无效模式切换的舒适性不够好，且不方便支持手掌握持手法下的有效模式和无效模式切换。另一种常见的腹腔镜手术器械将其锁定/解锁扳机设置在B2区域且仅包含锁定状态和无效状态两个状态(例如美国发明专利US6117158披露的结构)，与此专利技术类似的已大量生产和使用的腹腔镜手术器械(例如以ENDOPATH品牌销售的腹腔镜抓钳系列)，将其锁定/解锁按钮设置在B2区域，采用手指握持法或手掌握持法操作时均不方便进行锁功能的相关切换。另一种常见的腹腔镜手术器械将锁定/解锁扳机设置在A3区域且将有效/无效模式切换按钮设置在A2区域(例如美国发明专利US8551077，美国发明申请US20060004406披露的结构)，与此专利技术类似的已大量生产，和使用的腹腔镜手术器械(例如以CLICKline品牌销售的腹腔镜抓钳系列)，将锁定/解锁扳机设置在A3区域且将有效/无效模式切换按钮设置在A2区域。这种设计，通常需用中指操作扳机进行锁定/解锁切换，用中指或食指操作按钮进行有效/无效模式切换，操作和切换不舒适。需要特别指出的是，将扳机设置在A3区域可能引起诸多不便。最常见问题主要包括，当所述器械处于锁定状态时，手术医生无论是手指握持法还是手掌握持法，操作器械(抓钳)夹紧器官或组织并牵拉移动时，中指几乎都需要用于辅助施力，这种状态下极易触及扳机，导致误触发，使得器械意外的从锁定状态切换为解锁状态，导致器官或组织滑脱，引起临床使用不便，甚至诱发医疗事故。
图10-22更详细描绘了手术器械20的一种实施方案。所述手术器械20包含锁机构24，图10-18描绘了锁机构24的组成和结构。如图10和图17所示，所述锁机构24包含扳机205、锁片208，与后把手202连为一体的无齿悬臂226。所述无齿悬臂226包含从后把手202向外凸出的无齿悬臂体223以及无齿悬臂远端227。所述无齿悬臂体223设置为弧形结构，包括悬臂内壁229和悬臂外壁228，所述悬臂内壁229和悬臂外壁228的形状大体从把手202连接处沿手柄转轴261为圆心延伸而成组成同心圆弧的无齿悬臂体223。所述无齿悬臂体223材料包括和后把手202进行一体注塑的塑料材料，也可以是其他的半刚性或刚性材料甚至柔性材料制成。所述锁机构24还包含按钮组件25和弹性元件250，所述扳机205，弹性元件250和按钮组件25一起安装在所述前把手206中。所述弹 性元件250驱动扳机205在按压后进行实现复位。所述扳机205控制锁片208与无齿悬臂226配合实现锁定和解锁。现有技术中通常采用有齿锁带，所述锁带的锁齿容易露出手柄外，可能会造成手术医生手指或手套划伤。同时有齿锁带在使用时，锁齿的疏密程度决定了每个锁齿的间距，进而决定手术器械的工作头部夹紧组织器官的程度。本领域技术人员应该理解，在大力牵拉操作时，为了保持持续夹紧牵拉，如果力度不够，不能实现大力牵拉时保持状态，容易出现组织器官滑落，影响手术进程，甚至造成手术失败；另一方面如果工作头部过度夹紧，又可能造成组织器官的损伤，不利于患者恢复。所述锁带尽管可以通过加密锁齿来调整工作头部夹紧程度，但是由于锁齿过小可能使锁机构不可靠，造成锁机构打滑失效，而保持一定的锁齿间距又可能造成要么夹紧力不够，要么夹紧力过大。本发明的无齿悬臂体223与锁片208配合，可以实现任意位置的锁定，满足夹持力正好符合不同手术和不同组织器官位置的夹持要求，实现无极变化，使手术器械20可以保持合适的夹持力位置和夹持力度。
