CN101116631A - 远侧安装有气动旋转驱动构件的气动外科切割和紧固器械 - Google Patents

远侧安装有气动旋转驱动构件的气动外科切割和紧固器械 Download PDF

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CN101116631A
CN101116631A CNA2007101398035A CN200710139803A CN101116631A CN 101116631 A CN101116631 A CN 101116631A CN A2007101398035 A CNA2007101398035 A CN A2007101398035A CN 200710139803 A CN200710139803 A CN 200710139803A CN 101116631 A CN101116631 A CN 101116631A
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CN101116631B (zh
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F·E·谢尔顿四世
J·R·摩根
E·L·蒂姆珀曼
L·M·富吉卡瓦
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Abstract

一种远侧安装有气动旋转驱动构件的气动外科切割和紧固器械,包括远侧构件,其能够接收气动操作工具组件。该器械还可包括细长轴组件,其具有近端部分以及与所述远侧构件相连的远端部分。气动旋转驱动构件可由所述细长轴组件的所述远端部分支撑并能够在接收到至少一个来自气动源的气动驱动信号时所述气动操作工具组件施加至少两个旋转致动动作。气动驱动构件可包括气动马达。在各个实施例中,细长轴组件的远端部分可相对于其近端部分作关节运动,和/或所述细长轴组件的远端部分可与所述近端部分分离。

Description

远侧安装有气动旋转驱动构件的气动外科切割和紧固器械
相关申请的交叉引用
本申请与下面同时提交的美国专利申请相关,这些申请通过引用并入本文:
(1)发明名称为“具有机械连杆连接端部执行器和扳机机构的气动外科切割和紧固器械”(PNEUMATICALLY POWERED SURGICALCUTTING AND FASTENING INSTRUMENT WITH MECHNICAL LINKAGECOUPLING END EFFECTOR AND TRIGGER MOTION),发明人为FrederickE.Shelton,IV,Jerome R.Morgan,EugeneL.Timperman和LeslieM.Fugikawa的申请(K&LNG 060346/END5912USNP);
(2)发明名称为“击发致动速率能够通过机械能量辅助进行可变控制的气动外科切割和紧固器械”(PNEUMATICALLY POWEREDSURGICAL CUTTING AND FASTENING INSTRUMENT WITH A VARIABLECONTROL OF THE ACTUATING RATE OF FIRING WITH MECHANICAL POWERASSIST),发明人为Frederick E.Shelton,IV,Jerome R.Morgan,Eugene L.Timperman和LeslieM.Fugikawa的申请(K&LNG060323/END5913USNP);
(3)发明名称为“具有视听反馈构件的气动外科切割和紧固器械”(PNEUMATICALLY POWERED SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH AUDIBLE AND VISUAL FEEDBACK FEATURES),发明人为Frederick E.Shelton,IV,Jerome R.Morgan,Eugene L.Timperman和Leslie M.Fugikawa的申请(K&LNG060345/END5914USNP);
(4)发明名称为“具有可替换的能量源的气动外科切割和紧固器械”(PNEUMATICALLY POWERED SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH REPLACEABLE POWER SOURCES),发明人为FrederickE.Shelton,IV,Jerome R.Morgan,Eugene L.Timperman和LeslieM.FugikaWa的申请(K&LNG060326/END5955USNP);
(5)发明名称为“具有改进的容积存储功能的气动外科切割和紧固器械”(PNEUMATICALLY POWERED SURGICAL CUTTING ANDFASTENING INSTRUMENT WITH IMPROVED VOLUME STORAGE),发明人为Frederick E.Shelton,IV和Jerome R.Morgan的申请(K&LNG060327/END5956USNP);
(6)发明名称为“具有手动操作的回缩装置的气动外科切割和紧固器械”(PNEUMATICALLY POWERED SURGICAL CUTTING ANDFASTENING INSTRUMENT WITH MANUALLY OPERATED RETRACTIONAPPARATUS),发明人为Frederick E.Shelton,IV,Jerome R.Morgan,Eugene L.Timperman和Leslie M.Fugikawa的申请(K&LNG060328/END5957USNP);以及
(7)发明名称为“远端具有端部执行器的气动外科切割和紧固器械”(SURGICAL CUTTING AND FASTENING INSTRUMENT WITHACTUATOR AT DISTAL END),发明人为Frederick E.Shelton,IV,Jerome R.Morgan,Eugene L.Timperman和Leslie M.Fugikawa的申请(K&LNG060344/END5911USNP)。
背景技术
本发明整体上涉及外科器械,更具体而言,涉及气动外科切割和紧固器械。本发明可在常规内窥镜和打开式外科器械中进行应用并且可应用于机器人辅助手术中。
外科切割和紧固器械(缝合器)已经用于已有技术中来同步进行组织的纵向切开并将成排的缝钉应用到切口的相对两侧。这类器械一般包括一对协作钳构件,如果该器械试图用于内窥镜或腹腔镜应用中,则这对协作钳构件能够穿过管状通道。其中一个钳构件接收具有至少两个横向间隔的缝钉排的钉仓。另一个钳构件限定钉砧,钉砧具有与钉仓内的缝钉排对齐的缝钉成形窝。该器械包括多个往复式楔块,所述楔块在向远侧驱动时穿过钉仓上的开口并接合支撑缝钉的驱动器,从而实现将缝钉朝钉砧击发。
近年来,已经研发了各种用于启动切割和缝钉展开部件的不同方法。例如,授予Shelton,IV等人的美国专利No.6,978,921公开了一种采用组织切断的外科缝合器械和通过手动致动手柄上的各种扳机机构进行驱动的缝钉展开部件。已经研发出采用电池供电马达的其他外科缝合设备。在授予Viola等人的美国专利No.5,954,259中公开了这些设备。
还有其他外科缝合器由压缩气体源进行致动。例如,授予Green等人的美国专利NO.6,619,529中公开了一种采用手柄内的压缩气体源的外科缝合器,该压缩气体也用于给同样位于该手柄内的气缸供能。该气缸容纳一个由进入气缸内的压缩气体进行致动的活塞组件。该活塞被构造成与位于细长管部分和手柄构件内的部件共同合作,以促使展开在远侧装配的端部执行器内的缝钉和手术刀。然而,这种设计采用复杂的部件集,来将装配于手柄上的活塞的运动传递给位于装置端部执行器部分上的部件。另外,当使用这类装置时,在手术操作期间存在能源耗尽的风险,因为没有办法监视气体仓中剩余气体的量。如果在击发或回缩循环期间发生这样的情况,那么这类装置缺乏用于用新的容器或备用能源来轻松替换用完的容器的部件。
在Roy的美国专利公开No.US2006/0151567中公开了另一种气动外科缝合设备。该设备采用支撑在设备手柄内的气动马达或活塞系统来产生用来致动端部执行器的动作。该设备由可拆除的仓或来自外部的能源诸如医院现有的气动空气或气体供应进行供能。
这种应用设备手柄部分中的仓或容器的气动设备同样受到气缸大小的约束,该气缸需要存储足够体积的压缩气体以方便在最小可用压力下致动设备达所需的次数。在过去,设计用于施加/操作很多次的设备或者需要使用大的气缸或者如果要使用小气缸,则这种气缸具有不希望的压力。另外,对采用可无限次使用的可拆卸的仓的设备必须进行重新处理和重新消毒。这种设置显著地改变了性能,因而是不希望的。
已有的气动内镜切割器(endocutters)存在其他的问题。例如,一旦外科医生通过单一开关或致动扳机来致动该器械,该器械完成击发循环或至少试图完成击发循环。其后,击发部件可由驱动系统回缩。虽然外科医生应用在美国专利公开US2006/0151567中公开的设备可中止击发循环和/或通过扳机组件来调整给设备的气流,但是没有监视设备运行的部件。另外,如果在手术期间停止或中断操作压力,则这种已有设备缺乏手动回缩刀和击发杆机构的部件。此外,该设备缺乏使临床医生能手动地将附加的力施加到驱动系统上以辅助击发机构前进或减缓其前进的部件。
因此需要一种无需使用大量部件集就能将气动产生的缝合和击发运动传递给端部执行器部件的气动外科缝合设备。
另外需要一种气动外科缝合设备,其为外科医生提供当设备在整个击发和回缩循环中进行运动时控制和监视设备进展的手段。
另外需要一种气动外科缝合设备,其在击发期间给外科医生提供有关遇到的力的触觉和其他反馈,并且还在设备已经到达其致动位置时提供通知并准备回缩。
需要一种气动外科缝合设备,其即经济又具有易于互换能源的能力,同时限制这种能源被互换的次数。
另外需要能更有效地将气体储存在气缸中用于给外科缝合设备供能的方法和装置,使得用单个气缸为更多的使用供能。
还需要一种气动缝合设备,其具有在气动失效或中止时能够手动回缩刀和击发杆组件的部件。
还需要具有一个或多个上述特征并且同样具有端部执行器的设备,该端部执行器可选择性地相对雨手柄组件和/或与之相连的细长轴组件的一部分进行关节运动。
还需要一种具有一个或多个上述特征的设备,其同样能够容纳可拆卸地连接的端部执行器以方便使用与一次性端部执行器布置有关的设备。
发明内容
在一个总的方面,本发明涉及一种外科器械,其包括被构造成接收气动操作工具组件的远侧构件。该器械可包括具有近端部分和远端部分的细长轴组件。该远端部分可连接到远侧构件上。该器械还可包括由细长轴组件的远端部分支撑的气动驱动构件。该驱动构件可被构造成在收到到至少一个来自气动源的气动驱动信号时向支撑在远侧构件中的气动操作工具组件施加至少两个旋转致动动作。
在另一总的方面,本发明涉及一种外科器械,包括:手柄组件;和闭合驱动器,其由所述手柄组件支撑并能够产生闭合动作和打开动作。由所述手柄组件支撑致动器机构,使得所述致动器机构与气动源通讯,以选择性地产生至少一种气动致动信号。细长轴组件可以可操作地连接到所述手柄组件上并与所述闭合驱动器通讯,以传递所述打开和闭合动作以及气动致动信号。气动驱动构件可由所述细长轴组件的远端部分可操作地支撑,并且能够响应所述气动致动信号产生旋转击发运动和旋转回缩运动。该器械还可包括连接到所述细长轴组件上的端部执行器。在各个非限制性实施例中,所述端部执行器可包括细长通道,其尺寸适于将钉仓接收于其中。钉砧可枢转地连接到所述细长通道上并可枢转地响应来自所述细长轴组件的所述打开和闭合动作。切割和切断构件可操作地支撑在所述细长通道内并可响应来自所述旋转驱动构件的所述击发和回缩运动。
本发明具体涉及如下方面:
(1)一种外科器械,包括:
远侧构件,其能够接收气动操作工具组件;
细长轴组件,其具有近端部分以及与所述远侧构件相联的远端部分;以及
气动旋转驱动构件,其由所述细长轴组件的所述远端部分支撑并流体连接动气动源上,所述旋转驱动构件能够在接收至少一个来自所述气动源的气动驱动信号时选择性地向由所述远侧构件支撑的所述气动操作工具组件施加至少两种旋转致动动作。
(2)根据第(1)项所述的外科器械,其中,所述旋转驱动构件包括气动马达。
(3)根据第(1)项所述的外科器械,其中,所述旋转驱动构件能够在接收到来自所述气动源的气流时向由所述远侧构件支撑的所述气动操作工具组件施加旋转击发运动,并且在接收到来自气动源的另一气流时向由所述远侧构件支撑的所述气动操作工具组件施加旋转回缩运动。
(4)根据第(1)项所述的外科器械,其中,所述细长轴组件的所述远端部分通过关节运动接头枢转地连接到所述近端部分上。
(5)根据第(4)项所述的外科器械,其中,机械地致动所述关节运动接头。
(6)根据第(4)项所述的外科器械,其中,气动地致动所述关节运动接头。
(7)根据第(1)项所述的外科器械,其中,所述细长轴组件的所述远端部分可选择性地与所述细长轴组件的所述近端部分分离。
(8)根据第(1)项所述的外科器械,其中,所述细长轴组件的所述近端部分和所述远端部分中的一个具有可选择性枢转的关节运动接头,并且所述远端部分可选择性地与所述细长轴组件的所述近端部分分离。
(9)根据第(1)项所述的外科器械,还包括:
手柄组件;以及
致动器机构,其由所述手柄组件支撑并可操作地与所述气动源和所述旋转驱动构件通讯,所述致动器机构能够选择性地控制来自所述气动源的所述气动驱动信号向所述旋转驱动构件的施加。
(10)根据第(9)项所述的外科器械,其中,所述致动器机构包括:
变流量控制构件,其与所述气动源和所述旋转驱动构件流体连通;以及
致动扳机,其由所述手柄组件可操作地支撑并可操作地连接到所述变流量控制构件上,用于选择性地对其进行操作。
(11)一种处理外科器械的方法,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;以及
将所述器械保存在无菌容器中。
(12)一种外科器械,包括:
手柄组件;
闭合驱动器,其由所述手柄组件支撑并能够产生闭合动作和打开动作;
由所述手柄组件支撑的致动器机构,所述致动器机构与气动源通讯,以选择性地产生至少一种气动致动信号;
细长轴组件,其连接到所述手柄组件上并与所述闭合驱动器连接,以传递所述打开和闭合动作以及所述至少一种气动致动信号;
气动旋转驱动构件,其由所述细长轴组件的远端部分可操作地支撑,并且能够响应所述至少一种气动致动信号,且能够产生旋转击发运动和旋转回缩运动;以及
连接到所述细长轴组件上的端部执行器,所述端部执行器包括:
细长通道,其尺寸适于将钉仓接收于其中;
钉砧,其枢转地连接到所述细长通道上并可枢转地响应来自所述细长轴组件的所述打开和闭合动作;以及
切割和切断构件,其可操作地支撑在所述细长通道内并可响应来自所述旋转驱动构件的所述击发和回缩运动。
(13)根据第(12)项所述的外科器械,其中,所述旋转驱动构件包括气动马达。
(14)根据第(12)项所述的外科器械,其中,所述细长轴组件的所述远端部分通过关节运动接头组件枢转地连接到所述细长轴组件的所述近端部分上。
(15)根据第(14)项所述的外科器械,其中,机械地致动所述关节运动接头组件。
(16)根据第(14)项所述的外科器械,其中,气动地致动所述关节运动接头组件。
(17)根据第(12)项所述的外科器械,其中,所述细长轴组件的所述远端部分可选择性地从所述细长轴组件的所述近端部分分离,以使连接有新的端部执行器的新的远端部分连接到细长轴组件的近端部分上。
(18)根据第(12)项所述的外科器械,其中,所述气动源定位在所述手柄组件的外部。
(19)一种外科器械,包括:
手柄组件;
细长轴组件,其具有可操作地连接到所述手柄组件上的近端部分,所述细长轴组件还具有远端部分;
可操作地支撑气动操作工具组件的部件,所述气动操作工具组件连接到所述细长轴组件上;以及
用于产生至少一个旋转致动力的产生构件,响应于来自与所述产生构件流体连接的气动源的至少一个气动驱动信号,所述至少一个旋转致动力施加到由所述用于可操作地支撑的部件支撑的气动操作工具组件上,所述产生构件由所述细长轴组件的所述远端部分支撑。
(20)根据第(18)项所述的外科器械,其中,所述气动源由所述手柄组件支撑。
附图说明
通过结合附图的示例,在此描述了本发明的各个实施例,其中相同的附图标记用于描述相同的构件,其中:
图1是本发明切割和紧固器械的实施例的透视图;
图2是可与本发明各个实施例结合应用的端部执行器布置的分解组装视图;
图3是图1和2的端部执行器的俯视图,其中去除了钉砧部分,并以虚线示出闭合管组件;
图4是图3的端部执行器布置的剖面侧视图,具有其上连接的钉砧部分并显示为打开位置;
图5是可应用于本发明各个实施例的一部分关节运动控制器的剖面俯视图;
