CN106659498A - D形外科钉 - Google Patents

D形外科钉 Download PDF

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Publication number
CN106659498A
CN106659498A CN201480080250.9A CN201480080250A CN106659498A CN 106659498 A CN106659498 A CN 106659498A CN 201480080250 A CN201480080250 A CN 201480080250A CN 106659498 A CN106659498 A CN 106659498A
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surgical
nail
configuration
leg
surgical staples
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N·H·怀特
M·P·沙勒
M·穆里洛
J·L·范克利夫
P·R·马诺斯
B·D·克内德尔
B·J·马蒂亚斯
J·E·里韦拉
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De Stella Surgical Inc
Dextera Surgical Inc
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De Stella Surgical 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
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • A61B17/0644Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position
    • 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
    • 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
    • A61B2017/07228Arrangement of the staples
    • 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
    • A61B2017/07257Stapler heads characterised by its anvil
    • A61B2017/07264Stapler heads characterised by its anvil characterised by its staple forming cavities, e.g. geometry or material
    • 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
    • A61B2017/07278Stapler heads characterised by its sled or its staple holder
    • 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
    • A61B90/03Automatic limiting or abutting means, e.g. for safety
    • A61B2090/037Automatic limiting or abutting means, e.g. for safety with a frangible part, e.g. by reduced diameter

Abstract

