CN101336836B - 外科缝合器械 - Google Patents

外科缝合器械 Download PDF

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CN101336836B
CN101336836B CN2008101317066A CN200810131706A CN101336836B CN 101336836 B CN101336836 B CN 101336836B CN 2008101317066 A CN2008101317066 A CN 2008101317066A CN 200810131706 A CN200810131706 A CN 200810131706A CN 101336836 B CN101336836 B CN 101336836B
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end effector
trigger
ratchet
surgical instruments
anvil block
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CN101336836A (zh
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C·P·布德罗克斯
J·S·斯韦兹
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Ethicon Endo Surgery Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • A61B17/07207Surgical 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 the staples being applied sequentially
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B17/295Forceps for use in minimally invasive surgery combined with cutting implements
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003Steerable
    • A61B2017/00318Steering mechanisms
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681Aspects not otherwise provided for
    • A61B2017/00734Aspects not otherwise provided for battery operated
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • A61B2017/07214Stapler heads
    • A61B2017/07271Stapler heads characterised by its cartridge
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • A61B2017/07214Stapler heads
    • A61B2017/07285Stapler heads characterised by its cutter
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B17/2909Handles
    • A61B2017/2912Handles transmission of forces to actuating rod or piston
    • A61B2017/2913Handles transmission of forces to actuating rod or piston cams or guiding means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B17/2909Handles
    • A61B2017/2912Handles transmission of forces to actuating rod or piston
    • A61B2017/2913Handles transmission of forces to actuating rod or piston cams or guiding means
    • A61B2017/2916Handles transmission of forces to actuating rod or piston cams or guiding means pins in guiding slots
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B17/2909Handles
    • A61B2017/2912Handles transmission of forces to actuating rod or piston
    • A61B2017/2923Toothed members, e.g. rack and pinion
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2927Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2927Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929Details 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2932Transmission of forces to jaw members
    • A61B2017/2943Toothed members, e.g. rack and pinion
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2946Locking means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08Accessories or related features not otherwise provided for
    • A61B2090/0807Indication means
    • A61B2090/0811Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument

Abstract

本发明公开了一种外科缝合器械。所述外科器械包括轴、相对于所述轴可动的端部执行器、锁定机构和闭合系统,其中,所述锁定机构能够接合轴和/或端部执行器,以固定轴与端部执行器之间的相对关系,所述闭合系统能够闭合端部执行器并且接合锁定机构以防止其解锁。该器械还可以包括击发驱动器,所述击发驱动器包括扳机、击发构件和棘爪,该棘爪能够在第一位置和第二位置之间旋转,其中,在第一位置处,棘爪脱离击发构件,在第二位置处,扳机能够朝向端部执行器推进棘爪和击发构件。该器械也可以包括卷轴、带和回复机构,其中,所述带能够卷绕在所述卷轴上以回缩击发构件,所述回复机构用于使扳机选择性地接合击发构件和卷轴。

Description

外科缝合器械
本发明涉及以下与本文同时提交的共同所有的美国专利申请,这些美国专利申请通过引用整体结合入本文:
(1)题为“END EFFECTOR CLOSURE SYSTEM FOR A SURGICALSTAPLING INSTRUMENT”、律师档案号为END6085USNP/070054的美国专利申请;
(2)题为“SURGICAL STAPLING INSTRUMENT WITH AN ANTI-BACKUP MECHANISM”、律师档案号为No.END6100USNP/070053的美国专利申请;
(3)题为“SURGICAL STAPLING INSTRUMENT WITH A RETURNMECHANISM”、律师档案号为No.END6091USNP/070061的美国专利申请;和
(4)题为“SURGICAL STAPLING INSTRUMENT WITH AN ARTCULATINGEND EFFECTOR”律师档案号为No.END6092USNP/070062的美国专利申请。
技术领域
本发明总体涉及外科缝合器械,并且更具体地涉及具有用于闭合端部执行器的闭合系统和用于展开缝钉的击发系统的外科缝合器。
背景技术
已知在现有技术中,外科缝合器通常用于将缝钉展开在软组织中以便例如特别是在横向切割组织的过程中减少或消除来自软组织的出血。外科缝合器例如内切割器可以包括可相对于细长轴组件进行驱动或进行关节运动的端部执行器。端部执行器通常被构造成将软组织固定在第一钳口构件和第二钳口构件之间,其中第一钳口构件通常包括钉仓,第二钳口构件通常包括砧座,所述钉仓被构造成用于可拆卸地存放缝钉。这样的外科缝合器可以包括用于相对于钉仓枢转所述砧座的闭合系统。但是,在闭合所述钳口构件之后,所述闭合系统不会阻碍端部执行器相对于轴组件进行关节运动。因此,当端部执行器进行关节运动时,端部执行器可能在被俘获在钳口构件之间的软组织上施加剪切力。
如上所述,外科缝合器可被构造成用于相对于所述钉仓来枢转端部执行器的砧座,以便俘获处于钉仓和砧座之间的软组织。在不同情况下,所述砧座可被构造成在软组织上施加夹紧力来将软组织紧紧地保持在砧座和钉仓之间。但是如果外科医生对端部执行器的位置不满意,那么外科医生通常必须激活外科缝合器上的释放机构以将砧座枢转至张开位置并随后重新定位端部执行器。此后,通常通过驱动器将缝钉从钉仓展开并将软组织层固定在一起,所述驱动器横穿钉仓中的通道并且使缝钉抵靠在砧座上变形。已知在现有技术中,缝钉通常以多条缝钉线或缝钉排展开以便更可靠地将组织层固定在一起。端部执行器也可以包括切割构件例如刀,所述切割构件在两条缝钉排之间推进以便在将软组织层缝合在一起之后切断软组织。
在端部执行器内推进驱动器和切割构件之后,通常有必要将驱动器和/或切割构件回缩到其起始位置。以前的外科缝合器例如包括回复弹簧,在外科医生致动外科缝合器上的释放按钮或拨动开关之后,所述回复弹簧相对于钉仓回缩所述切割构件。在各种实施方式中,回复弹簧的第一端部可以连接到外科器械的外壳上,并且回复弹簧的第二端部可以连接到切割构件上。但是这样的缝合器通常不易使用,因为在切割构件推进的过程中伸展所述回复弹簧通常需要很大的力。另外,在切割构件的推进过程中,这样的回复弹簧通常将偏压力施加在切割构件上,在不同情况下,特别是在扳机需要多个冲程才能完全推进切割构件的实施方式中,这可能会过早将切割构件退回。需要对上述情况进行改进。
发明内容
在本发明的至少一种形式中,外科器械可以包括轴组件、端部执行器和锁定机构,所述端部执行器可相对于轴组件运动,所述锁定机构被构造成与轴组件和/或端部执行器接合以便固定或锁定所述轴组件和端部执行器之间的相对关系。在各种实施方式中,端部执行器可以包括砧座和通道,其中所述通道可被构造成用于装纳钉仓并且所述砧座可动地连接到所述通道上。在至少一种实施方式中,外科器械还可以包括闭合系统,所述闭合系统被构造成产生闭合动作,其中砧座可以响应所述闭合动作。在各种实施方式中,闭合系统可以进一步被构造成与锁定机构接合并且防止锁定机构将轴组件和端部执行器之间的相对关系解锁。