图6是示出了图1所示的端部执行器的关节运动的顶部剖面图;
图7是示出了闭合管组件和支撑在手柄组件内的梭子布置的实施例的分解组装图,为了清楚省略了外壳组件内的其他部件;
图8是本发明各个实施例的外壳组件布置的剖面图;
图8A是可与本发明各个实施例结合应用的一部分闭合扳机锁定系统的局部剖面图;
图8B是本发明另一手柄组件实施例的剖面图,其中压缩气体源在手柄组件外部;
图8C是本发明另一手柄组件实施例的剖面图;
图9是图8手柄组件的另一剖面图;
图10是刀杆布置和击发驱动构件的侧视图,该击发驱动构件包含本发明各个实施例的两级气缸组件,气缸组件以剖面图示出;
图11是图10所示的刀杆和两级气缸布置的另一侧视图,其中刀杆在伸出位置;
图12是本发明另一刀杆和击发驱动构件布置的侧视图,其中刀杆被回缩到以剖面图示出的气缸组件中;
图13是图12所示的刀杆和气缸布置的另一侧视图,其中刀杆在伸出位置;
图14是容纳图12和13中所示的气缸和刀杆布置的端部执行器和脊组件布置的俯视图;
图15是图14所示的端部执行器和脊组件布置的剖面侧视图,其中钉砧部分连接于其上并处于打开位置;
图16是与图12-15所示的实施例结合使用的手柄组件的剖面图;
图16A是与图12-15所示的实施例结合使用的手柄组件的另一剖面图,其中压缩气体源在手柄组件的外部;
图16B是本发明另一手柄组件实施例的剖面图;
图17是支撑本发明另一实施例的另一击发驱动构件的另一刀杆和脊组件布置的俯视图,所述另一击发驱动构件是波纹管组件的形式;
图18是图17所示的实施例的端部执行器和脊组件布置的剖面侧视图;
图19是图17和18所示的实施例的波纹管组件的局部剖面组装视图;
图20是图19波纹管组件一部分的放大视图;
图21是与图17-20中所示的实施例结合使用的手柄组件实施例的剖面图;
图21A是与图17-20中所示的实施例结合使用的另一手柄组件实施例的剖面图,其中压缩气体源在手柄组件的外部;
图21B是本发明另一手柄组件实施例的剖面图;
图22是根据本发明其他实施例的另一外科切割和紧固器械的透视图;
图23是图22所示的实施例的端部执行器和脊组件的剖面侧视图;
图24是在将远侧轴组件连接到近侧轴组件之前图22和23的实施例的快速脱离接头布置的剖面图;
图25是图24中沿线25-25截取的近侧轴组件的剖面图;
图26是连接近侧轴组件的远侧轴组件的局部透视图,其中为了清楚省略了一部分远侧轴组件;
图27是图24-26的实施例的接头组件的剖面侧视图,其中远侧轴组件连接到近侧轴组件上;
图28是在连接到近侧轴组件之前一部分远侧轴组件的透视图;
图29是可用于图12-16A所示的实施例的另一快速脱离接头布置的局部剖面图;
图30是图29中沿线30-30截取的近侧轴组件的剖面图;
图31是与图22-30所示的实施例结合使用的一部分近侧轴组件的透视图;
图32是本发明另一外科切割和紧固器械的透视图,其应用了本发明各个实施例的气动致动关节运动接头;
图33是将远侧脊段连接到图32所示的实施例的近侧脊段上的一部分关节运动接头的局部透视图;
图34是图33的关节运动接头布置的另一透视图,其中从其上去除封盖,且示出了相对于近侧脊段关节运动的远侧脊段;
图35是图33和34的关节运动接头布置的分解组装视图;
图36是图33-35的接头组件的剖面侧视图;
图37是本发明开关组件的实施例的透视图;
图38是图37开关组件的侧视图;
图39是图37中沿线39-39截取的图37和38的开关组件的剖面图;
图40是图38中沿线40-40截取的在脱开位置上的开关组件的剖面图;
图41是处于致动位置上的图37-40的开关组件的另一剖面图;
图42是图41中沿线42-42截取的图41的开关组件的剖面图;
图43是图37-42的开关组件的仰视图;
图44是在其内具有图37-43的开关组件并容纳压缩气体源的手柄组件的剖面图;
图45是在其内具有图37-43的开关组件的手柄组件的剖面图,其中压缩气体源在手柄组件的外部;
图46是本发明另一外科缝合和切割器械的透视图,其应用了图33-36中所示的关节运动接头的实施例以及图23-31中所示的快速脱离接头的实施例;
图47是在将远侧轴组件连接到近侧轴组件之前图46的实施例的快速脱离接头布置的剖面图;
图48是图47中沿线48-48截取的图47的实施例的接头组件的剖面图;
图49是本发明另一外科切割和紧固器械的实施例的透视图;
图50是与图49中所示的实施例结合使用的端部执行器布置的分解组装视图;
图51是与图49中所示的实施例结合使用的端部执行器布置、脊组件和闭合管组件的分解组装视图;
图52是图51的端部执行器、脊组件和闭合管组件的剖面侧视图,其中为了清楚省略了钉砧部分;
图52A是本发明另一非限制性实施例的端部执行器、脊组件和闭合管组件的剖面侧视图,其中从手柄组件的远侧支撑气动马达;
图52B是本发明另一非限制性实施例的端部执行器、脊组件和闭合管组件的剖面侧视图,其中从手柄组件的远侧支撑气动马达;
图53是与图49的实施例结合使用的手柄组件的剖面图;
图53A是可与图49的实施例结合使用的另一手柄组件的剖面图,其中压缩气体源在手柄组件的外部;
图54是图53手柄组件的另一剖面图;
图55是本发明各个实施例的相对位置击发扳机布置的侧视图;
图56是可与本发明各个实施例结合使用的本发明控制系统实施例的示意图;
图57是可从本发明各个手柄组件实施例的原始连接部分上分离的可分离握持部分的剖面图;
图58是显示了与本发明各个实施例的手柄组件原始连接部分相连的可分离握持部分的局部剖面图;
图59是图58的可分离握持部分和原始连接部分的局部剖面图,并且为了清楚省略了头部和相关的气缸部件;
图60是图59中沿线60-60截取的图58和59的可分离握持部分和原始连接部分的剖面图;
图61是图59中沿线61-61截取的图58和59的可分离握持部分和原始连接部分的剖面图;
图62是图59中沿线62-62截取的图58-61的可分离握持部分和原始连接部分的剖面图;
图63是图59中沿线63-63截取的图58-61的可分离握持部分和原始连接部分的另一局部剖面图;
图64是在初始位置上的本发明锁止系统实施例的图解视图;
图65是图64的锁止系统的另一图解视图,示出了当握持构件初始地连接到手柄组件的原始连接部分上时它的动作;
图66时在握持构件从手柄组件的原始连接部分上再次分离之前,图64和65的锁止系统的另一图解视图;
图67是图64-66的锁止系统的另一图解视图,示出了当握持部分已经连接到原始连接部分上时系统部件的位置;
图68是图64-66的锁止系统的另一图解视图,示出了在握持部分再次连接到原始连接部分期间系统部件的位置;
图69是示出了握持构件已经再次或最后连接到原始连接部分之后,锁止系统的另一图解视图;
图70是本发明另一外科切割和紧固器械实施例的透视图;
图71是可与图70所示的器械结合使用的手柄组件实施例的剖面图;
图72是本发明各个实施例的梭子和回缩棒组件的分解组装视图;
图72A是本发明另一实施例的梭子和回缩棒组件的分解组装视图;
图73是图72所示的部件的组装视图,其气缸组件在完全伸出位置上;
图74是本发明的梭子组件的实施例的后视图;
图75是图74的梭子组件的另一后视图,其中回缩棒和推杆伸入推杆开口,并且推杆连接到连接器构件上;
图76是梭子组件左侧部分的后透视图;
图77是梭子组件左侧部分的另一后透视图;
图78是用于图70-77中所示的实施例的控制系统布置的示意性示图;
图79是图70-78中所示的实施例的手柄组件布置的剖面图,其中气缸组件在伸出位置;
图80是图70-79中所示的实施例的手柄组件布置的另一顶部剖面图,其中气缸组件在回缩位置;
图81是图70-80中所示的实施例的手柄组件的剖面图;
图81A是可用于图70-80中所示的实施例的手柄组件实施例的剖面图,其中压缩气体源在手柄组件的外部;
图82是图81的手柄组件另一剖面图,其中气缸组件被伸出;
图83是图81的手柄组件另一剖面图,其中气缸组件被回缩;以及
图83A是图72B中所示的实施例手柄组件的剖面图,其中气缸组件被回缩并且击发棒处于其最近侧位置。
具体实施方式
回到附图,其中相同的附图标记在所有附图中表示相同的部件,图1示出了能够实施本发明若干独特优势的外科缝合和切割器械10。图1中示出的实施例包括手柄组件300、细长轴组件100和连接到细长轴组件100的端部执行器12。本发明各个实施例可包括一种端部执行器,其如在2006年1月10提交的、题为“SURGICALINSTRUMENT HAVING AN ARTICULATING END EFFECTOR”美国专利申请No.11/329,020中所公开的端部执行器一样能枢转地连接到细长轴组件100并枢转地由弯曲的缆线或带进行驱动,上述申请通过引用并入本文。然而,随着对具体实施方式的继续描述,本领域的普通技术人员应当理解本发明各个实施例能成功地与端部执行器布置结合进行实施,所述端部执行器可采用不同的枢转机构和控制器,并且本发明各个实施例可成功地与非关节运动式端部执行器布置结合使用,如下面将详细解释的一样。
如图1中所示,器械10的手柄组件300可包括闭合扳机302和击发扳机310。应当理解,针对不同手术任务具有端部执行器的器械可具有不同数量和类型的扳机或其他用于端部执行器操作的合适控制器。所示的端部执行器12通过优选为细长的轴组件100与手柄组件300分离。临床医生可通过利用致动控制器200使端部执行器12相对于轴组件100作关节运动。
应该理解,在此参照附图给出的空间术语诸如竖直、水平、右、左等假设外科器械10的纵向轴线与细长轴组件100的中心轴线同轴,其中扳机302,310以锐角从手柄组件300的底部向下延伸。然而,在实际应用中,可将外科器械10以多个角度定向,这样,相对于外科器械10本身使用这些空间术语。此外,“近侧”用于表示将端部执行器12放置在临床医生远侧或远处的在手柄组件300后方的他或她的视角。
如此处所用的,术语“压缩气体”指适于用在无菌环境下所用的气动系统中的任何气体。这种介质的非限制示例包括压缩空气、二氧化碳(CO2)、氮、氧、氩、氦、氢化钠、丙烷、异丁烷、丁烷、氯氟甲烷、二甲醚、甲基乙醚、一氧化氮、氢氟烷推进剂(HFA),例如HFA134a(1,1,1,2,-四氟乙烷)或HFA227(1,1,1,2,3,3,3-七氟丙烷)。
如此处所用的,术语“流体连接”是指元件与适合的管路或者其他部件一起连接以允许压缩气体在其间通过。如此处所用的,如用在“供应管路”或“返回管路”中的术语“管路”指由刚性或柔性导管、管道、管材等形成的适当的通路,用于将压缩气体从一个部件传送到另一部件。
如此处所用的,术语“气动信号”或“气动驱动信号”指从压缩气体源到与压缩气体源流体连接的一个或多个部件的气体流或者指彼此流体连接的部件之间的气体流。
如此处所用的,语句“基本上垂直于纵向轴线”指几乎与纵向轴线的方向垂直,其中“纵向轴线”是轴的轴线。然而,应当理解,稍微偏离垂直于纵向轴线的方向也认为基本上垂直于纵向轴线。
图2示出了可用于本发明各个实施例中的一种气动操作工具组件或端部执行器的分解组装视图。将图1-4中所示的气动操作工具组件12构造成用作气动内镜切割器。然而,随着对具体实施方式的描述,应当理解,同样可构想将本发明实施例的各个独特和新颖的驱动布置用于驱动被构造成执行其他手术任务的其他端部执行器,从而需要对附图中所示物体进行部件的拆卸、修改或增加。同样,应当理解,可以为了特定的手术应用而定制图1-4中所示的端部执行器12。
图2中示出了一种可用于本发明各个实施例的端部执行器。如图中所示,端部执行器12应用电子束(E-beam)击发机构(“刀组件”)30,其除了切割组织并击发位于钉仓中的缝钉,还有利地相对于钉仓控制端部执行器12的钉砧部分间隔。在授予Shelton,IV等人的题为“集成电子束击发机构的外科缝合器械”的美国专利No.6,978,921中描述了电子束击发机构的各个方面,其相关部分通过引用并入本文。然而,根据对具体实施方式的描述,本领域的普通技术人员应当理解在不脱离本发明精神和范围的情况下可有利地应用其他刀和击发机构构型。
如此处所用的,术语“击发机构”是指从未致动位置移动的气动工具和/或端部执行器的一部分或多个部分,其中击发机构基本上停靠在致动位置或称末端位置,其中所述一部分或多个部分移动或重新定位到最终位置,其中这种移动导致工具响应至少一次击发动作的施加而完成一个或多个动作。该击发机构可例如包括:(i)完全由气动工具支撑并与手术设备中的部件配接的部件;(ii)定位在气动工具和手术设备中的部件的组合;或(iii)由手术设备支撑并可进出气动工具的部件。如此处所用的,术语“击发冲程”是指击发机构从未致动位置到致动位置的实际移动。术语“回缩冲程”是指击发机构从致动位置到未致动位置的返回移动。
如图2中所示,端部执行器12包括远侧构件,其在各个非限制性实施例中包含具有连接于其上的可平移的钉砧40的细长通道20。该细长通道20被构造成接收和支撑钉仓50以响应刀组件30驱动缝钉70接触钉砧40。应当理解,虽然在此有利地描述了易于替换的钉仓,但是与本发明多个方面相符的钉仓可永久地固定或一体地形成于细长通道20中。
在各个实施例中,击发机构或刀组件30包括在击发过程中控制端部执行器12间隔的竖直间隔销。具体地,上部销32行进进入到钉砧40和细长通道20之间的枢轴附近的钉砧袋42中。参见图4。当随钉砧40闭合击发之后,上部销32向远侧前进到穿过钉砧40向远侧延伸的纵向钉砧狭槽44中。通过上部销32施加的向下的力来克服在钉砧40中的任何镜像向上移动。
刀组件30还包括向上接合在细长通道20中形成的通道狭槽23(图2)的刀杆帽34,从而与上部销32协作,以在钉砧40和细长通道20之间夹紧的组织超出的情况下,将钉砧40和细长通道20稍微地拉得更靠近些。在各个实施例中,刀组件30可有利地包括中部销36,其穿过在钉仓50的下表面和细长通道20的上表面所形成的击发驱动狭槽(未显示),从而如下面所述的来驱动其中的缝钉70。中部销36通过在细长通道20上进行滑动有利地抵抗任何将端部执行器12压紧关闭到其远端的趋势。然而,通过使用其他刀组件布置可实现本发明各个实施例的独特和新颖方面。
回到图2,在刀组件30上的上部销32和中部销36之间的位于远例的切割刃38横过钉仓50中位于近侧的竖直狭槽54,来切断夹紧的组织。刀组件30相对于细长通道20和钉砧40的确定定位确保执行有效的切割。在各个实施例中,钉砧40的下表面在其中可设有多个缝钉成形袋(未显示),当在细长通道内接收钉仓50时,这些缝钉成形袋排列成对应于钉仓50的上表面56中的多个缝钉孔58。在各个实施例中,可将钉仓50扣合匹配到细长通道20中。具体地,钉仓50的延伸部分60,62分别摩擦地且可释放地接合细长通道20的凹槽24,26。
还如图2中所示,钉仓50包含仓体51、楔形滑道64、缝钉驱动器66、缝钉70和仓盘68。当装配时,仓盘68将楔形滑道64、缝钉驱动器66和缝钉70保持在仓体51中。通过细长轴组件100将细长通道20连接到手柄组件300,该细长轴组件100包括远侧脊或框架段110以及近侧脊或框架段130。细长通道20在近侧设置有连接腔22,每一个连接腔22接收在近侧脊段110的近端上所形成的相应通道锚定构件114。该细长通道20还具有枢转地接收钉砧40上的相应钉砧枢轴43的钉砧凸轮槽28。闭合的衬套组件170接收于脊组件102之上,并包括远侧闭合管段180和近侧闭合管段190。如下面将要描述的,闭合衬套组件170相对于脊组件102的轴向移动引起钉砧40相对于细长通道20枢转。
如在图2中所示,将锁定弹簧112安装在远侧脊段110上用作刀组件30的锁止件。在远例脊段110上形成远侧和近侧方孔111,113以限定其间的夹杆115,夹杆115接收锁定弹簧112的顶臂116,如下面将进一步详细讨论的,锁定弹簧112的下部远侧延伸臂118在气缸组件501的远侧上施加向下的力,支撑从刀组件30突出的活塞杆部分5。应当理解,各个实施例可包含其他类型的锁止件或根本没有锁止件。
在图1-6所示的实施例中,通过能够弯曲以将端部执行器12围绕枢轴104拉动的缆线或带的集合可使端部执行器12相对于近侧闭合管段190(和手柄组件300)进行关节运动。本领域的普通技术人员将会理解,这种布置仅代表能与这些类型的设备结合使用的多种关节运动布置的其中之一。在该实施例中,远侧脊段110的近端在其上具有隆凸。近侧脊段130的远端设有带贯穿其中的孔136的柄脚134。近侧脊段130相对于远侧脊段110进行定位,使得孔136与隆凸122中的孔124共轴对齐,以便使枢轴销138能从中穿过。见图4,当组装时,这种布置允许端部执行器12相对于近侧脊段130围绕枢转轴线A-A进行枢转。