本发明公开了一种用于在外科手术中处理患者的组织的外科装置,所述外科装置包括外科钉。根据本发明的实施例,所述外科钉可从第一构型(例如,未部署构型)变形为第二构型(例如,已部署构型)。根据本发明的实施例,所述外科钉包括第一腿部和第二腿部,其中所述外科钉在处于所述第一构型时基本上类似于V形或缝合针,并且在处于所述第二构型时基本上形成D形。

Description

D形外科钉
相关申请的交叉引用
本专利申请要求2014年7月23日提交的美国专利申请序列号14/339,054(代理人案卷号412)的权益和优先权,该专利申请全文以引用方式并入本文。
技术领域
本发明整体涉及外科缝合器与缝合。
背景技术
直线切割器(endocutter)是一种用于缝合与切割组织、从而来横切该组织同时使切口末端止血的外科工具。直线切割器的直径足够小,以用于微创外科手术,在手术过程中通过套管针、孔口或体内小切口抵达手术部位。线型切割器是直线切割器的放大版本,用于横切胃肠道的多个部分。典型的直线切割器在其远侧端部接收包括数排钉的可丢弃单次使用性钉仓,并包括与该钉仓相对的砧座。在致动直线切割器的过程中,钉仓将其中保持的钉全部击发。为了部署更多的钉,必须将直线切割器从手术部位移开,再从患者体内取出,然后把旧钉仓更换为新钉仓。随后将直线切割器重新插入患者体内。然而,在重新插入之后,要找到手术部位可能很困难并且/或者耗时。另外,在每次使用后将直线切割器从患者体内取出,更换钉仓,然后再次找到手术部位,这一过程既繁长不便,还相当耗时,外科手术需要多次使用直线切割器时这些缺点尤为突出。这种不便可能使外科医生不愿在手术过程中使用直线切割器,而在该过程中使用直线切割器可能让患者受益。除直线切割器外,使用外科缝合器也可能伴随类似的不便。
发明内容
本发明公开了一种被构造成能够部署外科钉的外科装置,其中根据本发明的实施例,所述外科钉可从第一构型(例如,未部署构型)变形为第二已部署构型。这种外科装置的外科钉包括第一腿部和第二腿部,其中所述外科钉形成基本上呈D形的第二已部署构型。
该外科装置进一步被构造成包括给料带,外科钉的所述第一腿部的至少一个端部可以易分离地附连到所述给料带,而外科钉的所述第二腿部的一个端部可以是自由的(例如,未附接或未附连到给料带)。
该外科装置在处于所述第二构型时,所述钉的端部在第二构型中可比在第一构型中更靠近彼此。
该外科装置在处于所述第二构型时,所述钉的端部可彼此接触。
该外科装置在部署外科钉时,外科钉可从第一构型可塑性地变形为第二构型。
该外科装置在未部署的外科钉处于第一构型时,外科钉的第一腿部可基本上是直的,而外科钉的第二腿部可至少部分是弯曲的。
该外科装置在处于第二部署构型时,外科钉可形成完全闭合的D形。
该外科装置在处于第一构型(例如,未部署构型)时,外科钉可大致为V形的形式。
该外科装置在处于第一构型(例如,未部署构型)时,外科钉可包括连续弯曲的部分。
本发明公开了一种用于在外科手术中处理组织的外科装置,该外科装置包括外科钉,所述外科钉包括第一腿部和第二腿部,其中所述外科钉被构造成能够通过仅使第二腿部变形来部署。在部署后,外科钉在第二腿部变形之后基本上类似于D形。
本发明公开了一种用于在外科手术中处理组织的外科装置,该外科装置包括外科钉,所述外科钉包括第一腿部和第二腿部,其中所述外科钉被构造成能够从基本上类似于V形的第一构型部署为基本上类似于D形的第二构型。
本发明公开了一种用于在外科手术中处理组织的外科装置,该外科装置包括外科钉,所述外科钉包括第一腿部和第二腿部,其中所述外科钉被构造成能够通过在部署过程中仅使第二腿部从第一构型变形为第二构型来部署。外科钉被构造成在处于第一构型时基本上类似于V形。外科钉被构造成在部署之后处于第二构型时基本上类似于D形。
本发明公开了一种用于处理组织的外科装置,该外科装置包括外科钉,所述外科钉包括第一腿部和第二腿部,其中通过所述外科装置部署所述外科钉涉及仅使所述外科钉的第二腿部变形。通过所述外科装置部署所述外科钉涉及将所述钉从基本上类似于V形或缝合针的第一构型变形为基本上类似于D形的第二构型。
