CN101254125B - 具有驱动钉驱动器的多个堆叠的楔形凸轮的外科缝合装置 - Google Patents
具有驱动钉驱动器的多个堆叠的楔形凸轮的外科缝合装置 Download PDFInfo
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Abstract
本发明公开了一种具有驱动钉驱动器的多个堆叠的楔形凸轮的外科缝合装置。外科缝合装置具有端部执行器和多个堆叠的可致动楔形带组。端部执行器包括具有钉成形表面的砧座和面对钉成形表面的钉仓。钉仓包括多个钉和能够可移动地支撑在钉仓中的多个钉驱动器。每个钉驱动器与多个钉中的一个接触,并能够在钉驱动器被致动时驱动钉穿过钉仓以通过抵靠砧座的钉成形表面来成形钉。每个堆叠的楔形带组包括至少两个不同高度的楔形带,用于轴向穿过端部执行器。每个楔形带包括位于其远端处的楔形凸轮,用于在楔形带被致动时驱动一些钉驱动器。多个堆叠的楔形带组中的第一组的累计高度小于多个堆叠的楔形带组中的第二组的累计高度。
Description
相关申请的交叉引用
本申请是F.Shelton的于2005年8月31日提交的题为“StapleCartridges For Forming Staples Having Differing Formed StapleHeights”的美国专利申请No.11/216562的部分继续申请,通过引用将其包含在这里。
本申请还与以下同时提交的美国专利申请相关,通过引用将其包含在这里:
(1)J.Hueil等人的“能够形成具有不同长度的成形钉的外科缝合装置(Surgical Stapling Device That Produce Formed StaplesHaving Different Lengths)”,律师档案号No.050504CIP1/END5675USCIP1;
(2)J.Swayze等人的“具有支撑多种丝径钉的钉驱动器的外科缝合装置(Surgical Stapling Device With Staple Driver ThatSupports Multiple Wire Diameter Staples)”,律师档案号No.050504CIP2/END5675USCIP2;
(3)J.Morgan等人的“带有具有不同深度的钉成形凹槽的外科缝合装置(Surgical Stapling Device With Anvil Having StapleForming Pockets Of Varying Depth)”,律师档案号No.050504CIP3/END5675USCIP3;和
(4)J.Hueil等人的“具有不同高度的钉驱动器的外科缝合装置(Surgical Stapling Device With Staple Drivers Of DifferentHeight)”,律师档案号No.050504CIP5/END5675USCIP5。
技术领域
本申请整体上涉及能够施加成排钉的缝合器械,更具体地,涉及有关用于外科缝合器械的钉仓的改进,该外科缝合器械能够在对组织进行切割的同时将具有不同成形钉高度的成排钉施加到组织。
背景技术
在现有技术中外科缝合器已经用于在组织中同时形成纵向切口并将成排钉施加到切口的相对侧。这类器械通常包括一对协作的钳口构件,如果想要将该器械用于内窥镜或腹腔镜应用,钳口构件能够穿过插管通道。其中一个钳口构件容纳具有至少两排横向间隔开的钉的钉仓。另一个钳口构件限定砧座,该砧座具有与钉仓中的成排钉对准的钉成形凹槽。该器械包括多个往复的楔形件,当向远侧驱动时,这些楔形件穿过钉仓中的开口并接合支撑钉的驱动器来向着砧座对钉实施击发。