如上所述,该实施例应用带来使端部执行器12作关节运动。具体地,带150,160可如图2和3中所示朝着关节运动枢轴104向远侧延伸。带150可沿其左侧穿过近侧闭合管段190延伸,其中它途经带构件160并越过近侧闭合管段190的右侧。此处,例如,带150可在连接点123处机械地连接到隆凸122。同样,带160可沿其右侧穿过近侧闭合管段190延伸,其中它途径带构件150并越过近侧闭合管段190的左侧。此处,带160可在连接点125处机械地连接到隆凸122。
图3是在具有虚线所示的闭合管组件100的端部执行器和脊组件102的俯视图。图4是器械10的相同部分的局部剖面例视图。如图4中所示,根据一非限制性实施例,所示的带150和160显示为彼此偏移以防止运动中的干扰。例如,将带150显示为比带160更低的位置。在另一非限制性实施例中,可颠倒带150和160的竖直位置。同样如图2和3中所示,带构件150围绕近侧框架段130的柄脚部分134中的销140延伸。同样,带构件160围绕近侧框架段130的柄脚部分134中的销142延伸。同样可参见图2。
带部分150和160可从隆凸122沿近侧闭合管段190延伸到关节运动控制器200,图5中所示。关节运动控制器200可包括关节运动滑块202、框架204和封罩206。带部分150,160可借助于槽208或其他孔穿过关节运动滑块202,但是应当理解带部分150,160可通过任何合适的手段连接到滑块202上。关节运动滑块202可以是一片,如图5所示,或在一非限制性实施例中的两片,其中两片之间的界面限定了槽208。在一个非限制性实施例中,关节运动滑块可例如包括多个槽,每个槽对应其中一个带部分150,160。封罩206可覆盖控制器200的各个部件以防止碎屑进入。
在各个实施例中,带150,160可在从槽208近侧定位的连接点210,212处锚定到框架204上。图5的非限制性实施例显示带部分150,160从连接点210,212到在近侧闭合管段190的纵向轴线附近定位的槽208预弯曲。应当理解,可将带150,160锚定到从槽208近侧定位的器械10上的任何地方,包括手柄组件300。
在使用中,图2的实施例可具有如图所示的非关节运动位置。所示的关节运动控制器200和带150,160位于轴组件100的纵向轴线的大致中间位置上。因此,端部执行器12在中间或非关节运动位置。在图6中,显示了关节运动控制器200,其中关节运动滑块202推过关节运动框架到轴组件100的右侧。因此,带150,160朝轴组件100的右侧弯曲。由此可知,带150向右侧的弯曲在隆凸122上施加从隆凸122的枢轴点偏移的横向力。该偏移力促使隆凸122围绕关节运动枢轴104旋转,又如图所示促使端部执行器12向右枢转。应当理解,将关节运动滑块202推向轴组件100的左侧可在带150,160上施加侧向力,使带150,160都朝轴组件100的左侧弯曲。接着带160的弯曲在隆凸122上施加侧向力,其如上所述一样从隆凸122的枢轴点偏移。这又促使隆凸122围绕关节运动枢轴旋转,促使端部执行器12向左枢转。
在各个实施例中,轴组件100包含接收在脊组件120上的闭合管组件170。参见图2。闭合管组件170包含远侧闭合管段180和近侧闭合管段190。远侧闭合管段180和近侧闭合管段190可由聚合物或其他合适的材料制造。近侧闭合管段190是中空的并具有贯穿其中的轴向通道191,其大小适于将一部分脊组件102接收其中。
在图2和4所示的实施例中,应用双枢轴闭合接头172。应当理解,本发明并非限于双枢轴闭合接头设计并可包括任何合适的闭合管或衬套,或者根本没有闭合管或衬套。特别参考图4,远侧闭合管段180具有上部和下部近侧凸出柄脚182,184。远侧闭合管段180还包括马蹄形孔185和翼片186,用于接合钉砧40上钉砧打开/关闭翼片46,以便如下面进一步详细讨论地促使钉砧40在打开和闭合位置之间枢转。参见图2。
近侧闭合管段190类似地设有向远侧延伸的上部柄脚192和向远侧延伸的下部柄脚194。上部双枢轴链174包括向上突出的远侧和近侧枢轴销175,176,它们分别接合上部近侧的突出柄脚182中的上部远侧销孔183和上部远侧突出柄脚192中的上部近侧销孔193。接头布置还包括下部双枢轴连接件177,其使远侧和近侧枢轴销178,179(图2中未显示,但在图4中可见)向下突出,远侧和近侧枢轴销178,179分别接合下部近侧突出柄脚184中的下部远侧销孔187和下部侧突出柄脚194中的下部近侧销孔195。
在使用中,闭合管组件170例如响应于闭合扳机310的致动向远侧平移到闭合的钉砧40。通过将闭合管组件170向远侧平移到脊组件102上来闭合钉砧40,促使马蹄形孔185的背部撞击钉砧40上的打开/闭合翼片46,并促使它枢转到闭合位置。为了打开钉砧40,在脊组件102上的近侧方向上轴向移动闭合管组件170,促使翼片186接触并推动打开/闭合翼片46,以将钉砧40枢转到打开的位置。
图7示出了本发明各个实施例的非限制性手柄组件300的分解组装视图。在图7所示的实施例中,手柄组件具有“手枪式握把”结构并由右手壳构件320和左手壳构件330构成,右手壳构件320和左手壳构件330由聚合物或其他合适的材料模制或以其他方式制造并设计成匹配在一起。这种壳构件320和330可通过扣合部分、模制的栓和座或在内部形成的其他方式和/或通过粘合剂、螺钉、螺栓、夹具等连接在一起。右手壳构件320的上部322与左手壳构件330对应的上部323匹配以形成表示为340的主外壳部分。类似地,右手壳构件320的下握持部324与左手壳构件330对应的下握持部324匹配以形成表示为342的握持部。在图7所示的实施例中,整个握持部342与主外壳部分340形成一体。这种布置特别适于压缩气体源永久安装到握持部342中的应用。这种布置还适合用于这样的压缩气体源,它在手柄组件300的外部并通过外壳组件上的一个端口或多个端口插入到容纳在其中的控制部件中。在另一实施例中,如下面进一步详细描述的,握持部342可从主外壳部分340上拆除。根据对具体实施方式的描述应当理解,这种布置提供了众多的好处和优势。然而,本领域的普通技术人员应当理解能提供具有不同形状和大小的手柄组件300。
为了清楚起见,图7仅示出了用于控制闭合管组件170轴向移动的部件,其最终控制钉砧40的打开和关闭。如图中所示,通过连杆组件430连接于闭合扳机302的闭合梭400支撑在主外壳部分340中。闭合梭400同样可制造成两片402,404,它们由聚合物或其他合适的材料模制或以其他方式制造并设计为互相匹配。例如,在图7示出的实施例中,右手部分402设有紧固柱403,其被设计用来接收到左手部分404中对应的座内(未显示)。右手部分和左手部分402,404可通过扣合构件和/或粘合剂和/或螺栓、螺钉、夹具等以其他方式进行保持。如图中可见,在近侧闭合管段190的近端设有保持沟槽196。闭合梭400的右手部分402具有右保持凸缘段405,其适于与闭合梭400左手部404上的左保持凸缘段(未显示)协作来形成延伸进入近侧闭合管段190的保持沟槽196中的保持凸缘组件。
如图7中所示,右脊组件保持栓326从右手壳构件320向内突出。这种栓326伸入闭合梭400右手部402中的狭槽或窗406中。类似的闭合梭保持栓(未显示)从左手壳构件330向内突出,并被接收于闭合梭400左手部402中所设的另一窗或槽408中。保持栓用作将近侧脊段130的近端133(图7未显示)不可移动地固定在手柄组件300上,同时允许闭合梭400相对于它轴向移动。通过例如螺栓、螺钉、粘合剂、扣合部件等可将保持栓机械地连接到近侧脊段130的近端。另外,闭合梭400设有侧向延伸的导轨410,411。导轨410被构造成可滑动地接收于右手壳构件320中的导轨导向件328中,并且导轨411被构造成可滑动地接收于左手壳构件330中的导轨导向件(未显示)中。
通过朝手柄组件300的握持部342移动闭合扳机302来产生闭合梭400和闭合管组件170在远侧方向上(箭头“C”)的轴向移动,并且通过将闭合扳机302远离握持部342来产生闭合梭400在近侧方向上(箭头“D”)的轴向移动。在各个实施例中,闭合梭400设有方便连接闭合连杆组件430的连接器翼片412。参见图8和9。闭合连杆组件430包括通过销414枢转地销接到连接器翼片412上的轭部432。闭合连杆组件430还具有闭合臂434,如图7中所示闭合臂434通过闭合销436枢转地销接到在闭合扳机302上形成的轭组件304上。通过在右手壳部320和左手壳部330之间延伸的枢轴销306,将闭合扳机302枢转地安装在手柄组件300内。
当临床医生想要闭合钉砧40以夹紧端部执行器12中的组织时,临床医生朝握持部342拉动闭合扳机302。当临床医生朝握持部342拉动闭合扳机302时,闭合连杆组件430在远侧“C”方向上移动闭合梭400,直到闭合连杆组件430移入图8所示的锁定位置内。当在这一位置中时,闭合连杆组件430倾向于将闭合梭400保持在该锁定位置上。当闭合梭400移到锁定位置时,闭合管组件170在脊组件102上向远侧移动,促使远侧闭合管段180内的马蹄形孔185的近端接触钉砧40上的闭合/打开翼片46,从而将钉砧40枢转到闭合(夹紧)位置。
在各个实施例中,为了进一步将闭合梭400保持在闭合位置上,闭合扳机302可设有可释放的锁定机构301,其适于接合握持部342和可释放地将闭合扳机302保持在锁定位置上。其他锁定装置也可用于可释放地将闭合梭400保持在锁定位置上。在图8,8A,8B和9所示的实施例中,闭合扳机302包括柔性纵向臂303,其包括从其延伸的侧销305。例如,臂303和销305可由模制塑料制成。手柄组件300的手枪式握把部342包括在其中设置有侧向延伸的楔块352的开口350。当回缩闭合扳机302时,销305接合楔块352,并且楔块352的下表面迫使销305向下(即,臂303顺时针旋转)。当销305完全通过下表面354时,去除臂303上的顺时针的力,并且销305逆时针旋转,使得销305停靠在楔块352后的凹口356中,从而锁定闭合扳机302。通过从楔块352延伸的柔性挡块358进一步将销305保持在锁定位置中。
为了解锁闭合扳机302,操作者可进一步挤压闭合扳机302,促使销305接合开口350的倾斜后壁359,迫使销305向上经过柔性挡块358。接着销305可自由地穿出开口360中的上通道,使得闭合扳机302不再锁定到手枪式握把部342上。在授予Shelton,IV等人的、于2006年1月31日提交的题为“具有可拆卸电池的外科器械”的美国专利申请No.11/344,020中公开了这种布置的其他细节,该申请的相关部分通过引用并入本文。还可应用其他可释放锁定布置。
在本发明各个实施例中,刀组件30可具有从其上突出或以其他方式与其连接的基本上为刚性的活塞杆部35,其是驱动构件500的一部分,可操作地由远侧脊段110支撑并被构造成给刀组件30施加至少两个致动动作(例如击发动作和回缩动作)。在图3、4、10和11所示的实施例中,驱动构件500包含两级气动致动气缸组件501。刀组件30可由一个整体部件构成或可被设置成由多个部件构成以使器械10的组件更容易推动。例如,如图10和11所示,刀杆组件30包含远侧部分31,其含有上部销32、帽34、中部销36和刀38。远侧部分31可设有孔33,其大小适于接收在活塞杆部35的远侧末端上设置的突起37。突起37可摩擦地接收于孔33中和/或通过粘合、焊接等保持在其中。
气缸组件501包含第一气缸外壳510,其具有第一闭合近端512和通入第一气缸外壳510中的第一轴向通道516内的第一打开远端514。气缸组件501还包含第一气缸外壳520,其具有第二近端522和通入第二轴向通道526的第二打开远端524。第二闭合近端522具有在其上形成的第一活塞头528,该活塞头的大小相对于第一轴向通道516制定以与第一气缸外壳510的第一壁511产生基本气密的滑动密封件,从而限定在第一近端512的远侧与第一活塞头528的近侧之间的第一气缸区域515。第一气缸外壳510的第一远端514还具有从其上向内延伸的第一凸缘517,用于与第二气缸外壳520外壁表面建立基本气密的滑动密封件,从而限定第一凸缘517的近侧和第一活塞头528的远侧之间的第二气缸区域518。
穿过第一活塞头528设置第一通道527。如图10和11中所示,活塞杆35的近端延伸穿过第二气缸外壳520的第二打开远端524并进入第二轴向通道526。第二活塞头530形成于或以其他方式连接于活塞杆35的近端。第二活塞头50的大小相对于第二轴向通道526来制定从而与第二气缸外壳520的第二壁521产生基本气密的滑动密封件以限定第三气缸区域532。第二气缸外壳520的第二远端524还具有在其上形成的向内延伸的第二凸缘525用于与活塞杆35建立基本气密的滑动密封件以限定第二凸缘525的近侧和第二活塞头530的远侧之间的第四气缸区域534。
如图3和4中所示,气缸组件501被安装到远侧脊段110内。在各个实施例中,在第一气缸外壳510的近端上设置一对凸耳(trunion)519。在远侧脊段110的近端凸耳孔119中接收凸耳519,从而使气缸组件501能在远侧脊段110内围绕枢转轴线B-B枢转。参见图3。第一供应管路或称供应管路540从手柄组件300中的方向控制阀610(图8和9)延伸,穿过近侧闭合管段190,连接到第一气缸外壳510的第一近端512上,以便通过第一供应端口513或第一气缸外壳510的第一近端512上的开口供应压缩气体。参见图10和11。另外,第二供应管路542从方向控制阀610延伸,穿过近侧闭合管段190并连接于临近其远端514的第一气缸外壳510,从而通过第二端口529将压缩气体供应给第二气缸区域518。
参考图8-11,现在将描述击发机构或刀组件30的伸出和回缩。如图8和9中所示,供应管路540和542连接于传统的方向阀610,该方向阀610是容纳在手柄外壳350内的致动器系统的一部分。在各个实施例中,方向阀610可通过选择器开关612或易于通过手柄外壳350接近的推动按钮而手动地在向前(伸出)和反向(回缩)位置之间进行切换。见图1。在图8和9所示的实施例中,应用可去除的压缩气体源620。如下面将进一步讨论的,这种压缩气体源包括能用优选的压缩气体再填充的气缸622。然而,本领域的普通技术人员应当理解,同样可有效地应用非再填充/再填充压缩气体源(气缸)。在其他实施例中,手柄组件300可设有端口616,以从外部压缩气体源618供应压缩气体。例如,器械10可通过柔性供应管路617连接到设备的压缩气体供应源618。参见图8B。
下面将进一步讨论可去除/再填充气缸622的独特和新颖的方面。然而,为了便于解释活塞杆35和刀组件30的伸出和回缩,可以看出来自气缸622(或外部压缩源618)的压缩气体流穿过供应管路650进入可包含传统流量阀660的变力致动器。特别如图9和55中所示,流量阀660连接供应连杆机构662,而供应连杆机构662连接于致动扳机670。如此处所用的,术语“变力致动组件”至少包含流量阀660和致动扳机670以及它们各自的同等结构。在各个实施例中,致动扳机670支撑在击发扳机310附近,通过在右手壳构件320和左手壳构件330之间延伸的枢轴销370可将击发扳机310枢转地连接到手柄组件300上。向内朝着击发扳机310挤压致动扳机670,促使流量阀660增加从气缸622流入连接到方向阀610上的供应管路680中的压缩气体流。依据方向阀610的位置,压缩气体将流入供应管路540或542。例如,当临床医生击发刀组件30来致动方向阀610时,允许压缩气体流过供应管路540并通过第一活塞头528上的第一开口进入第一气缸区域515并在致动扳机670致动下进入第三气缸区域532。当压缩气体进入第三气缸区域532时,第二活塞头530向远侧压迫活塞杆35。位于第四气缸区域的气体通过第二气缸外壳520中的排气开口523排出。类似地,允许第二气缸区域518所含的气体通过第二供应管路542中的第二开口529排出。第二供应管路542将排出的气体运送到方向阀610,在此最终将其排出。连续给第一气缸区域515和第三气缸区域532施加压缩气体促使刀组件30完全延伸穿过端部执行器12。当刀组件30穿过端部执行器12时,它切断夹在其间的组织并击发钉仓50内的缝钉70(驱动缝钉与钉砧40的下表面进行接触)。一旦刀组件30已经推进到端部执行器12的最远侧位置,则临床医生通过释放致动扳机670来停止施加压缩气体。
为了回缩击发机构或刀组件30,临床医生手动移动选择器开关612或合适的按钮用于将方向阀610调整到回缩位置,并开始挤压致动扳机670,这促使压缩气体流入第二供应管路542。流过第二供应管路542的气体进入第二气缸区域518,这促使第二气缸外壳520向近侧回缩到第一气缸外壳510中。允许第一气缸区域515中的气体通过第一供应开口513排入第一供应管路540中。气体穿过第一供应管路540进入方向阀610,在此将其排出。如图10所示,一旦进入第二气缸区域518的压缩气体促使第二气缸外壳520回缩到第一气缸外壳510中,则穿过第二开口529的气体现在能够穿过第一气缸外壳510中的排气口523并进入到第四气缸区域534。当压缩气体进入第四气缸区域534中时,第二活塞头530将活塞杆35向近侧拉入第二气缸外壳520中。第三气缸区域532中的气体穿过第一开口527进入第一气缸区域515,从这里将其以上面所述方式排出。