如图10-12所示，所述按钮组件25包括按钮滑块203和第一按钮237以及第二按钮237a。所述按钮块203包含带限位槽231的滑块体230，所述滑块体230包含滑块侧壁234(235)和限位挡块233。所述滑块侧壁234(235)和限位挡块233一起限定出限位槽231。所述滑块侧壁234(235)向外延伸出与第一按钮237以及第二按钮237a配合固定的按钮安装柱232，推动第一按钮237或第二按钮237a可以用于驱动所述按钮滑块203从远端向近端滑动或从近端向远端滑动，进而推动所述扳机205旋转，实现有效模式和无效模式的切换。所述第一按钮237包含带弧面的摩擦条238，可以方便手指用力。
如图13所示，所述扳机205包括扳机转轴孔258以及与前把手206连接扳机转轴269、第一凸轮面251，第二凸轮面255和手指扣259。所述扳机205包含大致呈月牙状的扳机体254，所述第一凸轮面251设置在扳机体254一侧，而手指扣259设置在扳机体254另一侧。所述扳机体254靠近所述第一凸轮面251位置设置孔257用于安装弹性元件250。所述扳机转轴孔258贯穿所述扳机体254设置在第一凸轮面251和手指扣259之间。所述第一凸轮面251包括凸轮弧线段253和凸轮直线面252。当推动按钮组件25从近端向远端移动时，所述按钮组件25的限位挡块233，与第一凸轮面251的凸轮弧线段253和凸轮直线面252分别接触配合，进而推动所述扳机205旋转实现有效模式到无效模式切换。第二凸轮面255沿所述扳机体254的侧面向外延伸而成，所述第二凸轮面255随所述扳机205旋转推动所述锁片208与所述无齿悬臂226实现锁定和解锁。
如图14所示，所述锁片208包含与所述无齿悬臂226外形和尺寸相匹配的锁孔 284，所述无齿悬臂226穿透所述锁孔284。所述锁片208包括第一片体281，第二片体283，以及连接两者的过渡段282，所述第一片体281，第二片体283和过渡段组成大致呈“Z”字型的锁片208。所述第二片体283的近端面设置锁片弹簧204。第二片体283与锁片弹簧204可以通过焊接，或活动轴限定等方式连接。所述第一片体281的锁孔284包含第一锁孔壁285和第二锁孔壁286，所述第一锁孔壁285和第二锁孔壁286与无齿悬臂226的悬臂内壁229和悬臂外壁228大致匹配，且第一锁孔壁285和第二锁孔壁286之间的距离大于悬臂内壁229和悬臂外壁228之间的距离。所述锁片208材料包括刚性材料，如金属材料，热固性塑料材料，也可以包括半刚性型制成。当扳机205的第二凸轮面255可以选择性的与所述锁片208的接触，施加外力驱动所述手指扣259使得所述扳机205围绕扳机转轴269旋转，而第二凸轮面255驱动所述锁片208运动，使之与无齿悬臂226间隙配合，允许后把手206背离前把手202张开；一种可选的方式，所述第一片体281与所述无齿悬臂226大致垂直时，所述第一锁孔壁285与悬臂内壁229间隙配合，第二锁孔壁286与悬臂外壁228间隙配合，所述无齿悬臂226绕手柄转轴261旋转，所述无齿悬臂226可以自由的从所述锁孔284中穿过，此时对应的是解锁状态或无效模式。当所述第一片体281与所述无齿悬臂226倾斜接触时，所述锁片弹簧204驱动所述锁片208使之与无齿悬臂226紧配合，所述第一锁孔壁285与悬臂内壁229压紧接触，第二锁孔壁286与悬臂外壁228压紧接触，所述无齿悬臂226绕手柄转轴261旋转，允许后把手202朝向前把手206合拢而限制后把手202背离前把手206张开，此时为锁定功能。