适用于内窥镜应用的外科缝合器的一个例子在美国专利申请US2004/0232196A1中公开,其内容全部引入本文作为参考。在使用时,医生能够将缝合器的钳口构件闭合在组织上,以在击发前定位组织。一旦医生已确定钳口构件正确夹持了组织,医生然后就可以击发外科缝合器,从而切断并缝合组织。同时切断和缝合避免了当分别用仅仅进行切割或者缝合的不同外科工具相继进行所述动作时可能引起的并发症。
无论何时经过不同的组织复合区域横切组织时,最接近切割线的钉具有比距离切割线最远的那些钉的成形高度小的成形高度将是有利的。在实践中,内侧的成排钉用于提供止血屏障,而具有较大成形高度的外侧成排钉提供了组织从紧密压缩的止血部分过渡到非压缩的相邻部分的束紧效果。在其它的应用中,在单排钉中的钉具有不同成形高度是有用的。授予Pruitt的美国专利US4941623和US5027834公开了外科缝合器和钉仓设置,该钉仓设置采用具有不同尖头长度的钉而最终实现具有不同成形高度的成排钉。同样地,WO2003/094747A1公开了外科缝合器和钉仓,该钉仓具有六排钉,其中外侧的两排钉包括比内侧的两排和中间的成排钉更大的钉。因此,所有这些方法都需要在同一钉仓中使用不同尺寸的钉。
发明内容
在一个总的方面中,本发明涉及能够形成具有不同成形长度的钉的外科缝合装置。例如,在这样的也能切割被缝合组织的装置中,钉中最靠近纵向切割线的内侧排的成形高度可以小于外侧排的钉的成形高度。以此方式,内侧排的钉可以提供止血的阻挡物,而具有较大成形高度的外侧排的钉可以提供束紧的效果,组织从被紧密压缩的止血部分过渡到未压缩的相邻部分。
根据各种方式,钉仓可以具有不同高度的钉驱动器,以形成具有不同成形长度的钉。由较短的钉驱动器驱动的钉将具有较长的成形长度(假设不存在可以影响钉的成形高度的其他不同)。此外,砧座中的钉成形凹槽可以具有不同的深度。在较深的凹槽中成形的钉往往比在较浅的凹槽中成形的钉长。此外,一些钉成形凹槽可以形成于砧座的柔性材料部分中。在这样的凹槽中成形的钉将比在砧座的非柔性(或较少柔性)的部分中成形的钉长。此外,通道可以具有内部阶梯,其将形成具有不同成形高度的钉。通过用以较低的台阶开始的钉驱动器形成的钉将比通过用以较高的台阶开始的钉驱动器形成的钉具有更大的成形长度。此外,可以使用具有不同直径的钉。较粗的钉易于产生具有较长成形长度的钉。就此而言,本发明的实施方式涉及能够容纳具有不同粗细丝径的钉的钉推动器。此外,可以使用不同材料的钉。由更强硬但是较少柔性的材料制成的钉将易于形成较长的成形钉。
根据其他实施方式,外科缝合装置可以包括多个堆叠的楔形带组。每个堆叠的楔形带组可以包含彼此堆叠的多个楔形带。楔形带可以按顺序接连被致动以按连续的步骤驱动钉。就是说,例如,在具有堆叠的三个楔形带的实施方式中,第一楔形带可以首先被致动以部分地展开钉,堆叠中的第二楔形带可以在接下来被致动以开始成形钉,并且堆叠中的第三楔形带可以被最后致动以完成钉的成形。为了形成具有不同成形高度的钉,例如,堆叠的高度(对应于堆叠中楔形带的累计高度)可以不同。
用于形成具有不同高度的成形钉的技术可以用在各种外科缝合装置中。例如,缝合装置可以是切割被夹钳的布置的装置或者不包含切割器械的装置。外科缝合器例如可以是内径切割器、开放式的直线型缝合装置或者圆形缝合器。
更具体地,本发明涉及如下内容:
(1).一种外科缝合装置,包括:
端部执行器,所述端部执行器包括:
具有钉成形表面的砧座;和
面对所述砧座的钉成形表面的钉仓,其中所述钉仓还包括:
多个钉;和
可移动地支撑在所述钉仓中的多个钉驱动器,每个钉驱动器与所述多个钉中的一个接触,并被构造成使得当所述钉驱动器被致动时,所述钉驱动器驱动所述钉穿过所述钉仓,以通过抵靠所述砧座的钉成形表面来成形所述钉;和