本发明各个实施例的以流量阀660的形式存在的变力致动器可应用弹簧或其他偏压部件(未显示)来将流量阀660偏压到未致动的位置。当位于未致动的位置时,流量阀660可被构造成防止任何来自气体源620或618的气体流过阀660内的孔(未显示)。这样,当致动器扳机670处于未致动位置时,该设备基本上处于关闭。
在上述的实施例中,流量阀660可通过供应连杆臂662机械地连接到致动扳机670,使得当临床医生向内朝击发扳机310挤压致动扳机670时,连杆臂662促使流量阀660允许气流流两通过阀660增加。这样,快速挤压致动扳机670可促使设备的击发速度增加,并且减慢挤压致动扳机670的速度能够减缓击发速度。这样,允许通过流量阀660的气体流量基本上与施加到致动扳机670上的手动力成比例。
在其他实施例中,可电子控制流量阀660,使得一旦致动扳机致动,则流量阀660数字化(digitally)地喷射气体。流量阀660以脉冲的方式释放少量的气体,并且挤压致动扳机670越有力,则脉冲越密。这种布置用于可选择地调节用于致动设备的气体体积。
同样,在其他实施例中,致动机构可包含不同类型的机构,其不会像致动扳机670一样相对于手柄组件枢转地支撑。例如,致动扳机可包含弹簧致动滑动开关等。因此,对本发明那些实施例的保护并不仅仅限定为应用枢转致动扳机的实施例。
同样在各个实施例中,如图8和8A中所示压力计541可流体地连接到供应管路540。通过手柄组件300的对应部分所设的窗口543能使临床医生观看压力计541或者应用其他布置能使临床医生在使用期间观看压力计541。见图7。在各个实施例中,压力计541可包含电动压力计或度盘压力计。在这些非限制性实施例中,压力计541可提供一种可提供在击发冲程期间遇到的力的反馈的部件。本领域的普通技术人员将会理解,在一些非限制性实施例中,致动击发机构所需的力直接与气缸组件501中的压力成比例。如果那些力较小,则气缸组件501无需大的压力来致动。另一方面,如果需要致动气缸组件501的力很高,则必须释放更多的气体进入气缸组件501中以增加其中的压力来充分致动击发机构。压力计541用于使临床医生能成比例地读取由端部执行器所经受的力。
在其他各个实施例中,如图8C所示,在供应管路540上设有可听出口545。这种可听出口允许少量气体从供应管路540中释放。随压力的增加,必然使由气体释放所产生的笛音调增高。然后临床医生可将笛音调与击发机构所经受的力关联起来。这样,这种布置给临床医生提供了听觉反馈机构,用于监视驱动系统500所经受的击发力及最终监视击发机构所经受的击发力。
各个非限制性实施例同样可设有在击发机构已经到达击发冲程末端时自动通知临床医生的部件。例如,如图4所示,可将限制开关546设在远侧脊段110内,用于检测嵌入或以其他方式连接到击发棒35的致动构件547,如图11所示。这样定位致动构件547使得当击发杆35和击发机构达到击发冲程末时,由限制开关546检测致动构件547,限制开关546可电连接到方向控制阀610用于给它传送适当的信号。当接收到这种信号时,方向控制阀610可被构造成自动移到回缩位置并允许击发机构回缩。另外,限制开关546可连接到图8中表示为549的指示构件。在各个实施例中,该指示构件可给临床医生提供听觉信号、视觉信号或听觉和视觉信号的组合,以指示击发机构已经达到击发冲程末。例如,该指示构件可包含发声设备、发光二极管(led)、振动产生设备等,或者这些设备的组合。限制开关和相关的控制部件可由在外壳组件300中支撑的电池(未显示)供电或者它可由外部电源进行供电。这样,本发明的各个非限制性实施例可设有给临床医生提供指示击发机构已经达到击发冲程末的视觉和/听觉信号的部件,和/或自动气动地将击发机构回缩到未致动位置的部件。
如图4、10和11中所示,在活塞杆35的底部上可形成锁定突起39。当刀组件30在如图4所示的完全回缩位置时,锁定弹簧112的臂118给气缸组件501的远端施加偏压力。因为气缸组件501通过凸耳519枢转地安装在远侧脊段110上,气缸组件501的远端在远侧脊段110内向下枢转并进一步使活塞杆35上的锁定突起39进入细长通道20内的锁定开口21中。这种布置通过锁定突起39与细长通道20的其中限定了锁定开口的部分进行的摩擦接合,而将刀组件30锁在回缩位置上。如图10和11所示,锁定突起39具有近侧斜面39’和远侧斜面39”,使锁定突起能够轻易地进入或退出细长通道20中的锁定开口。本领域的普通技术人员应当理解,在不脱离本发明精神和范围内,也可成功地应用其他刀杆锁定布置。
图12-16A示出了本发明另一实施例,其中气动构件500包含气缸组件800,其除了下述方面外,结构类似于上述气缸组件501。例如,在该实施例中,弹簧850、852用于回缩活塞杆35。如图12和13所示,气缸组件800包括第一外壳810,其具有第一闭合端812和贯穿其中的第一供应端口813。第一供应管路840连接到第一闭合端812以通过第一供应端口813供应压缩气体。在该实施例中,第一气缸外壳810缺乏上述各个实施例中描述的第二开口529。第二气缸外壳820滑动地接收于第一气缸外壳810中,并具有其上形成有第一活塞头828的第二闭合近端822。在第一闭合端812和第一活塞头828之间限定了第一气缸区域815。在第一活塞头828和形成于第一气缸外壳810远端上的第一凸缘817之间设有第一回缩弹簧850。第一回缩弹簧850用来将第二气缸外壳820偏压到第一气缸810中的回缩位置上,如图12所示。活塞杆35具有阶梯式端部35’,其大小适于进入第二气缸外壳820的第二远端824中。在第二远端824上形成第二凸缘825以基本实现与活塞杆35的阶梯式端部35’的滑动密封。在阶梯式活塞杆部35’的近端上设有第二活塞头830以限定第二活塞头830和第一活塞头828之间的第三气缸区域832。穿过第一活塞头828设有第一开口827,使气体能在第一气缸区域815和第三气缸区域832之间通过。如图12所示,在第二凸缘825和第二活塞头830之间设有第二回缩弹簧852,以将第二活塞头830和阶梯式活塞杆35’偏压到第二气缸外壳820中的完全回缩位置,如图12所示。
本发明的该实施例可如下操作。如图16所示,手柄组件300设有如上所述可替换的压缩气体源620。然而,本领域的普通技术人员应当理解,也可同样有效地应用不可替换的压缩气体源(气缸)。在其他实施例中,手柄组件300可设有端口616用于方便将方向控制阀610和相关部件连接到外部压缩气体源618上。见图16A。例如,器械10可通过柔性供应管路617连接到设备的压缩气体管路上。
为了操作该器械,临床医生移动方向控制阀选择器开关612(图1)或将按钮推到向前(伸出)位置并开始挤压致动扳机670,这允许压缩气体从气缸622(或外部源618)流过供应管路680,流过方向控制阀610并进入供应管路840中。压缩气体从第一供应管路840通过第一供应端口813进入第一气缸区域815,通过第一开口827进入第三气缸区域832。进入第三气缸区域832的气体促使第二活塞头830和活塞杆35的阶梯式部分35’向远侧移动。在第二活塞头830已经移到完全伸出位置之后(图13),继续进入第一气缸区域815的气体将第二外壳820偏压到其完全伸出位置上。一旦刀组件30已经前进到端部执行器12中的其最远侧位置时,临床医生通过释放致动扳机670来停止压缩气体的施加。
为了回缩击发机构或刀组件30,临床医生30将方向阀选择器开关612移到反向(回缩)位置,其中第一供应管路840连接到方向阀610的通气口。允许第三气缸区域832和第一气缸区域815中的气体通过第一供应端口813排入供应管路840并最终通过方向阀610排出。当气体排出第三气缸区域832时,第二回缩弹簧852将活塞杆35的阶梯式部分35’回缩到第二气缸外壳820中。类似地,当气体排出第一气缸区域815时,第一回缩弹簧850将第二气缸外壳520偏压到第一气缸外壳810中。
同样在该实施例中,如图16和16A所示,压力计541可流体连接到供应管路840,它能以上述方式发挥作用并用来使临床医生成比例地读取端部执行器所经受的力。在其他各个实施例中,如图16B所示,在供应管路上可设有可听出口545,它可以上述方式发挥作用来给临床医生提供听觉反馈机构,用于监视驱动系统500及最终监视击发机构所经受的击发力。在其他替代实施例中,在远侧脊段110内可设有限制开关546(图15)用于检测嵌入到击发杆35内的致动构件547(图12和1),从而自动控制方向开关610和/或提供指示击发机构已经到达击发冲程末的视觉和听觉信号。
图17-21A示出了本发明又一实施例,其中驱动构件500包含波纹管组件900。波纹管组件900可具有连接于刀杆组件30远侧部分30的远端902。远端902具有在其上形成的突起904,其大小适合接收于部分30中的孔33内。突起904可摩擦地接收于孔33中和/或通过粘合、焊接等保持在其中。远侧部分31可如上面的详细描述一样进行构造和布置。
如图18所示,波纹管组件900还包括可延伸/回缩的波纹管部分910,其大小适于在远侧脊段中的波纹管通道117内进行延伸和回缩。波纹管组件900可用如图20所示的金属丝包容环912形成,并将其连接到基部914,基部914不可移动地连接到远侧脊段110或构成远侧脊段110的一体的部分。基部914可通过粘合剂、螺钉等连接到远侧脊段110。穿过波纹管基部914设有供应端口916,并且供应管路940连接到供应端口916。供应管路940还连接到手柄组件300内的方向控制阀610。见图21、21A。方向控制阀610同样通过真空管路922与安装到手柄组件300中的真空端口620进行连通。真空端口620通过例如柔性管路632连接到真空源630。真空源可以是设施中的永久真空供应管路。柔性真空管路632从端口620连接到真空源630,使临床医生能够自由操作该器械。
该器械可设有如上所述的闭合管组件170和闭合扳机310布置。这样,以上述方式将组织夹在端部执行器12中。在组织已经夹在端部执行器12中后,临床医生可按如下方式来击发该器械。临床医生将选择器开关612(图1)或方向控制阀610的按钮移到向前(伸出)位置并开始挤压致动扳机670。当致动扳机670受到挤压时,流量阀660允许压缩气体从压力源620(图21)或618(图21A)流向方向控制阀610。方向控制阀610允许压缩气体流过供应管路940进入波纹管910,从而使其向远侧延伸。当波纹管910向远侧延伸时,它通过端部执行器12驱动缝钉70,切断夹在其中的组织,并驱动钉仓50中的缝钉70与钉砧40的下表面进行接触。在刀组件30已经被驱动到端部执行器12的最远侧位置之后,临床医生释放致动扳机670。为了回缩刀组件30,临床医生将方向控制阀610的选择器开关612移到缩回位置,从而允许真空源630连接到供应管路940。给供应管路940进行真空施加,使得波纹管910回缩到图8所示的其回缩位置。在波纹管910已经完全回缩之后,临床医生可将选择器开关612或按钮移到其中方向控制阀阻止给供应管路940施加真空的位置上。然而,供应管路940内剩余的真空可用于将波纹管910保持在回缩位置上。
在图21所示的实施例中,应用可去除的压缩气体源620。如下面进一步详细讨论的,这种压缩气体源包含能再次填充的气缸622。然而,本领域的普通技术人员应当理解,同样可有效地应用压缩气体或压缩流体的非再填充/可再填充源(气缸)。在其他实施例中,手柄组件300可设有给外部压缩气体源供应压缩气体的端口616。例如,器械10可通过柔性供应管路617连接到设施的压缩气体管路上。见图21A。
同样在该实施例中,如图21和21A所示压力计541可流体连接到供应管路940。其可以上述方式发挥作用并用来使临床医生成比例地读取端部执行器所经受的力。在其他各个实施例中,如图21B所示,在供应管路上可设有可听出口545,其以上述方式发挥作用并给临床医生提供听觉反馈机构,用于监视驱动系统500并最终监视击发机构所经受的击发力。在其他替代实施例中,在远侧脊段110内可设置限制开关546(图18),用于检测波纹管组件900上的致动构件912’(图20),从而自动控制方向开关610和/或提供指示击发机构或刀组件30已经到达击发冲程末的视觉或听觉信号。
图22-27示出了应用很多上述实施例的独特和新颖特征的一次性非关节运动端部执行器12。如图23所示,该实施例可采用上面详细描述的端部执行器12和任何驱动构件500。然而,在该实施例中,端部执行器12是一次性的并连接于远侧轴组件1010上,远侧轴组件1010通过整体表示为1000的独特且新颖的快速断开类型的接头可释放地与近侧轴组件1020连接。一旦已经使用端部执行器12,根据需要,端部执行器12和与其连接的远侧轴组件1010可从近侧轴组件1020上分离并被丢弃。然后新的无菌端部执行器12,连同其自己的远侧轴组件1010和气缸布置一起连接到近侧轴组件1020上以完成另一手术操作。如将在下面进一步详细的解释,远侧轴组件101包括远侧脊段1110和远侧闭合管段1180。近侧轴组件1020包括近侧脊段1150、近侧闭合管段1190和可释放的衬套1200。
远侧脊段1110和近侧脊段1150协作形成脊组件1030。在该实施例中,除了它们各自的近端不同,远侧脊段1110可基本上与上面详细描述的远侧脊段110一样。类似地,除了远端不同外,近侧脊段1150可与上述近侧脊段130基本相同,从而能使远侧脊段1110和近侧脊段1150非枢转地连接在一起。同样在该实施例中,除了它们的近端不同外,远侧闭合管段1180与上述远侧闭合管段180基本相同。类似地,除了它们远端不同外,近侧闭合管段1190与近侧闭合管段190基本相同,能使远侧闭合管段1180和近侧闭合管段1190非枢转地彼此连接。
如图23中所示,锁定弹簧112安装到远侧脊段1110中作为用于活塞杆35的锁止件。在远侧脊段1110的顶部上形成远侧和近侧方孔1111、1113,以限定其间的夹杆1115,其接收锁定弹簧112的顶臂116,锁定弹簧112的下远侧延伸臂1118如上所讨论的一样在气缸组件的远端上施加向下的力。应当理解,各个实施例可包括其他类型的锁止件或根本没有锁止件。
远侧脊段1110的近端1114具有在其上形成的远侧连接器部分1116。见图24和27。如图24中所示,远侧连接器部分1116具有连接到第一供应管路段540’的第一远侧供应端口1117。第二远侧供应端口1120设在远侧连接器部分1116内并连接到第二供应管路段542’。如图23中所示,第一供应管路段540’连接到第一气缸外壳810中的第一供应端口513,而第二供应管路段542’连接到第一外壳510远端上的第二供应端口529。如图所示,第一供应喷嘴部分1118在近侧方向上从第一远侧供应端口1117突出。第二供应喷嘴部分1122在近侧方向上从第二供应端口1120上向外突出。
类似地,近侧脊段1150的远端1152具有第二连接器部分1154,其具有连接到另一第一供应管路段540”的第一近侧供应端口1156。第二连接器部分1154还具有连接到另一第二供应管路段542”的第二近侧供应端口1160。将第一近侧供应端口1156构造成可拆除地将第一供应喷嘴1118接收于其中(图27),而第二近侧供应端口1160的大小适于可拆除地将第二供应喷嘴1122接收于其中。如图24和27中所示,第一O形环密封件1158连接第一近侧供应端口1156,用来在第一喷嘴1118插入到第一近侧供应端口1156时,在第一供应管路段540’和另一第一供应管路段540”之间形成基本气密的密封。当以这样的方式连接在一起时,第一供应管路段540’和540”结合以形成第一供应管路540。类似地,第二O形环密封件1162连接第二近侧供应端口1160,以在第二供应喷嘴1122插入到第二近侧供应端口1160时,在第二供应管路段542’和另一第二供应管路段542”之间形成基本气密(或不透流体)的密封。当以这样的方式连接在一起时,第二供应管路段542’和542”形成第二供应管路542。本领域的普通技术人员将会理解,在不脱离本发明精神和范围的情况下,其他可分离的连接布置、快速分离布置也可用于将第一供应管路段540’与另一第一供应管路段540”可拆卸地连接,以及将第二供应管路段542’与另一第二供应管路段542”可拆卸地连接。
远侧连接器部分1116和近侧连接器部分1154可构造成使它们能仅在一个方向上彼此连接。例如,如图24所示,远侧连接器部分1116可设有凹口部分1119,其适于与近侧连接器部分1154上的另一凹口部分1155匹配,从而确保在安装期间第一喷嘴1118接合第一近侧供应端口1156,而第二喷嘴1122接合第二近侧供应端口1160。这种独特和新颖的连接布置防止无意间将第一喷嘴1118连接到第二近侧供应端口1160而将第二喷嘴1122连接到第一近侧供应端口1156。还可应用其他类似锁的结构来确保远侧连接器部分1116与近侧连接器部分1154在适当的方向上连接。