在本发明的至少一种形式中,外科器械可以包括闭合系统,所述闭合系统被构造成比如在张开位置、部分闭合位置和闭合位置之间运动端部执行器的砧座。在各种实施方式中,外科器械还可以包括锁定构件,当砧座被定位在其部分闭合位置和闭合位置的一个中时,所述锁定构件被构造成有选择地接合和锁定所述闭合系统。在至少一种实施方式中,外科器械例如可以包括被构造成使砧座枢转的扳机,其中所述扳机可以包括凸轮面和凸轮面中的第一凹口。在各种实施方式中,所述锁定构件可以包括随动部分,并且闭合驱动装置可以包括锁定弹簧,所述锁定弹簧被构造用于将所述随动部分偏压在扳机的凸轮面上,使得当砧座枢转进入其部分闭合位置中时所述随动部分可以与扳机的第一凹口接合。在至少一种实施方式中,当随动部分与第一凹口接合时,第一凹口可以防止砧座枢转进入其张开位置中。在各种实施方式中,所述凸轮部分还可以包括第二凹口,并且所述随动部分被构造成在所述砧座枢转进入其闭合位置中时能与所述第二凹口接合。
在本发明的至少一种形式中,外科器械可以包括具有击发构件的击发驱动器和连接到击发构件上的柔性带,所述击发构件被构造用于例如在端部执行器内推进切割构件,所述柔性带被构造用于回缩所述击发构件。在至少一种实施方式中,外科器械可以包括例如被构造成与带接合的制动器,由此限制击发构件的运动。在各种实施方式中,击发驱动器还可以包括卷轴,所述卷轴被构造成当回缩击发构件时用于卷起所述带的至少一部分。在至少一种实施方式中,击发驱动器还可以包括扳机,所述扳机可与击发构件和卷轴有选择地接合,使得当扳机与击发构件可操作地接合时,扳机的致动能用于推进击发构件,并且当扳机与卷轴可操作地接合时,扳机的致动可用于旋转所述卷轴并经由所述带回缩所述击发构件。
具体而言,本发明公开了如下内容:
(1).一种外科器械,包括:
细长轴;
接头;
端部执行器,所述端部执行器能绕所述接头相对于所述细长轴选择性地运动,所述端部执行器包括:
通道,其能够容纳钉仓;和
砧座,其可动地连接到所述通道上;
锁定机构,其具有锁定构型和解锁构型,当所述锁定机构处于所述锁定构型时,所述锁定机构能够接合所述细长轴和所述端部执行器中的至少一个,并且至少限制所述细长轴和所述端部执行器之间的相对运动;以及
闭合驱动装置,其与所述砧座可操作地接合,所述闭合驱动装置能够在第一位置和第二位置之间运动,以使所述砧座在打开位置和闭合位置之间运动,当所述闭合驱动装置位于所述第二位置时,所述闭合驱动装置能够将所述闭合机构保持在所述锁定构型。
(2).根据第(1)项所述的外科器械,其中,所述闭合驱动装置能够移动到中间位置,以使所述砧座枢转到部分闭合位置,当所述闭合驱动装置处于所述中间位置时,所述端部执行器能够相对于所述细长轴移动。
(3).根据第(1)项所述的外科器械,其中,所述锁定机构包括:
锁定构件,其包括第一端和第二端,所述锁定构件能够相对于所述接头滑动,当所述锁定机构处于所述锁定构型时,所述锁定构件的所述第一端能够接合所述端部执行器;以及
致动器,所述锁定构件的所述第二端与所述致动器可操作地接合,所述闭合驱动装置能够在其处于所述第二位置时抵接所述致动器,并且阻止所述锁定构件相对于所述接头滑动。
(4).根据第(3)项所述的外科器械,其中,所述闭合驱动装置包括扳机和驱动器,所述扳机能够朝向所述致动器移动所述驱动器,当所述闭合驱动装置处于所述第二位置时,所述驱动器能够抵接所述致动器,所述细长轴组件包括可操作地接合在所述砧座和所述扳机上的护套,在所述扳机致动时,所述扳机能够相对于所述端部执行器移动所述护套并枢转所述砧座。
(5).一种用于处理外科器械的方法,所述方法包括:
获得如第(1)项所述的外科器械;
对所述外科器械进行消毒;并且
将所述外科器械存储在无菌容器内。
(6).一种外科器械,包括:
细长轴;
接头;
端部执行器,所述端部执行器能够绕所述接头相对于所述细长轴选择性地运动,所述端部执行器包括:
通道,其能够容纳钉仓;和
砧座,其可动地连接到所述通道上;
锁定机构,其具有锁定构型和解锁构型,当所述锁定机构处于所述锁定构型时,所述锁定机构能够接合所述细长轴和所述端部执行器中的至少一个,并且至少限制所述细长轴和所述端部执行器之间的相对运动;以及
闭合驱动装置,其能够产生闭合动作,所述闭合驱动装置包括驱动器,所述砧座与所述驱动器可操作地接合并且能够可动地响应于所述闭合动作,由于所述闭合动作,所述驱动器能够接合所述锁定机构,并且阻止所述锁定机构被构造处于所述解锁构型。
(7).根据第(6)项所述的外科器械,其中,所述锁定机构包括:
锁定构件,其包括第一端和第二端,所述锁定构件能够相对于所述接头滑动,当所述锁定机构处于所述锁定构型时,所述锁定构件的所述第一端能够接合所述端部执行器;以及
致动器,所述锁定构件的所述第二端与所述致动器可操作地接合,由于所述闭合动作,所述驱动器能够抵接所述致动器,并且阻止所述锁定构件相对于所述接头滑动。
(8).根据第(7)项所述的外科器械,其中,所述闭合驱动装置还包括扳机,所述扳机能够朝向所述致动器移动所述驱动器,所述细长轴组件包括可操作地接合在所述砧座和所述扳机上的护套,在所述扳机致动时,所述扳机能够相对于所述端部执行器移动所述护套并且枢转所述砧座。
(9).根据第(1)项所述的外科器械,其中,所述闭合动作能够将所述砧座枢转到部分闭合位置,当所述砧座处于所述部分闭合位置时,所述端部执行器能够相对于所述细长轴移动。
(10).一种用于处理外科器械的方法,所述方法包括:
获得如第(6)项所述的外科器械;
对所述外科器械进行消毒;并且
将所述外科器械存储在无菌容器内。
(11).一种外科器械,包括:
端部执行器,包括:
通道,其能够容纳钉仓;和
切割构件,其可操作地支撑在所述通道内;以及击发驱动器,包括:
扳机;
击发构件,其与所述切割构件可操作地接合;
棘爪,所述棘爪能够在第一位置和第二位置之间旋转,当所述棘爪处于所述第二位置时,所述棘爪与所述击发构件接合;和
棘爪销,其可操作地接合到所述扳机和所述棘爪上,在所述扳机致动时,所述扳机能够朝向所述端部执行器推进所述棘爪销和所述棘爪,当所述棘爪处于所述第二位置时,所述棘爪能够朝向所述端部执行器推进所述击发构件。
(12).根据第(11)项所述的外科器械,其中,所述击发驱动器还包括倾斜机构,所述倾斜机构与所述棘爪可操作地接合,所述倾斜机构包括凸轮,当所述棘爪通过所述扳机推进时,所述棘爪能够接触所述凸轮,所述凸轮能够使所述棘爪旋转到所述第二位置。
(13).根据第(12)项所述的外科器械,其中,所述棘爪能够在接触所述凸轮之前相对于所述倾斜机构移动,所述棘爪能够在接触所述凸轮之后推进所述倾斜机构。
(14).根据第(12)项所述的外科器械,其中,所述倾斜机构包括第二凸轮,当所述棘爪接触所述第二凸轮时,所述第二凸轮能够将所述棘爪旋转到所述第一位置并且使所述棘爪脱离所述击发构件。
(15).一种用于处理外科器械的方法,所述方法包括:
获得如第(11)项所述的外科器械;
对所述外科器械进行消毒;并且
将所述外科器械存储在无菌容器内。
(16).一种外科器械,包括:
端部执行器,包括:
通道,其能够容纳钉仓;和
切割构件,其可操作地支撑在所述通道内;以及击发驱动器,包括:
扳机;
击发构件,其与所述切割构件可操作地接合;
棘爪,其与所述扳机可操作地接合,所述扳机能够推进所述棘爪,所述棘爪能够在第一位置和第二位置之间旋转,当所述棘爪处于所述第二位置时,所述棘爪能够接合所述击发构件并且朝向所述端部执行器推进所述击发构件;和
倾斜机构,其与所述棘爪可操作地接合,所述倾斜机构包括凸轮,当所述棘爪通过所述扳机推进时,所述棘爪能够接触所述凸轮,所述凸轮能够使所述棘爪旋转到所述第二位置。
(17).根据第(16)项所述的外科器械,其中,所述棘爪能够在接触所述凸轮之前相对于所述倾斜机构移动,所述棘爪能够在接触所述凸轮之后推进所述倾斜机构。
(18).根据第(16)项所述的外科器械,其中,所述倾斜机构包括第二凸轮,当所述棘爪接触所述第二凸轮时,所述第二凸轮能够将所述棘爪旋转到所述第一位置并且使所述棘爪脱离所述击发构件。
(19).根据第(16)项所述的外科器械,其中,所述击发驱动器还包括棘爪销,所述棘爪销可操作地接合在所述扳机和所述棘爪上,所述扳机包括能够容纳所述棘爪销的槽,在所述扳机致动时,所述槽朝向所述端部执行器推进所述棘爪销。
(20).一种用于处理外科器械的方法,所述方法包括:
获得如第(16)项所述的外科器械;
对所述外科器械进行消毒;并且
将所述外科器械存储在无菌容器内。
(21).一种外科器械,包括:
端部执行器,包括:
通道,其能够容纳钉仓;和
切割构件,其可操作地支撑在所述通道内;以及击发驱动器,包括:
扳机;
击发构件,其与所述切割构件可操作地接合;
棘爪,其与所述扳机可操作地接合,所述扳机能够推进所述棘爪,所述棘爪能够在第一位置和第二位置之间旋转,当所述棘爪处于所述第二位置时,所述棘爪能够接合所述击发构件并且朝向所述端部执行器推进所述击发构件,所述棘爪通过弹簧而不被偏压到所述第一位置和所述第二位置中。
(22).一种外科器械,包括:
端部执行器,包括:
通道,其能够容纳钉仓;和
切割构件,其可操作地支撑在所述通道内;以及击发驱动器,包括:
击发构件,其与所述切割构件可操作地接合,所述击发驱动器能够朝向所述端部执行器推进所述击发构件并且相对于所述通道移动所述切割构件;
卷轴;和
带,其可操作地连接到所述击发构件上,当所述击发构件朝向所述端部执行器前进时,所述击发构件能够相对于所述卷轴拉动所述带,所述卷轴能够相对于所述端部执行器拉动所述带并回缩所述击发构件。
(23).根据第(22)项所述的外科器械,其中,所述击发驱动器还包括扳机,所述扳机与所述击发构件可操作地接合,以在所述扳机第一次致动时朝向所述端部执行器推进所述击发构件,所述卷轴在所述扳机的所述第一次致动过程中不与所述扳机可操作地接合,在所述扳机的随后致动时,所述卷轴与所述扳机可操作地接合以便旋转所述卷轴并回缩所述带和所述击发构件。
(24).根据第(23)项所述的外科器械,其中,所述卷轴包括凸轮构件,所述击发驱动器还包括凸轮随动件,所述凸轮构件能够在第一位置和第二位置之间移动所述凸轮随动件,当所述凸轮随动件定位在所述第二位置时,所述凸轮随动件能够使所述卷轴与所述扳机可操作地接合。
(25).根据第(22)项所述的外科器械,其中,所述带连接到所述卷轴上,所述卷轴能够将所述带的至少一部分卷绕在所述卷轴上。
(26).一种用于处理外科器械的方法,所述方法包括:
获得如第(22)项所述的外科器械;
对所述外科器械进行消毒;并且
将所述外科器械存储在无菌容器内。
(27).一种外科器械,包括:
端部执行器,包括:
通道,其能够容纳钉仓;和
切割构件,其可操作地支撑在所述通道内;
击发驱动器,包括:
扳机;
击发构件,所述击发构件与所述切割构件可操作地接合,所述扳机与所述击发构件可选择地接合,在所述扳机的第一次致动时,所述扳机能够朝向所述端部执行器推进所述击发构件;
凸轮,当所述击发构件被朝向所述端部执行器前进时,所述击发构件能够沿第一方向旋转所述凸轮;和
凸轮随动件,当所述凸轮沿所述第一方向旋转时,所述凸轮能够在第一位置和第二位置之间移动所述凸轮随动件,当所述凸轮随动件通过所述凸轮定位在所述第二位置时,所述凸轮随动件能够使所述扳机与所述凸轮可操作地接合,当所述扳机与所述凸轮可操作地接合且在所述扳机的随后致动时,所述扳机能够沿第二方向旋转所述凸轮并回缩所述击发构件。