多个堆叠的可致动楔形带组,每个堆叠的楔形带组包括至少两个不同高度的楔形带,用于轴向穿过所述端部执行器,其中,每个楔形带包括位于其远端处的楔形凸轮,用于在所述楔形带被致动时驱动所述钉驱动器中的一些,堆叠中的两个楔形带中的第一个靠在堆叠中的两个楔形带中的第二个上,使得当所述至少两个楔形带被顺序驱动时,通过所述楔形带来顺序驱动所述钉驱动器,其中,所述多个堆叠的楔形带组中的第一组的累计高度小于所述多个堆叠的楔形带组中的第二组的累计高度。
(2).根据第(1)项所述的外科缝合装置,其中,每个堆叠的楔形带组包括三个堆叠的楔形带。
(3).根据第(2)项所述的外科缝合装置,其中,所述多个堆叠的可致动楔形带组包括:
外侧的两个堆叠的楔形带组,用于驱动外侧的两排钉驱动器;和
内侧的两个堆叠的楔形带组,用于驱动内侧的两排钉驱动器。
(4).根据第(1)项所述的外科缝合装置,其中,所述多个钉驱动器中的第一数量个钉驱动器具有第一高度,所述多个钉驱动器中的第二数量个钉驱动器具有第二高度,所述第一高度小于所述第二高度。
(5).根据第(1)项所述的外科缝合装置,其中,所述端部执行器还包括切割器械,用于轴向穿过所述端部执行器以切割夹钳在所述端部执行器中的组织。
(6).根据第(5)项所述的外科缝合装置,还包括用于击发所述切割器械的击发杆。
(7).根据第(6)项所述的外科缝合装置,还包括:
连接到所述端部执行器上的轴组件;和
连接到所述轴组件上的手柄组件。
(8).根据第(7)项所述的外科缝合装置,其中,所述轴组件容纳所述堆叠的楔形带。
(9).根据第(8)项所述的外科缝合装置,还包括位于所述轴组件的远端处的楔形带引导件,其具有通道,用于在所述楔形带被致动时将所述楔形带引导至所述端部执行器中。
(10).根据第(1)项所述的外科缝合装置,其中,所述多个钉驱动器中的至少一个具有上侧钉支撑表面,其将不同丝径的钉支撑在直立位置。
(11).一种外科缝合装置,包括:
端部执行器,所述端部执行器包括:
具有钉成形表面的砧座;
面对所述钉成形表面的多个钉;
多个钉驱动器,每个钉驱动器与所述多个钉中的一个接触,并被构造成使得当所述钉驱动器被致动时,所述钉驱动器驱动所述钉穿过所述钉仓,以通过抵靠所述砧座的钉成形表面来成形所述钉;和
连接到所述端部执行器上的轴组件,其中所述轴组件容纳多个堆叠的可致动楔形带组,每个堆叠的楔形带组包括至少两个不同高度的楔形带,用于轴向穿过所述端部执行器,其中,每个楔形带包括位于其远端处的楔形凸轮,用于在所述楔形带被致动时驱动所述钉驱动器中的一些,堆叠中的两个楔形带中的第一个靠在堆叠中的两个楔形带中的第二个上,使得当所述至少两个楔形带被顺序驱动时,通过所述楔形带来顺序驱动所述钉驱动器,其中,所述多个堆叠的楔形带组中的第一组的累计高度小于所述多个堆叠的楔形带组中的第二组的累计高度。
(12).根据第(11)项所述的外科缝合装置,其中,所述端部执行器还包括切割器械,用于轴向穿过所述端部执行器以切割夹钳在所述端部执行器中的组织。
(13).根据第(12)项所述的外科缝合装置,还包括用于击发所述切割器械的击发杆。
(14).根据第(13)项所述的外科缝合装置,还包括位于所述轴组件的远端处的楔形带引导件,其具有通道,用于在所述楔形带被致动时将所述楔形带引导至所述端部执行器中。
(15).一种外科方法,包括:
将组织夹钳在外科器械的端部执行器中使其位于端部执行器的砧座和钉仓之间;以及
选择性地按顺序致动两个或更多高度的多个楔形带堆叠,每个楔形带堆叠包括两个或多个堆叠的楔形带,每个楔形带包括位于其远端处的楔形凸轮,用于在所述楔形带被致动时驱动所述钉仓中的一些钉驱动器,堆叠中的两个楔形带中的第一个靠在堆叠中的两个楔形带中的第二个上,使得当所述至少两个楔形带被顺序驱动时,通过所述楔形带来顺序驱动所述钉驱动器,其中,所述多个堆叠的楔形带组中的第一组的累计高度小于所述多个堆叠的楔形带组中的第二组的累计高度。
