CN101011274A - 用于动力驱动的外科切割和紧固器械的齿轮选择器 - Google Patents

用于动力驱动的外科切割和紧固器械的齿轮选择器 Download PDF

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CN101011274A
CN101011274A CNA2007100069416A CN200710006941A CN101011274A CN 101011274 A CN101011274 A CN 101011274A CN A2007100069416 A CNA2007100069416 A CN A2007100069416A CN 200710006941 A CN200710006941 A CN 200710006941A CN 101011274 A CN101011274 A CN 101011274A
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CN101011274B (zh
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F·E·谢尔顿四世
J·S·斯韦兹
E·L·蒂姆珀曼
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Ethicon Endo Surgery Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis in a single operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00734—Aspects not otherwise provided for battery operated

Abstract

一种动力驱动的外科切割和紧固器械，包括：驱动轴；马达；以及换档组件，其连接到所述驱动轴和所述马达上。所述换档组件可包括：至少第一阶段齿轮组件，其连接到所述马达和所述驱动轴上，用于在第一齿轮组中操作换档组件；以及齿轮连接组件，其用于选择性地将至少一个附加齿轮连接到所述驱动轴上，从而在第二齿轮组中操作换档组件。

Description

用于动力驱动的外科切割和紧固器械的齿轮选择器
相关申请的交叉引用
本发明与下列同时提交的美国专利申请相关，这些专利申请的内容通过引用并入本文：
发明人为Frederick E.Shelton、IV、John Ouwerkerk和Jerome R.Morgan，发明名称为“MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITHUSER FEEDBACK SYSTEM”的申请(K&LNG 050519/END5687USNP)；
发明人为Frederick E.Shelton、IV、John N.Ouwerkerk、Jerome R.Morgan和Jeffrey S.Swayze，发明名称为 “MOTOR-DRIVEN SURGICAL CUTTINGAND FASTENINGINSTRUMENT WITH LOADING FORCE FEEDBACK”的申请(K&LNG050516/END5692USNP)；
发明人为Frederick E.Shelton、IV、John N.Ouwerkerk、Jerome R.Morgan和Jeffrey S.SWayze，发明名称为“MOTOR-DRIVEN  SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH TACTILE POSITION FEEDBACK”的申请(K&LNG050515/END5693USNP)；
发明人为Frederick E.Shelton、IV、John N.Ouwerkerk和Jerome R.Morgan，发明名称为“MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITHADAPTIVE USER FEEDBACK”的申请(K&LNG 050513/END5694USNP)；
发明人为Frederick E.Shelton、IV和Christoph L.Gillum发明名称为“MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITHARTICULATABLE END EFFECTOR”的申请(K&LNG 050692/END5769USNP)；
发明人为Frederick E.Shelton、IV和Christoph L.Gillum发明名称为“MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITHMECHANICAL CLOSURE SYSTEM”的申请(K&LNG 050693/END5770USNP)；
发明人为Frederick E.Shelton、IV和Kevin R.Doll，发明名称为“SURGICAL CUTTINGAND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM”的申请(K&LNG 050694/END5771USNP)；
发明人为Frederick E.Shelton、IV、John N.Ouwerkerk和Eugene L.Timperman，发明名称为“SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES”的申请(K&LNG 050698/END5773USNP)；
发明人为Frederick E.Shelton、IV、Kevin R.Doll、Jeffrey S.Swayze和Eugene L.Timperman，发明名称为“SURGICAL INSTRUMENT HAVING A REMOVABLEBATTERY”的申请(K&LNG 050699/END5774USNP)；
发明人为Jeffrey S.Swayze、Frederick E.Shelton、IV和Kevin R.Doll，发明名称为“ELECTRONIC LOCKOUTS AND SURGICAL INSTRUMENT INCLUDING SAME”的申请(K&LNG 050700/END5775USNP)；
发明人为Frederick E.Shelton、IV、Jeffrey S.Swayze、Mark S.Ortiz，和Leslie M.Fugikawa，发明名称为“ENDOSCOPIC SURGICAL INSTRUMENT WITH A HANDLETHAT CAN ARTICULATE WITH RESPECT TO THE SHAFT”的申请(K&LNG050701/END5776USNP)；
发明人为Frederick E.Shelton、IV、Stephen J.Balek和Eugene L.Timperman，发明名称为“ELECTRO-MECHANICAL SURGICAL CUTTING AND FASTENING INSTRUMENTHAVING A ROTARY FIRING AND CLOSURE SYSTEM WITH PARALLEL CLOSUREAND ANVIL ALIGNMENT COMPONENTS”的申请(K&LNG 050702/END5777USNP)；
发明人为Frederick E.Shelton、IV、Michael S.Cropper、Joshua M.Broehl、Ryan S.Crisp、Jamison J.Float和Eugene L.Timperman，发明名称为“DISPOSABLE STAPLECARTRIDGE HAVING AN ANVIL WITH TISSUE LOCATOR FOR USE WITH ASURGICAL CUTTING AND FASTENING INSTRUMENT AND MODULAR ENDEFFECTOR SYSTEM THEREFOR”的申请(K&LNG 050703/END5778USNP)；