(28).根据第(27)项所述的外科器械,其中,当所述凸轮随动件定位在所述第二位置时,所述凸轮随动件还能使所述扳机可操作地脱离所述击发构件。
(29).根据第(27)项所述的外科器械,其中,所述击发驱动器还包括连接到所述击发构件和所述凸轮上的带,当所述击发构件被推进时,所述击发构件能够相对于所述凸轮拉动所述带,所述凸轮能够拉动所述带以回缩所述击发构件。
(30).根据第(27)项所述的外科器械,其中,所述击发驱动器还包括与所述扳机可操作地接合的棘爪,所述扳机能够推进所述棘爪,所述棘爪能够在接合位置和脱离位置之间旋转,当所述棘爪处于所述脱离位置时,所述棘爪不与所述击发构件接合,当所述棘爪处于所述接合位置时,所述棘爪与所述击发构件接合并且能够朝向所述端部执行器推进所述击发构件,当所述凸轮随动件移动到所述第二位置时,所述随动件能够确保所述棘爪处于所述脱离位置。
(31).一种用于处理外科器械的方法,所述方法包括:
获得如第(27)项所述的外科器械;
对所述外科器械进行消毒;并且
将所述外科器械存储在无菌容器内。
(32).一种外科器械,包括:
端部执行器,包括:
通道,其能够容纳钉仓;和
切割构件,其可操作地支撑在所述通道内;
击发构件,其与所述切割构件可操作地接合;
扳机;
击发驱动器,其能够朝向所述端部执行器推进所述击发构件并且相对于所述通道移动所述切割构件,所述扳机能够与所述击发驱动器选择性地接合以操作所述击发驱动器;以及
反向驱动装置,其能够回缩所述击发构件使其远离所述端部执行器并且相对于所述通道移动所述切割构件,所述扳机与所述反向驱动装置可选择地接合以操作所述反向驱动装置,所述扳机能够在其致动之前或致动时可操作地脱离所述击发驱动器并且与所述反向驱动装置可操作地接合。
(33).一种外科器械,包括:
外壳;
端部执行器,包括:
通道,其能够容纳钉仓;和
切割构件,其可操作地支撑在所述通道内;以及击发驱动器,包括:
扳机;
击发构件,其与所述切割构件可操作地接合;
棘爪,其与所述扳机可操作地接合,所述扳机能够推进所述棘爪,所述棘爪能够在第一位置和第二位置之间旋转,当所述棘爪处于所述第二位置时,所述棘爪能够接合所述击发构件并且朝向所述端部执行器推进所述击发构件;和
倾斜机构,其能够在所述第一位置和所述第二位置之间旋转所述棘爪;所述倾斜机构与所述外壳摩擦接合。
附图说明
通过以下结合附图对本发明实施方式的描述,本发明的上述特征和其它优点及其实现方式变得更加清晰并且可以更好地理解本发明,其中:
图1是根据本发明的一种实施方式的外科器械的正视图;
图2是图1的外科器械的手柄部分的正视图;
图3是图1的外科器械的端部执行器的正视图;
图4是图3的端部执行器的俯视图;
图5是图1的外科器械的关节运动接头的立体图,其中去除了外科器械的一些零件;
图6是图1的外科器械的细长轴组件和关节运动接头的立体图,其中去除了外科器械的一些零件;
图7是图1的外科器械的手柄部分和细长轴组件的局部立体图,其中去除了外科器械的一些零件;
图8是图2的手柄部分的正视图,其中去除了外科器械的一些零件;
图9是图2的手柄部分的正视图,其中去除了外科器械的其他一些零件;
图10是根据本发明的一种替代实施方式的外科器械的关节运动锁定机构的致动器和端部执行器闭合系统的正视图,其中去除了外科器械的一些零件;
图11是图10的外科器械的正视图,示出了处于解锁位置中的关节运动锁定机构的致动器和处于张开构型中的端部执行器闭合系统;
图12是图10的外科器械的正视图,示出了处于解锁位置中的关节运动锁定机构的致动器和处于部分闭合构型中的端部执行器闭合系统;
图13是图10的外科器械的正视图,示出了处于闭合位置中的关节运动锁定机构的致动器和处于闭合构型中的端部执行器闭合系统;
图14是图1的外科器械的端部执行器闭合系统的闭合扳机的正视图;
图15是图14的闭合扳机的局部立体图;
图16是图15的闭合扳机的局部正视图;
图17是图1的外科器械的扳机锁定构件的立体图;
图18是图17的扳机锁定构件的正视图;
图19是图1的外科器械的击发驱动器的细部视图,其中去除了外科器械的一些零件;
图20是图19的击发驱动器的立体图;
图21是图19的击发驱动器的击发扳机、棘爪和倾斜机构的局部细部视图;
图22是图19的击发驱动器的棘爪、倾斜机构和棘爪回复弹簧的正视图;
图23是图22的棘爪的正视图;
图24是图19的击发驱动器的细部视图,示出了棘爪枢转进入与击发驱动器的击发连杆接合的位置中;
图25是图22的倾斜机构的立体图;
图26是图1的外科器械的机架的立体图;
图27是根据本发明的一种替代实施方式的外科器械的击发驱动器的细部视图,其中去除了外科器械的一些零件;
图28是图27的击发驱动器的细部视图,示出了击发驱动器的棘爪从击发连杆脱开;
图29是根据本发明第一方面的外科器械的回复机构的立体图,示出了击发扳机处于非致动位置中,其中去除了外科器械的一些零件;
图30是图29的回复机构的局部立体图,示出了击发扳机处于致动位置中,其中去除了回复机构的一些零件;
图31是图29的回复机构被设置成如图30所述构型时的正视图;
图32是图29的回复机构的正视图,示出了回复机构的回复滑架处于致动位置中;
图33是图29的回复机构的局部立体图,其中去除了回复机构的一些零件;
图34是图19的击发驱动器的棘爪和击发销的立体图;
图35是图29的回复机构的立体图,示出了所述回复滑架处于致动位置中并且击发扳机被回复到其非致动位置中;
图36是图29的回复机构被设置成如图35所示构型时的局部立体图,示出了回复机构的回复销与击发扳机可操作地接合;
图37是图29的回复机构的局部立体图,示出了在旋转所述回复销之后击发扳机处于致动位置中;
图38是图29的回复机构被设置成图37所示构型时的附加立体图;
图39是图29的回复机构的局部立体图,示出了击发扳机回到其非致动位置;
图40是图29的回复机构的立体图,示出了回复滑架回到其非致动位置;
图41是图29的回复机构被设置成如图40所示构型时的立体图,示出了回复机构的偏压弹簧和回复销之间的相互关系,其中去除了回复机构的一些零件;
图42是图29的回复机构被设置成如图40所示的构型时的立体图,示出了回复滑架可操作地与击发驱动器的击发销以及回复机构的回复销接合以便将所述击发驱动器和回复机构复位至其初始构型;
图43是图29的回复机构的卷轴的局部视图,示出了回复机构的回复带和图26的缝合器机架之间的相对关系;
图44是图43的卷轴的细部视图,示出了回复带和图26的缝合器机架的替代实施方式之间的相对关系;
图45是根据本发明的一种替代实施方式的外科器械的回复机构的立体图,所述回复机构具有止回棘轮机构;
图46是图45的具有回复滑架的回复机构的正视图,所述回复滑架处于非致动位置中;
图47是图45的回复机构的立体图,其中去除了外科器械的一些零件;
图48是图45的棘轮机构的回复齿轮、回复销和止回棘爪的立体图;
图49是图45的回复机构的另一正视图;
图50是图5的关节运动接头的立体图;
图51是图5的关节运动接头的立体图,其中去除了外科器械的一些零件;
图52是图5的关节运动接头的立体图,其中去除了外科器械的其他一些零件;
图53是图3的端部执行器的锁定构件的立体图;
图54是图53的端部执行器锁定构件的另一立体图;
图55是图53的端部执行器锁定构件的仰视图;
图56是图53的端部执行器锁定构件的正视图;
图57是先前的外科器械的关节运动接头的局部立体图;
图58是图5的关节运动接头的立体图,其中去除了端部执行器和细长轴组件的一些零件;
图59是图5的关节运动接头的另一立体图,其中去除了端部执行器和细长轴组件的一些零件;
图60是图53的端部执行器锁定构件的立体图,所述端部执行器锁定构件可操作地与细长轴组件的锁定构件接合;
图61是图60的轴组件锁定构件的立体图;
图62是图53的端部执行器锁定构件的仰视图,所述端部执行器锁定构件与图60的轴组件锁定构件可操作地接合;
图63是根据本发明的替代实施方式的外科器械的关节运动接头的立体图,其中去除了外科器械的一些零件;
图64是端部执行器锁定构件的俯视图,所述端部执行器锁定构件与图63的外科器械的轴组件锁定构件可操作地接合;
图65是端部执行器锁定构件的立体图,所述端部执行器锁定构件与图64的轴组件锁定构件可操作地接合;
图66是图64的端部执行器锁定构件的立体图;和
图67是图64的端部执行器锁定构件的正视图。
具体实施方式
在各附图中相应的附图标记表示相应的部件。本文展示的范例以一种形式示出了本发明的优选实施方式,并且这样的范例在任何情况下都不应被解释成对本发明范围的限制。
现在对一些示意性的实施方式进行描述,以便对本文所公开的装置和方法的结构、功能、制造和使用的原理有个总体理解。附图中示出了这些实施方式的一种和多种示例。本领域技术人员应当理解,本文详细描述并在附图中示出的装置和方法是非限制性的示意性实施方式,并且本发明的各种实施方式的范围仅仅通过权利要求限定。接合一种示意性实施方式示出和描述的特征可以与其它实施方式的特征结合。意图将这样的修改和变化包括在本发明的范围内。
在各种实施方式中,根据本发明的外科器械例如可以构造成用于将外科缝钉插入软组织中。参照图1至4,在至少一种实施方式中,外科器械100可以包括手柄部分102、细长轴组件104和端部执行器106。在各种实施方式中,参照图3和4,端部执行器106可以包括钉仓通道108和钉仓110,其中钉仓110可以构造成用于将缝钉可拆卸地存放在钉仓中。在至少一种实施方式中,端部执行器106还可以包括砧座112,所述砧座112可以枢转地连接到钉仓通道108上并且可以通过端部执行器闭合系统在张开位置和闭合位置之间枢转。为了将缝钉从钉仓110展开,外科器械100还可以包括缝钉驱动器和击发驱动器,所述缝钉驱动器被构造用于横穿所述钉仓110,所述击发驱动器用于在钉仓内推进缝钉驱动器。在各种实施方式中,砧座112可以被构造成在将缝钉从钉仓中展开的过程中使缝钉的至少一部分变形。虽然下面更详细地描述了端部执行器闭合系统和击发驱动器的各种实施方式,但是在以下文献中公开了端部执行器闭合系统和击发驱动器的数种实施方式:公告日为2005年6月14日、专利号为No.6905057、题为“SURGICAL STAPLING INSTRUMENTINCORPORATING A FIRING MECHANISM HAVING A LINKEDRACK TRANSMISSION”的美国专利,公告日为2006年5月16日、专利号为No.7044352、题为“SURGICAL STAPLING INSTRUMENTHAVING A SINGLE LOCKOUT MECHANISM FOR PREVENTIONOF FIRING”的美国专利,所述文献的内容通过引用结合入本文。
在各种实施方式中,根据本发明的外科器械可以包括用于相对于外科器械的细长轴组件运动端部执行器或使其进行关节运动的系统。参照图3至7,在至少一种实施方式中,外科器械100可以包括关节运动接头114,所述关节运动接头114能够可动地连接到端部执行器106和细长轴组件104上。在各种实施方式中,关节运动接头114可以允许在单个平面或可选地在多个平面中相对于轴组件104运动所述端部执行器106。在所有情形中,关节运动接头114可以包括一根或多根枢转轴线116(图5),端部执行器106可以围绕所述枢转轴线116进行关节运动。参照图5和6,在各种实施方式中,外科器械100还可以包括锁定机构118,所述锁定机构118能够固定或锁定端部执行器106和细长轴组件104之间的相对关系。在至少一种实施方式中,锁定机构118可以包括锁定构件120,所述锁定构件120可以相对于端部执行器106滑动,并且可以与端部执行器106接合以便防止或至少部分抑制端部执行器106和轴组件104之间的相对运动。在至少一种实施方式中,如下面详细描述的那样,锁定构件120可以构造成与端部执行器106的齿312(图5和6)中的至少一个接合,使得锁定构件120和齿312之间的相互作用能防止或至少部分抑制端部执行器106围绕轴线116进行旋转。