(16).根据第(15)项所述的方法,还包括致动所述端部执行器中的切割器械,以切割夹钳在所述端部执行器中的组织。
(17).根据第(16)项所述的方法,其中,在选择性地致动所述楔形带堆叠中的楔形带之后致动所述切割器械。
(18).根据第(15)项所述的方法,其中,所述楔形带堆叠每个都包括三个可单独致动的堆叠的楔形带。
(19).根据第(16)项所述的方法,其中,所述楔形带堆叠每个都包括三个可单独致动的堆叠的楔形带。
(20).根据第(16)项所述的方法,其中,致动所述切割器械与致动其中一个高度的所述楔形带堆叠同时发生。
附图说明
包含于本说明书中并构成其一部分的附图解释了本发明的实施方式,并与上面给出的本发明的总体说明和下面给出的实施方式的详细描述一起用于解释本发明的原理,其中:
图1示出了根据本发明的各种实施方式的处于打开位置的外科缝合和切割器械的局部切除的侧视图;
图2示出了根据本发明的各种实施方式,外科缝合和切割器械的端部执行器的沿着图1中的线2-2截取的侧部视图;
图3示出了根据本发明的各种实施方式,图2的外科缝合和切割器械的击发杆的放大的侧视图;
图4示出了根据本发明的各种实施方式,图2的外科缝合和切割器械的击发杆的放大的主视图;
图5示出了根据本发明的各种实施方式,用于图1的外科缝合和切割器械的其它端部执行器的侧剖视图,其中结合有击发杆,该击发杆没有防止端部执行器夹紧的中间销;
图6示出了根据本发明的各种实施方式,图1的外科缝合和切割器械的近端的手柄部分的侧剖视图,其中除去了左侧以暴露处于未夹钳、未击发(“开始”)位置的内部部件;
图7示出了根据本发明的各种实施方式,图1的外科缝合和切割器械的近端的手柄部分的分解透视图;
图8示出了根据本发明的各种实施方式,图1的外科缝合和切割器械的近端的手柄部分的侧剖视图,其中除去了左侧以暴露处于闭合(“夹钳”)位置的内部部件;
图9示出了根据本发明的各种实施方式,图1的外科缝合和切割器械的近端的手柄部分的侧剖视图,其中除去了左侧以暴露处于缝合及切割(“击发”)位置的内部部件;
图10示出了安装在根据本发明各种实施方式的端部执行器中的钉仓的俯视图;
图11是根据本发明各种实施方式的钉仓的一部分的放大俯视图;
图12是可在本发明的各种实施方式中采用的钉的侧视图;
图13是根据本发明的各种实施方式,将两个钉支撑于其上的内侧双驱动器的主视图;
图14是根据本发明的各种实施方式,图13的内侧双驱动器和钉的俯视图;
图14A是根据本发明的各种实施方式,位于安装在端部执行器中的钉仓的一部分中的图13的内侧双驱动器的剖视图,还示出了当处于闭合位置时砧座的相应部分;
图15是根据本发明的各种实施方式,图13和14的内侧双驱动器和钉的右视图;
图15A是根据本发明的各种实施方式,图15的内侧双驱动器的另一右视图,其中以虚线示出仓托盘和砧座的相应部分,以显示它们之间的关系;
图16是根据本发明的各种实施方式,将钉支撑于其上的一个外侧单驱动器的主视图;
图16A是根据本发明的各种实施方式,图16的外侧单驱动器的另一个主视图,其中显示出仓托盘和砧座的一部分,以示出它们之间的关系;
图17是根据本发明的各种实施方式,图16的外侧单驱动器和钉的俯视图;
图18是根据本发明的各种实施方式,图1的外科缝合和切割器械的执行部分的等轴测分解图;
图19是根据本发明的各种实施方式,沿着图10中的线19-19截取的剖视图,显示出击发杆、细长通道、楔形滑动件、钉驱动器、钉、钉仓和砧座之间的剖面关系;
图19A是端部执行器的另一个剖视图,显示出了根据本发明的各种实施方式,击发杆、细长通道、楔形滑动件、钉驱动器、钉和钉仓之间的剖面关系;
图20是本发明各种实施方式的一个楔形滑动件的透视图;