发明人为Frederick E.Shelton、IV、Jerome R.Morgan、Kevin R.Doll、Jeffrey S.Swayze和Eugene L.Timperman，发明名称为“SURGICAL INSTRUMENT HAVING AFEEDBACK SYSTEM”的申请(K&LNG 050705/EDN580USNP)。
技术领域
本发明总的涉及内窥镜外科器械，更具体地说，本发明涉及马达驱动的内窥镜外科器械。
背景技术
与传统的开放式外科器械相比，内窥镜外科器械通常更受青睐，这是因为较小的切口易于减少术后恢复时间和并发症。因此，各种内窥镜外科器械已经有了显著的发展，这些器械适于通过套管针的插管将远侧端部执行器精确放置在所需的手术部位。这些远侧端部执行器(例如，内切割器、抓钳、切割器、缝合器、夹具施放器、接入装置、药物/基因治疗输送装置、以及使用超声波、Rf、或激光等的能量装置)以各种方式与组织接合，达到诊断或治疗的效果。
已知的外科缝合器包括端部执行器，该端部执行器在组织中形成纵向切口的同时在切口的相对两侧上施加多排缝钉。所述端部执行器包括一对相配合的夹钳构件，如果器械用于内窥镜或者腹腔镜应用，这对夹钳构件能够穿过插管通道。夹钳构件中的一个装纳具有至少两个横向间隔的缝钉排的钉仓。另一个夹钳构件限定了具有缝钉成形凹口的砧座，所述凹口与钉仓中的缝钉排对准。该器械包括多个往复运动的楔形件，这些楔形件在被向远侧驱动时穿过钉仓中的开口并与支撑缝钉的驱动器接合，向着砧座击发缝钉。
在美国专利No.5465895中描述了适用于内窥镜应用的外科缝合器的例子，其披露了具有不同闭合和击发动作的内切割器。使用该装置的临床医生可在击发之前闭合组织上的夹钳构件来定位组织。一旦临床医生确定夹钳构件正确地夹持了组织，则临床医生就可用单个击发冲程击发外科缝合器，由此缝合和切割组织。击发将所有缝钉放置到组织中并使刀片行进对组织进行切割。同时切割和缝合避免了在使用分别仅仅进行切割或缝合手术的不同外利工具顺序地进行所述动作时引起的并发症。
可在击发之前在组织上闭合的一个具体的优点在于，临床医生可以通过内窥镜确认到达了需要切割的部位，包括确认已经在相对的夹钳之间捕获了足量的组织。否则，相对的夹钳会被拉得太近，特别是在其远端夹紧，不能在切割的组织中有效形成闭合的缝钉。用于外科缝合器的可多次使用的端部执行器通常是有利的。在另一极端，夹紧过量的组织可导致故障和不完全的击发。
每一代内窥镜缝合器/切割器不断增加复杂性和功能。一个主要的原因是为了满足低击发力(FTF)的要求，使所有或大多数外科医生能够处理。降低FTF的一种已知方案是采用CO2或马达。这些装置比传动的手动功能装置并不具有明显优势，但原因不同。外科医生通常青睐经受适当的力分布，不愿在形成缝钉时由端部执行器承受力，以确保切割/缝合周期完成，上限在大多数外科医生的能力范围内(通常大约15-30lbs)。他们通常希望保持控制缝钉的展开，并希望能够在感到装置的手柄中的力太大或因为其他一些临床原因随时停止。在目前的马达驱动的内切割器中不能适当的实现这些用户反馈。因此，在仅仅通过按压按钮来致动切割/缝合操作的情况下，医生很难接受马达驱动的内切割器。
根据被缝合和切割的组织的类型和密度，可能在不同情况下需要外科缝合和切割器械具有更多能量或者更高的精度。例如，如果医生需要缝合和切割相对致密的组织部分，例如矫正术的情况下，如果能够调节马达的齿轮组以传递更多的扭矩或更少的速度来适应致密组织，这对器械是有帮助的。总的说来，如果能够调节齿轮组，则能更好地控制端部执行器，尤其是当外科医生在特别致密或者特别稀薄的不同组织上操作时，更是如此。
发明内容
在不同实施例中，本发明涉及动力驱动的外科切割和紧固器械。该器械可包括驱动轴；马达；连接到驱动轴和马达上的换档组件。换档组件可至少包括：第一阶段齿轮组件，其连接到马达和驱动轴上，用于在第一齿轮组中操作换档组件；以及齿轮连接组件，用于选择性地将至少一个附加齿轮连接到驱动轴上，从而在第二齿轮组中操作换档组件。
本发明具体涉及：
(1)一种外科切割和紧固器械，包括：
(a)驱动轴；
(b)马达；以及
(c)换档组件，其连接到所述驱动轴和所述马达上，所述换档组件包括：
至少第一阶段齿轮组件，其连接到所述马达和所述驱动轴上，用于在第一齿轮组中操作换档组件；以及
齿轮连接组件，其用于选择性地将至少一个附加齿轮连接到所述驱动轴上，从而在第二齿轮组中操作换档组件。
(2)如第(1)项所述的器械，其中，所述第一阶段齿轮组件包括太阳齿轮，所述太阳齿轮至少部分与一个或多个行星齿轮相互啮合，为第一阶段齿轮组件提供行星齿轮布置。
(3)如第(1)项所述的器械，还包括连接到所述第一阶段齿轮组件上的第二阶段齿轮组件。
(4)如第(3)项所述的器械，其中，所述第一阶段齿轮组件和所述第二阶段齿轮组件中的至少一个包括太阳齿轮，所述太阳齿轮至少部分与一个或多个行星齿轮相互啮合，为第一阶段齿轮组件或第二阶段齿轮组件提供行星齿轮布置。
(5)如第(1)项所述的器械，其中，所述齿轮连接组件还包括太阳齿轮，所述太阳齿轮至少部分与一个或多个行星齿轮相互啮合，以提供能够选择性地连接到第一阶段齿轮组件上的行星齿轮布置。
(6)如第(5)项所述的器械，其中，所述齿轮连接组件的太阳齿轮还包括脊部，所述脊部被构造成在第二齿轮组件中与形成在输入轴上的脊部相应地相互啮合，所述输出轴从第一阶段齿轮组件收纳进入齿轮连接组件中。
(7)如第(5)项所述的器械，其中，所述齿轮连接组件的太阳齿轮还包括脊部，所述脊部被构造成不在第一齿轮组件中与形成在输入轴上的脊部相应地相互啮合，所述输出轴从第一阶段齿轮组件收纳进入齿轮连接组件中。
(8)如第(1)项所述的器械，其中，所述齿轮连接组件还包括套环，所述套环中形成有脊部。
(9)如第(8)项所述的器械，其中，所述套环的脊部被构造成第一齿轮组件或第二齿轮组件中与形成在驱动轴上的脊部相应地相互啮合。
(10)如第(1)项所述的器械，其中，所述换档组件还包括齿轮选择器组件，用于使齿轮连接组件在第一和第二齿轮组之间运动。
(11)如第(1)项所述的器械，其中，所述齿轮选择器组件还包括开关，所述开关连接到轭上，所述轭与齿轮连接组件的套环操作上相联。
(12)如第(1)项所述的器械，还包括至少一个连接到马达上和换档组件的第一阶段齿轮组件上的锥齿轮组件。
(13)如第(3)项所述的器械，其中，所述第一阶段齿轮组件和第二阶段齿轮组件每个都包括太阳齿轮，所述太阳齿轮至少部分与一个或多个行星齿轮相互啮合，为第一阶段齿轮组件和第二阶段齿轮组件提供行星齿轮布置。
(14)如第(3)项所述的器械，其中，所述齿轮连接组件还包括太阳齿轮，所述太阳齿轮至少部分与一个或多个行星齿轮相互啮合，以提供能够选择性地连接到第二阶段齿轮组件上的行星齿轮布置。
(15)如第(14)项所述的器械，其中，所述齿轮连接组件的太阳齿轮还包括脊部，所述脊部被构造成在第二齿轮组件中与形成在输入轴上的脊部相应地相互啮合，所述输出轴从第二阶段齿轮组件收纳进入齿轮连接组件中。
(16)如第(14)项所述的器械，其中，所述齿轮连接组件的太阳齿轮还包括脊部，所述脊部被构造成不在第一齿轮组件中与形成在输入轴上的脊部相应地相互啮合，所述输出轴从第二阶段齿轮组件收纳进入齿轮连接组件中。
(17)一种外科切割和紧固器械，包括：
(a)驱动轴；
(b)马达；以及
(c)换档组件，其连接到所述驱动轴和所述马达上，所述换档组件包括：
第一阶段齿轮组件，其连接到所述马达和所述驱动轴上，
用于在第一齿轮组中操作换档组件，所述第一阶段齿轮组件包括太阳齿轮，所述太阳齿轮至少部分与一个或多个行星齿轮相互啮合，为第一阶段齿轮组件提供行星齿轮布置；
第二阶段齿轮组件，其连接到第一阶段齿轮组件和驱动轴上，所述第二阶段齿轮组件包括太阳齿轮，所述太阳齿轮至少部分与一个或多个行星齿轮相互啮合，为第二阶段齿轮组件提供行星齿轮布置；