如图24和27中所示,近侧脊段1150的远端1152具有向远侧突出的中空的衬套部分1170。这种中空的衬套部分1170的大小适于将远侧脊段1110的近端1114接收于其中。为了可释放地将远侧脊段1110锁在近侧脊段1150上,在远侧脊段1110的近端1114上形成一对相对的制动构件1124。制动构件1124定位在通过切割或以其他方式在远侧脊段1110上所形成的柔性翼片1126上,使得当远侧脊段1110的近端1114插入到近侧脊段1150的中空衬套部分1170并且第一喷嘴1118密封地连接第一近侧供应端口1156而第二喷嘴1122密封地连接第二近侧供应端口1160时,在中空衬套部分1170内对应的开口1172中接收制动构件1124。见图24和27。
参考图24-27,将描述远侧闭合管段1180与近侧闭合管段1190的可释放的连接。如图中所示,远侧闭合管段1180的近端1182具有至少两个在其近侧方向上突出的销钉式锁定翼片1184。每个锁定翼片1184其上具有锥形锁定楔块1186,其大小适合接收于近侧闭合管段1190对应的锁开口1194中。当在图26和27中示出的位置中时,将远侧脊段1110锁定在近侧脊段1150上以形成脊组件1030,而将远侧闭合管段1180锁定在近侧闭合管段1190上以形成闭合管组件1178。这种布置允许闭合管组件1178在脊组件100上向近侧和远侧移动,从而在以上述各种方式打开和闭合端部执行器12上的钉砧40。
为了将远侧轴组件1010连接到近侧轴组件1020上,如图24所示,用户将远例轴组件1010的近端1012与近侧轴组件1020的远端1022对齐,然后将远端1012插入到近端1022。当在锁定开口1172中接收制动构件1124并且在开口1194中接收锁定楔块1186时,远例轴组件1010锁定到近侧轴组件1020上。通过通过握持闭合扳机310使闭合管组件1178向远侧移动,并以上述方式将扳机310枢转到手柄组件300的握持部342,从而使钉砧40闭合。刀杆30能以上述方式通过启动致动扳机670而被驱动。
为了能使远侧轴组件1010易于从近侧轴组件1020上分离,各个实施例应用可释放的衬套布置。在这些实施例中,可释放的衬套段1200可滑动地套过近侧脊段1150与近侧闭合管段1190之间的近侧脊段1150。在各个实施例中,可释放衬套1200的近端可设有可释放的按钮1204,它穿过近侧闭合管段1190的近端1195上的相应的槽1196而突出。见图22和31。这种布置允许可释放衬套1200在近侧脊段1150上向远侧和近侧轴向移动,而不妨碍脊组件1030上近侧闭合管段1190的轴向行进。
特别如图27中所示,可释放衬套1200的远端1202向内倾斜并被定向成使得它临近近侧闭合管段1190上的两个闭合管锁定开口1194。为了将远侧轴组件1010从近侧轴组件1020上释放,用户在槽1196中向远侧移动可释放按钮从而向远侧移动可释放衬套1200。当可释放衬套1200的倾斜远端1204接触到锁定楔块1186时,锁定楔块1186向内移动,脱离与近侧闭合管段1190上锁定开口1194的接合。在远侧方向上进一步移动可释放衬套1200促使可释放衬套1200中的第二倾斜内缘1206接触锁定制动构件1124并将其向内偏压,脱离与近侧脊段1150上开口1172的接合,从而使远侧轴组件1010能够从近侧脊组件1020上分离。
图22-28中所示的实施例可有效地与上述类型的气缸组件501一起使用。图29和30中所示的实施例可有效地与上述气缸组件800和波纹管组件900一起使用。如图29和30中所示,远侧连接器部1116仅有连接到供应管路段940’的一个端口1300。如图所示,第一供应喷嘴1302在近侧方向上从第一远侧供应端口1300突出。类似地,连接器部1154仅有一个连接到另一第一供应管路段940”的近侧供应端口1306。如图29和30中所示,O形环密封件1308连接近侧供应端口1306,用于当将供应喷嘴1302插入到近侧供应端口1306时,在第一供应管路段940’和另一第一供应管路段940”之间形成基本气密的密封(或不透过流体)。当以这样的方式连接在一起时,第一供应管路段940’和940”结合形成第一供应管路940。接着供应管路940给气缸组件800或波纹管组件900以上述方式供应压缩气体。
图32示出了可选的关节运动式外科切割和缝合器械2000,其中气动关节运动接头组件2002可结合上述端部执行器12和闭合管组件170一起使用。该实施例还可使用上述的气缸组件501。如图33-35中所示,接头组件2002包括脊组件2004,脊组件2004包含具有从其近端2012上突出的枢轴构件2014的远侧脊段2010。枢轴构件2014具有从其上突出的致动器翼2016。如图5所示,气缸组件501枢转地安装在凸耳519上的远侧脊段2010内。
枢轴构件2014枢转地接收于在近侧脊段2030的远端2032上所形成的枢轴座2034内。枢轴构件2014相对于近侧脊构件2030围绕枢转轴线E-E自由转动。见图36。如图35中可见,近侧脊段2032的远端2032具有在其上形成的沟槽2036,用于容纳一部分第一供应管路540。类似地,在近侧脊段200的远端202上设有第二沟槽2038,用于将第二供应管路542容纳于其中。供应管路540,542围绕枢轴座2034穿过,并进入远侧脊段2010的近端2012,其中它们以上述各种方式连接到气缸组件501。本领域普通技术人员应当理解,在中空的近侧脊段2030内的供应管路540和542中设置足够量的松弛,使远侧脊段2010能相对于近侧脊段200围绕枢转轴线E-E自由枢转。通过分别将供应管路540,542安置在沟槽2036,2038中,这些供应管路将不会干扰闭合管组件170相对于脊组件2004的轴向行进。
如图35中所示,第一竖直供应通路2040设置成与枢轴座2034连通。类似地,如图35中所示,同样第二竖直供应通路2050设置成与枢轴座2034连通。从安装在手柄组件300内的开关组件2100延伸的第三供应管路2042与第一竖直供应通路2040连通,而从开关组件2100延伸的第四供应管路2052与第二竖直通路2050连通。为了装配接头组件2002,将枢轴构件2014插入到枢轴座2034,并将封盖用螺钉2062或其他合适的紧固件连接到近侧脊段2030。这样,从第三供应管路2042进入第一竖直供应通路2040的压缩气体将引起远侧脊段2010在“F”方向上围绕枢转轴线E-E枢转,而从第四供应管路2052进入第二竖直供应端口2050的压缩气体将引起远侧脊段2010在“G”方向上围绕枢转轴线E-E枢转。见图34。
参考图37-45,将解释各个实施例的开关组件2100的结构和操作。在各个非限制性实施例中,开关组件2100包含开关块2110,在其内含有供应端口2112。供应端口2112连接到供应管路651,用于接收来自压缩气体源620(图44)和618(图45)的压缩气体。特别地,供应管路651可从供应管路650延伸到端口2112。开关腔2114设在开关块2110内并且其大小适于枢转地将选择器构件组件2130的主体部分2150接收于其中。枢轴杆2151从被枢转地安座于开关块2110的枢轴孔2111中的主体部分2150的基底上突出。见图39。这种布置允许选择器构件组件2130选择地围绕开关轴线H-H旋转。见图38。如图38和39中所示可设有一对O形环2152,2154和其他合适的密封构件以在选择器构件组件2130和开关块2110之间建立基本气密的密封。杆2156从主体部分2150突出以接收选择器手柄2158。旋转选择器手柄2158引起主体部分2150在开关盒内的旋转。如图39中所示,供应端口2112与开关块2110内的供应通路2116连通,其同样与在开关块2110内形成的头部区域2118连通。
选择器构件组件2130的主体部分2150具有中央供应端口2160,其与头部区域2118连通。第三供应通路2045设置在开关块2110上。见图40。第三供应通路2045在开关腔2114与连接第三供应管路2042的第三供应端口2044之间延伸。类似地,第四供应通路2055设置在开关块2110内,并在开关腔2114与连接第四供应管路2052的第四供应端口2054之间延伸。当如图40所示定位选择器构件组件210时,通过供应通路2116中的供应端口2112进入开关块2110的压缩气体进入头部区域2118并流入中央供应通路2160。然而,压缩气体被阻挡在中央供应通路2160的末端。这样,开关处于图40中的关闭位置。
为了使远侧脊段2010向右枢转(与图34中所示的位置相对),将选择器构件组件2130枢转到如图41所示的位置。如图中所示,通过供应端口2112并通过供应通路2116进入开关块2110并进入头部区域2118的压缩气体通过中央供应端口2160转移到第三供应通道2045并进入第三供应管路2042中。接着压缩气体流入第一竖直供应通道2040并接触枢轴构件2014上的致动器翼2016从而在“F”方向上压迫枢轴构件2014。致动器翼2016的相对侧上的压缩气体进入第二竖直通路2050并流入第四供应管路2052。当压缩气体进入开关块2110的第四端口2054时,它流入第四供应通路2055并进入主体部分2150中的第四排气通路2170。第四排气通路2170与选择器构件组件2130主体部分2150中的底切排气区域2155连通。见图43。这样,第四供应管路2052中的压缩气体通过第四排气通路2170排出并通过底切排气区域2155从开关排出。
为了将远侧脊段2010枢转到图34中所示的位置,临床医生旋转选择器构件组件2130,使得中央供应通路2160现在在头部区域2118和第四供应通路2055之间延伸。这样,从供应管路651流入供应通路2116并进入头部区域2118的压缩气体通过中央供应通路2160流入第四供应通路2055。压缩气体流出第四供应端口2054并进入第四供应管路2052。第四供应管路2052将压缩气体转移到第二竖直供应通路2050。当压缩气体进入第二竖直供应通路2050时,致动器翼2016在“G”方向上枢转枢轴构件2014。见图34。致动器翼2016相对侧上的气体流过第一竖直供应通路2040并进入第三供应管路2042。气体从第三供应管路2042排出并进入到第三供应通路2045并流入设在主体部分2150上的第三排气通路2180。第三排气通路2180被定向为将气体排出底切排气区域2155。
该实施例的另一独特和新颖的特征是自动中间(neutral)特征布置,这使临床医生能够简单地通过释放选择器开关手柄2158,将远侧脊部2010(和端部执行器12)锁定在所需的关节运动位置上。更具体地说,将构造成如图所示的回复弹簧2190如图40、41和43所示安装到开关块2110中。为了将弹簧2190保持在开关块2110中,一对相对的隆凸2192,2194从开关块2110的底面2113突出。弹簧2190分别被保持在隆凸2192,2194中的槽2193,2195中。见图43。如图43中所示,回复杆2153从选择器构件组件2130的主体部分2150突出。在回复弹簧2190的自由端2196,2198之间接收回复杆2153。图43示出了在中间(neutral)或闭合位置上的主体部分2150。
这样,当临床医生想要使端部执行器12作关节运动时,他或她旋转选择器手柄2158,在对应于所需关节运动行进的旋转方向上移动选择器构件组件2130的主体部分2150。当临床医生旋转主体部分2150时,该主体部分抵抗由回复弹簧2190的其中一个自由端2196,2198所产生力而旋转。一旦临床医生已经将端部执行器12关节运动到所需位置时,他或她释放选择器手柄2158并且回复弹簧2190将主体部分2150移动到闭合位置,这将端部执行器12保持在该位置。如果临床医生想要调整端部执行器12的关节运动位置,他或她只要将选择器手柄2158在所需方向上旋转到所需位置,其后释放手柄2158将端部执行器12保持在该位置。
图44示出了与本发明各个非限制性实施例的开关2100结合使用的控制系统部件的布置。如图中所示,应用了可拆卸的压缩气体源620。来自源620的气流通过供应管路650流到流量阀660并通过供应管路651流到开关组件2100的端口2112。在图44所示的实施例中,源620包含在外壳组件300的握持部342内安置的可替换/可再填充罐622。罐622可以是可再填充的。然而,本领域的普通技术人员应当理解,也可有效地应用不可替换/非再填充压缩气体源(气缸)。在其他实施例中,手柄组件300可设有供应来自压缩气体外部源618的压缩气体的端口616。例如,器械可通过柔性供应管路617连接到设施的压缩管路(未显示)上。见图45。
图46-48示出了与上述类型和结构的快速分离接头1000’有关的关节运动接头组件2002的布置的使用。然而,在这一布置下,使用总共四个端口。如图47中所示,远侧连接器端口1116具有连接到第一供应管路段540’的第一远侧供应端口1117。第二远侧供应端口设在远侧连接器部1116上并连接到第二供应管路542’。如图所示,第一供应喷嘴部1118在近侧方向上从第一远侧供应端口1117处突出。第二供应喷嘴部1122在近侧方向上从第二供应端口1120向外突出。
远侧连接器部1116还具有连接到第三供应管路段2042’的第三远侧供应端口1117’。第四远侧供应端口1120’设在远侧连接器部1116上并连接到第四供应管路段2052’。如图所示第三供应喷嘴部1118’在近侧方向上从第三远侧供应端口1117’处突出。第四供应喷嘴部1122’在近侧方向上从第四供应端口1120’向外突出。
类似地,近侧脊段1150的远端1152具有第二连接器部1154,它具有连接到另一第一供应管路段540’的第一近侧供应端口1156。第二连接器部1154还在其内具有连接到另一第二供应管路段542’的第二近侧供应端口1160。将第一近侧供应端口1156构造成可拆除地将第一供应喷嘴1118接收于其中,并且第二近侧供应端口1160的大小适于可拆除地将第二供应喷嘴1122接收于其中。如图47中所示,第一O形环密封件1158连接第一近侧供应端口1156,用于当将第一喷嘴1118插入到第一近侧供应端口1156时,在第一供应管路段540’和另一第一供应管路段540”之间形成基本气密的密封(或不透流体)。当以这样的方式连接在一起时,第一供应管路段540’和540”结合以形成第一供应管路540。类似地,第二O形环密封件1162连接第二近侧供应端口1160从而当将第二喷嘴1122插入到第二近侧供应端口1160时,在第二供应管路段542’和另一第一供应管路段542”之间形成基本气密的密封(或不透流体)。当以这样的方式连接在一起时,第二供应管路段542’和542”结合以形成第第二供应管路542。
另外,近侧脊段1150的远端1152具有第二连接器部1154,其具有连接到另一第三供应管路段2042’的第三近侧供应端口1156’。第二连接器部1154还在其中具有连接到另一第四供应管路段2052”的第四近侧供应端口1160’。将第三近侧供应端口1156’构造成可拆除地将第三供应喷嘴1118’接收于其中,并且第四近侧供应端口1160’的大小适于可拆卸地将第四供应喷嘴1122’接收于其中。如图47中所示,第三O形环密封件1158’连接第三近侧供应端口1156,用于当将第三喷嘴1118’插入到第三近侧供应端口1156’时,在第三供应管路段2042’和另一第三供应管路段2042”之间形成基本气密的密封(或不透流体)。当以这样的方式连接在一起时,第三供应管路段2042’和2042”结合以形成第三供应管路2042。类似地,第四O形环密封件1162’连接第四近侧供应端口1160’从而当将第四喷嘴1122’插入到第四近侧供应端口1160’时,在第四供应管路段2052’和另一第四供应管路段2052”之间形成基本气密的密封(或不透流体)。当以这样的方式连接在一起时,第四供应管路段2052’和2052”结合以形成第第四供应管路2052。本领域的普通技术人员将会理解,在不脱离本发明精神和范围的情况下,可应用其他可分离的连接布置、快速分离布置。
如上面在背景技术部分中所指示的,内镜切割器系统变得越来越小,开发能产生必要驱动力的气动系统的挑战变得更艰巨。通过使用电动马达来驱动旋转驱动轴使这类问题变得容易解决。旋转运动易于在长的柔性或可关节运动的驱动轴上传递。虽然在电动马达的尺寸和扭矩能力上已经做了巨大的进步,但是这种系统的效率仍将受到远侧细长轴直径大小的限制,并且受到能够被装配在尽可能地靠近缝合机构的区域的马打的尺寸的限制。在许多目前的应用中,所需轴直径的大小防止电动马达定位在系统的远端,同时能够提供足够的能量来驱动系统。