参照图7至9,在各种实施方式中,锁定机构118还可以包括致动器122,所述致动器122能够可操作地连接到锁定构件120上。在至少一种实施方式中,致动器122可以包括销124,所述销124可被容纳在锁定构件120中的槽121内,使得当致动器122相对于手柄部分102滑动时,所述销124能够抵靠槽121的侧壁并且相对于端部执行器106推动锁定构件120。在至少一种实施方式中,可以将所述致动器122从端部执行器106也就是向近侧拉开,以便将锁定构件120从端部执行器106脱开。虽然没有显示出来,但是也可以预见到其它实施方式,其中可以向远侧驱动或甚至旋转所述致动器122以便将锁定构件120从端部执行器106脱开。在所有情形中,锁定机构118还可以包括回复弹簧126(图6),所述回复弹簧126可以构造成用于向着端部执行器106也就是向远侧运动所述锁定构件120,以便在致动器122被释放之后使锁定构件120与端部执行器106接合。在2005年4月7日提交的序列号为No.11/100772、题为“SURGICAL INSTRUMENT WITH ARTICULATING SHAFT WITHSINGLE PIVOT CLOSURE AND DOUBLE PIVOT FRAMEGROUND”的美国专利申请;2005年9月29日提交的序列号为No.11/238358、题为“SURGICAL INSTRUMENT WITH ARTICULATINGSHAFT WITH RIGID FIRING BAR SUPPORTS”的美国专利申请;和2006年7月24日提交的序列号为No.11/491626、题为“SURGICALSTAPLING AND CUTTING DEVICE AND METHOD FOR USINGTHE DEVICE”的美国专利申请中披露了其它锁定机构,因此所述专利申请的全部公开内容通过引用结合入本文。
参照图1和2,在各种实施方式中,所述致动器122可以是波状外形,使得外科医生能够抓持住所述致动器122的外表面并如上所述可以向近侧拉动致动器122。在至少一种实施方式中,为了运动所述致动器122,外科医生可以例如将一只手放在手柄把手127上并将另一只手放在致动器122上,使得外科医生能够相对于手柄把手127运动所述致动器122。参照图10至13,在各种实施方式中,可以将致动器122’构造成使外科医生可以只用一只手就能操作外科器械。更具体地说,在至少一种实施方式中,致动器122’可以包括从其延伸出来的钩或凸起115,所述钩或凸起115允许外科医生用一只手把持住手柄把手127并用这只手的至少一根手指伸向远侧以便抓持住至少一个凸起115并且如上所述向近侧拉动致动器122’。本文中描述的致动器122’具有凸起115,致动器122或任何其它适当的致动器也可以包括凸起115和/或能协助外科医生用一只手来操作外科器械100的任何其它适当的特征。在至少一种实施方式中,凸起115可以至少部分地包括和/或涂有弹性材料或“软接触”材料,所述弹性材料或“软接触”材料能够增进外科医生对凸起115的抓持并能为外科医生提供人机工程学益处。在各种实施方式中,致动器122’例如可以与轴组件104可操作地接合,使得端部执行器106和轴组件104能够通过致动器122’围绕纵向轴线旋转。在这样的实施方式中,通过使端部执行器106如上所述进行关节运动和/或将端部执行器106旋转就位,外科医生能够将端部执行器106定向在外科手术部位中。在至少一种实施方式中,通过将手指定位在凸起115中的一个上并将力施加在所述凸起上,外科医生就能旋转所述致动器122’。在各种实施方式中,通过将手指放在凸起115上并抵抗致动器122’以及相应的端部执行器106的任何不需要的动作,外科医生可以将所述致动器122’保持就位。
在各种实施方式中,根据本发明的外科器械例如可以包括用于将端部执行器闭合或夹紧在软组织上的系统。参照图2、5、8和9,在至少一种实施方式中,外科器械100可以包括闭合扳机128、传动杆130、驱动器132和闭合管134。在各种实施方式中,在致动闭合扳机128时,闭合扳机128可被构造成用于向远侧移动传动杆130、驱动器132和闭合管134。更具体而言,在至少一种实施方式中,传动杆130可以包括第一端部和第二端部,所述第一端部枢转连接到扳机128上,所述第二端部枢转连接到驱动器132上,从而扳机128向着手柄把手127的旋转能够向前驱动传动杆130并且使驱动器132沿着由驱动器引导件136(图8)限定的轴线滑动。在各种实施方式中,驱动器132可以包括从其延伸出的凸起133,所述凸起能够被可滑动地装纳在驱动器引导件136中的槽137内,从而槽137能够限定出驱动器132运动时的路径。在各种实施方式中,闭合管134可以与驱动器132可操作地接合,使得当驱动器132如上所述向着远侧运动时,闭合管134能够与砧座112接合并且向下枢转所述砧座112。主要参照图5,闭合管134可被构造成在关节运动接头114上滑动并相对于钉仓110枢转所述砧座112。如图9所示,在至少一种实施方式中,闭合管134可以包括近端,所述近端具有从闭合管134延伸出的凸起135,所述凸起135可以装纳在驱动器132中的槽131内,从而将驱动器132的位移传递至闭合管134。
在各种实施方式中,如上所述,锁定机构118可以防止或至少部分抑制端部执行器106和轴组件104之间的相对运动。例如在软组织被夹紧在砧座112和钉仓110之间的情况下,端部执行器106和轴组件104之间的相对运动可能将剪切力施加到被夹紧在其间的软组织上,这会损伤软组织。在各种实施方式中,参照图10至13,当端部执行器106闭合时,为了防止或至少减少端部执行器106和轴组件104之间的相对运动,所述端部执行器闭合系统被构造成与锁定机构118接合来防止致动器122’被运动进入其解锁位置中。实际上,在至少一种实施方式中,对闭合扳机128进行致动不仅能够闭合端部执行器106,而且能够防止闭合机构118被解锁。在各种实施方式中,参照图10至13,外科器械100’可以包括驱动器132,所述驱动器132可以构造成当通过扳机128向远侧运动驱动器132时该驱动器132与致动器122’抵接或非常接近,由此防止致动器122’如上述所述致动器122一样向近侧运动。更具体而言,如图10和11所示,在致动所述扳机128之前,致动器122’可以向近侧滑动,以便使锁定构件120相对于端部执行器106滑动并将关节运动接头114解锁。但是,参照图13,在扳机128致动时,驱动器132可被构造成与致动器122’抵接或被定位在致动器122’附近,使得致动器122’不能向近侧运动来将锁定构件120从端部执行器106脱开。因此,端部执行器闭合系统可以防止端部执行器106在闭合之后进行关节运动,由此减少了将剪切力传递到被夹紧在端部执行器中的软组织上的可能性。
此外,端部执行器闭合系统可以给外科医生提供端部执行器已被闭合的反馈,以使外科医生将端部执行器解锁并使之进行关节运动,在能使端部执行器进行关节运动之前外科医生必须首先至少部分地再次张开端部执行器。更具体而言,由于在端部执行器106闭合时驱动器132和致动器122’之间的相互作用,当外科医生尝试向近侧拉动致动器122’来解锁关节运动接头114时,驱动器132基本上能够防止致动器122’运动,由此发出信号告知外科医生,端部执行器106被闭合并且在可以运动致动器122’和解锁关节运动接头之前必须首先张开端部执行器106。在各种实施方式中,这样的端部执行器闭合系统能够防止外科医生损坏外科器械和/或损伤俘获在端部执行器中或端部执行器周围的组织。更具体而言,在至少一种实施方式中,当如上所述推进闭合管134而使砧座112闭合时,闭合管134可以将力施加在砧座112上以便将砧座112保持在闭合位置中,并且在各种情况下所述力能够在关节运动接头114内产生摩擦力,所述摩擦力能够抑制(如果不是防止)端部执行器106围绕关节运动接头114的旋转。在不带如上所述的端部执行器闭合系统的实施方式中,如果外科医生尝试克服所述摩擦力而不首先部分地张开端部执行器,那么外科医生可能例如扳弯或折断外科器械的一个或多个零件。但是,在本发明的各种实施方式中,驱动器132可以例如防止外科医生如上所述释放关节运动锁定构件120,因此可以不给予外科医生解锁关节运动接头114的机会,更不用说致动端部执行器106。
在各种实施方式中,根据本发明的外科器械可以包括端部执行器闭合系统,所述闭合系统例如能够将砧座112定位在张开位置、闭合位置和部分闭合位置中。在至少一种实施方式中,外科医生能够将砧座112运动到部分闭合位置中并且在将砧座112运动进入其闭合位置之前对是否应该重新定位端部执行器或使端部执行器进行关节运动做出估计。在这样的实施方式中,可以相对于处在砧座112和钉仓110中间的软组织运动所述砧座112,而不会在完全闭合砧座112之前将剪切力或至少大的剪切力施加到软组织上。在至少一种实施方式中,砧座112被构造成使得当砧座112处于其部分闭合位置中时不会夹紧位于砧座112和钉仓110之间的软组织。作为替代方式,在砧座112被运动至其闭合位置中而施加很大夹紧力之前,当砧座112处于其部分闭合位置中时,砧座112可以构造成将很轻的夹紧力施加到软组织上。在至少一种实施方式中,外科器械可以包括可以在第一位置(图11)、第二位置(图12)和第三位置(图13)之间运动的扳机,所述第一位置对应于砧座112的张开位置,所述第二位置对应于砧座112的部分闭合位置,所述第三位置对应于砧座112的闭合位置。在各种实施方式中,参照图8和9,扳机128能够可枢转地安装到手柄部分102的外壳103上,使得扳机128能够围绕销129在其第一位置、第二位置和第三位置之间旋转。在各种实施方式中,参照图8、9、17和18,外科器械100还可以包括扳机锁定构件148,所述扳机锁定构件148能被构造成与扳机128接合并将扳机128有选择地锁定在所述第一位置、第二位置和第三位置中的至少一个中。在至少一种实施方式中,扳机128可以包括枢转端部138,所述枢转端部138包括凸轮面140、第一凹口142和第二凹口144,其中扳机锁定构件148能被构造成与第一凹口142和第二凹口144接合。特别地,参照图8和9,外科器械100还可以包括扳机锁定弹簧150,所述扳机锁定弹簧150可被构造成将扳机锁定构件148的随动部分149偏压在凸轮面140上,使得当第一凹口142或第二凹口144中的一个与随动部分149对齐时,扳机锁定弹簧150可以将随动部分149分别推入第一凹口142或第二凹口144中。在至少一种实施方式中,主要参照图8和图9,扳机锁定构件148能够经由销151可枢转地安装到手柄部分102的外壳103上。在各种实施方式中,可将扳机锁定弹簧150压缩在扳机锁定构件148的按钮部分152和外壳103之间,从而扳机锁定弹簧150能够使扳机锁定构件148围绕销151旋转并将扳机锁定构件148向下偏压在扳机128的凸轮面140上。