齿轮连接组件，其用于选择性地将至少一个附加齿轮连接到所述第二阶段齿轮组件上，从而在第二齿轮组中操作换档组件，
所述齿轮连接组件还包括太阳齿轮，所述太阳齿轮至少部分与一个或多个行星齿轮相互啮合，以提供能够选择性地连接到第一阶段齿轮组件上的行星齿轮布置。
(18)如第(17)项所述的器械，其中，所述齿轮连接组件的太阳齿轮还包括脊部，所述脊部被构造成在第二齿轮组件中与形成在输入轴上的脊部相应地相互啮合，所述输出轴从第二阶段齿轮组件收纳进入齿轮连接组件中。
(19)如第(17)项所述的器械，其中，所述齿轮连接组件的太阳齿轮还包括脊部，所述脊部被构造成不在第一齿轮组件中与形成在输入轴上的脊部相应地相互啮合，所述输出轴从第二阶段齿轮组件收纳进入齿轮连接组件中。
(20)一种外科切割和紧固器械，包括：
(a)驱动轴；
(b)马达；以及
(c)换档组件，其连接到所述驱动轴和所述马达上，所述换档组件包括：
第一阶段齿轮组件，其连接到所述马达和所述驱动轴上，用于在第一齿轮组中操作换档组件，所述第一阶段齿轮组件包括太阳齿轮，所述太阳齿轮至少部分与一个或多个行星齿轮相互啮合，为第一阶段齿轮组件提供行星齿轮布置；
第二阶段齿轮组件，其连接到第一阶段齿轮组件和驱动轴上，所述第二阶段齿轮组件包括太阳齿轮，所述太阳齿轮至少部分与一个或多个行星齿轮相互啮合，为第二阶段齿轮组件提供行星齿轮布置；
齿轮连接组件，其用于选择性地将至少一个附加齿轮连接到所述第二阶段齿轮组件上，从而在第二齿轮组中操作换档组件，所述齿轮连接组件还包括太阳齿轮，所述太阳齿轮至少部分与一个或多个行星齿轮相互啮合，以提供能够选择性地连接到第二阶段齿轮组件上的行星齿轮布置；
其中，所述齿轮连接组件的太阳齿轮还包括脊部，所述脊部被构造成在第二齿轮组件中与形成在输入轴上的脊部相应地相互啮合，所述输出轴从第二阶段齿轮组件收纳进入齿轮连接组件中，所述齿轮连接组件的太阳齿轮的脊部还被构造成不在第一齿轮组件中与形成在输入轴上的脊部相应地相互啮合，所述输出轴从第二阶段齿轮组件收纳进入齿轮连接组件中。
附图说明
结合附图通过例子的方式描述本发明的不同实施例，其中：
图1和2是根据本发明不同实施例的内窥镜外科器械的透视图；
图3-5是根据本发明不同实施例的器械的端部执行器和轴的分解图；
图6是根据本发明不同实施例的端部执行器的侧视图；
图7是根据本发明不同实施例的器械的手柄的分解图；
图8和9是根据本发明不同实施例的手柄的局部透视图；
图10是根据本发明不同实施例的手柄的侧视图；
图11是根据本发明不同实施例的器械中使用的电路的示意图；
图12-13是根据本发明其他实施例的手柄的侧视图；
图14-22示出了用于锁定根据本发明不同实施例的闭合扳机的不同机构；
图23A-B示出了可用在根据本发明不同实施例的器械的关节运动点处的万向接头(“u-接头”)；
图24A-B示出了可用在根据本发明不同实施例的器械的关节运动点处的万向接头(“u-接头”)扭转电缆；
图25-31示出了根据本发明另一个实施例的具有动力辅助的内窥镜外科器械；
图32-36示出了根据本发明又一个实施例的具有动力辅助的内窥镜外科器械；
图37-40示出了根据本发明不同实施例的具有触觉反馈的内窥镜外科器械；
图41-42示出了根据本发明不同实施例可使用的比例传感器；
图43包括可根据本发明不同实施例设置的外科器械的手柄的侧视图；
图44示出了可根据本发明不同实施例设置的换档组件的局部剖视的局部示意侧视图；
图45示出了可根据本发明不同实施例设置的行星齿轮布置的示意图；
图46是图44的局部放大图；
图47包括可根据本发明不同实施例设置的换档组件的分解图；
图48包括可根据本发明不同实施例设置的换档组件的局部剖视的局部示意侧视图；
图49是图48的一个截面的视图；以及
图50是图48的局部放大图。
具体实施方式
图1和2示出了根据本发明不同实施例的内窥镜外科器械10。内窥镜外科器械10包括手柄6、轴8、在关节运动枢轴14处连接到轴8上的关节运动端部执行器12。关节运动控制器16可设置在手柄6附近，使端部执行器12围绕关节运动枢轴14转动。在所示的实施例中，端部执行器12能够用作内切割器，用于夹紧、切割和缝合组织，但是在其他实施例中，可以使用其他类型的端部执行器，例如用于其他类型的外科装置的端部执行器，如内切割器、抓钳、切割器、缝合器、夹具施放器、接入装置、药物/基因治疗输送装置、以及使用超声波、RF、或激光等的装置。
器械10的手柄6可包括闭合扳机18和击发扳机20，用于致动端部执行器12。应当理解，具有用于不同手术任务的端部执行器的器械可具有不同数量和类型的扳机或者其他适合的控制器，用于操作端部执行器12。所示的端部执行器12通过优选细长的轴8与手柄6分离。在一个实施例中，器械10的临床医生或者操作者可以通过利用关节运动控制器16使端部执行器12相对于轴8关节运动，如Geoffrey C.Hueil等人2006年1月10日提交的名称为“Surgical InstrumentHaving An Articulating End Effector”待审美国专利申请No.11/329020中更详细地描述的一样，该申请通过引用并入本文。
在该实施例中，端部执行器12包括缝钉通道22和可枢转平移的夹紧构件如钉砧24等，它们之间保持确保有效缝合和切割夹紧在端部执行器12中的组织的间距。手柄6包括手枪式握把26，临床医生向着手枪式握把26枢转地拉动闭合扳机18，使钉砧24朝着端部执行器12的缝钉通道22夹紧或者闭合，从而夹紧定位在钉砧24和缝钉通道22之间的组织。击发扳机20在闭合扳机18更远的外侧。一旦闭合扳机18锁定在下面将进一步描述的闭合位置，击发扳机20可朝着手枪式握把26稍微转动，从而操作者可用一只手触及。然后操作者可以向着手枪式握把26枢转地拉动击发扳机20，从而缝合和切割端部执行器12中的夹紧组织。在其他实施例中，可以使用除钉砧24之外的不同类型的夹紧构件，例如，相对的夹钳等。
应当理解，此处使用的术语“近侧”和“远侧”是相对于握持手柄6的临床医生而言。因此，相对于更近侧的手柄6而言，端部执行器12位于远侧。还应当理解，为了方便和清楚起见，使用的空间术语例如“垂直”和“水平”是相对附图而言。但是，可以多种方位和位置使用外科器械，这些术语并不意味着限制和绝对化。
可以首先致动闭合扳机18。一旦临床医生对端部执行器12的定位满意，医生可将闭合扳机18拉回到邻近手枪式握把26的其完全闭合的锁定位置。然后致动击发扳机20。当医生移除压力时击发扳机20返回打开位置(图1和2所示)，下面将更详细地描述。按压手柄6上的释放按钮时可释放锁定的闭合扳机18。
图3是根据不同实施例的端部执行器12的分解图。如图示实施例所示，除了前面描述的通道22和钉砧24之外，端部执行器12还可包括切割器械32、滑块33、钉仓34以及螺旋轴36，钉仓34可移除地安置于通道22中。切割器械32例如可以使小刀。钉砧24可以在连接到通道22的近端上的枢转点25处可枢转地打开和闭合。钉砧24还可在近端包括突起27，突起27插入机械闭合系统(下面将进一步描述)的部件中，以打开和关闭钉砧24。当致动闭合扳机18时，即当器械10的用户拉动闭合扳机18时，钉砧24可以围绕枢转点25枢转到夹紧或者闭合位置，如果端部执行器12的夹紧是满意的，操作者可致动击发扳机20(下面将更详细地描述)，使得刀32和滑块33沿着通道22纵向运动，由此切割夹紧在端部执行器12中的组织。滑块33沿着通道22的运动使得钉仓34的缝钉(未示出)被驱动通过切割的组织，靠在闭合的钉砧24上，使得缝钉密封切割的组织。名称为“Surgical stapling instrument incorporating an E-beam firing mechanism”的美国专利6,978,921更详细地描述了这种双冲程式内窥镜器械，该专利通用引用并入本文。滑块33可以是钉仓34的部件，使得当刀32在切割操作后缩回时，滑块33不会缩回。