图21是根据本发明的各种实施方式,在图20中示出的楔形滑动件的内侧滑动件凸轮的侧视图;
图22是根据本发明的各种实施方式,在图20中示出的楔形滑动件的外侧滑动件凸轮的侧视图;
图23是根据本发明的各种实施方式,位于图1的外科缝合和切割器械的远端上的端部执行器的等轴测图,其中砧座处于向上或者打开位置,仓大部分被除去,以暴露出作为例子的单钉驱动器和双钉驱动器,以及抵靠击发杆的中间销保持在其开始位置的楔形滑动件;
图24是根据本发明的各种实施方式,位于图1的外科缝合和切割器械的远端上的端部执行器的等轴测图,其中砧座处于向上或者打开位置,从而暴露出钉仓和击发杆的切割边缘;
图25是根据本发明的各种实施方式,位于图1的外科缝合和切割器械的远端的等轴测图,其中砧座处于向上或者打开位置,钉仓完全被除去,并除去细长通道的一部分,以暴露出击发杆的最下面的销;
图26是根据本发明的各种实施方式,显示出图1中的外科缝合和切割器械的砧座、细长通道和处于闭合位置中的钉仓之间的机械关系的侧剖视图,剖面大致沿着图24中的线26-26截取,暴露出楔形滑动件、钉驱动器和钉,而且示出沿着纵向中心线的击发杆;
图27是根据本发明各种实施方式的钉仓的一部分的剖视图,其中楔形滑动件的外侧凸轮与外侧单驱动器相邻;
图28是根据本发明各种实施方式的钉仓的一部分的剖视图,其中楔形滑动件的外侧凸轮与三个外侧单驱动器接合;
图29是使用本发明各种实施方式的外科缝合和切割器械安装在切割线的每侧上的成排钉的示意图;
图30示出了通过本发明各种实施方式的一个内侧驱动器成形的钉;
图31示出了通过本发明各种实施方式的一个外侧驱动器成形的另一种钉;
图32是使用本发明各种实施方式的外科缝合和切割器械安装在切割线的每侧上的成排钉的示意图;
图33是使用本发明各种实施方式的外科缝合和切割器械安装在切割线的每侧上的成排钉的示意图;
图34是使用本发明各种实施方式的外科缝合和切割器械安装在切割线的每侧上的成排钉的示意图;
图35是根据本发明的各种实施方式,图1的外科缝合和切割器械沿着处于部分闭合但处于未夹钳位置,夹持着组织的端部执行器的纵向中心线截取的侧剖视图;
图36示出了根据本发明的各种实施方式,处于闭合或者夹钳位置的图1的外科缝合和切割器械的局部切除的侧视图;
图37示出了根据本发明的各种实施方式,处于闭合或者夹钳位置的图1的外科缝合和切割器械的侧剖视图,其中组织被适当压缩;
图38示出了根据本发明的各种实施方式,处于部分击发位置的图1的外科缝合和切割器械的远端沿着中心线的剖面的视图;
图39示出了根据本发明的各种实施方式,处于部分击发位置的图1的外科缝合和切割器械的局部切除的侧剖视图;
图40示出了根据本发明的各种实施方式,处于完全击发位置的图1的外科缝合和切割器械的远端沿着中心线的剖面的视图;
图41示出了根据本发明的各种实施方式,处于完全击发位置的图1的外科缝合和切割器械的局部切除的侧剖视图;
图42至44描述了根据本发明的各种实施方式,具有滑动件的端部执行器的各个方面,该滑动件带有多个滑动件凸轮,其中一个滑动件凸轮比另一个滑动件凸轮高;
图45描绘了根据本发明的各种实施方式,具有不同深度的钉成形凹槽的端部执行器的各个方面;
图46至47描绘了根据本发明的各种实施方式,具有不同预成形长度的钉的双钉驱动器;
图48描绘了根据本发明的各种实施方式,具有双钉驱动器的端部执行器的侧视图,所述双钉驱动器具有不同的钉驱动器高度;
图49至50描绘了根据本发明的各种实施方式,具有钉成形凹槽的端部执行器的侧视图,所述钉成形凹槽具有不同的深度;
图51至62描绘了根据本发明的各种实施方式的外科缝合装置的各个方面,该外科缝合装置具有堆叠的可致动楔形带;
图63至69描绘了根据本发明各种实施方式的开放式直线型外科缝合装置的各个方面;
图70至77描绘了根据本发明各种实施方式的端部执行器的主剖视图;