下面的实施例解决了与使用电动马达相关的问题和缺点。如下面将要讨论的,这些实施例应用气动马达将旋转能两传递给旋转驱动的内镜切割器。气动马达通常产生与传递给马达的气体压力和体积成比例的扭矩和每分钟转数。在图49-56所描述的非限制性实施例中,应用关节运动驱动轴组件将旋转运动从气动马达传递给端部执行器。然而,本领域的普通技术人员将会理解,本发明这些实施例的独特和新颖方面还可有效地与其他已知的旋转驱动端部执行器和其他外科器械结合使用,这些器械可应用柔性驱动轴布置来给内镜切割器传送旋转驱动运动。另外,本发明这些实施例的独特和新颖方面可有效地与非关节运动端部执行器布置结合使用。
图49-56示出了本发明应用旋转驱动内镜切割器1512的外科切割和缝合器械1500。存在多种旋转驱动内镜切割器和其他外科器械。例如,在授予Shelton,IV等人的于2006年1月1日提交的、题为
“具有用户反馈的马达驱动外科切割和缝合器械”的美国专利申请No.11/343,447中公开了一种这样的旋转内镜切割器布置。其相关部分通过引用并入本文。在授予Shelton,IV等人的于2006年6月27日提交的、题为“手动驱动外科切割和缝合器械的美国专利申请(KLNG No.050704/END5779USNP)中公开了其他示例其相关部分通过引用并入本文。
图50是根据各个非限制性实施例的端部执行器1512的分解图示。如示出的实施例所示,端部执行器1512可包括大小适于接收气动操作工具的细长通道1520。各个非限制性实施例的气动操作工具包含可操作地将“击发机构”支撑于其中的钉仓50。该实施例包括在其上运送刀部分1538的楔形滑块组件1530。楔形滑块组件1530旋拧在螺旋驱动螺钉1560上。定位在细长通道1520的远端1521的轴承1522接收该螺旋驱动螺钉1560,允许螺旋驱动螺钉1560自由地相对于细长通道1520进行旋转。螺旋驱动螺钉1560可与楔形滑块组件1530的螺纹开口(未显示)进行连接,从而螺旋驱动螺钉1560的旋转使得楔形滑块组件1530向远侧或近侧平移(取决于旋转的方向)通过在钉仓中支撑的缝钉全被击发的完全伸出位置或称致动位置与完全回缩位置或称未致动位置之间的细长通道1520。因此,当在一个方向上旋转螺旋驱动螺钉1560时,通过钉仓50向远侧驱动楔形滑块组件1530来切断夹在端部执行器1512中的组织,并击发钉仓50中的缝钉接触枢转地连接到细长通道1520的钉砧40的底部表明。楔形滑块组件1530的滑块部1532可由例如塑料制造,并可具有倾斜远侧表面1534。当楔形滑块组件1530横过细长通道1520时,倾斜向前的表面1534可推动或驱动钉仓50中的缝钉通过夹住的组织并抵靠住钉砧40。钉砧40使缝钉旋转,从而缝合切断的组织。当楔形滑块组件1530回缩时,刀部分1538和滑块部分1532变得脱离开,从而将滑块部分1532留在细长通道1520的远端。本领域的普通技术人员应当理解,也可应用具有其他击发机构的其他气动操作工具。
图51和52示出了一个用于给螺旋驱动螺钉1560传递来自在手柄组件300中的气动驱动马达的旋转运动的驱动轴布置。如参考图51中所示,该实施例可应用上面详细描述的闭合管组件170。在脊组件1540上滑动地接收闭合管组件170,该脊组件1540包含旋转地支撑主旋转(或近侧)驱动轴1544的近侧脊段1542,该主旋转驱动轴1544经由锥齿轮组件1500与第二(或远侧)驱动轴1546连通,该锥齿轮组件1500包括齿轮1552、1554、1556。第二驱动轴1546连接到接合螺旋驱动螺钉1560的近侧驱动齿轮1562的驱动齿轮1548上。竖直锥齿轮1552枢转地支撑在近侧脊段1542远端的开口1543中。远侧脊段1570用于闭合第二驱动轴1546和驱动齿轮1548、1554。主驱动轴1544、次驱动轴1546和关节运动组件(例如锥齿轮组件1500)有时候被一起称为“主驱动轴组件”。
如图53和54中所示,各个实施例的器械1500由压缩气体620形式的气动源来供能。在这些附图所示的实施例中,源620包含安置于外壳组件300的握持部642中的可替换/可再填充的罐622。罐622时可再填充的。然而,本领域的普通技术人员应当理解也可有效地使用非替换/不可再填充的压缩气体源(气缸)。在其他实施例中,手柄组件300可设有用于供应来自压缩气体外部源618的压缩气体的端口616。例如,器械1500可通过柔性供应管路617连接到设施的压缩气体管路(未显示)。见图53A。
将在下面进一步讨论可替换/可再填充气缸622的独特和新颖方面。然而,为了便于解释给端部执行器1512提供旋转运动的驱动系统,将压缩气体在压力下从气缸622或外部压力源618通过供应管路650流入传统的流量阀660。流量阀660连接到连接于致动扳机670上的供应连杆机构662上。见图53和58。在各个实施例中,将致动扳机670支撑在行进监视构件或相对位置击发扳机310’的附近,相对位置击发扳机310’通过在右手壳构件320和左手壳构件330之间延伸的枢轴销370枢转地连接到手柄组件300上。相对位置击发扳机310’可由塑料或其他合适的材料制造,并如图所示具有基本成U形横截面的部分以容纳致动扳机670。临床医生可将他或她的手放在外壳组件300的握持部52上,使得他们三个下部手指放在相对位置扳机310’上,而他们食指放在致动扳机670上。向内朝着相对位置扳机310’挤压致动扳机670促使流量阀660允许气体在压力下从源620(或图53A中的618)经过供应管路680进入方向控制阀1610。
如图56中所示,方向控制阀1610具有向前位置段1620、止挡段1630和反向段1640。控制阀段1620,1630,1640可通过推动突出手柄外壳00的按钮1612和1614手动地移动。见图49和56。两个供应/排气管路1700,1710从方向控制阀1610延伸到传统气动马达1730。这样,当临床医生将控制阀1610移动到向前位置时,向前通路1622允许压缩气体从供应管路680流出并进入供应/排气管路1700,从而促使气动驱动马达1730在第一方向上驱动马达驱动轴1732,如下面将进一步讨论的该方向导致给驱动轴1544传递旋转运动,驱动轴1544在击发冲程中驱动楔块滑动组件1532和刀部分1538向远侧通过端部执行器1512。通过供应管路1710排出气动马达1730的气体通过排气端口1632排掉。当控制阀1610移动到反向位置时,经过供应管路680的气体流过供应管路1710进入气动马达1730。通过供应/排气管路1710排出气动马达1730的气体通过排气端口1632排掉。当控制阀处于止挡位置1630时,供应管路1680和供应/排气管路1710闭合并且供应管路1700连接到排气端口1632。见图56。
进一步如图56中所示,气动马达1730的输出轴1732在其上具有第一驱动齿轮1734,其与安装在行星齿轮组件1740的输入轴1738上的第二驱动齿轮1736啮合。行星齿轮组件1740具有输出轴1742,它通过传统轴连接构件1743连接到驱动轴1544的近端1545,以传送旋转运动。这样,当控制阀1610移动到向前位置时,气动马达1730的输出轴1732通过齿轮1734,1736和行星齿轮组件1740给驱动轴1544传递旋转运动,从而促使楔形滑块组件1530和刀部分1538推动钉仓50,切断夹在端部执行器1512中的组织,并驱动钉仓50中的缝钉接触钉砧40。当控制阀1610移动到反向位置时,气动马达1730的输出轴1732给驱动轴1544传递相反的旋转运动,从而将楔形滑块组件1530和刀部分1538在近侧方向上回缩穿过钉仓50。
图49-56所示的实施例同样还具有独特和新颖的特征,其中具有增强的器械操作性,并能给临床医生提供各种形式的反馈使得当楔形滑块组件1530和刀部分1538向远侧前进以及回缩时,临床医生能监视它们在钉仓50中的位置。再次返回图56,可以看到反馈齿轮1750设在行星齿轮组件1740的驱动轴1544或输出轴1742上。反馈齿轮1750与安装在螺纹刀定位轴1754上的刀定位齿轮1752啮合接触。刀定位轴1754可由适当的轴承布置(未显示)来支撑以方便它在其中自由旋转。近侧限制开关1760连接到轴1754的近端1756而远侧限制开关1770连接到轴1754的远端1758。在刀定位轴1754上拧有螺纹刀指示器1780用于在其上向远侧和近侧行进。当驱动轴1544在促使楔形滑块组件1530和刀部分1538向远侧移动通过钉仓50的方向旋转时,刀指示器1780同样向近侧朝远侧限制开关1770移动。远侧限制开关1770被定向成使得当楔形滑块组件1530和刀部分1538在最远位置时,刀指示器1789致动远侧限制开关1770。在左手壳构件330(或右手壳构件320,这取决于刀定位轴1754在外壳组件300中的位置)上设有窗口,使得临床医生能观察刀指示器1780的位置,从而确定击发机构(楔形滑块组件1530和刀部分1538)在其击发冲程中的位置,并且还给临床医生提供在回缩冲程期间监视楔形滑块组件1530位置的手段。
同样在各个实施例中,从供应管路650到远侧限制开关1770可设置远侧引导管路1772。远侧限制开关管路1774可设在远侧限制开关1770与方向控制阀1610之间。这样,当楔形滑块组件1530和刀部分1538已经结束击发冲程并且刀指示器1780致动远侧限制开关1770时,远侧限制开关1770允许气体在压力下从供应管路650流向远侧限制开关管路1774,并流入方向控制阀1610,这在各个实施例中促使方向控制阀1610自动移动到反向位置,从而促使气动马达1730倒转并最终赋予驱动轴1544反向旋转运动。当气动马达1730使驱动轴1544反向时,反向旋转运动传递给刀定位柄1754,从而驱动刀定位指示器1780向后朝向近侧限制开关1760。近侧引导管路1662同样可在近侧限制开关1660和供应管路650之间延伸,使得当刀定位指示器1780致动近侧限制开关1660(表示楔形滑块1530和刀部分1538已经移动到其完全回缩的位置)时,则近侧限制开关1660允许气体流入近侧限制开关管路1664并进入方向控制阀1610,从而促使方向控制阀1610自动移动到止挡位置。
在各个实施例中,第一空气动力哨1790或其他合适的声音产生设备可与远侧限制开关管路1774(或远侧限制开关1770)连通,使得当在击发冲程末致动远侧限制开关1770时,穿过远侧限制开关管路1774的气体致动第一哨1790,给临床医生提供指示楔形滑块/刀已经到达击发冲程末的听觉信号。类似地,第二空气动力哨1792或其他合适的声音产生设备可与近侧限制开关管路1760,使得当在回缩冲程末致动近侧限制开关1760时,穿过近侧限制开关管路1764的气体致动第二哨1792,给临床医生提供指示楔形滑块/刀已经到达回缩冲程末的另一听觉信号。在其他实施例中,例如,电池供能的发光二极管或其他信号设备可与远侧和近侧限制开关1770,1760连通,在楔形滑块/刀已经到达击发冲程末和/或回缩冲程末时,给用户提供另一指示。在替代实施例中,哨1790,1790可用压力传感器或压力计替代以便在设备已经到达击发冲程和/或回缩冲程末时进行指示。
在图49-56所示的各个实施例中,气动驱动马达支撑在手柄组件300中。在图52A和52B所示的实施例中,气动马达1730’定位在远侧脊段110中。马达驱动轴1546在其上具有驱动齿轮1548’,它与螺旋驱动螺钉1560的近侧驱动齿轮1562啮合。图52A示出了这种与如上所述的关节运动接头104结合的远侧安装的气动马达。在图52B中所示的实施例中应用了如上所述的气动关节运动2002接头组件。这种远侧安装的气动马达布置也可结合其他关节运动接头布置来应用,或结合其中端部执行器并不相对于手柄组件或与之连接的细长轴组件部分进行关节运动的器械来使用。本领域普通技术人员将会理解,对于马达支撑在手柄组件中并且击发和回缩移动必须通过关节运动接头传递给端部执行器的实施例来说,这种远侧安装的气动马达布置使通过细长驱动轴布置所遇到的能量损失最小。例如在图52A和图52B中所示的实施例仅需要两个管路1710和1760来通过关节运动接头给马达1730’供能。管路1710和1760可包含柔性管等,并且与需要一个或多个驱动构件来通过接头的其他布置相比更不可能限制关节运动接头。
同样,可将本发明各个实施例构造成给用户提供关于器械击发部件相对位置的触觉形式的反馈。在这些实施例中,这可通过将行进监视构件或相对位置扳机310’与施加到设备驱动轴或击发机构上的前进或回缩移动进行关联来实现。特别参考图53-55,该实施例可包括反馈连杆组件1800,其在各个非限制性实施例中可包含有螺纹的手动反馈轴1801,它螺纹连接到螺帽构件334,该螺帽构件334可旋转地安装在相对位置扳机310’的上连接板部332。手动反馈轴1801的远端具有支撑手动反馈齿轮1804的万向节部1802,该手动反馈齿轮1804与刀部齿轮1752啮合。当方向控制阀610处于向前位置时,气动马达1730驱动驱动轴1544,使得楔形滑块1530和刀部158形式的击发机构通过气缸向远侧驱动(击发冲程)。反馈齿轮1750驱动刀定位齿轮1752,定位齿轮1752又驱动手动反馈齿轮1804。然后手动反馈齿轮1804旋转手动反馈轴,借助于手动反馈轴与螺帽334的螺纹连接,其将相对位置扳机310’朝着手柄组件300的握持部342拉动,从而给临床医生提供楔形滑块1530和刀部1538前进的“触觉”指示。本领域的普通技术人员将会理解,如果临床医生试图将相对位置扳机310’朝着手柄组件300的握持部342枢转时,手动反馈轴1801和螺帽334将阻止其任何行进。然而,相对位置扳机310’将关于楔形滑块1530和刀部1538的前进和回缩进行自动枢转。这种布置简单地通过在整个手术过程中紧握相对位置扳机310’,给临床医生提供了楔形滑块组件1530和刀部1538(击发机构)前进和回缩的自动触觉指示。这样,临床医生不必为获得这样的反馈而查看任何事物。这种布置给临床医生提供了击发机构在非致动位置和致动位置之间以及当击发机构从致动位置向后行进到非致动位置时的手持非视觉反馈。
各个实施例可进一步设有另一触觉反馈布置,表示为333。例如,如图53-56中所示,相对位置扳机310’的上连接板部分332可设有一系列槽335、制动构件、沟槽等,设计用于在击发和回缩过程中,相对位置扳机310’围绕销370枢转时,与安装在手柄组件300中的弹簧臂337进行接合。当上连接板部分332与相对位置扳机310’一起枢转时,弹簧臂337的端部落入每个连续的槽335中,并用于给上连接板部分332施加(一系列)力,这可由临床医生在紧握相对位置扳机310’时感觉到。这样,当相对位置扳机310’前进时,将给临床医生提供一系列对应击发机构运动的附加触觉反馈运动,从而确定相对位置扳机310’(和最终的击发机构)是在击发冲程中前进,还是在回缩冲程中回缩,任何一种情况均有可能。另外,当弹簧臂337的末端落入到每个连续的槽中时,它可产生听觉声响,卡嗒声等,从而给临床医生提供关于击发机构在击发冲程和回缩冲程中移动的听觉反馈。这样,该实施例提供了一系列(至少是两个)关于在未致动和致动位置之间击发机构运动的听觉声响。
本领域的普通技术人员应当理解,器械1500代表在现有的气动内镜切割器布置的基础上进行了巨大的改进。例如,各个实施例给临床医生提供当在击发冲程中驱动击发机构时可监视击发机构(楔形滑块/刀)的部件。在一些实施例中,当楔形滑块/刀到达击发冲程末时,其自动回缩。一旦在完全回缩位置后,控制阀可自动转到止挡位置,从而停止对气动马达1730供应来自源618或620的气体。然而,如果在致动过程中,临床医生希望停止楔形滑块/刀在气缸中向远侧前进,他或她可简单地手动将控制阀610转换到反向位置并继续启动致动扳机670,以便给气动马达1730供应压缩气体直到楔形滑块/刀移动到所需的回缩位置。此外,独特和新颖的相对位置扳机310’给临床医生提供在他或她紧握相对位置扳机310’时能感觉到的手动或触觉反馈。同样,当楔形滑块/刀已经到达击发冲程末和/或已经完全回缩时,可给临床医生提供听觉信号。
本领域技术人员应当理解,当应用驱动构件500,800和波纹管组件900,并将这些驱动构件的每一个与相对位置扳机310’的上连接板部分332或其他部分通过推/拉柔性绳索(未显示)或刚性构件(用于非关节运动实施例)进行连接,使得这些驱动构件的前进或回缩直接或间接与相对位置扳机310’相关联时,同样可实现由行进监视设备所提供的独特和新颖的特征。该独特和新颖的布置同样可用于下面图70-83中所示的实施例。
如上所述,反馈连杆组件1800不仅以与击发机构移动的速率相对应的速率自动移动相对位置扳机310’,从而给临床医生提供监视击发机构进程的手段,而且反馈连杆组件1800可应用螺纹或其他手段来有效地防止或极大地限制临床医生手动枢转相对位置扳机310’。在这些非限制性实施例中,相对位置扳机310’仅在反馈铰链组件使它移动时才移动。在其他实施例中,通过能够在致动时防止相对位置扳机310’的枢转运动的马达(未显示)或另一气缸(未显示),可防止相对位置扳机310’的手动移动。例如,在致动扳机670上存在的力启动了气体的释放,但直到击发机构开始移动后,才允许相对位置扳机310’随后移动,并且如果击发机构停止移动,则相对位置扳机310’也停止移动。