如图5，图10和图15-17所示描绘了安装固定锁机构24的前把手206。所述前把手206还包括与其配合的前把手盖209。所述前把手206除去前手指圈262部分，与前把手盖209大致呈对称结构。在大致A1-1区域和A1区域，所述前把手盖209和前把手206分别对称设置第一滑槽297和第二滑槽267，所述第一滑槽297和第二滑槽267限定所述按钮滑块203沿滑槽方向进行来回运动。本实施例中，所述第一滑槽297和第二滑槽267是狭长滑槽，所述狭长滑槽的方向基本平行于所述加长杆部22，本领域的技术人员应该理解，所述第一滑槽297和第二滑槽267也可以设置为弧形滑槽。如前文所述，食指在所述A1区域和A2区域时，手指处于弯曲状态，所以可以舒适的进行按压或推动动作，而食指采用弧形推动体验上不如直线方向的推动舒适。因此采用弧形滑槽的操作体验不如采用大致平行于杆部方向的直线型狭长滑槽。所述第一滑槽297和第二滑槽267近端开口297a(267a)和远端开口297b(267b)尺寸可以相同，一种优选的技术方案，所述近端开口尺寸297a(267a)大于远端开口尺寸297b(267b)，采用此方式在滑动时可以进一步提升操作体 验，在有效模式和无效模式转换时给手术医生明显的提示。
在大致A1-1区域和A1区域，所述前把手206包含与之固定的手柄转轴261和扳机转轴269，所述手柄转轴261和扳机转轴269可以设置为单独零件与前把手206安装固定，也可以前把手206注塑为一个零件。所述前把手盖209与手柄转轴261和扳机转轴269对应位置设置固定柱291(299)。一种可选的技术方案，所述扳机转轴269与扳机205的扳机转轴孔269设置成一个整体，扳机205包含扳机转轴269，所述前把手盖209与前把手206对应位置设置转轴孔。在大致B1区域和其对称区域，所述前把手206还包含远端位置的转轮安装槽265，所述前把手盖209包含转轮安装槽295。所述转轮安装槽265(295)一起限定转轮在槽内做旋转运动。所述前把手206和前把手盖209包括容纳后把手202无齿悬臂226通过的悬臂槽263(293)，所述悬臂槽263(293)组成完整的悬臂开口，所述悬臂开口尺寸大于无齿悬臂226外形尺寸，且无齿悬臂226绕手柄转轴旋转时不与所述悬臂槽263(293)接触。所述前把手206和前把手盖209还包括用于避让无齿悬臂226的悬臂仓266(296)，所述悬臂仓266(296)在手术器械20合拢时，可以容纳无齿悬臂226，一种可选的技术方案，所述悬臂仓266(296)在所述前把手206和前把手盖209表现为向外凸出的空心仓。所述前把手206和前把手盖209还包括限定锁片208做杠杆运动的支撑槽264(294)，所述支撑槽264(294)由两侧凸出的筋条260(290)限定而成。所述支撑槽264(294)的筋条260(290)在锁片208做旋转运动时作为旋转支撑点。所述前把手206和前把手盖209还包括用于限定锁片弹簧204的弹簧槽268(298)，锁片弹簧204一端与锁片208连接，另一端被限定在弹簧槽268(298)内处于压缩状态。
如图5和图17-20细致的描绘了锁机构24在有效模式和无效模式之间切换。当手指握持法，手术医生的右手操作为例，其无名指穿过所述前手指圈262，其中指贴在前手指圈262的上侧的A3区域，其食指可以灵活的控制A1区域、A2区域或B1区域。当手术器械20需要快速的进行闭合和打开操作时，典型的比如在胆囊手术进行血管剥离时，这时就需要将手术器械20由有效模式切换到无效模式。所述食指在A1区域由沿近端向远端推动按钮组件25的第一按钮237移动，所述第一按钮237带动按钮块203沿所述第一滑槽297和第二滑槽267移动。所述按钮块203限位挡块233与所述第一凸轮面251相互作用，驱动所述扳机205围绕扳机转轴269顺时针旋转，在此过程中，所述扳机205的第二凸轮面255随所述扳机205顺时针旋转推动锁片208的第二片体283沿逆时针旋转，所述第一片体281旋转翘起与所述锁孔284与无齿悬臂226间隙配合。当限位挡块233移动到所述第一凸轮面251的凸轮直线面252时，所述扳机205与所述按钮块203形成自 锁，所述弹性元件250不能复位。