本发明公开了一种用于处理组织的外科装置,该外科装置包括外科钉,所述外科钉包括第一腿部和第二腿部,其中通过所述外科装置部署所述外科钉包括使所述钉从第一构型变形为第二构型,其中使所述外科钉变形涉及仅使所述外科钉的所述第二腿部变形。在第一构型中,外科钉的第一腿部基本上是直的,而外科钉的第二腿部基本上是弯曲的。另外,在第一构型中,外科钉的第一腿部和第二腿部形成基本上呈V形的构型。另选地或类似地,在第一构型中,外科钉的第一腿部和第二腿部呈现出基本上类似于缝合针的构型或形状。在第二构型中,外科钉的第一腿部和第二腿部形成基本上呈D形的构型。
本发明公开了一种用于处理组织的外科装置,该外科装置包括外科钉,所述外科钉包括第一腿部和第二腿部,其中通过所述外科装置部署所述外科钉包括使所述外科钉从第一构型变形为第二构型,其中使所述外科钉变形涉及仅使所述外科钉的所述第二腿部变形,以形成基本上呈D形的所述第二构型。在第一构型中,外科钉的第一腿部和第二腿部基本上形成V形。在第一构型中,外科钉的第一腿部基本上是直的,而外科钉的第二腿部基本上是弯曲的。在第二构型中,外科钉的第一腿部基本上保持为直的,而外科钉的第二腿部基本上保持为弯曲的。
本发明还公开了一种使用示例性外科装置处理组织的方法,该方法涉及在外科钉呈现第一形状时迫使外科钉进入组织,然后使外科钉从第一形状变形为基本上呈D形的第二形状。
附图说明
图1为钉与之附连的示例性给料带的透视图。
图2为钉与之附连的托架的透视图。
图3为附接到示例性给料带的图2的托架与钉的顶视图。
图4为示例性楔形件的透视图。
图5为钉与之附连的另一个示例性托架在部署之前的透视图。
图6为图5在部署之后的透视图。
图7为处于第一状态的示例性钉的侧视图。
图8为图7的示例性钉处于第二状态时的侧视图。
图9为图7的示例性钉处于第三状态时的侧视图。
图10为图7的示例性钉处于第四已部署状态时的侧视图。
图11为钉组与之附连的示例性给料带的透视图。
图12为不同尺寸的钉从其延伸的示例性给料带的侧视图。
图13为具有砧座和钉保持器的示例性外科器械的侧视图。
图14为示例性砧座的底视图。
图15为其中限定有不均一的钉凹坑的砧座的侧剖面图。
图16为从对应给料带延伸的第一组钉的透视图。
图17为从图16的给料带延伸的第二组钉的透视图。
图18为从图16的给料带延伸的第三组钉的透视图。
图19为处于第一构型的示例性可变厚度钉的侧视图。
图20为图19的钉处于第二构型时的侧视图。
图21为图19的钉处于第三构型时的侧视图。
图22为被构造成能够共同递送三排钉的两个示例性给料带的透视图。
图23为图22的给料带的端视图。
图24为三排钉从其延伸的示例性给料带的透视图。
图25为三排钉从其延伸的示例性给料带组件的端部。
图26为三排钉从其延伸的另一个示例性给料带组件的端部。
在不同附图中使用相同的附图标记指示相似或相同的项目。
具体实施方式
2008年10月31日提交的美国专利申请序列号12/263,171(“直线切割器文件”)特此全文以引用方式并入本文。该“直线切割器文件”描述了用于外科缝合器的示例性给料带。参见图1,给料带2可以是一个或多个钉4从其延伸的长窄型薄材料带。本发明文件的给料带2和钉4可基本上如“直线切割器文件”中所述,不同的是具有本发明文件提出的发明特征。每个钉4都可具有自由端部6,和连接到给料带2的相对端8。有利的是,钉4易分离地附连到给料带2,使得这些钉在部署期间从给料带2上剪下。然而,钉4可按任何合适的方式连接到给料带2。钉4的一个或多个排10可连接到给料带2。钉4的每个排10都是相对于给料带2的纵向中心线定位在基本上相同的侧向位置的钉4的组,并且钉4的每个排10都可大致纵向取向。在部署之后,每个钉4都可基本上形成D形。如图1中所见,示例性给料带2可以是大致平的且大致为线性的材料片,其上承载着多个钉4。给料带2可基本上位于单个平面内。给料带2可以是柔性的,或相反,可以是刚性的。