此外,在至少一种实施方式中,当将扳机128运动进入其第二位置中并且将砧座112运动进入其部分闭合位置中时,第一凹口142可以与随动部分149对齐。在各种实施方式中,在可以将扳机128运动进入其第三位置和/或回复到其第一位置中之前,随动部分149能被可靠地保持在第一凹口142内,使得扳机锁定构件148可能需要从扳机128手动地脱开。在至少一种实施方式中,参照图8和9,外科医生能够压下锁定构件148的按钮部分152,使得锁定构件148围绕销151旋转并将随动部分149向上提升使随动部分149与扳机128脱离接合。在其他实施方式中,第一凹口142被构造成使得在将力施加在扳机128上时,随动部分149能够滑出第一凹口142。在所有情形中,在将随动部分149从第一凹口142脱开之后,外科医生可以将扳机128有选择地运动进入其第三位置中或将扳机128释放并且允许扳机弹簧将扳机128例如回复到扳机128的第一位置。在至少一种替代实施方式中,第一凹口142和随动部分149被构造成使得在将扳机128运动进入其第二位置中之后且在可以将扳机128回复到其第一位置中之前必须将扳机128运动进入其第三位置中。在所有情形中,在至少一种实施方式中,当将扳机128运动进入其第三位置中并将砧座112运动进入其闭合位置中时,扳机128的第二凹口144可以与随动部分149对齐。同第一凹口142一样,可将第二凹口144构造成将随动部分149保持在其中直到将锁定构件148从扳机128脱开和/或在扳机128上施加足够的力将随动部分149从第二凹口144移开。此后,在各种实施方式中,扳机弹簧能够将扳机128从其第三位置运动进入其第二位置中,此时可能如上所述要求外科医生将随动部分149从第一凹口142脱开。在至少一种替代实施方式中,第一凹口142被构造成使得随动部分149能够滑动通过第一凹口142并且允许将扳机128从其第三位置驱动到其第一位置,而不要求外科医生将随动部分149从第一凹口142移开。
此外,虽然没有显示,但是当闭合扳机128位于其第一位置时,锁定构件148的按钮部分152例如可以凹入到外科器械外壳103内。在其它实施方式中,可以将按钮部分152设置成与外壳103齐平或者按钮部分152可以从外壳103稍稍延伸出来。在所有情形中,在至少一种实施方式中,当将闭合扳机128运动进入其第二位置时,按钮部分152可以相对于外壳103向外运动。这样的运动能够给外科医生提供外科器械的砧座处于其部分闭合位置中的视觉反馈。另外,按钮部分152的运动也可以伴随着听觉和/或触觉反馈。在所有情形中,在如上所述向外运动所述按钮部分152使得锁定构件148可以从扳机128脱开之后,外科医生可以接近按钮部分152。在各种实施方式中,当将扳机128从其第二位置驱动到其第三位置时,按钮部分152可以进一步向外运动。类似于如上所述的,这样的运动能提供告知外科医生砧座现处于其闭合位置中的视觉信号并且可以伴随听觉和/或触觉反馈,如上所述。虽然在扳机128于其第一和第三位置之间推进的过程中,按钮部分152如上所述向外运动,但是本发明不限于此。相反,按钮部分152或任何其它适当的指示器可以以任何适当的方式给外科医生提供反馈。
在替代实施方式中,虽然没有显示出来,但是可以将砧座112如上所述保持或保留在比上述三个位置(即张开位置、闭合位置和部分闭合位置)更多的位置中。在至少一种实施方式中,砧座112可以被保持在张开位置、闭合位置和两个或更多中间位置中。在这样的实施方式中,当将砧座112向着其闭合位置运动时,砧座112能够逐渐经过这些中间位置并将不断增加的力施加在被端部执行器106捕获的软组织中。在至少一种实施方式中,与上述情况类似,扳机128同样可以包括多个凹口,所述凹口可以对应于砧座112的各个中间位置。在各种替代实施方式种,虽然没有显示,但是端部执行器闭合系统可以包括棘轮组件,所述棘轮组件可以允许将扳机128保持在多个位置中,由此将砧座112保持在多个位置中。在这样的实施方式中,砧座112和扳机128可以通过棘爪保持就位,所述棘爪与棘轮可枢转地接合,所述棘轮与扳机128可操作地接合。
在各种实施方式中,参照图10至13,如上所述,可以限制致动器122’和手柄部分102’之间的相对运动,以便控制锁定构件120能够移动通过的范围。更具体而言,参照图10和11,致动器122’的远侧部分可以包括从其延伸出的凸起123,所述凸起123能被装纳在腔125中,其中可通过所述腔125的近侧壁117和远侧壁119限制致动器122’的移动。在至少一种实施方式中,当扳机128处于其第一位置中时(如图10和11所示),驱动器122’可以从远侧位置(如图10所示)运动至更近侧位置(如图11所示)中,在所述远侧位置中凸起123可以与远侧壁119抵接,在所述更近侧位置中凸起123不与远侧壁119抵接。如上所述,在更远侧的位置中,锁定构件120可以从端部执行器106脱开并且端部执行器106可以相对于轴组件104旋转。参照图12,当扳机128处于其第二位置中时,驱动器132可以限制致动器122’的动作范围,使得凸起123不能靠在近侧壁117上。但是,在至少一种实施方式中,致动器122’可以向近侧运动足够距离以便将锁定构件120从端部执行器106脱开。在这些情况下,虽然砧座112可以部分地闭合在软组织上,但是外科医生例如可以重新定位端部执行器106。如图13所示,当扳机128处于其第三位置中时,驱动器132可以迫使致动器122’向远侧运动,使得凸起132与远侧壁119抵接或位于远侧壁119附近,并且致动器122’不能运动足够距离来解锁关节运动接头114。
在各种实施方式中,根据本发明的外科器械可以包括击发驱动器,所述击发驱动器能够被构造成如上所述在端部执行器内推进切割构件和/或缝钉驱动器。在至少一种实施方式中,参照图8、9和19至25,外科器械100的击发驱动器可以包括击发扳机160、第一击发连杆162、第二击发连杆164和击发构件166。在各种实施方式中,击发扳机160能够可操作地接合击发构件166、击发连杆162和164中的至少一个,以便在细长轴组件104内推进刀杆168。在至少一种实施方式中,刀杆168可操作地接合端部执行器106中的切割构件(没有显示)和缝钉驱动器(没有显示),其中切割构件可以被构造成例如用于切割组织,并且缝钉驱动器可以被构造成将缝钉从钉仓110展开。先前通过引用结合入本申请的美国专利Nos.6905057和7044352详细公开了切割构件和缝钉驱动器,因此,本文中不再对这些装置进行更详细描述。在2006年9月29日提交的序列号为11/541123、题为“SURGICAL STAPLES HAVINGCOMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURINGTISSUE THEREIN AND STAPLING INSTRUMENTS FORDEPLOYING THE SAME”的美国专利申请和2007年1月11日提交的序列号为No.11/652169、题为“SURGICAL STAPLING DEVICEWITH A CURVED CUTTING MEMBER”的美国专利申请中公开了其它切割构件和缝钉驱动器,上述专利申请的全部公开内容通过引用结合入本文。
在各种实施方式中,主要参照图19和20,击发扳机160能通过销161可枢转地连接到外科器械外壳103(图8和9)上。在使用中,在至少一种实施方式中,击发扳机160可以围绕销161枢转,以便向远侧推进击发构件166以及击发连杆162和164。在各种实施方式中,击发扳机160可以包括槽159,其中槽159可以用于装纳击发销172。在各种实施方式中,当将击发扳机160从其如图2所示位置击发或旋转至与手柄把手127相邻的位置时,槽159的侧壁可被构造成用于与击发销172接合并向远侧推进击发销172。在至少一种实施方式中,参照图23,击发驱动器还可以包括棘爪170,其中棘爪170可以包括孔171。在各种实施方式中,孔171可以构造成装纳至少一部分击发销172,使得当通过扳机160向远侧推进击发销172时,击发销172也能向远侧推进棘爪170。在各种实施方式中,参照图24,棘爪170可以包括齿174并且击发构件166可以包括凹槽167,其中凹槽167可以被构造成用于装纳齿174。在使用中,当通过击发销172向远侧推进棘爪170并且齿174与凹槽167的侧壁接合时,棘爪170也能向远侧推进击发构件166。在各种实施方式中,可以通过击发销172沿着基本线性的路径向远侧推进棘爪170。在这样的实施方式中,槽159可以包括弧形轮廓,所述弧形轮廓可以与击发销172协作将击发扳机160的旋转运动转变成棘爪170的平移运动。在至少一种实施方式中,施加在棘爪170上的力可以基本上(如果不是完全的话)指向远侧方向。因此,在这样的实施方式中,棘爪170被束缚或阻塞在缝合器机架184上的可能性降低。
在各种实施方式中,棘爪170可以在第一位置和第二位置之间枢转,在所述第一位置中棘爪170从击发构件166可操作地脱开,参照图19和20,在所述第二位置中棘爪170与击发构件166可操作地接合。主要参照图21至25,击发驱动器还可以包括倾斜机构178,所述倾斜机构178可被构造成使棘爪170在其第一位置和第二位置之间枢转。在使用中,当致动所述击发扳机160时,至少最初可以相对于倾斜机构178运动棘爪170,使得可以将棘爪170的至少一部分与倾斜机构178抵接,并且将棘爪170向上枢转成与击发构件166操作接合。在至少一种实施方式中,主要参照图23,棘爪170可以包括槽175,所述槽175可以用于装纳从倾斜机构178的中央部分延伸出来的凸起179(图25)。在至少一种实施方式中,当向远侧推进棘爪170时,槽175的近侧壁176可以与凸起179上的凸轮面接触,并且由于通过枢转所述销172而施加在棘爪170上的力,棘爪170可以向上枢转或旋转,使得能如上所述将齿174定位在击发构件166的凹槽167中。在将棘爪170枢转之后,在向着端部执行器106推动棘爪170的过程中棘爪170可以向远侧拖动倾斜机构178。更具体而言,在至少一种实施方式中,倾斜机构178可以包括可变形构件180,所述可变形构件180可被装纳在缝合器机架184中的槽182内,使得可变形构件180和缝合器机架184之间的相互作用至少部分地抑制倾斜构件178相对于缝合器机架184的运动。换句话说,由于可变形构件180和槽182的侧壁之间的静摩擦力,在能够相对于缝合器机架184“拖动”倾斜机构178之前,必须在倾斜机构178上施加足够克服所述摩擦力的力。
在致动击发扳机160并且推进击发构件166之后,可以释放扳机160使其回复到如图2所示的未致动的位置中,并且可以将棘爪170从击发构件166脱开使之回缩至其如图19所示的起始位置中。更具体而言,在至少一种实施方式中,外科器械100还可以包括扳机弹簧(没有显示),所述扳机弹簧能够可操作地接合扳机160与外壳103,例如,其中在将棘爪170从击发构件166脱开之后,扳机弹簧可以构造成用于围绕销161旋转扳机160并向近侧驱动击发销172。在各种实施方式中,当棘爪170如上所述通过倾斜机构178从其如图24所示的第二位置枢转至其第一位置中时,棘爪170可以从击发构件166脱开。在这样的实施方式中,可以相对于倾斜机构178至少初始地运动所述棘爪170,使得槽175的远侧壁177可以与凸起179的第二凸轮面接触,并且由于通过扳机160或回复弹簧186施加在击发销172上的力,可以向下旋转棘爪170,从而能够将棘爪170的齿174从击发构件166中的凹槽167脱开。此后,扳机160和/或回复弹簧186可以相对于击发构件166拉动或回缩棘爪170。在各种实施方式中,与上述情形类似,棘爪170可以被构造成在槽182内向近侧拖动倾斜机构178。因此,不需要将棘爪170偏压到其第一或第二位置中。在各种情况下,棘爪170可以在其第一和第二位置之间自由旋转,而不必克服通过偏压弹簧施加在棘爪170上的力。实际上,在各种实施方式中,在棘爪170的第一位置和第二位置之间驱动棘爪170的力只需克服棘爪170的重力以及棘爪170和附近的外科器械零件之间的摩擦力。