然而,在其他各个实施例中,反馈连杆组件1800可被构造成使临床医生能够在击发冲程期间辅助气动马达1740形式的驱动构件,以便在临床医生需要的情况下增加其上的力或阻止击发机构的前进。在这些各个实施例,例如,可用梯形螺纹或其他类型的螺纹布置或构造形成反馈轴1801,这实际上允许临床医生给相对位置扳机310’施加压力,从而借助于它与螺帽334的接合来给轴1801传递旋转运动。通过给轴1801传递旋转运动,临床医生同样给与齿轮1750啮合的齿轮1804施加旋转力,其中齿轮1750在驱动轴1544上行进。这样,如果击发机构遭遇阻力,则临床医生可通过挤压相对位置扳机310’给驱动轴1544施加机械地产生的能量。如果临床医生希望减慢或阻止击发机构的移动,则临床医生可给相对位置扳机310’施加力,相对位置扳机310’又阻碍/减缓轴1801和齿轮1804的旋转,并最终阻碍/减缓驱动轴1544的旋转。
结合为了操作设备而在压力下供应气体的可拆卸气缸622描述了上述各个实施例。在各个实施例中,可拆卸气缸622最初在压力下装满气体并且不可再填充。例如,气缸622可包含填充二氧化碳的传统一次性气缸。一旦气缸清空,则用户将其从手柄组件上去除并用新的充满的气缸来代替它。也可应用其他类型的气体,例如,压缩气体、二氧化碳(CO2)、氮、氧、氩、氦、氢化钠、丙烷、异丁烷、丁烷、氯氟甲烷、二甲醚、甲基乙醚、一氧化氮、氢氟烷推进剂(HFA),例如HFA134a(1,1,1,2,-四氟乙烷)或HFA227(1,1,1,2,3,3,3-七氟丙烷)。这种布置在已有气动外科器械布置上提供了巨大的改进。然而,器械的使用次数取决于能存储在这种气缸中气体的体积,并需要有效地维持设备的消毒。
本发明另一实施例应用了一种气缸622,当在储存压力下以液体状态存储气体,接着当放置在较低压力下设备被致动时该液体转化为气态。可应用在这些实施例中的这种液体示例包含一氧化氮、二甲醚、甲基乙醚、氢化钠、丙烷、异丁烷、丁烷、氢氟烷推进剂(HFA),例如HFA134a(1,1,1,2,-四氟乙烷)或HFA227(1,1,1,2,3,3,3-七氟丙烷),以及高压下的二氧化碳(CO2)
图57示出了气缸622的非限制性实施例,其具有上面提到的液体物质624中的一种。气缸622可由钢、铝或其他与存储于其中的液体/蒸汽兼容并能够承受其内部产生内压的材料制造。当应用此处所述类型的这种外科器械时,临床医生常常将手柄组件300在多个位置上转动-包括上下转动以获得端部执行器12的理想位置。因此,在这些实施例中,为了防止在这种操作期间液体从气缸622的移出并进入控制系统中,在气缸622中设置膜626。膜626可由防止液体物质穿过但允许从液体变成的蒸汽628穿过膜626的材料制造。这样,临床医生可自由地操纵手柄组件300,而没有液体物质624进入方向控制阀1610和/或气动马达1720的危险。虽然将气缸622示成一体结构,但是气缸622可由两个或多个件制成,以方便将液体物质624和膜626装于其中。可应用合适的密封构件在这种实施例中建立气缸各个部分之间不透流体的密封。另外,可设有充注端口(未显示)以便给气缸622填充。
在图57所示的实施例中,当临床医生将方向控制阀1610偏移到向前的位置并致动流量阀660时,气缸622内的压力降低。这种压力降低促使液体物质624开始蒸发,并且蒸汽628穿过膜626,用于给上述各个控制系统供能。这样,通过降低气缸622中的压力,液体物质624开始蒸发并且加压的蒸汽628用于给设备供能。
其他实施例可使用需要燃烧以便将液体物质转化成它的气体状态的液体物质。这种液体物质的示例是丙烷、丁烷和其他石油产品。可应用传统的按钮点火器或其他点火器系统来点燃该液体物质。在这种应用中,设备的其他部件由能安全地分散由此所产生的任何热/烟的物质制造。其他实施例可应用状态改变的物质,特别设计成在低的压力和温度下通过输入热而从固态转化成液体,从固态转化成气态或者从液态转化成气态。这些物质的示例是石蜡和氢化钠的多种混合物。这些状态改变物质在将热输入到系统中的情况下,可具有很大的体积变化。这类设备将应用诸如燃烧器的部件来给物质提供所需的热量。再次,暴露给这种热的这些设备部件用能安全分散这种热并在使用期间保护临床医生的材料进行设计和构造。
图57所示的实施例可使用上述多种不同类型的气缸,并提供相对于其他实施例的各种个优势,其中气缸永久地安装在手柄组件00内。更具体地并参考图57,气缸622可接收于在手柄组件300的握持部342中形成的腔671内。为了获得通往腔671的通路,可将握持部342制造成两个易于分离的片或使它设有可去除的封盖板(未显示),该板通过扣合或以其他方式与之可去除地连接。在各个实施例中,气缸622的排放端630旋进头顶块632中的螺纹端口634。螺纹端口634与通过针形阀638进行打开和关闭的供应通道636连通。特别地,在各个实施例中,针阀638旋进头顶块632中,使得通过旋转针阀638能打开和关闭供应通路636。然而也可使用其他的阀或流量控制布置。
为了在使用期间给临床医生提供气缸压力指示,可与供应通路636流体连通地安装传统压力计640。压力计窗口642可设在握持部342上使用户能在使用期间观看压力计640。见图49。
如图57和58中所示,气缸622可支撑在能拆卸的握持部342中,它可去除地连接到从主手柄部340向下突出的主连接部344上。可拆卸的握持部342能通过任何合适的布置与主连接部344接合。例如,根据各个实施例,可拆卸的握持部342与主连接部344的接合可通过如图所示的直线滑动布置来实现。如图所示,例如,在图57-59和61中,可释放的握持部342还包括第一和第二上滑轨367以及第一和第二下滑轨368。同样如那些图中所示,第一上滑轨367限定了斜面369。将上滑轨367设计成接收在由面板380和382在主手柄部340中所限定的相应区域384内。
该外科器械可还包括锁止系统1900。例如在图59和64-69中更详细所示,将锁止系统1900构造和布置成在可拆卸的握持部342从主连接部344分离达预定的次数之后,阻挡主连接部344到可拆卸的握持部342的连接。该预定的次数可以是任何次数。特别有利的是,这种布置通过限制设备使用次数来确保有效维持设备的消毒。例如,根据各个实施例,锁止系统1900在可拆卸的握持部342从主连接部344分离两次后,阻挡主连接部344到可拆卸的握持部342的连接。虽然显示出锁止系统1900主要位于主外壳部分340中,但是可以理解的是,根据其他实施例,锁止系统1900可主要位于可拆卸的握持部分342中。
如图59所示,锁止系统1900包含计数器1902和连接计数器1902到的阻挡组件1904。将计数器1902构造和布置成当可拆卸的握持部342从手柄组件300的主连接部344分离时就前进。如图59中所示,计数器1902连接到轴1906,轴1906由连接到右手壳构件320的隆凸1908支撑。计数器1902包含连接到轴1906的分度轮1910,以及连接到分度轮1910的偏压构件1912。偏压构件1912可例如包含能够在逆时针方向偏压分度轮1910的扭转弹簧。见图59。
分度轮1910限定了突起1914,1914’,1914”,它们与阻挡组件1904协作来限制分度轮1910的前进。将其中一个突起1914”构造和布置成与阻挡组件1904协作,以在握持部342从主连接部344分离达预定次数之后,阻挡可拆卸的握持部342到主连接部344的连接。虽然所示的分度轮1910限定了突起1914,1914’,1914”,但是可以理解的是,根据其他实施例,分度轮1910可限定与阻挡组件1904协作来限制分度轮1910前进的凹口,并且其中一个凹口与阻挡组件1904协作,以在握持部342从主连接部344分离达预定次数之后,阻挡可拆卸的握持部342到主连接部344的连接。
将轴1906构造和布置成允许分度轮1910复位到先前的位置。例如,轴1906可限定六边形开口1916,并且六边形工具可插入左手壳构件330上的开口1918(图60所示)并进入六边形开口1916,然后顺时针方向旋转,将分度轮1910复位到先前的位置。
如图59中所示,阻挡组件1904包含阻挡构件1920、阻挡构件导杆1922、门构件1924和偏压构件1926。门构件1924接触阻挡构件1920,枢转地连接到阻挡构件导杆1922,并与突起1914,1914’,1914”协作来限制分度轮1910的前进。偏压构件1926连接到门构件1924。偏压构件1926包含例如构造成将门构件1924在顺时针方向上偏压的扭矩弹簧。锁止系统1900的操作将在下面参考图64-69进行更详细的描述。
例如,如图所示,在图59-63中,手柄组件300还包括释放系统1930,其能够将可拆卸的握持部342初始从主连接部344上脱离。释放系统1930位于主连接部344内并包含释放按钮1932、连接释放按钮1932上并与之形成一体的第一和第二释放构件1934。第一和第二释放构件1934每个限定了释放斜面1936。释放系统1930还包括接触各个释放斜面1936的第一和第二释放销1938,以及接触第一和第二下滑轨368的第一和第二顶出弹簧1942。见图62。如图59中所示,弹簧1940的自由端1941延伸穿过右手壳构件320上相应的孔321以及左手壳构件330上相的孔331,进入上滑轨367的相应孔372中,将可拆卸的握持部342保持与主连接部344接合。
为了开始将可分离握持部342从握持连接部344上脱离,推进释放按钮1932,另外还促使第一和第二释放构件194和各个释放斜面1936前进。当释放斜面1936前进时,释放斜面1936促使第一和第二释放销1938改变位置。第一和第二释放销1938各个位置的改变促使第一和第二锁定弹簧1940向上移出上滑轨367的孔372达足够的量,从而允许第一和第二上滑轨367滑出其接合。当可拆卸的握持部342从主要握持连接部344上移去时,第一和第二顶出弹簧1942的每一个释放存储的能量,从而分别在第一和第二下滑轨368上施加力。所施加的力帮助可分离握持部342从主要握持连接部344上脱离。应该理解,根据本发明,释放系统1930可包含适于将可分离握持部342从主握持连接部344上初始释放的其他部件和/或结构。
参考图57和58,供应通路636的远端637具有在其上形成的尖端639,能够使远端637刺破安装在设于主连接部344中的闭合头顶腔644内的无菌密封膜646。特别地,供应通路636的远端637插入头顶腔644内的端口645。无菌膜646可由任何适于穿刺的材料制造,所述材料能进行消毒,并当插入其中且从其中移除供应通路636的末端637后保持头顶腔644内的区域无菌时,实现供应通路636的远端637之间基本不透流体或气密的密封。
同样如图57和58中所示,供应管路650流体连接到头顶腔644,使得进入头顶腔644中来自供应管路636的压缩气体流入供应管路650。图57示出了在连接到主连接部644之前的可拆卸的握持部42。图58示出了连接到主连接部344的握持部42。如图58中所示,供应通路636的远端637已经刺穿无菌膜646。为了帮助供应通路636的远端637插入无菌膜,在可分离的握持部342和头顶块632之间设置压缩弹簧649。这种布置在供应通路636的远端637插入膜646时,给头顶块632提供一些“弹性”。
图64-69示出了在连接/分离操作期间各个时间的锁止系统1900的部件的相对位置。图64示出了在握持部342首次完全接合到主连接部44之前的相对位置。门构件1924接触突起1914,从而防止分度轮1910前进。
通过将滑轨637推入对应的通道384将握持部342连接到连接部344。阻挡构件1920通过面板380上孔381伸入其中一个通道384。见图59。当第一和第二上滑轨367前进时,其中一个第一上滑轨367上的斜面369接触阻挡构件1920,并促使它朝着分度轮1910向上移动。当阻挡构件1920朝着分度轮1910前进时,阻挡构件1920促使门构件1924离开分度轮1910。见图65。当第一上滑轨367和斜面369连续前进时,阻挡构件1920连续朝着分度轮1910前进。如图66所示,当握持部352完全与主部分351接合时,阻挡构件1920接触最初与门构件1924接触的突起1914,从而防止分度轮1910前进。
在握持部342从主连接部344开始脱离之后,第一和第二上滑轨367沿相反方向前进,由第一上滑轨367限定的斜面369允许阻挡构件1920离开分度轮1910。如图67所示当阻挡构件1920离开分度轮1910时,阻挡构件1920允许门构件1924朝着分度轮1910前进,并通过突起1914。当握持部342从主连接部344上分离时,阻挡构件1920前进到离开分度轮1910,足以失去与突起1914的接触,并允许分度轮1910旋转直到第二突起1914’接触门构件1924,如图68所示。
这样,计数器1902前进一个位置,并且握持部342能够再次连接到主连接部344上。连接/分离循环可重复进行。图68示出了第二次再连接的过程。当握持部342完全接合主连接部344时,阻挡构件1920接触突起1914”,从而防止分度轮1910前进,如图69所示。在第二循环末,当握持部342从主连接部344上分离时,门构件1926接触第三突起1914”,如图69所示。将第三突起1914”构造和布置成通过阻挡构件1920防止门构件1926前进离开分度轮1910,从而防止主连接构件344再次接触到握持部342(和连接到替换的握持段)。因此,根据这些实施例,外科器械是能有效地二次使用的器械。然而,本领域的技术人员应当理解如果分度轮1910限定额外的突起或凹口,则可增加使用次数。
图70-83示出了本发明另一独特和新颖的气动手术切割和紧固设备3010,它使临床医生能够在手动回缩击发部件同时监视击发冲程的进程。该实施例可与上述端部执行器12或与其他端部执行器布置结合使用。
该实施例的细长脊组件3102可包含连接到远侧脊段3106的近侧脊段3104。在替代实施例中,细长脊组件3102可包含第一部件。细长脊组件3102基本上是中空的,并且不可移动地连接到外壳组件300上。如图79和80所示,通过从右手壳构件320突出的右连接栓3110和从左手壳构件30突出的左连接栓3112,近侧脊段的近端3105可连接到外壳组件上。细长脊构件3102的远端能以上述方式连接到细长通道20。
同样在该实施例中,细长闭合管3190从手柄组件300延伸到端部执行器12。闭合管3190的远端3192具有贯穿其中的马蹄形孔3194,并且在闭合管3190在脊构件102上轴向移动时,用于以上述方式对接钉砧40上的打开/闭合翼片46。见图70。
如图71中所示,通过连杆组件430连接到闭合扳机302的梭子组件3400支撑在主外壳部340中。梭子组件3400同样可制造成两片3402,3404,其由聚合物或其他合适的材料进行模制或以其他方式制造,并设计为彼此匹配。通过扣合构件和/或粘合剂和/或螺栓,螺钉,夹具等将片3402,3404保持在一起。梭子组件3400的右手部3402具有右保持凸缘段3405,其适于与梭子组件3400的左手部3404上的左保持凸缘段(未显示)协作,从而形成保持凸缘组件,该保持凸缘组件以上述方式延伸进入细长闭合管3190的近端3196内的保持沟槽(未显示)中。细长脊段3102的近端3104延伸进入在梭子组件3400远端所形成的开口3403中,并分别通过右手部3402和左手部404中的延伸穿过开口3406的右保持栓3110和延伸穿过开口3408的左保持栓3112不可移动地连接到右手壳构件320上。另外,梭子组件3400设有侧向延伸导轨3410,3411。将导轨3410构造成可滑动地接收于右手壳构件320中对应的轨导杆中,而将导轨3411构造成可滑动地接收于左手壳构件330中对应的轨导杆中。这样,梭子组件3400和闭合管3190可相对于连接手柄组件300的脊组件3102轴向移动。
通过朝着手柄组件300的握持部342移动闭合扳机302来产生梭子组件3400和细长闭合管3190在远侧方向上(箭头“C”)的轴向移动,而通过将闭合扳机302远离握持部342来产生梭子组件3400在近侧方向上(箭头“D”)的轴向移动。在各个实施例中,梭子组件3400设有方便闭合连杆组件3430连接的连接器翼片3412。见图71和72。闭合连杆组件3430包括通过销3414枢转地销接到连接器翼片3412上的轭部3432。闭合连杆组件3430还具有通过闭合销436枢转地销接到闭合扳机302上形成的轭组件304上的闭合臂3434,如图71中所示。通过在右手壳构件320和左手壳构件330之间延伸的枢轴销306,将闭合扳机302枢转地安装在手柄组件300中。