还参见图2至图3,至少两个钉4可以大致为D形,并可从托架16延伸。钉4的这种构型可被称为“双D构型”。每个钉4的连接到托架16的端部8可固定到托架16,使得钉4无法轻易从托架16分离。而托架16本身可固定到给料带2,并可轻易从该给料带分离。用这种方式,托架16连同附接的钉4一起被植入组织。托架16与给料带2之间的连接可铸造而成,或可采用其他方式加工而成,以便托架易于从给料带2分离。这种连接可采用与“直线切割器文件”中所述的钉4与给料带2之间的连接相同或相似的方式制成,也可采用不同的方式制成。如图2所示,附接到托架16的钉4可基本上彼此处于同一平面内,使得钉4都从托架16的同一侧延伸。另外,这些钉4可沿彼此基本上相同的方向取向,使得每个钉4的自由端部6都位于每个钉4的近侧端部或远侧端部处。另选地,附接到托架16的至少一个钉4可沿相对于至少一个另外的钉4不同的方向取向。至少一个托架16可与给料带2基本上位于同一平面内,并可相对于给料带2侧向定位。
还参见图4,楔形件20可具有三维形状,其用来形成钉4,然后从给料带2上剪下托架16。也就是说,楔形件20可包括两个分开的坡道22、24,其中第一坡道22被构造成能够使钉4变形,第二坡道24被构造成能够将托架16从给料带2上剪下。楔形件20可基本上如“直线切割器文件”中所述那样致动,但有以下几点区别。第一坡道22可相对于第二坡道24位于侧向外侧。随着楔形件20相对于给料带2滑动,第一坡道22相继地接合钉4,使这些钉向上变形从而与砧座接触,这将导致钉进一步变形。第一坡道22被成形为有利于这种变形,如“直线切割器文件”中所述。第二坡道24可相对于第一坡道22位于侧向内侧。第二坡道24被成形为使得:在附接到托架16的钉4由于与第一坡道22接触而变形之后,第二坡道24接触并施加力给托架16和/或料带2与托架16之间的接合部,以便将托架16从给料带2上剪断,或以其他方式将托架从给料带分离。另选地,可以不使用具有两个分开的坡道22、24的三维楔形件20,而是使用两个独立的楔形件20,其中一个楔形件20使钉4变形,另一个楔形件20将托架16从给料带2上剪下。
另选地,附接到托架16的至少一个钉4可位于附接到托架16的至少一个另外的钉4所处的平面之外。还参见图5,托架16可具有从其延伸的两个或更多个钉4,其中至少一个钉4相对于至少一个另外的钉4从托架16的不同侧延伸。至少一个钉4可沿与至少一个另外的钉4不同的方向取向。例如,如图5所示,两个钉4可附接到托架16,其中一个钉4的自由端部6位于该钉4的近侧端部,另一个钉4的自由端部6位于该钉4的远侧端部。钉4的这种构型可被称为“B构型”。两个独立的楔形件20可与钉4和托架16结合使用。还参见图6,这两个楔形件20可沿相对于彼此相反的方向移动,以使钉4变形。楔形件20之一可基本上如图4所示构造,因此,该楔形件20既可使一个或多个钉4变形,也可将托架16从给料带2上剪下。所获得的变形的钉4与托架16的组合,可大致形成B形。另选地,两个楔形件20都可如“直线切割器文件”中所述构造,且钉4可直接连接到给料带2,而不连接到托架16。
还参见图7至图10,楔形件20沿单个方向移动时,钉4可被成型为B构型。这种钉4可彼此基本上共面地附接到托架16,与图2的构型类似。作为另一个例子,至少两个钉4可按相对于彼此异面的方式附接到托架16,与图5的构型类似。如图7中所见,至少一个钉4可相对于楔形件20被取向为使得随着楔形件20逐渐靠近钉4,自由端部6在纵向上比相对端部8更靠近该楔形件。楔形件20与钉4接触的表面和钉4本身被成形为使得:随着楔形件20相对于钉4滑动,所述表面与钉之间的接触迫使钉4的自由端部6向上,还参见图8。随着楔形件20继续相对于钉4滑动,楔形件20遇到在纵向上依次出现的下一个钉4,也迫使该钉4向上,还参见图9。任选地,在至少两个钉4按相对于彼此异面的方式附接到托架16的情况下,可使用两个楔形件20。在楔形件20使两个钉4变形之后,这两个钉4呈现B构型,如图10所示。随后可用楔形件20将托架16从给料带2分离。任选地,可使用图4的三维楔形件20,以便首先使钉4变形,然后将托架16从给料带2分离。