在至少一种实施方式中,一旦棘爪170已经回复到其初始位置中,那么棘爪170的齿174可以不再与击发构件166中的凹槽167对齐。相反,总体参照图19和20,棘爪170的齿174可以与第一击发连杆162中的凹槽163对齐。更具体而言,第一击发连杆162能可枢转地连接到击发构件166上,使得如上所述当向远侧推进击发构件166时,击发构件166可以将第一击发连杆162拉入先前被击发构件166占据的位置中。因此,在第二次致动击发构件160时,棘爪170可以从其第一位置枢转至其第二位置中,使得齿174与凹槽163可操作地接合,并且棘爪170可以向远侧推进击发连杆162。在至少一种实施方式中,击发连杆162可以向远侧推动击发构件166和刀杆168,并且由此在端部执行器106内向远侧推动切割构件和缝钉驱动器。此后,棘爪170可以再次从其第二位置枢转至其第一位置中,并且可以相对于第一击发连杆162回缩。一旦棘爪170第二次回到其初始位置,棘爪170的齿174就不再与第一击发连杆162的凹槽163对齐。相反,与上述情形类似,齿174可以与第二击发连杆164中的凹槽165对齐并且可以重复上述过程。
虽然没有显示出来,但是根据本发明的外科器械可以包括多于两根或少于两根击发连杆,以便在端部执行器106内将切割构件和缝钉驱动器推进到它们所需的位置中。在各种实施方式中,虽然没有显示出来,但是击发构件166可以包括多个凹槽167,使得棘爪170能够向着端部执行器106多次直接推进击发构件166。在至少一种这样的实施方式中,如上所述在向远侧推进击发构件166之后可以将所述棘爪170缩回,使得当棘爪170再次向上倾斜时,棘爪170能够与击发构件166中的另一凹槽167接合并且能够再次向着端部执行器106推进击发构件166。因此,在至少一种实施方式中,可以不需要击发连杆162和164。
在各种实施方式中,外科器械可以包括一个或多个弹簧构件,所述弹簧构件被构造成使棘爪170运动进入其第一位置和第二位置的至少一个中。在至少一种实施方式中,参照图27和28,击发驱动器可以包括棘爪170’、击发销172和倾斜机构178’,其中,与上述情形类似,当向远侧推进棘爪170’时,倾斜机构178’可以被构造成向上枢转棘爪170’。击发驱动器还可以包括枢转弹簧188,所述枢转弹簧188可操作地连接到棘爪170’上,使得当将棘爪170’向上枢转进入其如图27所示的第二位置中时,棘爪170’可以挠曲或弹性弯曲所述枢转弹簧188。在推进棘爪170’之后,如图28所示,可以通过枢转弹簧188将棘爪170’向下枢转进入第一位置中。更具体而言,由于在枢转弹簧188被挠曲时存储在枢转弹簧188中的势能,一旦棘爪170’不再通过倾斜结构178’和击发销172保持在其第二位置中,弹簧188就可以向下驱动棘爪170’。此后,如上所述,可以相对于击发构件166和/或击发连杆162和164回缩棘爪170’。在各种实施方式中,倾斜机构178’可以不包括用于将棘爪170’枢转进入其第一位置中的第二凸轮面。在这样的实施方式中,可以如上所述通过施加在击发销172上的力将棘爪170’回缩。在各种替代实施方式中,虽然没有显示,但是倾斜机构178’和棘爪170’也可以包括用于将棘爪170’向下枢转进入其第一位置中的协作特征。
在各种实施方式中,参照图19和20,外科器械100还可以包括带190,所述带190可以构造成用于相对于端部执行器106运动击发构件166以及击发连杆162和164。在至少一种实施方式中,带190的第一端部可以连接到击发构件166上,例如使得当向远侧推进击发构件166时也可以向远侧拉动带190。在各种替代实施方式中,带190可以连接到第一击发连杆162和/或第二击发连杆164上。在至少一种实施方式中,可以将带190设置在卷轴或卷筒192的至少一部分周围,使得当通过击发构件166拉动带190时,可以将带190从卷轴192展开或松卷。在至少一种实施方式中,带190的第二端部可以连接到卷轴192上,使得在外科器械100的正常工作条件下,带190不容易从卷轴192脱开。在所有情形中,当通过击发构件166拉动带190时,根据带190围绕卷轴192的设置方式,卷轴192可以沿着顺时针或逆时针方向中的一个方向旋转。为了回缩击发构件166,可以沿着相反方向旋转所述卷轴192以便向近侧运动击构件166以及击发连杆162和164,并将带190卷绕在卷轴192上。
在各种实施方式中,可以将带190卷绕在卷轴192上,从而将带192包裹在卷轴192上的大致圆柱表面上。在至少一种实施方式中,卷轴192的旋转轴线和圆柱表面之间的距离可以在卷轴192的周长上基本等距离。在这些实施方式中,卷轴192的机械效益在如上所述向近侧拉动所述带190的过程中可以基本保持不变,并且卷轴192将拉力施加在带190上的能力基本保持相同。但是在替代实施方式中,卷轴192可以被构造成提供可变的机械效益。在至少一种实施方式中,卷轴192可以包括非圆柱表面,带190可以绕在所述非圆柱表面上,卷轴192的旋转轴线和非圆柱表面之间的距离围绕卷轴192的周长不再是等距离的。因此,在这些实施方式中,卷轴192将力施加到带190上的能力可以随着带190卷绕在卷轴192上而变化。在至少一种实施方式中,卷轴192可以起凸轮的作用并且可以对其形状进行优化,使得当初始回缩带190时(也就是说当用来回缩切割构件的力可以例如处于其最大时)所述形状可以给带190提供附加力。
在各种实施方式中,参照图29至42,击发扳机160可以与外科器械100的回复机构有选择地接合。在至少一种实施方式中,当击发扳机160如上所述与击发构件166通过棘爪170可操作地接合时,击发扳机160的致动可以向远侧推进击发构件166,并且当击发扳机160与击发构件166经由带190可操作地接合时,击发扳机160的致动可以向近侧缩回击发构件166。在各种实施方式中,可以手动致动回复机构以便将击发扳机160从击发构件166脱开并将击发扳机160与卷轴192可操作地接合。在至少一种实施方式中,回复机构可以包括回复滑架194,所述回复滑架194能够可枢转地安装在外科器械外壳103中,使得回复滑架194可以在如图29所示的第一位置或非致动位置和如图32所示的第二位置或致动位置之间枢转。在至少一种这样的实施方式中,回复滑架194可以包括按钮部分195,所述按钮部分195在受力时能够将回复滑架194从其非致动位置驱动至其致动位置。
当将回复滑架194定位在其如图29至31所示的非致动位置中时,击发扳机160可以被构造成如上所述推进击发构件166,并且扳机160的齿轮部分158与扳机齿轮196可操作地接合。在各种实施方式中,齿轮部分158和扳机齿轮196能可操作地接合,使得扳机160围绕销161的旋转能够围绕由回复销198限定的轴线驱动扳机齿轮196。在至少一种实施方式中,当回复滑架194处于其非致动位置中时,扳机齿轮196可以被构造成围绕回复销198自由旋转,使得扳机齿轮196的旋转不会传递或至少不会大部分传递至回复销198。更具体而言,参照图30,可以将回复销198的键199偏压脱离与扳机齿轮196接合,使得扳机齿轮196的旋转不会传递至键齿轮206和卷轴192。因此,当回复滑架194处于其非致动位置中时,扳机齿轮196的致动不会旋转或至少基本旋转卷轴192。
在端部执行器106内推进切割构件和缝钉之后,可以将回复滑架194运动进入其致动位置。在各种实施方式中,参照图30,卷轴192可以包括从其延伸出来的凸轮构件202,所述凸轮构件202可以与回复滑架194接触并向下旋转回复滑架194。在至少一种实施方式中,凸轮构件202可以在最终致动扳机160的过程中与回复滑架194接触,这在端部执行器106内推进切割构件和缝钉驱动器。在至少一种实施方式中,凸轮构件202在第三次致动击发扳机160之后可以与回复滑架194接触。在各种实施方式中,参照图32至35,当将齿轮滑架194运动进入其致动位置中时,回复滑架194可以将扳机齿轮196和卷轴192可操作地接合。在至少一种实施方式中,参照图33和35,回复滑架194可以包括偏压弹簧200,其中当回复滑架194处于其未致动位置中时,可以将弹簧200设置在如图33所示的位置中,当将回复滑架194运动进入其如图35所示的致动位置中时,弹簧200可以与回复销198接触并向着扳机齿轮196偏压回复销198。在至少一种实施方式中,参照图31,扳机齿轮196可以包括D形腔197,在如下所述的一些情况下,所述D形腔197能够装纳从回复销198延伸出来的键199并且能使扳机齿轮196可操作地接合键齿轮206和卷轴192。在各种实施方式中,回复滑架194进入其致动位置中的运动可以伴随着听觉和/或触觉反馈,以便告知外科医生,外科器械的回复机构已经与扳机160接合。
此外,当回复销198向着扳机齿轮196滑动时,D形腔197可以被设置成使得键199不会立即进入腔197中。相反,参照图31,弹簧200能够偏压回复销198,使得键199开始与扳机齿轮196的面204抵接。但是,在释放扳机160使之回到其非致动位置之后,D形腔197可以旋转并与键199对齐,使得弹簧200可以如图36所示将所述键199偏压到腔197中。在至少一种实施方式中,参照图31,当回复销198向着扳机齿轮196滑动时,回复销198的一端可以如图32所示装纳在回复滑架194中的槽193中。在将键199插入腔197中之后,随后致动扳机160能够导致D形腔197的驱动面210与键199抵接并且将回复销198旋转至如图37和38所示的位置中。实际上,在至少一种实施方式中,对扳机160的致动可以将键199大约旋转半周,使得在起始时基本向下延伸的键199(图36)能够旋转成基本向上延伸(图37)。此后,可以释放扳机160并且扳机齿轮194可以相对于键199旋转,其中如图39至41所示,键199能够保持沿着基本向上的方向定向。
在各种实施方式中,主要参照图38,键齿轮206可以与回复销198可操作地接合,使得回复销198的旋转能够传递到键齿轮206。在至少一种实施方式中,键齿轮206可以包括键形孔212,所述键形孔212能够用于可滑动地装纳回复销198的键199。在至少一种这样的实施方式中,当回复销198与扳机齿轮196接合时,键199能够可操作地与扳机齿轮196的凹槽197和键齿轮206的孔212接合。在各种替代实施方式中,键齿轮206可以牢固地安装到回复销198上。在这样的实施方式中,当回复销198相对于扳机齿轮196滑动时,键齿轮206也可以相对于扳机齿轮196滑动。在各种实施方式中,总体参照图38,卷轴192可以包括安装在其上的直齿轮216,其中直齿轮216能够与键齿轮206可操作地接合,使得键齿轮206的旋转可以传递到卷轴192。在至少一种实施方式中,当如上所述向着扳机齿轮196滑动时,键齿轮206可以滑动进而与卷轴192形成可操作接合。在替代实施方式中,直齿轮216可被构造成使得键齿轮206与直齿轮216处于可操作接合,而与是否向着扳机齿轮196偏压键齿轮206无关。
因此,当回复滑架194被定位在如图32所示的非致动位置中时,扳机160的致动能够旋转卷轴192并将带190卷绕在卷轴的至少一部分上。如果当致动回复滑架194时键199与扳机齿轮196不能可操作地接合,那么可以手动旋转卷轴192以便将带190收回。在至少一种实施方式中,参照图33和37,螺栓或紧固件218可以与卷轴192可操作地接合,使得螺栓218的旋转能够实现卷轴192的旋转。在各种实施方式中,外科医生能够将螺栓218插入穿过外科器械外壳103中的开口并且将螺栓218与卷轴192接合。在至少一种实施方式中,外科器械100还可以包括计数机构(没有显示),所述计数机构可以计算扳机160的致动次数,并且在至少一种这样的实施方式中,螺栓218例如能够与计数机构可操作地接合以便旋转卷轴192。因此,在各种实施方式中,外科器械可以包括用于卷绕所述卷轴192的第一或初级致动器和被构造用于替代第一致动器卷绕卷轴192的第二致动器。