应当注意，尽管这里描述的器械10的实施例采用缝合切割的组织的端部执行器12，在其他实施例中可以采用其他技术来闭合或者密封切割的组织。例如，也可采用利用RF能量或者粘结剂来密封切割的组织的端部执行器。Yates等人的名称为“Electrosurgical Hemostatic Devicewith Recessed and/or Offset Electrodes”的美国专利No.5,688,270和Yates等人的名称为“Electrosurgical Hemostatic Device”的美国专利No.5,709,680披露了利用RF能量密封切割的组织的内窥镜切割器械，这两篇专利通过引用并入本文。Jerome R.Morgan等人的美国专利申请No.11/267,811和Frederick E.Shelton，IV等人的美国专利申请No.11/267,383公开了采用粘结剂来密封切割的组织的内窥镜切割器械，这两篇申请通过引用并入本文。因此，尽管这里的描述涉及切割/缝合操作和下面的类似操作，应当理解，这只是示例性的实施例，并不因为这限制。可采用其他组织密封技术。
图4和5是分图示实施例示出的，轴8可包括由枢转连接件44枢转连接的近侧闭合管40和远侧闭合管42。远侧闭合管42包括开口45，钉砧24上的突起27插入该开口45，以打开和闭合钉砧24，如下面进一步描述的一样。近侧脊管46可设置在闭合管40、42内。主旋转(或近侧)驱动轴48可设置在近侧脊管46内，驱动轴48通过锥齿轮组件52与第二(远侧)驱动轴50连接。第二驱动轴50连接到驱动齿轮54上，驱动齿轮54接合螺旋轴36的近侧驱动齿轮56。垂直锥齿轮52b可安座于近侧脊管46的远端的开口57中，并可在该开口57中枢转。
远侧脊管58可用于装纳第二驱动轴50和驱动齿轮54、56。主驱动轴48、第二驱动轴50和关节运动组件(例如锥齿轮组件52a-c)有时整体称作“主驱动轴组件”。
滑块33可例如由塑料制成，并可具有倾斜的远侧表面。当滑块33横过通道22时，倾斜向上的表面可向上推动或驱动钉仓中的缝钉通过夹紧的组织，靠在钉砧24上。钉砧24转动缝钉24，由此缝合切割的组织。当刀32缩回时，刀32和滑块33可脱离接合，由此使滑块33留在通道的远端。
如上所述，由于用户缺乏切割/缝合操作的反馈，在仅仅通过按压按钮致动切割/缝合操作的情况下，医生难以接受马达驱动的内切割器。相反，本发明的实施例提供了这样一种马达驱动的切割器，其具有端部执行器中的切割器械的展开、受力和/位置的用户反馈。
图7-10示出了马达驱动的内切割器尤其是其手柄6的一个示例性实施例，该手柄6提供有关端部执行器中的切割器械的展开和加载力的用户反馈。另外，该实施例可采用用户在缩回击发扳机20时提供的能量，以对装置供能(所谓的动力辅助模式)。如该示例性实施例所示，手柄6包括外部下侧件59、60和外部上侧件61、62，它们相互配合整体上形成手柄6的外部。电池64，例如锂离子电池，可设置在手柄6的手枪式握把26中。电池64对设置在手柄6的手枪式握把26的上部中的马达供电。根据不同实施例，马达65可以是DC电刷驱动马达，其最大转速为大约5000RPM。马达可驱动包括第一锥齿轮68和第二锥齿轮70的90°的锥齿轮组件66。锥齿轮组件66可驱动行星齿轮组件72。行星齿轮组件72可包括连接到驱动轴76上的小齿轮74。小齿轮74可驱动相配合的环形齿轮78，环形齿轮78通过驱动轴82驱动螺旋齿轮鼓80。环84可拧入螺旋齿轮鼓80。因此，当马达65转动时，通过中间夹设的锥齿轮组件66、行星齿轮组件72和环形齿轮78使环84沿着螺旋齿轮鼓80运动。
手柄6还可包括与击发扳机20连通的运转马达传感器110，当操作者朝着手柄6的手枪式握把26拉近(或者“关闭”)击发扳机20时，运转马达传感器110进行检测，由此通过端部执行器12致动切割/缝合操作。传感器110可以是比例传感器，例如变阻器或者可变电阻器。当拉近击发扳机20时，传感器110检测运动并发出供给马达65的表现为电压(或动力)的电信号。当传感器110时可变电阻器等时，马达65的转速可以与击发扳机20的运动量大致成比例。也就是说，如果操作者仅轻微拉动或者关闭击发扳机20，马达65的转速较低。当完全拉近击发扳机20(或者出于完全关闭位置)，马达65的转速为其最大值。换句话说，用户越用力拉动击发扳机20，施加到马达65上的电压越多，产生更大的转速。
手柄6可包括位于击发扳机20的上部附近的中间手柄件104。手柄6还可包括偏压弹簧112，其连接在中间手柄件104上的柱和击发扳机20之间。偏压弹簧112可将击发扳机20偏压到其完全打开位置。这样，当操作者释放击发扳机20时，偏压弹簧112将击发扳机20拉到其打开位置，由此释放传感器110的致动，从而停止马达65的转动。此外，借助于偏压弹簧112，每当用户关闭击发扳机20时，用户会感到关闭操作的阻碍，由此提供给用户有关马达65转动量的反馈。另外，操作者可停止缩回击发扳机20，以从传感器110移除力，由此停止马达65。同样，用户可停止展开端部执行器12，由此为操作者提供对切割/密封操作的控制的测量。
螺旋齿轮鼓80的远端包括驱动环形齿轮122的远侧驱动轴120，该环形齿轮122与小齿轮124啮合。小齿轮124连接到主驱动轴组件的主驱动轴48上。这样，马达65的转动使得主驱动轴组件转动，从而致动端部执行器12，如上面所描述的一样。
拧入螺旋齿轮鼓80的环84可包括设置在带槽臂90的槽88中的柱86。带槽臂90的相对端部94具有开口92，装纳连接在手柄外侧件59、60之间的枢轴销96。枢轴销96还穿过通过击发扳机20中的开口100和中间手柄件104中的开口102。
另外，手柄6可包括反转马达65(或冲程结束)传感器130和停止马达65(冲程开始)传感器142。在不同实施例，反转马达传感器130可以是位于螺旋齿轮鼓80远端的限制开关，使得当环84到达螺旋齿轮鼓80的远端时拧入螺旋齿轮鼓80的环84接触和脱扣反转马达传感器130。反转马达传感器130在启动时对马达65发送信号，以倒转其转动方向，由此在切割操作之后缩回端部执行器12的刀32。
停止马达传感器142例如可以是常闭限制开关。在不同实施例中，停止马达传感器142可以位于螺旋齿轮鼓80的近端，使得当环84到达螺旋齿轮鼓80的近端时环84断开(trip)开关142。
在操作中，当器械10的操作者拉回击发扳机20时，传感器110检测击发扳机20的展开并对马达65发送信号，使得马达65例如以与操作者拉回击发扳机20所用力的程度成比例的速度向前旋转。马达65的向前旋转又使得行星齿轮组件72远端的环形齿轮78旋转，由此使得螺旋齿轮鼓80转动，从而使拧入螺旋齿轮鼓80的环84沿着螺旋齿轮鼓80向远侧运动。螺旋齿轮鼓80的转动还驱动如上所述的主驱动轴组件，这又使得端部执行器12中的刀32展开。也就是说，使得刀32和滑块33纵向运动经过通道22，由此切割夹紧在端部执行器12中的组织。此外，在使用缝合式端部执行器的实施例中使端部执行器12产生缝合操作。
当端部执行器12的切割/缝合操作完成时，螺旋齿轮鼓80上的环84到达螺旋齿轮鼓80的远端，由此使反转马达传感器130断开，对马达65发送信号使马达65倒转其转动方向。这使得刀32缩回，从而使螺旋齿轮鼓80上的环84运动回到螺旋齿轮鼓80的近端。
如图8和9中最清楚地显示的一样，中间手柄件104包括后侧肩部106，后侧肩部106接合带槽臂90。中间手柄件104还具有接合击发扳机20的向前运动挡块107。带槽臂90的运动如上所述受马达65的转动控制。当环84从螺旋齿轮鼓80的近端朝远端运动时，在带槽臂90逆时针转动(CCW)的情况下，中间手柄件104自由逆时针转动。因此，当用户拉近击发扳机20时，击发扳机20接合中间手柄件104的向前运动挡块107，使得中间手柄件104逆时针转动。由于后侧肩部106接合带槽臂90，中间手柄件104仅能够在带槽臂90允许的范围内逆时针转动。这样，如果马达65由于一些原因停止转动，带槽臂90也会停止转动，用户就不能进一步拉近击发扳机20，因为带槽臂90使得中间手柄件104不能自由逆时针转动。