钉4可按任何合适的方式沿给料带2组合在一起。作为一个例子,还参见图11,沿给料带2,钉4可被组织成在纵向上彼此间由空白空间24隔开的两个或更多个组22。空白空间24可具有任何合适的长度。有利的是,没有钉4沿给料带2上的空白空间24从给料带2延伸。至少一个钉4可以被部署为与至少一个另外的钉4不同的闭合形状。作为一个例子,还参见图12,组22内的钉4不必均一。例如,一个或多个钉4可从给料带2向下延伸比一个或多个另外的钉4更大的距离。钉4a可从给料带2向下延伸第一距离26。另一个钉4b可从给料带2向下延伸比第一距离26大的第二距离28。又一个钉4c可从给料带2向下延伸比第二距离28大的第三距离30。钉4c可比钉4a、4b大。钉4a、4b、4c可按任何合适的方式在纵向上相对于彼此定位。有利的是,不均一的钉4按照与待执行的特定外科手术有关的方式,在纵向上相对于彼此定位,且彼此不同。例如,钉4a定位在钉4b近侧,钉4b又定位在钉4c近侧。用这种方式,可有效地缝合厚度以已知方式变化的组织,其中,该组织从近侧到远侧逐渐变厚。从给料带2向下更远延伸的钉4,围绕其附接端部8旋转的量,可与从给料带2向下延伸较短距离的钉4基本上相同。因此,从给料带2向下延伸第三距离30的钉4c的自由端部6,将在给料带2上方位于从给料带2向下延伸第一距离26的钉4c的自由端部可扫过组织的高度之上的高度扫过组织,其中第一距离26小于第三距离30。作为另一个例子,可将一个或多个钉4与一个或多个另外的钉4成形为不同的形状,这些钉4的一子组从给料带2向下延伸与这些钉4的一不同子组不同或相同的距离。作为另一个例子,组22内的一个或多个钉4在成形和剪切之后可具有D构型,而同一个组22内的一个或多个钉4可具有B构型、双D构型和/或任何其他合适的构型。组22内的一个或多个钉4可在任何其他合适的方面与同一个组22内的一个或多个另外的钉4不同。另选地,至少一个组22内的所有钉4都可基本上均一。
还参见图13至图14,如“直线切割器文件”中所述,从给料带2部署钉4的外科器械可包括端部执行器40,该端部执行器包括钉保持器42和砧座44。一个或多个给料带2可延伸穿过位于端部执行器40近侧并连接到该端部执行器的轴46,再进入钉保持器42。砧座44的内表面48是砧座44上通常朝向钉保持器42取向的表面,其可包括限定于其中的钉成形凹坑(staple forming pockets)50。在部署钉4时,每个钉4的自由端部6都可被压入相应的钉成形凹坑50中,由此,钉4的自由端部6与钉成形凹坑50之间的接触造成钉4闭合。每个钉成形凹坑50可按任何合适的方式来成形。
还参见图15,钉成形凹坑50不必均一。作为一个例子,一个或多个钉成形凹坑50相比一个或多个另外的钉成形凹坑50,可更多延伸到砧座44的内表面48中。一个砧座成形凹坑50a可在砧座44的内表面48上方延伸第一距离52。另一个砧座成形凹坑50b可在砧座44的内表面48上方延伸第二距离54,其中第二距离54可小于第一距离52。另一个砧座成形凹坑50c可在砧座44的内表面48上方延伸第三距离56,其中第三距离56可小于第二距离54。作为另一个例子,至少一个钉成形凹坑50可按与至少一个另外的钉成形凹坑50不同的方式弯曲或成形。例如,一个钉成形凹坑50可具有比不同的钉成形凹坑50更紧的曲率半径。作为另一个例子,一个钉成形凹坑50可具有复杂的形状,而另一个钉成形凹坑50可为简单的弓形。用这种方式,不同的砧座成形凹坑50a、50b、50c可将对应的钉4成形为不同的形状。不均一的砧座成形凹坑50可与给料带2一起使用,该给料带采用至少一个均一钉4的组22,使得可跨基本上相同的多个钉4施加不同程度的弯曲和成形,以便得到不同方式成形的闭合钉4。作为另一个例子,不均一的砧座成形凹坑50可与特征不同的钉4一起使用(诸如上文所述那样),其中特定的钉4被定位用于部署到相应的特定砧座成形凹坑50中。
作为另一个例子,砧座44的内表面48不必是平坦的,使得在端部执行器40闭合的情况下,不同的砧座成形凹坑50可位于离开钉保持器42的不同距离处。用这种方式,可容纳不同高度的钉4。作为另一个例子,无论砧座44的内表面48是否基本上平坦,内表面48和钉保持器42之间的间隙都可以调节。用这种方式,可控制钉4在砧座44与钉保持器42之间保持的特定组织结构内变形的程度。该间隙可以采用任何合适的方式调节,诸如2009年6月3日提交的共同未决美国专利申请序列号12/477,302中所述的机制、结构或方法,该专利申请据此全文以引用方式并入本文。