图78至83描绘了根据本发明的各种实施方式,能够容纳具有不同丝径的钉的钉驱动器;
图84至89描绘了根据本发明各种实施方式的圆形外科缝合装置;以及
图90至95描绘了根据本发明各种实施方式的另一种外科缝合器械。
具体实施方式
参照附图,其中相同的附图标记在全部附图中表示相同的组成元件,图1和2示出了能够实现本发明的独特优点的外科缝合和切割器械10的一种实施方式。但是应当理解,在不脱离本发明的精神和范围的条件下,本发明的新颖及独特的方面可有利地与各种其它缝合器或者钉合器械结合。因此,本发明的各种实施方式所赋予的本发明的范围不应当被限制为仅仅用于这里所描述的特定类型的外科缝合和切割器械。
如图1和2中所示,外科缝合和切割器械10包括具有致动器或者E形梁击发机构(“击发杆”)14的端部执行器12,该致动器或者E形梁击发机构可有利地控制端部执行器12的间距。特别地,细长通道16和可枢转平移的砧座18被保持在确保有效缝合及切割的间距处。这避免了与被捕获在端部执行器12中的组织的变化量有关的问题。
应理解,这里使用的术语“近侧”和“远侧”是以握持器械的手柄的医生为参照的。因此,端部执行器12相对于更近侧的手柄部分20处于远侧。还应理解,为了方便和简明起见,这里使用的空间术语例如“垂直”和“水平”参照附图给出。然而,外科器械可以各种朝向和位置使用,这些术语并不是想要对其进行限制和绝对化。
外科缝合和切割器械10包括与执行部分22连接的手柄20,该执行部分22还包括远端终止于端部执行器12中的轴23。手柄部分20包括手枪式把手24,由医生向着该手枪式把手24可枢转地拉动闭合扳机26将引起砧座18向着端部执行器12的细长通道16夹钳或称闭合。击发扳机28在闭合扳机26更远的外侧,并可由医生可枢转地拉动,从而引起端部执行器12中夹钳的组织的缝合及切割。
在实践中,首先致动闭合扳机26。一旦医生对端部执行器12的定位感到满意,医生可将闭合扳机26拉回到其靠近手枪式把手24的完全闭合的锁定位置。然后,致动击发扳机28。当医生除去压力时击发扳机28弹回。当压下位于手柄部分20的近端处的释放按钮30时释放任何锁定的锁定扳机26。
闭合套管32包围着框架34,该框架34又包围由击发扳机28定位的击发驱动构件36。框架34将手柄部分20连接到端部执行器12。如图所示,随着通过闭合扳机26向近侧拉动闭合套管32,砧座18弹性地打开,可枢转地离开细长通道16并随着闭合套管32向近侧平移。细长通道16容纳着钉仓37。
特别参考图2-4,击发杆14包括在击发期间控制端部执行器12的间隔的三个垂直间隔开的销。特别地,上部销38分段进入在砧座18和细长通道16之间的枢轴附近的砧座凹槽40。当击发并且砧座18闭合时,上部销38在经砧座18向远侧延伸的纵向砧座槽42中向远侧行进。在砧座18中任何微小的向上偏转都可通过由上部销38施加的向下的力来克服。击发杆14还包括最下部的销或者击发杆帽44,其在细长通道16中向上与通道槽45接合,从而在过多的组织被夹钳于其间的情况下,与上部销38共同工作将砧座18和细长通道16略微拉近到一起。击发杆14有利地包括中间销46,其穿过在仓37的下表面和细长通道16的上表面中形成的击发驱动槽47,从而驱动其中的钉,如下所述。中间销46通过在细长通道16中的滑动有利地防止端部执行器12被夹紧闭合于其远端的任何倾向。为了解释中间销46的优点,图5示出了在击发杆14’上没有中间销的另一端部执行器12’。在该图示中,端部执行器12’被允许夹紧闭合于其远端,这可能损害所需的钉成形。