图41和42示例性示出了可用作根据本发明的不同实施例的运转马达传感器110的可变传感器的两科状态。传感器110可包括表面部分280、第一电极(A)282、第二电极(B)284和电极282、284之间的可压缩的电介质材料286(例如EAP)。可以定位传感器110，使得表面部分280接触缩回的击发扳机20。因此，当击发扳机20缩回时，电介质材料286被压缩，如图42所示，使得电极282、284靠得更近。由于电极282、284之间的距离“b”与电极282、284之间的阻抗直接相关，距离越大，阻抗越大，距离越小，阻抗越小。这样，由于击发扳机20的缩回使电介质材料286被压缩的量(图42中表示为“F”)与电极282、284之间的阻抗成比例，可以用来成比例地控制马达65。
图7-10还显示出了用于通过缩回闭合扳机18闭合(夹紧)端部执行器12的钉砧24的示例性闭合系统的部件。在该示例性实施例中，闭合系统包括轭250，其通过销251连接到闭合扳机18上，销251通过闭合扳机18和轭250中对准的开口插入。枢轴销252通过闭合扳机18中的另一个孔插入，该孔偏离销251插入闭合扳机18中的那个孔，闭合扳机18围绕枢轴销252枢转。这样，闭合扳机18的缩回使得闭合扳机18的上部逆时针转动，轭250通过销251连接到闭合扳机18的所述上部上。轭250的远端通过销254连接到第一闭合支架256上。第一闭合支架256连接到第二闭合支架258上。闭合支架256、258整体限定了一个开口，近侧闭合管40(参见图4)的近端安座并保持在该开口中，从而闭合支架256、258的纵向运动使得近侧闭合管40纵向运动。器械10还包括设置在近侧闭合管40内的闭合杆260。闭合杆260可包括窗口261，手柄外部件中的一个(例如该示例性实施例中的外部下侧件59)上的柱263设置在窗口261中，以将闭合杆260固定地连接到手柄6上。这样，近侧闭合管40能够相对于闭合杆260纵向运动。闭合杆260还可包括远侧轴环267，轴环267装配到近侧脊管46的腔269中并通过帽271(参见图4)保持在其中。
在操作中，当由于闭合扳机18缩回使得轭250转动时，闭合支架256、258使近侧闭合管40向远侧(远离器械10的手柄端部)运动，这使得远侧闭合管42向远侧运动，从而使钉砧24围绕枢轴销25转动到夹紧或者闭合位置。当闭合扳机18从锁定位置解锁时，使近侧闭合管40向近侧滑动，这又通过插在远侧闭合管42的开口45中的突起27使得远侧闭合管42向近侧滑动，从而使钉砧24围绕枢轴销25转动到打开或者松开位置。这样，通过缩回和锁定闭合扳机18，操作者可夹紧钉砧24和通道22之间的组织，并且可以在切割/缝合操作之后通过从锁定位置解锁闭合扳机18来松开组织。
图11是根据本发明不同实施例的器械10的电路的示意图。当操作者在锁定闭合扳机18之后首次拉近击发扳机20时，传感器110被启动，允许电流流过。如果常开反转马达传感器开关130打开(意味着没有到达端部执行器冲程的末端)，电流流向单极双掷继电器132。由于反转马达传感器开关130没有闭合，继电器132的线圈134不会被供电，使得继电器132处于未供电状态。该电路还包括钉仓锁定传感器136。如果端部执行器12包括钉仓34，则传感器136处于闭合状态，允许电流流过。否则，如果端部执行器12不包括钉仓34，传感器136则打开，由此防止电池64对马达65供电。
当存在钉仓34时，传感器136闭合，使得对单极单掷继电器138供电。当继电器138被供电时，电流借助于双极双掷继电器140经过可变电阻器传感器110流向马达65，由此对马达65供电，允许马达65向前转动。
当端部执行器12到达其冲程末端时，反转马达传感器130被启动，由此关闭开关130并对继电器132供电。这使得继电器132处于供电状态(图11没有示出)，从而使电流绕过钉仓锁定传感器136和可变电阻器110，而且使得电流流向常闭双极双掷继电器140并回到马达65，但是电流通过继电器140使马达65倒转其转动方向。
由于停止马达传感器开关142是常闭开关，所以电流流回继电器132，以保持继电器132关闭直到开关142打开。当刀32完全缩回时，停止马达传感器开关142被启动，使得开关142打开，由此将能量从马达65移除。
在其他实施例中，可以使用开-关式传感器而不是比例式传感器110。在这些实施例中，马达65的转动速度与操作者施加的力不成比例。马达65是以恒定的速度转动。但是操作者还是感到力的反馈，因为击发扳机20连接在齿轮传动系统中。
图12是根据另一个实施例的动力辅助马达驱动的内切割器的手柄6的侧视图。图12的实施例类似于图7-10的实施例，只是在图12的实施例中没有连接到拧在螺旋齿轮鼓80上的环84上的带槽臂90。相反，在图12的实施例中，环84包括传感器部分114，当环114在螺旋齿轮鼓80上向下前进(以及回来)时，传感器部分114与环84一起运动。传感器部分114包括凹口116。反转马达传感器130可位于凹口116的远端，停止马达传感器142可位于凹口116的近端。当环84在螺旋齿轮鼓80上向下运动(以及回来)时，传感器部分114与环84一起运动。另外，如图12所示，中间手柄件104可以具有伸入凹口116中的臂118。
在操作中，当器械10的操作者朝着手枪式握把26缩回击发扳机20时，运转马达传感器110检测该运动并且发送信号对马达65供电，这使得螺旋齿轮鼓80转动。当螺旋齿轮鼓80转动时，拧在螺旋齿轮鼓80上的环84前进(或者缩回，取决于转动)。此外，由于拉近击发扳机20，与击发扳机20接合的向前运动的挡块107使得中间手柄件104与击发扳机20一起逆时针转动。中间手柄件104的逆时针转动使得臂118与环84的传感器部分114一起逆时针转动，使得臂118保持设置在凹口116中。当环84到达螺旋齿轮鼓80的远端时，臂118接触倒转马达传感器130并由此将其断开。同样，当环84到达螺旋齿轮鼓80的近端时，臂118接触停止马达传感器142，由此将其断开。如上所述，这些动作分别可以倒转和停止马达65。
图13是根据另一个实施例的动力辅助马达驱动的内切割器的手柄6的侧视图。图13所示的实施例类似于图7-10的实施例，只是图13的实施例的臂90没有设置槽。而拧在螺旋齿轮鼓80上的环84包括垂直通道126。臂90包括设置在通道126中的柱128，而不包括槽。当螺旋齿轮鼓80转动时，拧在螺旋齿轮鼓80上的环84前进(或者缩回，取决于转动)。如图13所示，当环84前进时由于柱128设置在通道126中，臂90逆时针转动。
如上所述，在使用双冲程马达驱动的器械时，操作者首先拉回闭合扳机18并将其锁定。图14和15示出了将闭合扳机18锁到手柄6上的手枪式握把26上的方式的一个实施例。在该示例性实施例中，手枪式握把26包括钩状物150，其受扭转弹簧152偏压，以围绕枢转点151逆时针转动。此外，闭合扳机18包括闭合杆154。当操作者拉近闭合扳机18时，闭合杆154接合钩状物150的倾斜部分156，由此使钩状物150向上(或者如图14-15顺时针)转动，直到闭合杆154完全将倾斜部分156送入钩状物150的凹口158中，由此将闭合扳机18锁定就位。操作者可通过下压在手枪式握把26的后侧或相对侧上的滑动释放按钮160来释放闭合扳机18。下压滑动释放按钮160使得钩状物150顺时针转动，从而使闭合杆154从凹口158释放。
图16示出了根据不同实施例的另一个闭合扳机锁定机构。在图16所示的实施例中，闭合扳机18包括具有箭头部分161的楔形件160。通过板簧162向下(或顺时针)偏压箭头部分161。楔形件160和板簧162可例如由模制的塑料制成。当闭合扳机18缩回时，箭头部分161通过手柄6的手枪式握把26中的开口164插入。箭头部分161的下部斜切表面166接合开口164的下部侧壁168，迫使箭头部分161逆时针转动。下部斜切表面166最后完全经过下部侧壁168，由此去除箭头部分161上的逆时针方向的力，从而使下部侧壁168滑入箭头部分161后侧的凹口170中的锁定位置。
为了解锁闭合扳机18，用户可下压闭合扳机18的相对侧上的按钮172，使箭头部分161逆时针转动，并允许箭头部分161滑出开口164。