此时锁机构24由有效模式切换到无效模式，本领域的技术人员应该理解，在无效模式下，由于所述锁孔284与无齿悬臂226间隙配合始终处于间隙配合状态，所以手柄21的前把手206和后把手202可以方便的进行合拢和打开，满足在手指握持法时进行剥离和剪切的组织的需要。而当手术医生采用右手由手指握持法切换手掌握持手法进行大力牵拉器官或组织并实现咬合时，这时就需要将手术器械20由无效模式切换到有效模式。外科手术医生的手掌贴紧所述剪刀型手柄21的侧面，其拇指按住剪刀型手柄21的对侧面将后把手202夹紧在手掌中，形成一个U型的夹持。由于手掌的夹持阻挡，食指无法控制A1区域内切换状态的第一按钮237，而此时正好拇指按压在A1-1区域，所以可以通过拇指进行方便的推动第二按钮237a沿远端向近端推动移动，所述第二按钮237a带动按钮块203沿所述第一滑槽297和第二滑槽267移动。所述按钮块203限位挡块233与所述第一凸轮面251相互作用，驱动所述扳机205围绕扳机转轴269逆时针旋转，在此过程中，所述扳机205在弹性元件250的作用下做复位运动，所述第二凸轮面255随所述扳机205逆时针旋转驱动第二片体283并带动所述锁片的第一片体281沿顺时针旋转复位，所述第一片体281与所述无齿悬臂226倾斜接触，所述锁片弹簧204驱动所述锁片208使之与无齿悬臂226紧配合，所述第一锁孔壁285与悬臂内壁229压紧接触，第二锁孔壁286与悬臂外壁228压紧接触，所述无齿悬臂226绕手柄转轴261旋转，允许后把手202朝向前把手206合拢而限制后把手202背离前把手206张开。此时，手术医生就可以通过所述锁片208使之与无齿悬臂226的压紧摩擦实现工作头部23咬合锁定，避免长时间的夹持用力造成手掌的疲劳。本领域的技术人员应该理解，上述有效模式和无效模式之间相互进行切换，无论是采用手指握持法或手掌握持手法时，均可以单手自由操作。
此外，当左手习惯的手术医生在完成上述有效模式和无效模式之间相互进行切换操作时，整个操作过程类似，其区别主要是在右手进行手指握持法时，食指拨动的是第一按钮237，采用手掌握持手法时，拇指拨动的是第二按钮237a；而左手进行手指握持法时，食指拨动的是第二按钮237a，采用手掌握持手法时，拇指拨动的是第一按钮237。本领域的技术人员应该理解，通过在手柄21的A1区域和A1-1设置第一按钮237和第二按钮237a，一方面可以使手术医生在不同的手术环境中，比如需要快速的进行闭合和打开的剥离操作或者长时间的牵拉器官操作等，使用同一只手即可方便的进行有效模式和无效模式之间相互切换，不需要另外一只手进行配合或他人进行配合完成操作；另一方面也满足了无论是右手习惯或左手习惯进行操作的手术医生都可以一只手实现有效模式和无效模式 的相互切换。
如图5，图14和图19-22细致的描绘了锁机构24在有效模式下，锁定功能和解锁功能之间的切换。首先确认手柄21的第一按钮237或第二按钮237a处于近端位置，即手术器械20处于有效模式下。如图17-18所示，当需要长时间进行大力牵拉器官时，以手术医生采用手掌握持手法为例进行简述。外科手术医生的手掌贴紧所述剪刀型手柄21的侧面，其拇指按住剪刀型手柄21的对侧面将后把手202夹紧在手掌中，形成一个U型的夹持，后把手202作为固定柄，其小指按压在所述前把手206的支撑臂264之上，无名指穿过所述前手指圈262，其中指贴在所述前手指圈262的上侧位置，通过中指，无名指和小指一起用力，驱动前把手206旋转实现手柄21的合拢，进而实现工作头部23和闭合夹持。在此过程中，前把手206由远端向近端做顺时针的旋转运动，所述后把手202相对于前把手206做逆时针的旋转运动，所述无齿悬臂226绕手柄转轴261旋转，所述第一片体281被推动做逆时针运动，第二片体283推动压缩锁片弹簧204，此时所述第一锁孔壁285与悬臂内壁229接触，第二锁孔壁286与悬臂外壁228接触，但不影响后把手202朝向前把手206合拢。