当临床医生希望闭合钉砧40并将组织夹在端部执行器12中时,临床医生将闭合扳机302朝着握持部342拉动。当临床医生将闭合扳机302朝着握持部342拉动时,闭合连杆组件3430在远侧“C”方向上移动梭子组件3400直到闭合连杆组件3430移入图71所示的锁定位置内。当在此位置上时,连杆组件3430将试图使梭子组件3400保持在锁定位置上。当梭子组件3400移动到锁定位置时,闭合管3190在脊组件3102上向远侧移动促使通过闭合管段3190的远端3192上的马蹄形孔3194的近端接触钉砧40上的闭合/打开翼片46,从而将钉砧40枢转到闭合(夹住)位置。为了进一步将梭子组件3400保持在闭合位置上,可如上所述应用锁定机构301。
如上面所指示的,本发明这些实施例应用能够使临床医生监视击发和回缩冲程的进程并且同时提供手动回缩击发杆4030能力的独特和新颖的回缩杆组件4000。如图72所示,回缩杆组件4000包括可滑动地销接到推杆4020上的回缩杆4010。具体而言,回缩杆4010具有贯穿其中的细长槽4012,其大小适于滑动地接收用于将回缩杆4010连接到推杆4020的两个销4014。回缩手柄握持部4016可连接到回缩杆4010的近端。
推杆4020具有远端4022,其被设计成对接细长击发杆4030的近端。如图72所示,击发杆4030的近端4032具有在其上形成的连接器部分4034,其大小适合接收于推杆4020远端4022内对应的连接器孔4024中。这样,推杆4020可用于在击发冲程的远侧方向上轴向推动击发杆4030或者在回缩冲程的近侧方向上击发杆4030。本领域普通技术人员应当理解击发杆4030延伸穿过脊组件3102。在替代实施例中,击发杆4030具有矩形、方形等截面形状并如上所述击连接到刀组件30的远端31上,或连接到需要轴向移动来致动端部执行器的不同类型的刀杆和其他端部执行器部件上。
图72-77包含各个梭子组件3400的视图。如这些附图所示,左手梭子端口3404包括将推杆开口3420限定于其中的两个间隔开的竖直支撑壁3416和3418。推杆4020的远端4022延伸穿过推杆开口3420连接到击发杆4030的近端4032。如图72中所示,推杆4020的近端4026连接“Z”形连接器片4040。特别地,推杆的近端4026具有从其上突出的连接栓4028,其可接收于Z形连接器片4040近端4041上连接翼片4042的开口4049中。见图72。然而,推杆4020的近端4026可通过螺钉或其他合适的紧固件连接到连接翼片4042上。Z形连接器片4040的远端4045在其上具有远侧连接翼片4046,其适于连接从气动气缸组件5000上突出的活塞气缸5040。
如图79中所示,气缸组件5000可包含第一气缸外壳5010,该外壳具有第一闭合近端5012和第一打开远端5014,该第一打开远端5014通往第一气缸外壳5010内的第一轴向通路5016。气缸组件5000同样包含第二气缸外壳5020,其具有第二近端5022和第二打开于第二轴向通路5026内的打开远端5024。第二近端5022具有在其上形成的第一活塞头5028,其大小相对于第一轴向通路5016产生与第一气缸外壳5010的第一壁5011之间基本气密的滑动密封,从而在第一近端5012的远侧与第一活塞头5028的近侧之间限定出一个第一气缸区域5015。第一气缸外壳5010的第一远端5014还具有在其上形成的向内延伸的第一凸缘5017,用于建立与第二气缸外壳5020的外壁表面之间基本气密的滑动密封,从而在第一凸缘5017的近侧与第一活塞头5028的远侧之间限定出第二气缸区域5018。
第一通路5027设有穿过其中的第一活塞头5028。如图79中所示,活塞气缸5040延伸穿过第二气缸外壳5020的第二打开远端5024并进入第二轴向通路5026。活塞气缸5040具有近端5042和闭合的远端5044。在活塞气缸5040的近端5042上形成第二活塞头5046。将第二活塞头5046的大小制成相对于第二轴向通路5026以便与第二气缸外壳5020的第二壁5021之间产生基本气密的滑动密封,从而限定第三气缸区域5032。第二气缸外壳5020的第二远端5024还具有在其上形成向内延伸的第二凸缘5025,用于与活塞气缸5040建立基本气密的滑动密封,从而在第二凸缘5025的近侧与第二活基头5030的远侧之间限定出第四气缸区域5034。开口5047穿过第二活塞头5046进入活塞气缸5040内的通路5048。
如图79和80中所示,气缸组件5000安装在外壳组件300内。第一供应管路或称供应管路5050从手柄组件300内的方向控制阀610开始延伸,连接第一气缸外壳5010的第一近端5012,从而通过第一供应端口5013或第一气缸外壳5010的第一近端5012内的开口供应压缩气体。另外,第二供应管路或供应管路5052从方向控制阀610延伸到临近其远端5014的第一气缸外壳5010,从而通过第二端口5029将压缩气体提供给第二气缸区域5018。见图78。
参考图78和79,现在将解释击发杆4030的伸出和回缩。如图78中所示,供应管路5050和5052连接到传统方向控制阀1610,其是手柄组件300内致动器系统1600的一部分。方向控制阀1610具有向前位置段1620、止挡段1630和反向段1640。通过突出手柄外壳300的推动按钮1612和1614可手动移动控制阀段1620,1630,1640。在各个实施例中,应用可去除的压缩气体源620。见图71和81-83。然而,本领域普通技术人员应当理解也可有效地使用压缩气体的不可替换/可再填充源(气缸)。在其他气体实施例中,手柄组件300可设有供应来自压缩气体外部源618的压缩气体的端口616。例如,器械3010可通过柔性供应管路617连接到设备的压缩气体源618上。见图81A。
来自气缸622(或外部压力源618)的压缩气体通过供应管路650进入传统流量阀660中。最具体地如图78中所示,流量阀660连接到与致动扳机670连接的供应连杆机构662上。在各个实施例中,致动扳机670支撑在击发扳机310的附近,通过在右手壳构件320和左手壳构件330之间延伸的枢轴销370枢转地将击发扳机310连接到手柄组件300上。向内朝着击发扳机310挤压致动扳机670使流量阀660允许更多的压缩气体穿过其中进入供应管路680进入方向控制阀1610内。根据方向控制阀1610的位置,压缩气体将流入供应管路5050或5052中。例如,当临床医生致动方向控制阀610来伸出击发扳机30时,控制阀1610偏压到向前的位置,使得在前通路1622允许压缩气体从供应管路680流入到供应管路5050。流过供应管路5050的气体通过闭合端5012内的第一供应端口5013进入第一气缸区域5015,并通过第一活塞头5028内的开口5027进入第三气缸区域5032。进入第三气缸区域532的压缩气体同样穿过第二活塞头5046内的开口5047进入中空的活塞气缸5040并向远侧压迫活塞气缸5040。位于第四气缸区域5034内的气体从其中通过排气开口5023排放到第二气缸外壳5020中。类似地,允许位于第二气缸区域5018中的气体从其中通过第二开口5029排放到第二供应管路5052中。第二供应管路5052将排放的气体运送到方向阀610内的通道1624中,其中气体最终从排气通道1632排出。给第一气缸区域5015、第三气缸区域5032和活塞气缸5040内的通道5048连续施加压缩气体,促使活塞气缸5040如图73和79所示向远侧伸出。当活塞气缸5040向远侧伸出时,Z形连接器4040借助于其与活塞气缸5040远端5044的连接同样向远侧伸出。Z形连接器4040向远侧压迫推杆4020,这同样也向远侧压迫击发杆4030。当击发杆4030向远侧移动时,刀组件30的远端部分31通过钉仓50前进以便切断夹在端部执行器12中的组织并击发缝钉。一旦刀组件30前进到其在端部执行器12内的最远侧位置时,临床医生通过释放致动扳机670来停止压缩气体的施加。
该实施例同样可设有用于当刀组件30已经到达其钉仓50中的最远侧位置时进行指示的部件。特别地,从供应管路650到远侧限制开关1770可设有远侧引导管路1772。远侧限制开关管路1774设在远侧限制开关1770和方向控制阀1610之间。这样,当刀组件30已经结束击发冲程时,远侧限制开关1170相对于一部分气缸组件5000进行定向,使得通过它的一部分可致动远侧限制开关1170。远侧限制开关1170允许气体在压力从供应管路650流到远侧限制开关1170并进入方向控制阀1610,其在各个实施例中促使方向控制阀1610自动移动到反向位置,这如下面所讨论的可促使击发杆4030回缩。在各个实施例中,第一气动哨1790或其他合适的声音产生设备可与远侧限制开关管路1774(远侧限制开关1170)连通,使得当在击发冲程末致动远侧限制开关1170时,穿过远侧限制开关管路1774的气体致动第一哨1790,从而给临床医生提供指示刀组件30已经到达击发冲程末的听觉信号。在替代实施例中,压力开关计等可用于代替哨1790给临床医生提供何时刀组件30已经到达击发冲程末的指示。
为了气动地回缩击发杆4030,临床医生可推动按钮1612将控制阀1610移动到反向位置,并开始挤压致动扳机670,这促使压缩气体流入第二供应管路5052中。流过第二供应管路5052中的气体进入第二气缸区域5018,这促使第二气缸外壳5020向近侧回缩到第一气缸外壳5010中。允许第一气缸区域5015中的气体通过第一供应开口5013排入第一供应管路5040中。穿过第一供应管路5040的气体进入方向阀1610,在此它从通风孔1632排出。一旦进入第二气缸区域5018中的压缩气体已经促使第二气缸外壳5020回缩进入到第一气缸外壳5010时,穿过第二开口5029的气体现在能够穿过第一气缸外壳5010内的排气开口5023进入第四气缸区域5034。当压缩气体进入第四气缸区域5034时,第二活塞头5046将活塞气缸5040向近侧拉入第二气缸外壳5020中。在第三气缸区域5032的气体穿过第一开口5027进入第一气缸区域5015,从这里它以上述方式排出。当回缩活塞气缸5040时,Z形连接器4040向近侧移动并用其推动与其连接的推杆4020和击发杆4030。
在各个实施例中,近侧引导管路1662同样在近侧限制开关1760和供应管路650之间延伸。近侧限制开关1660相对于气缸组件5000或连接器4040定向成使得当击发杆400已经完成回缩时,致动近侧限制开关1760,并接着允许气体流入近侧限制开关管路1764和方向控制阀1610中,促使方向控制阀1610自动移动到止挡位置。在备选方案中,第二气动哨1792或气体合适的声音产生设备可与近侧限制开关1760连通,使得当在回缩冲程末致动近侧限制开关1760时,穿过近侧限制开关管路1764的气体致动第二哨1792,给临床医生提供指示击发杆4030和刀部分30已经到达回缩冲程末的另一听觉信号。在其他实施例中,例如,电池供能的发光二极管或其他信号设备可与远侧和近侧限制开关1770,1760连通,在楔形滑块/刀已经到达击发冲程和/或回缩冲程末时,给用户提供另一指示。本领域普通技术人员易于意识到,如果在击发冲程期间,临床医生希望停止击发冲程并回缩击发杆和刀,则他或她所要做的是手动将控制阀1610转换到反向位置。
在上述实施例中,临床医生没有应用本发明该实施例的独特和新颖的回缩杆组件4000。回缩杆组件具有多个优势。第一,如果在击发和回缩冲程期间,由于可能是耗空供应气缸620或归因于无意间中断压缩气体供应的其他原因,使得气动供能无意间丧失,则临床医生可简单地通过手动将控制阀1610移到反向位置并紧握连接回缩杆近端的手柄握持部4016并向近侧方向上拉动该杆直到击发杆已经完全回缩后,从而手动地回缩击发杆(和刀组件30)。见图83。通过将控制阀1610移到反向位置能够使气缸组件中的气体在刀杆回缩时排出。
本发明该实施例的另一有利设置是能够在击发冲程期间当击发杆和刀部分向远侧移动时视觉监视它们的击发进程。这一优势可通过如图83所示在开始击发冲程之前,将回缩杆拉到其最近位置上而简单地实现。当在该位置时,当气缸组件5000向远侧推进连接器4040、推杆4020和击发杆4030时,推杆4020借助于与其进行的销连接向远侧拉动回缩杆4010。在各个实施例中,回缩杆4010的长度设置成使得当击发杆4030完全伸出时,回缩杆4010没有部分从手柄组件300突出。这样,临床医生可通过观察回缩杆4010从手柄组件300突出的位置来确定击发杆4030和刀组件30的进程。
在图72A和83A所示的替代实施例中,回缩杆4010可设有至少一个而优选为至少两个用于将销4014接收于其中的凹口4015。本领域普通的技术人员应当理解,这种布置将给临床医生提供在回缩冲程期间视觉监视击发杆4030和刀组件30进程的能力。特别地,当击发杆4030回缩时,推杆4020借助于销4014与凹口4015的接合,促使回缩杆4010向近侧前进到外壳组件300外。这样,临床医生可通过观察回缩杆4010伸出手柄组件300外的距离来判断在回缩冲程期间击发杆400已经行进的距离。然而,当器械不使用时,可将回缩杆4010推入手柄组件内如图81所示位置。
虽然已经描述了若干实施例,但是应意识到,本领域技术人员能够想到用在获得本发明一些或所有优势的同时对这些实施例进行各种修改、变型或改变。例如,根据各个实施例,可用多个部件来代替单个部件,以及用单个部件来代替多个部件,以执行指定的供能或多个供能。因此在不脱离后附权利要求所限定的本发明公开的精神和范围的情况下,本申请旨在覆盖所有这样的修改、变型或改变。
这里公开的设备也可以被设计成在单次使用后被处置,或者它们可以被设计成多次使用。然而,在任一情况中,在至少一次使用之后设备可以被整修以供再使用。整修可以包括以下步骤的任何组合:拆卸设备,然后清洁或替换特殊零件,随后再组装。特别地,设备可以被拆卸,并且设备的许多特殊零件或部分可以在任何组合中选择性地被替换或去除。一旦清洁和/或替换特殊部分,在外科操作将要开始之前设备可以在整修设备或者由手术团队再组装供随后使用。本领域的技术人员将会理解设备的整修可以利用拆卸、清洁和/或替换,和再组装的多种技术。
优选地,这里描述的本发明将在手术前被处理。首先,获得新的或用过的器械,必要时清洁器械。然后可以消毒器械。在一个消毒技术中,将器械放置在闭合和密封容器中,例如塑料或TYVEK袋。然后将容器和器械放置在可以穿透容器的辐射场中,例如伽马辐射,x射线,或高能电子。辐射杀死器械上和容器中的细菌。然后可以将已消毒器械储存在无菌容器中。密封容器保持器械无菌直到它在医疗机构中被打开。优选的是设备被消毒。
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。
要求保护的本发明并不解释为限制在所公开的具体实施方式。因此应将实施方式看作示例性的而非限制性的。在不脱离本发明精神的情况下可由他人进行变动或改动。因此,本发明清楚地包含落在如权利要求所限定的本发明精神和范围内的所有等同方案、变型或改变。

Claims (10)

1.一种外科器械,包括:
远侧构件,其能够接收气动操作工具组件;
细长轴组件,其具有近端部分以及与所述远侧构件相联的远端部分;以及
气动旋转驱动构件,其由所述细长轴组件的所述远端部分支撑并流体连接动气动源上,所述旋转驱动构件能够在接收至少一个来自所述气动源的气动驱动信号时选择性地向由所述远侧构件支撑的所述气动操作工具组件施加至少两种旋转致动动作。
2.根据权利要求1所述的外科器械,其中,所述旋转驱动构件包括气动马达。
3.根据权利要求1所述的外科器械,其中,所述旋转驱动构件能够在接收到来自所述气动源的气流时向由所述远侧构件支撑的所述气动操作工具组件施加旋转击发运动,并且在接收到来自气动源的另一气流时向由所述远侧构件支撑的所述气动操作工具组件施加旋转回缩运动。
4.根据权利要求1所述的外科器械,其中,所述细长轴组件的所述远端部分通过关节运动接头枢转地连接到所述近端部分上。
5.根据权利要求4所述的外科器械,其中,机械地致动所述关节运动接头。
6.根据权利要求4所述的外科器械,其中,气动地致动所述关节运动接头。
7.根据权利要求1所述的外科器械,其中,所述细长轴组件的所述远端部分可选择性地与所述细长轴组件的所述近端部分分离。
8.根据权利要求1所述的外科器械,其中,所述细长轴组件的所述近端部分和所述远端部分中的一个具有可选择性枢转的关节运动接头,并且所述远端部分可选择性地与所述细长轴组件的所述近端部分分离。
9.根据权利要求1所述的外科器械,还包括:
手柄组件;以及
致动器机构,其由所述手柄组件支撑并可操作地与所述气动源和所述旋转驱动构件通讯,所述致动器机构能够选择性地控制来自所述气动源的所述气动驱动信号向所述旋转驱动构件的施加。
10.根据权利要求9所述的外科器械,其中,所述致动器机构包括:
变流量控制构件,其与所述气动源和所述旋转驱动构件流体连通;以及
致动扳机,其由所述手柄组件可操作地支撑并可操作地连接到所述变流量控制构件上,用于选择性地对其进行操作。
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