图17-22示出了根据另一个实施例的闭合扳机锁定机构。如该实施例所示，闭合扳机18包括挠性纵向臂176，挠性纵向臂176包括从其伸出的横向销178。臂176和销178可以例如由模制的塑料制成。手柄6的手枪式握把26包括开口180，横向延伸的楔形件182设置在开口180中。当闭合扳机18缩回时，销178接合楔形件182，并且通过楔形件182的下表面184迫使销178向下运动(即，使臂176顺时针转动)，如图17和18所示。当销178完全经过下表面184时，移除臂176上的顺时针方向的力，使得销178逆时针转动，从而销178靠在楔形件182后侧的凹口186中，如图19所示，并由此锁定闭合扳机18。通过从楔形件184延伸的挠性挡块188将销178进一步保持就位于锁定位置中。
为了解锁闭合扳机18，操作者可进一步挤压闭合扳机18，使销178接合开口180的倾斜后壁190，迫使销178向上运动经过挠性挡块188，如图20和21所示。然后销178可在开口180的上部通道192外自由运动，使得闭合扳机18不再锁定到手枪式握把26上，如图22所示。
图23A-B示出了万向接头(“u-接头”)195。u-接头195的第二部件195-2沿着第一部件195-1所处的水平面转动。图23A示出了沿直线(180°)定向的u-接头195，图23B示出了以大致150°定向的u-接头195。可以在主驱动轴组件的关节运动点14处使用u-接头195来使端部执行器12关节运动，而不是使用锥齿轮52a-c(如图4所示)。图24A-B示出了可以代替锥齿轮52a-c和u-接头195的扭转电缆197，用于实现端部执行器12的关节运动。
图25-31示出了具有根据本发明另一个实施例的动力辅助系统的马达驱动的双冲程内窥镜外科器械10的另一个实施例。图25-31的实施例与图6-10的实施例类似，只是图25-31的实施例不使用螺旋齿轮鼓80，而是包括替代的齿轮驱动组件。图25-31的实施例包括齿轮箱组件200，齿轮箱组件200包括多个设置在框架201中的齿轮，这些齿轮在驱动轴48的近端处连接在行星齿轮72和小齿轮124之间。如下面进一步描述的，齿轮箱组件200通过击发扳机20向用户提供关于端部执行器12的展开和加载力的反馈。此外，用户可通过齿轮箱组件200提供动力，以辅助端部执行器12的展开。这样，与上面描述的实施例类似，图25-31所示的实施例是另一种动力辅助的马达驱动的器械10，其向用户提供关于切割器械32所受的加载力的反馈。
在该示例性实施例中，击发扳机20包括两个部件，即主体部分202和加强部分204。主体部分202可以例如由塑料制成，加强部分204可以由更具刚性的材料制成，例如金属。在该示例性实施例中，加强部分204与主体部分202相邻，但是根据其他实施例，加强部分204可以设置在主体部分202内部。枢轴销207可以插入击发扳机部件202、204的开口中，击发扳机20可以围绕枢轴销207枢转。另外，弹簧222可以偏压击发扳机20，使其逆时针转动。弹簧222可具有连接到销224上的远端，销224连接到击发扳机20的部件202、204上。弹簧222的近端可以连接到手柄外部下侧件59、60中的一个上。
在该示例性实施例中，主体部分202和加强部分204在它们的上端部分别包括齿轮部分206、208。如下面所描述的，齿轮部分206、208接合齿轮箱组件200中的齿轮，以驱动主驱动轴组件，并且向用户提供关于端部执行器12的展开的反馈。
在该示例性实施例中，如图所示，齿轮箱组件200可包括六个齿轮。齿轮箱组件200的第一齿轮210接合击发扳机20的齿轮部分206、208。另外，第一齿轮210接合较小的第二齿轮212，较小的第二齿轮212与较大的第三齿轮214同轴。第三齿轮214接合较小的第四齿轮216，较小的第四齿轮216与第五齿轮218同轴。第五齿轮218是90°的锥齿轮，其接合相配合的90°锥齿轮220(如图31最清楚地示出的)，锥齿轮220连接到小齿轮124上，小齿轮124驱动主驱动轴48。
在操作中，当用户缩回击发扳机20时，运转马达传感器(未示出)被致动，从而可对马达65提供信号，使其以与操作者缩回击发扳机20的程度或用力的大小成比例的速度转动。这使得马达65以与来自传感器的信号成比例的速度转动。用于该实施例的传感器未示出，但是其可以类似于上述运转马达传感器110。该传感器可以位于手柄6中，从而当击发扳机20缩回时传感器被下压。此外，可以使用开/关式传感器，而不是比例式传感器。
马达65的转动使得锥齿轮66、70转动，这又使得行星齿轮72转动，从而通过驱动轴76使得环形齿轮122转动。环形齿轮122与小齿轮124啮合，小齿轮124连接在主驱动轴48上。这样，小齿轮124的转动驱动主驱动轴48，这使得端部执行器12的切割/缝合操作被致动。
小齿轮124的向前的转动又使得锥齿轮220转动，从而通过齿轮箱组件200中的其他齿轮使得第一齿轮210转动。第一齿轮210接合击发扳机20的齿轮部分206、208，由此当马达65对端部执行器12提供向前的驱动力时，使击发扳机20逆时针转动(并且当马达65反转以缩回端部执行器12时，使击发扳机20顺时针转动)。这样，用户通过握持在击发扳机20上感受到关于端部执行器12的加载力和展开的反馈。因此，当用户缩回击发扳机20时，操作者感受到与由端部执行器12所受的加载力有关的阻力。同样，当操作者在切割/缝合操作后释放击发扳机20时，击发扳机20回到其原始位置，用户可以从击发扳机20感受到顺时针转动力，其与马达65的反转速度基本上成比例。
还应注意，在该实施例中，用户可施加力(代替来自马达65的力或者除了来自马达65的力之外)，以通过缩回击发扳机20来致动主驱动轴组件(因此致动端部执行器12的切割/缝合)。也就是说，缩回击发扳机20使得齿轮部分206、208逆时针转动，这使得齿轮箱组件200的齿轮转动，由此使得小齿轮124转动，从而使主驱动轴48转动。
尽管图25-31没有显示，但器械10还可以包括反转马达传感器和停止马达传感器。如上所述，反转马达传感器和停止马达传感器可分别检测切割冲程的结束(刀32和滑块33完全展开)和缩回操作的结束(刀/滑块驱动构件32完全缩回)。可使用与图11所示的电路类似的电路来对马达65适当地供电。
图32-36示出了具有根据另一个实施例的动力辅助系统的双冲程马达驱动的内窥镜外科器械10。图32-36的实施例类似于图25-31的实施例，只是图32-36的实施例中击发扳机20包括下部228和上部230。上部230和下部228都连接到枢转销207上并围绕其枢转，枢转销207穿过每个部分228、230。上部230包括与齿轮箱组件200的第一齿轮210的齿轮部分232。弹簧222连接到上部230上，使得上部230受到偏压，顺时针方向转动。上部230还可包括下部臂234，下部臂234接触击发扳机20的下部228的上表面，从而当上部230顺时针转动时，下部228也顺时针转动，当下部228逆时针转动时，上部230也逆时针转动。同样，下部228包括接合上部230的下侧肩部的转动挡块238。这样，当上部230逆时针转动时，下部228也逆时针转动，当下部228顺时针转动时，上部230也顺时针转动。
该实施例还包括运转马达传感器110，其对马达65发送信号，在不同实施例中，该信号可使马达65以与缩回击发扳机20时操作者施加的力成比例的速度转动。传感器110可以例如是变阻器或者这里描述的其他的可变电阻传感器。此外，器械10可包括反转马达传感器130，传感器130当与击发扳机20的上部230的前表面242接触时断开或者转换。当反转马达传感器130被致动时，会对马达65发送信号，以使其倒转方向。此外，器械10可包括停止马达传感器142，传感器142在与击发扳机20的下部228接触时断开或者致动。停止马达传感器142在被致动时发送信号以停止马达65的反转。