还参见图16至图18,给料带2上的钉4可形成在纵向上依次出现的组22,其中至少一个组22中的钉4的数目或构型可与至少一个另外的组22不同。这样组织钉4对于特定的外科手术可能是有利的。参见图16,第一组22a的钉4可连接到给料带2。参见图17,第二组22b的钉4可邻近第一组22a连接到给料带2。第一组22a的钉4所包括的钉4的数目可与第二组22b不同。参见图18,第三组22c的钉4可邻近第二组22b连接到给料带2。第三组22c的钉4所包括的钉4的数目可与第一组22a和/或第二组22b不同。第一组22a在第二组22b之前部署,第二组22b又在第三组22c之前部署。如果每个组22a、22b、22c包括的钉4依次比前一个组少,则这种构型的给料带2可适用于用给料带2处理宽度越来越窄的组织结构的外科手术。
如果在处于闭合位置的端部执行器40中,砧座44和钉保持器42之间的间隙可变,则钉4可按任何方式构造,以利用该可变间隙。作为一个例子,还参见图19至图21,至少一个钉4可被构造成能够以多种程度闭合。参见图19,钉4可闭合到第一程度,此时,钉4的两侧被闭合到相距第一距离60a。该第一距离60a可因砧座44和钉保持器42之间的第一间隙而产生。还参见图20,钉4可闭合到第二程度,此时,钉4的两侧被闭合到相距第二距离60b,该第二距离可小于第一距离60a,并且可因砧座44和钉保持器42之间的第二间隙而产生,该第二间隙小于上述第一间隙。还参见图21,钉4可闭合到第三程度,此时,钉4的两侧被闭合到相距第三距离60c,该第三距离可小于第一距离60a和第二距离60b,并且可因砧座44和钉保持器42之间的第三间隙而产生,该第三间隙小于上述第一间隙和第二间隙。
钉4可按任何方式构造,以通过多种紧密度60a、60b、60c闭合,而不造成钉4的自由端部6与钉4的其余部分之间的干扰。作为一个例子,至少一个钉4可在钉4的固定到给料带2的端部8处或附近包括凹口62。这种凹口62减缩了钉4的厚度,使得随着钉4被闭合到一定程度(此时,若没有这种凹口,自由端部6原本会在端部8附近与钉4碰撞并对其造成干扰),钉4的自由端部6可在该凹口内行进。作为另一个例子,至少一个钉4可侧向弯曲,使得自由端部6与钉成形凹坑之间的接触由于该钉4的形状的影响,造成钉4的自由端部6侧向移动到钉8的另一个端部8并从其上扫过。作为另一个例子,至少一个钉成形凹坑50的形状主动地使至少一个钉4的自由端部6侧向偏转,从而由于该钉成形凹坑50的形状的影响,允许该自由端部扫过钉4的相对端部8。另选地,这种钉成形凹坑50可结合如上文刚描述过的侧向弯曲的钉4使用。作为另一个例子,钉4的自由端部6和/或钉4的其余部分可被成形为使得:自由端部6与钉4的其余部分之间的接触会造成自由端部6侧向偏转,并防止这两者间出现干扰。要实现该目的,自由端部6可以是圆锥形或以其他方式弯曲的,钉4的其余部分也可能是这样。
可在钉保持器42中使用多个给料带2,以便在由钉保持器42保持的刀片的每一侧上提供钉4的任何适宜数量的排10,以用于组织中由端部执行器40形成的横切口或其他切口。还参见图22至图23,可在横切口的一侧或两侧上使用两个给料带2,其中一个给料带2a包括两个排10的钉4,如上文参照图1所述。另一个给料带2b可包括以任何合适的方式构造的单排10的钉4。作为一个例子,为方便制造,给料带2a可按照与给料带2b基本上相同的方式构造,在这种情况下,只需省去在给料带2b上制造第二排10的钉4。另选地,给料带2b可具有任何其他构型的钉4。例如,从给料带2b延伸的钉4无需定位在排10中,而是可相对于彼此侧向交错。另选地,两个给料带2各自可包括两个排10的钉4,因此四个排10的钉4可部署在横切口的每一侧。用这种方式,由于可多次使用同一个给料带2,而无需制造不同构型的给料带2,所以可简化给料带2的制造。