一旦停止合拢运动，由于所述锁片弹簧204压缩后的反作用力驱动所述锁片208使之与无齿悬臂226紧配合，所述第一片体281与所述无齿悬臂226倾斜接触，所述第一锁孔壁285与悬臂内壁229压紧接触，第二锁孔壁286与悬臂外壁228压紧接触，限制后把手202背离前把手206张开。此时，手术医生就可以通过所述锁片208使之与无齿悬臂226的压紧摩擦实现工作头部23咬合锁定，避免长时间的夹持用力造成手掌的疲劳。
如图10以及图19-22所示，当需要解锁操作时，以手术医生采用手掌握持手法为例进行简述。外科手术医生的手掌贴紧所述剪刀型手柄21的侧面，其拇指按住剪刀型手柄21的对侧面将后把手202夹紧在手掌中，形成一个U型的夹持，后把手202作为固定柄，其小指按压在所述前把手206的支撑臂264之上，无名指穿过所述前手指圈262，其中指贴在所述前手指圈262的上侧位置，首先通过食指按压施加外力驱动所述手指扣259顺时针旋转，驱动所述第二凸轮面255随所述扳机205旋转，所述扳机205的第二凸轮面255随所述扳机205顺时针旋转推动锁片208的第二片体283沿逆时针旋转，所述第一片体281旋转翘起与所述锁孔284与无齿悬臂226间隙配合。所述第二片体283推动压缩锁片弹簧204，此时所述第一锁孔壁285与悬臂内壁229不接触，第二锁孔壁286与悬臂外壁228也不接触，允许后把手202背离前把手206张开，即为解锁功能。在保持食指按压所述扳机205状态下，所述把手202和前把手206可以进行自由的合拢和打开操作。当食 指松开所述手指扣259时，所述扳机205在弹性元件250的作用下自动复位，所述第二凸轮面255与第二片体283分离，所述锁片208在锁片弹簧204的反弹作用下自动复位，所述锁片208使之与无齿悬臂226的压紧。
本领域的技术人员应该理解，本发明采用无齿悬臂226和锁片208实现手术器械20的解锁功能和锁定功能，在手柄21合拢过程中，可以实现任意位置的锁定，满足夹持力正好符合不同手术和不同组织器官位置的夹持要求，实现无极变化，克服有齿锁带来的弊端，使手术器械20可以保持合适的夹持力位置和夹持力度。
如图23-26描绘了又一种实施例，手术器械30与手术器械20大致相同，主要是针对锁机构24用于锁定的无齿悬臂226和锁片208进行替换，采用有齿的悬臂326和扳机305配合实现锁定功能和解锁功能。
所述手术器械30包括包含远端工作头部23，近端剪刀型手柄31及在其间延伸的加长杆部22；所述手柄31包含前把手206，后把手202及连接其的手柄转轴261，且所述前把手206和后把手202可相对于所述手柄转轴261作旋转运动。所述手柄31包括锁机构34，所述锁机构34和锁机构24都包含有效模式和无效模式，两者切换方式基本等同，此处不再累述。所述锁机构34包括从后把手202延伸而成的悬臂326和扳机305配合实现锁定。所述悬臂326包含多个第一锁齿325，而所述扳机305包含与所述锯齿相匹配的第二锁齿342；当所述锁机构34为有效模式时，所述弹性元件350驱动所述扳机305使得所述第一锁齿325和第二锁齿342相互咬合，允许后把手202朝向前把手206合拢而限制后把手背离前把手张开，即为锁定功能；施加外力驱动手指扣259使得所述扳机305围绕扳机转轴旋转，使所述第一锁齿325和第二锁齿342相互脱离，允许后把手背离前把手张开，即为解锁功能。
已经展示和描述了本发明的很多不同的实施方案和实例。本领域的一个普通技术人员，在不脱离本发明范围的前提下，通过适当修改能对所述方法和器械做出适应性改进。好几种修正方案已经被提到，对于本领域的技术人员来说，其他修正方案也是可以想到的。因此本发明的范围应该依照附加权利要求，同时不应被理解为由说明书及附图显示和记载的结构，材料或行为的具体内容所限定。