在操作中，当操作者将闭合扳机18缩回到锁定位置时，击发扳机20稍微缩回(通过本领域已知的机构，包括Swayze等人的名称为“Surgical Stapling Instrument incorporating a Firing Mechanism having a Linked RackTransmission”的美国专利No.6,905,057，该专利通过引用并入本文)，使得用户可以抓住击发扳机20，以开始切割/缝合操作，如图32和33所示。此时，如图33所示，击发扳机20的上部230的齿轮部分232运动成与齿轮箱组件200的第一齿轮210接合。当操作者缩回击发扳机20时，根据不同实施例，击发扳机20可在断开运转马达传感器110之前少量转动(例如5度)，如图34所示。传感器110的启动使得马达65以由操作者施加的缩回力成比例的速度向前转动。如上所述，马达65的向前转动使得主驱动轴48转动，这使得端部执行器12中的刀32展开(例如开始运动经过通道22)。连接到主驱动轴48上的小齿轮124的转动使得齿轮箱组件200中的齿轮210-220转动。由于第一齿轮210与击发扳机20的上部230的齿轮部分232接合，使得上部230逆时针转动，从而使下部228也逆时针转动。
当刀32完全展开(即切割冲程结束时)，上部230的前表面242断开反转马达传感器130，发送信号使马达65倒转转动方向。这使得主驱动轴组件倒转转动方向，以缩回刀32。主驱动轴组件的反转使得齿轮箱组件200中的齿轮210-220倒转方向，使得击发扳机20的上部230顺时针转动，从而使得击发扳机20的下部228顺时针转动，直到刀32全缩回时上部230的前表面242断开或者致动停止马达传感器142，使得马达165停止。这样，用户通过握持在击发扳机20上感受到关于端部执行器12的展开的反馈。因此，当用户缩回击发扳机20时，操作者感受到与端部执行器12的展开有关的阻力，特别是与刀32承受的加载力有关的阻力。同样，当操作者在切割/缝合操作后释放击发扳机20使其回到原始位置时，用户可以从击发扳机20感受到顺时针转动力，其与马达的反转速度基本上成比例。
还应注意，在该实施例中，用户可施加力(代替来自马达65的力或者除了来自马达65的力之外)，以通过缩回击发扳机20来致动主驱动轴组件(因此致动端部执行器12的切割/缝合)。也就是说，缩回击发扳机20使得上部230的齿轮部分232逆时针转动，这使得齿轮箱组件200的齿轮转动，由此使得小齿轮124转动，从而使主驱动轴组件转动。
上述实施例采用了用于双冲程马达驱动内窥镜外科器械的动力辅助用户反馈系统，其具有或者不具有自适应控制功能(例如利用马达65、齿轮传动系和端部执行器的闭环控制系统外部的传感器110、130和142)。也就是说，在缩回击发扳机20时由用户施加的力可以借助于连接到马达65和主驱动轴48之间的齿轮传动系上的击发扳机20添加到由马达65施加的力上。在本发明的其他实施例中，用户可有关于端部执行器12中的刀32的位置的触觉反馈，但是击发扳机20不连接到齿轮传动系上。图37-40示出了具有这种触觉位置反馈系统的马达驱动的内窥镜外科器械10。
在图37-40所示的示例性实施例中，击发扳机20可具有下部228和上部230，类似于图32-36所示的器械10。但是，与图32-36所示的实施例不同的是，上部230不具有与部分齿轮传动系配合的齿轮部分。器械10而是包括第二马达265，其螺纹杆266拧入其中。当马达265转动时，根据转动方向，螺纹杆266纵向往复运动进入和离开马达265。器械10还包括编码器268，其响应于主驱动轴48的转动，以例如将主驱动轴48(或者主驱动组件的其他部件)的增量角运动转化成对应的数字信号序列。在该示例性实施例中，小齿轮124包括连接到编码器268上的近侧驱动轴270。
器械10还包括可通过使用微控制器或者其他类型的集成电路执行的控制电路(未示出)，该控制电路接受来自编码器268的数字信号。根据来自编码器268的数字信号，控制电路可计算端部执行器12中的刀32的展开的阶段。也就是说，控制电路可计算刀32是否完全展开、完全缩回或者处于中间阶段。根据端部执行器12的展开阶段的计算结果，控制电路可对第二马达265发送信号，以控制其转动，由此控制螺纹感266的往复运动。
在操作中，如图37所示，当闭合扳机18未锁定到夹紧位置时，击发扳机20转动离开手柄6的手枪式握把26，使得击发扳机20的上部230的前表面242不与螺纹杆266的近端接触。当操作者缩回闭合扳机18并将其锁定到夹紧位置时，击发扳机20朝着闭合扳机18稍微转动，使得操作者可以抓住击发扳机20，如图38所示。在该位置，上部230的前表面240接触螺纹杆266的近端。
当用户缩回击发扳机20时，运转马达传感器110在初始转动量(例如旋转5度)之后可以被启动，使得传感器110如上所述对马达发送信号，使其以与操作者对击发扳机20施加的缩回力的量成比例的速度向前转动。马达的向前转动通过齿轮传动系使主驱动轴48转动，从而使刀32和滑块33沿着通道22向下运动，并且切割夹紧在端部执行器12中的组织。控制电路接收来自编码器268的关于主驱动轴组件的增量转动的输出信号并且对第二马达265发送信号，使第二马达265转动，从而使螺纹杆266缩回到马达265。这允许击发扳机20的上部230逆时针转动，从而允许击发扳机的下部228也逆时针转动。这样，由于螺纹杆266的往复运动与主驱动轴组件的转动有关，所以器械10的操作者通过他对击发扳机20的握持感受到关于端部执行器12的位置的触觉反馈。但是，操作者施加的缩回力不直接影响主驱动轴组件的驱动，因为该实施例中击发扳机20没有连接到齿轮传动系上。
通过借助于来自编码器268的输出信号跟踪主驱动轴组件的增量转动，控制电路可以计算刀32何时完全展开(即完全伸出)。此时，控制电路可对马达发送信号，使其倒转方向，从而缩回刀32。马达的反转使得主驱动轴组件的转动方向也倒转，这也可由编码器268检测到。根据编码器268检测的反转方向，控制电路对第二马达265发送信号，使其倒转转动方向，从而螺纹杆266开始从马达265纵向伸出。该运动迫使击发扳机20的上部230顺时针转动，从而使下部228顺时针转动。这样，操作者可从击发扳机20感受到顺时针方向的力，其向操作者提供了关于端部执行器12中的刀32的缩回位置的反馈。控制电路可确定刀32何时完全缩回。此时，控制电路可对马达发送信号停止转动。
根据其他实施例，可采用如上所述的反转马达传感器和停止马达传感器，而不具有确定刀32的位置的控制电路。另外，可使用开/关式开关或传感器，而不使用用于控制马达的转动的比例传感器110。在这种实施例中，操作者不能控制马达的转速。马达而是以预编程的速度转动。
总的参照图43-50，在本发明的不同实施例中，可采用换档组件1002，以例如与器械10的马达65相互作用。换档组件1002可以连接到马达65上和驱动轴76上，并且能够允许用户调节从马达65传递到驱动轴76的机械动力。如下面将更详细描述的，换档组件1002允许选择性地增加或者减少传动比，以传递器械10的马达65产生的动力。该选择性的增加/减少特征对于与涉及使用切割/缝合各种类型和密度的组织的外科手术联用是有利的。
参照图43-47，换档组件1002包括第一阶段齿轮组件1004，其接收来自连接到马达65上的输入轴1006的机械输入动力量。在不同实施例中，输入轴1006可直接连接到马达65上，或者动力可从马达65通过一个或多个其他部件(例如锥齿轮组件66、70)传递到输出轴1006。如图45更具体地示出的，第一阶段齿轮组件1004可包括太阳齿轮1004A，其至少部分与一个或多个周围的行星齿轮1004B、1004C、1004D相互啮合，为第一阶段齿轮组件1004提供行星齿轮布置。在操作器械10的过程中，第一阶段齿轮组件1004的太阳齿轮1004A可连接到输入轴1006上，以传递来自马达65的机械输入动力，使太阳齿轮1004A转动。由于太阳齿轮1004A转动，可以看出，每个行星齿轮1004B、1004C、1004D也相应转动。每个行星齿轮1004B、1004C、1004D可(分别)通过销1004E、1004F、1004G连接，以将由太阳齿轮1004A的旋转运动产生的机械动力传递到如图所示的第一阶段齿轮组件1004的齿轮盘1004H上。