另选地,三个或更多个排10的钉4可附接到单个给料带2。还参见图24,可基本上如“直线切割器文件”中所述将两个排10的钉4附接到给料带2。第三个排10可通过用延伸臂64将钉4各自附接到给料带2来提供。至少一个延伸臂64在可基本上垂直于给料带2的纵向中心线的方向上,可相对于该给料带大致侧向地延伸。至少一个延伸臂64可基本上位于与相应的给料带2相同的平面内。另选地,至少一个延伸臂64可相对于给料带2不同地取向或构造。钉4可被构造成能够例如被图4的三维楔形件20从延伸臂64的侧向端部66剪下或以其他方式从该侧向端部分离。另选地,至少一个延伸臂64可从给料带2上剪下或以其他方式从给料带分离,并且可保持固定到钉2。有利的是,每个延伸臂64都连接到一个相应的钉4。另选地,至少一个延伸臂64可具有连接到其上并从其延伸的两个或更多个钉4。固定到相应延伸臂64的钉4可与给料带2侧向间隔开。
另选地,可按不同方式制造具有附接到单个给料带2的三个或更多个排10的钉4的给料带2。作为一个例子,参见图25,给料带2a可连同给料带2b一起提供,诸如上文参照图23所述。如从端部看到的那样,给料带2b通常可再成形。给料带2a可包括多个从中穿过的孔。给料带2b可紧固到给料带2a的上表面,使得给料带2b的钉4b延伸穿过给料带2a中的孔并在给料带2a下方延伸。给料带2b可通过激光焊接或任何其他合适的方式被紧固到给料带2a的上表面。另选地,参见图26,可提供主带70,在这种情况下,一个或多个L形给料带2b通过激光焊接或任何其他合适的方式附接到主带下侧。主带70不必具有从其延伸的钉4,且可以只承载一个或多个L形给料带2b。另选地,主带70可紧固到一个或多个双排给料带2a。另选地,主带70可包括多个从中穿过的孔。至少一个给料带2b可紧固到主带70的上表面,使得给料带2b的钉4b延伸穿过主带70中的孔并在给料带70下方延伸。
本文所述的给料带2可诸如本文件、“直线切割器文件”中所述那样致动,或以任何其他合适的方式致动。作为另一个例子,可使用两阶段部署来部署一个或多个钉4。一个或多个楔形件20或其他部署机构在第一次通过时,可大致沿一个纵向方向相对于一个或多个钉4滑动。在第一次通过期间,一个或多个楔形件20可部分或完全部署一个或多个钉4。随后,这些楔形件20或其他部署机构在第二次通过时,可大致沿相反的纵向方向相对于一个或多个钉4滑动。在第二次通过期间,一个或多个楔形件20可完成对任何部分部署的钉4的部署。另选地,楔形件20在第一次通过时使钉4变形,而楔形件在第二次通过时将钉4从给料带2上剪下。
尽管已详细地描述了本发明,但对于本领域的技术人员来说显而易见的是,可在不脱离本发明的前提下作出各种变化和修改,并可采用等同形式。应当理解,本发明不限于在上文的描述中所阐述或在附图中所示出的构造细节、部件布置和/或方法。本文件的说明书摘要中的陈述以及本文件中的任何概括性陈述仅仅是示例性的;这些陈述不限制、也不能被解释为限制权利要求书的范围。另外,附图仅是示例性的,而非限制性的。主题性标题和副标题仅用于方便读者理解。这些标题不应当、也不能被理解为具有任何实质性的意义、含义和解释,而且不应当、也不能被视为表明:与任何特定主题相关的所有信息将能在任何特定标题和副标题下找到或受限于任何特定标题和副标题。因此,本发明仅受限于下面的权利要求书及其法律等同物。

Claims (17)

1.一种用于处理组织的外科装置,包括:
外科钉,所述外科钉包括第一腿部和第二腿,其中通过所述外科装置部署所述外科钉包括使所述外科钉从第一构型变形为第二构型,其中使所述外科钉变形涉及仅使所述外科钉的所述第二腿部变形,以形成基本上呈D形的所述第二构型。
2.根据权利要求1所述的外科装置,其中在所述第一构型中,所述外科钉的所述第一腿部和所述第二腿部基本上形成V形。
3.根据权利要求1所述的外科装置,其中在所述第一构型中,所述外科钉的所述第一腿部基本上是直的,而所述外科钉的所述第二腿部基本上是弯曲的。
4.根据权利要求1所述的外科装置,其中在所述第二构型中,所述外科钉的所述第一腿部基本上保持为直的,而所述外科钉的所述第二腿部基本上保持为弯曲的。
5.一种用于处理组织的外科装置,包括:
外科钉,所述外科钉包括第一腿部和第二腿部,其中通过所述外科装置部署所述外科钉包括使所述外科钉从第一构型变形为第二构型,其中使所述外科钉变形涉及仅使所述外科钉的所述第二腿部变形。
6.根据权利要求5所述的外科装置,其中在所述第一构型中,所述外科钉的所述第一腿部基本上是直的,而所述外科钉的所述第二腿部基本上是弯曲的。
7.根据权利要求5所述的外科装置,其中在所述第一构型中,所述外科钉的所述第一腿部和所述第二腿部基本上形成V形构型。
8.根据权利要求5所述的外科装置,其中在所述第一构型中,所述外科钉的所述第一腿部和所述第二腿部呈现为基本上类似于缝合针的构型或形状。
9.根据权利要求5所述的外科装置,其中在所述第二构型中,所述外科钉的所述第一腿部和所述第二腿部形成基本上为D形的构型。
10.一种用于处理组织的外科装置,包括:
外科钉,所述外科钉包括第一腿部和第二腿部,其中通过所述外科装置部署所述外科钉涉及仅使所述外科钉的所述第二腿部变形。
11.根据权利要求10所述的外科装置,其中通过所述外科装置部署所述外科钉涉及将所述外科钉从基本上类似于V形或缝合针的第一构型变形为基本上类似于D形的第二构型。
12.一种用于在外科手术中处理组织的外科装置,包括:
外科钉,所述外科钉包括第一腿部和第二腿部,其中所述外科钉被构造成能够通过在部署过程中仅使所述第二腿部从第一构型变形为第二构型来部署。
13.根据权利要求12所述的外科装置,其中所述外科钉被构造成在处于所述第一构型时基本上类似于V形。
14.根据权利要求12所述的外科装置,其中所述外科钉被构造成在部署之后处于所述第二构型时基本上类似于D形。
15.一种用于在外科手术中处理组织的外科装置,包括:
外科钉,所述外科钉包括第一腿部和第二腿部,其中所述外科钉被构造成能够从基本上类似于V形的第一构型部署为基本上类似于D形的第二构型。
16.一种用于在外科手术中处理组织的外科装置,包括:
外科钉,所述外科钉包括第一腿部和第二腿部,其中所述外科钉被构造成能够通过仅使所述第二腿部变形来部署。
17.根据权利要求16所述的外科装置,其中,在通过部署所述外科钉而使所述第二腿部变形之后,所述外科钉基本上类似于D形。
CN201480080250.9A 2009-06-03 2014-07-25 D形外科钉 Pending CN106659498A (zh)

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US14/339,054 US10130362B2 (en) 2009-06-03 2014-07-23 D-shaped surgical staples
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US8056789B1 (en) 2011-11-15
US9386986B2 (en) 2016-07-12
US8365973B1 (en) 2013-02-05
US20190053802A1 (en) 2019-02-21
US10130362B2 (en) 2018-11-20
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US20120080497A1 (en) 2012-04-05
CA2953123A1 (en) 2016-01-28
WO2016014072A1 (en) 2016-01-28
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US20140332580A1 (en) 2014-11-13
EP3171789A4 (en) 2018-05-09
US20130126585A1 (en) 2013-05-23
US11096685B2 (en) 2021-08-24
JP2017526395A (ja) 2017-09-14

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