Claims (10)

  1. 一种手术器械，包含远端工作头部，近端手柄及在其间延伸的加长杆部；所述手柄包含前把手，后把手及连接其的手柄转轴，且所述前把手和后把手可相对于所述手柄转轴作旋转运动；所述工作头部包含一对钳头及与之相连的驱动机构；所述加长杆部包括转轮，外杆部和内拉杆，所述外杆部和转轮固定在一起并安装在前把手中，所述内拉杆一端与所述驱动机构连接而其另一端与后把手连接，其特征在于，
    1)所述手柄还包含锁机构，所述锁机构包含有效模式和无效模式；
    2)所述锁机构包含安装在前把手中的扳机，按钮和弹性元件；
    3)所述按钮与所述扳机相互作用，驱动所述扳机旋转，实现锁机构在有效模式和无效模式之间切换；
    4)所述按钮包含第一按钮和第二按钮，所述第一按钮和第二按钮分别安装在所述前把手的两个侧面。
  2. 如权利要求1所述的手术器械，其特征在于，所述按钮设置在前把手A1区域，且满足如下要求：左手或右手采用手指握持法操作所述手柄时，操作之手的食指可以方便的拨动其中一个按钮；左手或右手采用手掌握持法操作所述手柄时，操作之手的拇指可以方便的拨动其中一个按钮。
  3. 如权利要求1所述的手术器械，其特征在于，所述A1区域满足以下条件：
    定义手柄转轴到后把手的拇指圈中心位置长度为D；
    所述加长杆部包含第一轴线，过手柄转轴与第一轴线垂直方向设置第二轴线；
    所述第一轴线和第二轴线相交于交点，所述A1区域由从交点沿第一轴线近端向远端方向延伸D/2长度与沿第二轴线由交点到手柄转轴方向延伸D/3长度限定的区域组成。
  4. 如权利要求3所述的手术器械，其特征在于，所述前把手包含贯穿其两个侧面的狭长滑槽，所述第一按钮和第二按钮可在所述狭长滑槽中滑动。
  5. 如权利要求3所述的手术器械，其特征在于，所述狭长滑槽的方向平行于所述加长杆部。
  6. 如权利要求1所述的手术器械，其特征在于，所述扳机包含扳机转轴，第一凸轮面；所述按钮与所述第一凸轮面相互作用，驱动所述扳机围绕扳机转轴旋转，实现锁机构在有效模式和无效模式之间切换。
  7. 如权利要求1所述的手术器械，其特征在于，
    1)所述悬臂包含多个第一锁齿；所述锁机构还包含手指扣以及与所述第一锁齿相匹配的第二锁齿；
    2)当所述锁机构为有效模式时，所述弹性元件驱动所述扳机围绕所述扳机转轴旋转，使得所述第一锁齿和第二锁齿相互咬合，允许后把手朝向前把手合拢而限制后把手背离前把手张开，即为锁定功能；施加外力驱动所述手指扣使得所述扳机围绕扳机转轴旋转，使得所述第二锁齿与第一锁齿脱开，允许后把手背离前把手张开，即为解锁功能。
  8. 一种含无极锁机构的手术器械，包含远端工作头部，近端手柄及在其间延伸的加长杆部；所述手柄包含前把手，后把手及连接其的手柄转轴，且所述前把手和后把手可相对于所述手柄转轴作旋转运动；所述工作头部包含一对钳头及与之相连的驱动机构；所述加长杆部包括转轮，外杆部和内拉杆，所述外杆部和转轮固定在一起并安装在前把手中，所述内拉杆一端与所述驱动机构连接而其另一端与后把手连接，其特征在于，
    1)所述手柄还包含锁机构，所述锁机构包含有效模式和无效模式；
    2)所述锁机构包含与后把手连为一体的无齿悬臂；所述锁机构还包含锁片，其中所述锁片包含与所述无齿悬臂外形和尺寸相匹配的锁孔，所述无齿悬臂穿透所述锁孔；
    3)所述锁机构还包含安装在前把手中的扳机，按钮和弹性元件；所述扳机包含扳机转轴，第一凸轮面，第二凸轮面和手指扣；所述按钮与所述第一凸轮面相互作用，驱动所述扳机围绕扳机转轴旋转，实现锁机构在有效模式和无效模式之间切换；