第一阶段齿轮组件1004的齿轮盘1004H可以连接到输入轴1008上，输入轴1008又可以连接到第二阶段齿轮组件1010上。第二阶段齿轮组件1010可以基本上根据第一阶段齿轮组件1004(如上所述)的结构和部件来构造。第二阶段齿轮组件1010可包括太阳齿轮1010A，其至少部分与一个或多个行星齿轮(例如行星齿轮1010B)相互啮合，为组件1010提供行星齿轮布置。第二阶段齿轮组件1010的太阳齿轮1010A可连接到输入轴1008上，以传递从第一阶段齿轮组件1004接收的转动输入动力。以类似于第一阶段齿轮组件1004的行星齿轮1004B、1004C、1004D的方式，行星齿轮1010B可通过销1010C连接，以将由太阳齿轮1010A的旋转运动产生的机械动力传递到第二阶段齿轮组件1010的齿轮盘1010D上。
在换档组件1002的第一齿轮组中，如图44所示，第一阶段齿轮组件1004和第二阶段齿轮组件1010可连接到器械10的驱动轴76上。但是，应当理解，比示出的齿轮组件1004、1010更多或更少的齿轮组件或者其一部分可以适当地应用于器械10中，取决于传动比或者器械10的应用。例如，在一些实施例中，第一阶段齿轮组件可以包括在齿轮传动系中，其中输入轴连接到第二阶段齿轮组件1010的输出轴上。
在不同实施例中，齿轮连接组件1020可以通过输入轴1022连接到第二阶段齿轮组件1010的齿轮盘1010D上。齿轮连接组件1020可包括太阳齿轮1020A，其至少部分与一个或多个行星齿轮例如行星齿轮1020B啮合。这种包括太阳齿轮1020A和行星齿轮1020B的行星齿轮布置可以由保持盘1020C邻接，保持盘1020C通过销1020D连接，销1020D通过每个行星齿轮1020B延伸到套环1020E。此外，推力轴承1020F可以定位在太阳齿轮1020A和保持盘1020C之间，推力轴承1020G可以定位在太阳齿轮1020A和套环1020E之间，以促进将太阳齿轮1020A固定地定位在齿轮连接组件1020中。
太阳齿轮1020A可包括脊部1020H，脊部1020H能够与形成在输入轴1022上的脊部1024相应地相互啮合。在图44所示的第一齿轮组中，太阳齿轮1020A的脊部1020H不与输入轴1022的脊部1024相互啮合。应当理解，第一齿轮组从第二阶段齿轮组件1010提供驱动力到齿轮连接组件1020的保持盘1020C，无需太阳齿轮1020A与输入轴1022相互作用。换句话说，允许齿轮连接组件1020的太阳齿轮1020A在第一齿轮组中自由转动，齿轮连接组件1020的太阳齿轮1020A没有与第一阶段齿轮组件1004和第二阶段齿轮组件1010一起连接到驱动轴76上。套环1020E包括脊部1020I，脊部1020I能够与形成在驱动轴76上的脊部1026相应地相互啮合。可以看出，在第一齿轮组中，套环1020E的脊部1020I与驱动轴76的脊部1026相互啮合，以将机械转动动力从套环1020E传递到驱动轴76。另外，在第一齿轮组中，套环1020E的脊部1020I可以相应地与输入轴1022上的脊部1024相互啮合。
在不同实施例中，可以通过使用齿轮选择器组件1032将齿轮连接组件1020从第一齿轮组移出或移入第一齿轮组。齿轮选择器组件1032包括连接到轭1032B上的开关1032A。开关1032A能够通过其与轭1032B的连接例如允许用户的拇指或手指将齿轮连接组件1020移出或移入第一齿轮组。如图47更具体地示出的，轭1032B可以通过收纳在至少一部分套环1020E圆周周围的轭收纳沟槽1020J中，从而连接到齿轮连接组件1020的套环1020E上。轭1032B可以包括一个或多个从轭1032B伸出的销1032C、1032D，它们可以收纳在轭收纳沟槽1020J中，以促进将轭1032B固定在其中。如图44所示，齿轮选择器组件1032已经被致动，以将换档组件1002放入第一齿轮组的位置中。
参照图48-50，在换档组件1002的第二齿轮组中，齿轮连接组件1020可以相对于马达65选择性地向远侧运动，以将太阳齿轮1020A的脊部1020H与输入轴1022的脊部1024接合或连接。轭1032B由于其与齿轮连接组件1020的套环1020E的连接，通过轭1032B的动作使齿轮连接组件1020运动。如上所述，轭1032B使齿轮连接组件1020在第一和第二齿轮组之间运动的动作可以通过用户致动齿轮选择器组件1032的开关1032A来进行。可以看出，在第一和第二齿轮组中套环1020E的脊部1020I保持与形成在驱动轴76上的脊部1026接合或相互啮合，以将机械动力通过齿轮连接组件1020传递到驱动轴76。
可以理解，在第一齿轮组中，只有第一和第二阶段齿轮组件1004、1010在直接驱动驱动轴76方面与马达65在操作上相关。第一齿轮组件可用于较低扭矩较高速度的驱动轴76的应用，例如用于涉及切割/缝合低密度的组织的操作。在第二齿轮组中，齿轮连接组件1020的行星齿轮布置可以连接到传动系上，以提供较高扭矩较低速度的驱动轴76的动作，例如用于涉及切割/缝合高密度的组织的操作。总之，在不同实施例中，换档组件1002允许用户实现传动系的扭矩和速度的适当混合，取决于器械10用于不同密度、厚度或其他特性的组织的不同操作的需要。
尽管本发明已经对一些公开的实施例进行了描述，但可以对这些实施例进行许多改进和变型。例如，可以使用不同类型的端部执行器。此外，对于公开的用于一些部件的材料，可以采用其他的材料。前述说明和后附的权利要求书旨在覆盖所有这些改进和变型。
通过引用而全部或者部分并入本文中的任何专利、公开出版物或者其它公开的材料，仅限于不会与在本申请中公开的定义、陈述或者其它公开的材料相矛盾的部分。如此一来，必要时这里明显阐述的公开内容替代任何通过引用而并入本文中的相矛盾的材料。被声称通过引用并入本文中但是与本发明公开的定义、陈述或者其它公开的材料矛盾的任何材料或其部分将只并入不会使得所并入的材料与本发明公开的材料相矛盾的部分。

Claims (10)

1.一种外科切割和紧固器械，包括：
(a)驱动轴；
(b)马达；以及
(c)换档组件，其连接到所述驱动轴和所述马达上，所述换档组件包括：
至少第一阶段齿轮组件，其连接到所述马达和所述驱动轴
上，用于在第一齿轮组中操作换档组件；以及
齿轮连接组件，其用于选择性地将至少一个附加齿轮连接到所述驱动轴上，从而在第二齿轮组中操作换档组件。
2.如权利要求1所述的器械，其特征为，所述第一阶段齿轮组件包括太阳齿轮，所述太阳齿轮至少部分与一个或多个行星齿轮相互啮合，为第一阶段齿轮组件提供行星齿轮布置。
3.如权利要求1所述的器械，还包括连接到所述第一阶段齿轮组件上的第二阶段齿轮组件。
4.如权利要求3所述的器械，其特征为，所述第一阶段齿轮组件和所述第二阶段齿轮组件中的至少一个包括太阳齿轮，所述太阳齿轮至少部分与一个或多个行星齿轮相互啮合，为第一阶段齿轮组件或第二阶段齿轮组件提供行星齿轮布置。
5.如权利要求1所述的器械，其特征为，所述齿轮连接组件还包括太阳齿轮，所述太阳齿轮至少部分与一个或多个行星齿轮相互啮合，以提供能够选择性地连接到第一阶段齿轮组件上的行星齿轮布置。
6.如权利要求5所述的器械，其特征为，所述齿轮连接组件的太阳齿轮还包括脊部，所述脊部被构造成在第二齿轮组件中与形成在输入轴上的脊部相应地相互啮合，所述输出轴从第一阶段齿轮组件收纳进入齿轮连接组件中。
7.如权利要求5所述的器械，其特征为，所述齿轮连接组件的太阳齿轮还包括脊部，所述脊部被构造成不在第一齿轮组件中与形成在输入轴上的脊部相应地相互啮合，所述输出轴从第一阶段齿轮组件收纳进入齿轮连接组件中。
8.如权利要求1所述的器械，其特征为，所述齿轮连接组件还包括套环，所述套环中形成有脊部。
9.如权利要求8所述的器械，其特征为，所述套环的脊部被构造成第一齿轮组件或第二齿轮组件中与形成在驱动轴上的脊部相应地相互啮合。
10.如权利要求1所述的器械，其特征为，所述换档组件还包括齿轮选择器组件，用于使齿轮连接组件在第一和第二齿轮组之间运动。
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AU2007200306B2 (en) 2012-05-10
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