在各种实施方式中,如上所述,卷轴192可被构造成用于拉动带190和向近侧回缩击发构件166以及击发连杆162和164。更具体而言,如上所述,可以相对于棘爪170回缩击发构件166以及击发连杆162和164,以便将击发构件166以及击发连杆162和164重新定位在其初始位置中。在这样的实施方式中,特别是在棘爪170可以如上所述枢转的实施方式中,外科器械100的回复机构还可以构造成保持棘爪170脱离与击发构件166以及击发连杆162和164可操作地接合,同时击发构件166和击发连杆162和164可以相对于棘爪170运动。更具体而言,当将回复滑架194运动进入其如图35所示的致动位置中时,回复滑架194可以与击发销172的端部接触并且向着棘爪170滑动击发销172,使得击发销172与棘爪170接合并且防止棘爪170向上枢转。更具体而言,参照图34,击发销172可以包括第一端部220,所述第一端部220可以包括例如倾斜面和/或倒圆面,其中当回复滑架194与第一端部220接触时,回复滑架194可以向着棘爪170推动击发销172。在至少一种实施方式中,棘爪170可以包括凹槽173,当击发销172向着棘爪170运动时,所述凹槽173能够装纳从击发销172延伸出来的键222。当键222和凹槽173可操作地接合时,击发销172可以防止棘爪170向上枢转与击发构件166和击发连杆162、164形成接合。
在将击发构件166和击发连杆162、164回缩之后,可以将新的钉仓110固定在端部执行器106中并且可以将外科器械100复位,使得外科器械能够再次用于切割和缝合软组织。在各种实施方式中,参照图39至42,可以将回复滑架194从其如图32所示的致动位置驱动至其如图40所示的非致动位置。在至少一种实施方式中,当在按钮部分195上施加力时,可以向上旋转或枢转回复滑架194。作为替代方式,参照图29,当向上旋转扳机锁定构件148时,回复滑架194可以向上移动,以便将随动部分149从闭合扳机128脱开,从而如上所述重新打开端部执行器106。更具体而言,当在扳机锁定构件148的按钮部分152上施加力时,扳机锁定构件148可以向上旋转,使得从扳机锁定构件148延伸出来的凸起147能够与回复滑架194接触并且也向上驱动回复滑架194。在所有情形中,参照图42,当将回复滑架194向上运动进入其非致动位置中时,回复滑架194可以将击发销172从棘爪170脱开并且另外将回复销198从扳机齿轮196脱开。更具体而言,回复滑架194可被构造成与击发销172的倾斜或倒圆端部221抵接,使得当向上旋转回复滑架194时,回复滑架194能够将回复销172滑离棘爪170并且将键222从凹槽173脱开。同样,当向上移动回复滑架194时,槽193的侧壁可以被构造成与回复销198的端部接触并且将回复销198从扳机齿轮196滑开,从而将键199从D形凹槽197脱开。简而言之,在至少一种所示实施方式中,当按下锁定构件148的按钮部分152并且向上驱动回复滑架194时,外科器械可以复位并再次使用。
虽然在将切割构件和缝钉驱动器于端部执行器106内完全推进之后,如上所述的外科器械可以复位,但是例如在将切割构件和缝钉驱动器于端部执行器106内仅部分推进之后就可以按下回复滑架194的按钮部分195。在各种实施方式中,回复滑架194还可以包括在回复滑架194的相对侧之间延伸的导销191。在至少一种实施方式中,导销191能够可滑动地装纳在机架184中的导槽185内(图31),使得槽185和销191可以限定回复滑架194的路径。在各种实施方式中,当如上所述将回复滑架194从其致动位置驱动至其非致动位置时,导销191和导槽185可以用于确保将回复滑架194接合到击发销172和回复销198上并且复位外科器械。
在各种实施方式中,外科器械100还可以包括制动器,所述制动器用于防止或至少部分抑制击发驱动器例如在端部执行器内推进和/或回缩切割构件和缝钉驱动器。在至少一种实施方式中,参照图43,机架184可以包括制动面187,其中制动面187被构造成用于将致动力施加在带190上。更具体而言,当如上所述向近侧和/或远侧拉动带190时,机架184可以使得带190在制动面187上滑动并且在它们之间产生摩擦力。在各种实施方式中,参照图44,制动面187’可以构造成使得带190在击发构件166和卷轴192之间的路径被制动面187’打断并且可以在带190上施加很大的法向力。
在至少一种实施方式中,当带190静止时,带190可以与制动面187’接合,使得带190和制动面187’之间的静摩擦力能够至少起始地防止在将拉力施加在带190上时带190相对于制动面187’运动。当施加在带190上的拉力超过静摩擦力时,带190可以相对于制动面187’运动。当多次致动扳机160以便在端部执行器106内推进切割构件和/或缝钉驱动器时,这样的实施方式可能特别有用。更具体而言,在扳机160致动之后,棘爪170可以如上所述相对于击发构件166回缩,在各种实施方式中,在回缩棘爪170的过程中,带190和制动面187’之间的摩擦力可以防止或至少部分抑制击发构件166和/或击发连杆162、164向近侧和/或远侧运动。因此,当相对于击发构件174和击发连杆162、164驱动棘爪170时,可以保持棘爪170的齿174与击发构件166、击发连杆162和164中的凹槽之间的对齐。
同样,在至少一种实施方式中,带190的刚性也协助将击发构件166和击发连杆162、164保持就位。更具体而言,为了使击发构件166“后退”或向近侧运动,击发构件166可能必须向近侧推动带190并且实际上将带190卷绕在卷轴192上。在各种实施方式中,带190的刚度可以使得需要很大的力来将带190卷绕在卷轴192上,并且由此可以将击发构件166保持就位。为了进一步提高将带190卷绕在卷轴192上所需的力,参照图44,可以对带190的路径进行控制,使得带不是以正切方向卷绕在卷轴192上。更具体而言,如果带190的路径使得带190是以正切方向卷绕在卷轴192上,那么通过带190传递的力的一部分将损失,由此导致卷绕所述卷轴192的低机械效益。
在各种实施方式中,外科器械100可以包括制动器,所述制动器与卷轴192接合或者与击发驱动器的任何其它零件接合,以便防止击发构件166和/或击发连杆162、164例如被无意中回缩。在至少一种实施方式中,虽然没有显示,但是可以在第一位置和第二位置之间运动所述制动器,其中当制动器处于第一位置中时,制动器例如可以将第一制动力施加到带190上。在至少一种实施方式中,当制动器处于第二位置中时,制动器例如可以将第二制动力施加到带190上,所述第二制动力可以大于或小于第一制动力。在各种替代实施方式中,当制动器处于其第二位置中时,制动器可以不与带190或击发驱动器的任何其它部分接合。在各种实施方式中,虽然没有示出,但是外科器械100可以包括制动机构,所述制动机构能够将制动力施加到卷轴192和/或带190上。在至少一种实施方式中,制动机构可以包括球形制动装置和弹簧构件,所述弹簧构件用于将球形制动装置接合在卷轴192和/或带190上。
在各种实施方式中,外科器械100可以包括棘轮机构,所述棘轮机构允许卷轴192沿着第一方向转动,但是在各种情况下防止卷轴192沿着与第一方向相反的方向转动。在至少一种实施方式中,参照图45至49,外科器械100可以包括棘轮组件230,其中棘轮组件230可以包括棘轮232和棘爪234。在各种实施方式中,棘轮232可以以与如上所述的键齿轮206基本相同的方式运行,除了以下之外:主要参照图47和48,棘轮232可以包括棘齿236,所述棘齿236由于与棘爪234的啮合而能够防止例如当回复滑架194’处于非致动位置(图47)中时棘轮232沿着顺时针方向转动。更具体而言,每个棘齿236可以包括平表面240,其中参照图48,至少一个平表面240可以与棘爪234的边缘235抵接,并且由此防止棘轮232沿着顺时针方向旋转。
每个棘齿236还可以包括倾斜面238,其中当棘轮232沿着逆时针方向转动时,倾斜面238可被构造成在棘爪234下面滑动。因此,至少当回复滑架194处于其非致动位置中时,棘轮组件230可以允许例如通过击发构件166向远侧拉动带190,但是防止或至少基本抑制向近侧驱动带190。当如上所述对于回复滑架194而言将回复滑架194’向下枢转至其致动位置中时,棘轮232可以向着扳机齿轮196’滑动并且与棘爪234不再可操作地接合。此后,因此棘轮232可以沿着顺时针或逆时针方向旋转,而没有来自棘爪234的干扰或至少大致干扰。在棘轮232不向着扳机齿轮196’滑动的各种替代实施方式中,当将回复滑架194’向下驱动至其致动位置中时,可以向下驱动棘爪234使之不与棘齿236可操作地接合。在所有情形中,当回复滑架194’处于其致动位置中时,扳机齿轮196’和回复销198’可以旋转棘轮232和凸轮192’,以便将带190和击发构件166回缩。
在各种实施方式中,参照图50,外科器械100可以包括端部执行器106和细长轴组件104,其中端部执行器106和轴组件104可以通过关节运动接头114可枢转地相连。如上所述,关节运动接头114可以允许围绕轴线116相对于轴组件104移动端部执行器106或使其进行关节运动。在各种情况下,外科医生可以使端部执行器106进行关节运动以便更容易地接近患者体内的外科手术位置。更具体而言,外科医生可以将端部执行器106和轴组件104插入穿过套管,所述套管被至少部分地插入患者体内,并且一旦端部执行器106通过套管,端部执行器106就可以枢转或进行关节运动,以便将端部执行器106例如相对于软组织定位在有待缝合和/或切割的外科手术位置中。一旦定位好端部执行器106,就可以通过锁定机构固定或锁定端部执行器106和轴组件104之间的相互关系,以下将对此进行详细描述。
在至少一种实施方式中,参照图51和52,关节运动接头114可以包括端部执行器锁定构件300和枢轴302。在各种实施方式中,参照图53至56,端部执行器锁定构件300可以包括连接器部分320,所述连接器部分320可以将锁定构件300固定到端部执行器106上,并且参照图52,轴组件104可以包括枢转连接器342,其中枢转连接器342可以包括从其延伸出来的枢轴302。在各种实施方式中,锁定构件300可以包括孔301,所述孔301的大小和构造能够将枢轴302的至少一部分装纳在其中。在至少一种实施方式中,枢轴302和孔301可以构造成使得端部执行器106能够围绕轴线116自由旋转。在其它不同方式中,虽然端部执行器106和轴组件104之间允许有相对运动,但是枢轴302和孔301可以构造成使得枢轴302和孔301之间的摩擦能阻止端部执行器106和轴组件104之间的相对运动。虽然没有显示,但是关节运动接头114可以包括多条轴线或枢轴,端部执行器106能够围绕这些轴线或枢轴旋转。