    5)当所述锁机构为有效模式时，所述弹性元件驱动所述锁片使之与无齿悬臂紧配合，允许后把手朝向前把手合拢而限制后把手背离前把手张开，即为锁定功能；所述第二凸轮面可以选择性的与所述锁片接触，施加外力驱动所述手指扣使得所述扳机围绕扳机转轴旋转，而第二凸轮面驱动所述锁片运动，使之与无齿悬臂间隙配合，允许后把手背离前把手张开，即为解锁功能。
  9. 如权利要求8所述的手术器械，其特征在于，所述按钮包含第一按钮和第二按钮，所述第一按钮和第二按钮分别安装在所述前把手的两个侧面。
  10. 如权利要求8所述的手术器械，其特征在于，所述前把手包含贯穿其两个侧面的狭长滑槽，所述第一按钮和第二按钮可在所述狭长滑槽中滑动，所述狭长滑槽设置在转轮的后侧，且满足如下要求：左手或右手采用手指握持法操作所述手柄时，操作之手的食指可以方便的拨动其中一个按钮；左手或右手采用手掌握持法操作所述手柄时，操作之手的拇指可以方便的拨动其中一个按钮。
PCT/CN2018/089200 2018-04-02 2018-05-31 一种手术器械 WO2019192068A1 (zh)

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US5626608A (en) * 1996-03-29 1997-05-06 United States Surgical Corporation Surgical instrument having locking handle
US20060004406A1 (en) * 2004-07-05 2006-01-05 Helmut Wehrstein Surgical instrument
US20070095877A1 (en) * 2000-10-13 2007-05-03 Racenet David C Surgical stapling device
CN105615947A (zh) * 2016-03-18 2016-06-01 杭州光典医疗器械有限公司 一种医用钳按钮式锁卡装置及其解锁方式
CN105816214A (zh) * 2016-06-08 2016-08-03 宁波维尔凯迪医疗器械有限公司 一种保险系统及具有该保险系统的吻合器

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Publication number Priority date Publication date Assignee Title
US5626608A (en) * 1996-03-29 1997-05-06 United States Surgical Corporation Surgical instrument having locking handle
US20070095877A1 (en) * 2000-10-13 2007-05-03 Racenet David C Surgical stapling device
US20060004406A1 (en) * 2004-07-05 2006-01-05 Helmut Wehrstein Surgical instrument
CN105615947A (zh) * 2016-03-18 2016-06-01 杭州光典医疗器械有限公司 一种医用钳按钮式锁卡装置及其解锁方式
CN105816214A (zh) * 2016-06-08 2016-08-03 宁波维尔凯迪医疗器械有限公司 一种保险系统及具有该保险系统的吻合器

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