在各种实施方式中,例如通过将端部执行器106推靠在外科手术位置周围的腔侧壁上并且在轴组件104上施加力使得端部执行器106围绕轴线116枢转,外科医生可以使端部执行器106相对于轴组件104进行关节运动。此后,如果外科医生需要对端部执行器106重新定心,也就是沿着一条线将端部执行器106和轴组件104对齐,外科医生可以再次将端部执行器106放置在例如腔侧壁上并如上所述将力施加在轴组件104上。在各种实施方式中,参照图51和52,外科器械100可以包括重定心机构,所述重定心机构能相对于轴组件104自动重新定心或至少基本重新定心端部执行器。在各种实施方式中,端部执行器锁定构件300可以包括多个定心面316并且细长轴组件104可以包括定心轴328和偏压构件330,其中偏压构件330被构造成将定心轴328偏压在定心面316上。在至少一种这样的实施方式中,可以将各个定心面316设置在轴线116的大致相反侧上,使得定心轴328能够将基本相同的扭矩或动量施加到锁定构件300上,并且在缺少附加推动力时将端部执行器106保持在基本定心的位置中。当如上所述通过这样的推动力使端部执行器106进行关节运动时,锁定构件300可以构造成向近侧移动定心轴328中的一个并且压缩与定心轴328可操作地接合的偏压构件330。更具体而言,可以将偏压构件330设置在引导件331和至少一个从定心轴328延伸出来的凸起329之间,使得当通过轴328向近侧驱动凸起329时,偏压构件330被压缩在凸起329和定心轴328之间。在移去推动力之后,被压缩的偏压构件330可以扩张并且经由定心轴328将锁定构件300旋转至其中心位置或旋转至其中由偏压构件330施加的扭矩基本上平衡的位置中。虽然示出的偏压构件330是螺旋弹簧,但是偏压构件330可以包括任何适当的弹性构件。
在各种实施方式中,即使在将推动力移去之后,锁定机构仍然可以用于将端部执行器106保持在其关节运动位置中。在至少一种实施方式中,参照图53至56,端部执行器300可以包括具有第一面308的第一部分、具有第二面304的第二部分、齿312和在齿312之间限定出的凹槽314,其中如以下详细描述,齿312和凹槽314可以构造成与轴组件锁定机构可操作地接合,以便固定或锁定端部执行器106和轴组件104之间的相互关系。在各种实施方式中,齿312和凹槽314可以设置在第一面308和第二面304之间。在至少一种实施方式中,第一面308可以从孔301延伸至第一外周310,并且第二面304可以从孔301延伸至第二外周306。在各种实施方式中,第一外周310可以限定第一平面并且第二外周306可以限定第二平面,其中齿312和凹槽314可以设置在第一和第二平面之间。在第一外周310与第二外周306不同的实施方式中,齿312可以在第一外周310和第二外周306之间以一个角度或倾斜延伸。在各种实施方式中,齿312与第一外周310相交的点可以比齿312与第二外周306相交的点更加远离轴线116。在至少一种实施方式中,至少一个齿312可以限定第一轴线313,所述第一轴线313在第一面308和第二面304之间沿着不与第一面308和/或旋转轴线116垂直的方向延伸。在这样的实施方式中,齿312可以例如在位于关节运动接头114周围的软组织上滑动。换句话说,当端部执行器106进行关节运动时,由于齿112的成角度的或倾斜的面,可以减少齿112挂住或冲击关节运动接头114周围的软组织的可能性。在至少一种实施方式中,齿312可以不延伸超过第一外周310,使得例如如果第一外周310的至少一部分与软组织接触时,第一外周310和齿312可以如上所述相对于软组织容易滑动。
此外,本发明的实施方式可以提供优于以前的外科器械的重要优点。更具体而言,参照图57,以前的端部执行器的关节运动接头包括锁定构件,例如锁定构件299,所述锁定构件299可以包括从锁定构件的外周向外延伸出来的齿298。因此,当使端部执行器相对于外科器械的轴组件进行关节运动时,齿298会挂住或冲击周围的软组织,并且可能引发创伤。在不同情况下,可以将组织抓持在相邻齿298之间,使得当端部执行器进行关节运动时,能够将软组织拉入关节运动接头内并且能够通过关节的相对运动零件来压紧。在本发明的实施方式中,其中锁定构件的齿是具有角度的或倾斜的,如上所述和图58所示,软组织可以容易地从齿中溢出并且减少了将软组织拉入关节运动接头内的可能性。
如上所述,参照图59至62,外科器械100还可以包括锁定构件120,所述锁定构件120可以相对于端部执行器106滑动并且可以与端部执行器106可操作地接合,以便防止或至少限制轴组件104和端部执行器106之间的相对运动。在至少一种实施方式中,锁定构件120可以构造成与齿312中的至少一个接合,从而防止端部执行器106相对于锁定构件120运动。更具体而言,锁定构件120可以包括端部部分338和轴部分340,其中端部部分338可以包括凹槽336,所述凹槽336能够构造成用于以紧配合甚至过盈配合关系的方式装纳锁定构件300的齿312。在各种替代实施方式中,端部部分338可以如上所述以紧配合甚至过盈配合关系的方式装纳在凹槽314的至少一个中。在所有情形中,外科器械100还可以包括弹簧126,所述弹簧126可以构造成将锁定构件120偏压成与端部执行器锁定构件300形成接合。在至少一种实施方式中,如果凹槽336不与齿312对齐,那么由弹簧126施加在锁定构件120上的偏压力可以使锁定构件120与端部执行器锁定构件300接触并且围绕轴线116旋转端部执行器锁定构件300直到齿312中的一个与凹槽336对齐。在各种实施方式中,弹簧126可以包括任何适当的偏压构件,所述偏压构件包括螺旋弹簧、板簧或其它偏压材料。
在各种替代实施方式中,按照图63至67,外科器械可以包括端部执行器锁定构件350,所述锁定构件350包括孔301、具有第一面358的第一部分、具有第二面354的第二部分(图67)和连接部分320。端部执行器锁定构件350还可以包括齿362和在所述齿362之间限定出来的凹槽364,其中在至少一种实施方式中,齿362和凹槽364可以设置在第一面358和第二面354之间。在各种实施方式中,参照图65至67,齿362可以不延伸超过第一面358的第一外周357和/或第二面354的第二外周343。在至少一种这样的实施方式中,齿362可以完全设置或包含在第一面358和第二面354之间。在至少一种替代实施方式中,齿362可以从第一外周357和/或第二外周353部分地延伸出来。在各种实施方式中,第一外周357和第二外周353可以在其间限定出外表面,其中凹槽364可以限定在外表面中。由于上述特征,端部执行器锁定构件350可以相对于位于关节运动接头附近的软组织滑动,而不会碰撞所述软组织。在各种实施方式中,可以将齿362钝化或圆化来进一步易化如上所述的相对滑动。在至少一种实施方式中,参照图63至65,锁定机构可以构造成将齿362中的至少一个和凹槽364接合并且可以包括锁定构件382,所述锁定构件382包括端部部分388和轴部分390。在至少一种实施方式中,如上所述,端部部分388可以包括凹槽394,所述凹槽394可以构造成例如与齿362的至少一个接合。
本文所公开的装置能够被设计成在单次使用后丢弃或可以被设计成能够多次使用。在所有情形中,所述装置在使用至少一次后可以修复以便再次使用。修复还可以包括所述装置的拆卸步骤的任何组合,接着清洗或更换特定件,继而重新组装。特别是,所述装置可以拆卸,并且可以以任何组合的方式选择性地更换或去除所述装置的任何数量的特定件或部件。根据对特定部件的清洗和/或更换,所述装置可以在修复设施处重新组装或者由外科团队即将进行手术之前重新组装以便随后使用。本领域技术人员应当理解,设备的修复可以采用各种用于拆卸、清洗/更换和重新组装的技术。这些技术的使用和获得的修复好的器械都在本申请的保护范围之内。
优选的是,在进行外科手术之前执行本文所述的发明。首先,获得新的或用过的器械。然后可以对所述器械进行消毒。在一种消毒技术中,可以将器械放置在封闭并密封的容器中,例如塑料袋或高密度聚乙烯合成袋中。随后将所述容器和器械放置在能够穿透容器的辐射场中,例如伽马辐射、X射线或高能电子。所述辐射杀死器械上和容器中的细菌。随后可以将经过消毒的器械存放在无菌容器中。所述密封容器保持器械无菌直到在医疗设施中被打开为止。虽然描述了具有示意性设计的本发明,但是可以在本公开的范围和主旨内对本发明进一步修改。因此本申请意图覆盖各种本发明的使用其基本原理的任何修改、用法或匹配。另外,本申请意图覆盖那些在本发明所属技术领域的已知或习惯做法范围内的与本发明公开内容偏离的内容。

Claims (6)

1.一种外科器械,包括:
a.细长轴;
b.接头;
c.端部执行器,所述端部执行器能绕所述接头相对于所述细长轴选择性地运动,所述端部执行器包括:
i.通道,其能够容纳钉仓;和
ii.砧座,其可动地连接到所述通道上;
d.锁定机构,其具有锁定构型和解锁构型,当所述锁定机构处于所述锁定构型时,所述锁定机构能够接合所述细长轴和所述端部执行器中的至少一个,并且至少限制所述细长轴和所述端部执行器之间的相对运动;以及
e.闭合驱动装置,其与所述砧座可操作地接合,所述闭合驱动装置能够在第一位置和第二位置之间运动,以使所述砧座在打开位置和闭合位置之间运动,当所述闭合驱动装置位于所述第二位置时,所述闭合驱动装置能够将所述锁定机构保持在所述锁定构型;
其中,所述闭合驱动装置能够移动到中间位置,以使所述砧座枢转到部分闭合位置,当所述闭合驱动装置处于所述中间位置时,所述端部执行器能够相对于所述细长轴移动。
2.根据权利要求1所述的外科器械,其中,所述锁定机构包括:
锁定构件,其包括第一端和第二端,所述锁定构件能够相对于所述接头滑动,当所述锁定机构处于所述锁定构型时,所述锁定构件的所述第一端能够接合所述端部执行器;以及
致动器,所述锁定构件的所述第二端与所述致动器可操作地接合,所述闭合驱动装置能够在其处于所述第二位置时抵接所述致动器,并且阻止所述锁定构件相对于所述接头滑动。
3.根据权利要求2所述的外科器械,其中,所述闭合驱动装置包括扳机和驱动器,所述扳机能够朝向所述致动器移动所述驱动器,当所述闭合驱动装置处于所述第二位置时,所述驱动器能够抵接所述致动器,所述细长轴包括可操作地接合在所述砧座和所述扳机上的护套,在所述扳机致动时,所述扳机能够相对于所述端部执行器移动所述护套并枢转所述砧座。
4.一种外科器械,包括:
a.细长轴;
b.接头;
c.端部执行器,所述端部执行器能够绕所述接头相对于所述细长轴选择性地运动,所述端部执行器包括:
i.通道,其能够容纳钉仓;和
ii.砧座,其可动地连接到所述通道上;
c.锁定机构,其具有锁定构型和解锁构型,当所述锁定机构处于所述锁定构型时,所述锁定机构能够接合所述细长轴和所述端部执行器中的至少一个,并且至少限制所述细长轴和所述端部执行器之间的相对运动;以及
d.闭合驱动装置,其能够产生闭合动作,所述闭合驱动装置包括驱动器,所述砧座与所述驱动器可操作地接合并且能够可动地响应于所述闭合动作,由于所述闭合动作,所述驱动器能够接合所述锁定机构,并且阻止所述锁定机构处于所述解锁构型;
其中,所述锁定机构包括:
i.锁定构件,其包括第一端和第二端,所述锁定构件能够相对于所述接头滑动,当所述锁定机构处于所述锁定构型时,所述锁定构件的所述第一端能够接合所述端部执行器;以及
ii.致动器,所述锁定构件的所述第二端与所述致动器可操作地接合,由于所述闭合动作,所述驱动器能够抵接所述致动器,并且阻止所述锁定构件相对于所述接头滑动。
5.根据权利要求4所述的外科器械,其中,所述闭合驱动装置还包括扳机,所述扳机能够朝向所述致动器移动所述驱动器,所述细长轴包括可操作地接合在所述砧座和所述扳机上的护套,在所述扳机致动时,所述扳机能够相对于所述端部执行器移动所述护套并且枢转所述砧座。
6.根据权利要求4所述的外科器械,其中,所述闭合动作能够将所述砧座枢转到部分闭合位置,当所述砧座处于所述部分闭合位置时,所述端部执行器能够相对于所述细长轴移动。
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