参照图2-4,在击发杆14上的上部和中间销38、46之间的指向远侧的切割边缘48横跨仓37中指向近侧的垂直槽49,以切割夹钳的组织。击发杆14相对于细长通道16和砧座18的这种有利定位确保可进行有效地切割。由E形梁击发杆14提供的有利的垂直间隔适合于用于内窥镜装置的受限尺寸。而且,E形梁击发杆14使砧座18构造有在砧座远端施加垂直偏转的曲面(camber),与图5中所示的位置相同。这种带曲面的砧座18有利地帮助在端部执行器12中获得所需的间隔,即使砧座18具有减小的厚度,这更适于尺寸受限的内窥镜装置。
参照图6-9,手柄部分20包括由聚合材料(例如填充有玻璃的聚碳酸酯)模制成的第一和第二基体部分50和52。第一基体部分50设置有多个圆柱形销54。第二基体部分52包括多个延伸构件56,每个延伸构件具有六边形开口58。圆柱形销54容纳于六边形开口58中,并通过摩擦保持于其中,以便保持第一和第二基体部分50和52的装配。
旋钮60具有完全贯通其延伸的腔62,用于围绕其纵向轴线接合并旋转执行部分22。旋钮60包括沿着腔62的至少一部分延伸的向内突出的凸起64。突出的凸起64容纳于在闭合套管32的近侧部分处形成的纵向槽66中,从而旋钮60的旋转使闭合套管32旋转。应理解,凸起64还穿过框架34延伸并与击发驱动构件36的一部分接触并使它们旋转。因此,端部执行器12(在图6-9中未显示)随着旋钮60旋转。
框架34的近端68从近侧穿过旋钮60,并设置有周向切口70,该周向切口70由分别从基体部分50和52延伸的相对的通道连接构件72接合。仅仅显示了第二基体部分52的通道连接构件72。从基体部分50、52延伸的通道连接构件72用于连接框架34和手柄部分20,使框架34不能相对于手柄部分20沿纵向运动。
闭合扳机26具有手柄段74、扇形齿轮段76和中间段78。腔80延伸穿过中间段78。从第二基体部分52延伸的圆柱形支撑构件82穿过腔80,将闭合扳机26可枢转地安装在手柄部分20上。从第二基体部分52延伸的第二圆柱形支撑构件83穿过击发扳机26的腔81,用于可枢转地安装在手柄部分20上。在圆柱形支撑构件83上设置六边形开口84,用于容纳从第一基体部分50伸出的连接销(未显示)。
闭合轭形件86容纳于手柄部分20中,用于在其中往复运动,并用于将运动从闭合扳机26传送到闭合套管32。从第二基体部分52伸出的支撑构件88和延伸穿过轭形件86中的槽89的连接构件72将轭形件86支撑于手柄部分20中。
闭合套管32的近端90设有凸缘92,该凸缘卡扣配合于在轭形件86的远端96中形成的容纳槽94中。轭形件86的近端98具有由闭合扳机26的扇形齿轮段76接合的齿条100。当闭合扳机26向着手柄部分20的手枪式把手24运动时,轭形件86向远侧运动并因此使闭合套管32向远侧运动,从而压下向近侧偏压轭形件86的弹簧102。闭合套管32向远侧的运动使砧座18向远侧并向着端部执行器12的细长通道16进行枢转平移运动,并且向近侧运动影响闭合,如下所述。
通过与击发扳机28的接合表面128相互作用的前表面130使闭合扳机26向前偏压到打开位置。在手柄部分20中围绕销106从顶部枢转到后部的夹钳第一钩状件104限制击发扳机28向着手枪式把手24运动,直到闭合扳机26被夹钳到其闭合位置。钩状件104通过与击发扳机28中的锁定销107接合来限制击发扳机28的运动。钩状件104还与闭合扳机26接触。特别地,钩状件104向前的突起108与闭合扳机26的中间段78上的构件110接合,该构件110向着手柄段74置于腔80的外面。钩状件104被向着与闭合扳机26的构件110接触的方向偏压,并通过释放弹簧112与击发扳机28中的锁定销107接合。当闭合扳机26被压下时,钩状件104从顶部向后部运动,从而压下被捕获在钩状件104上的向后的突起114和释放按钮30上的向前的突起114之间的释放弹簧112。当轭形件86响应于闭合扳机26的向近侧的运动而向远侧运动时,释放按钮30的上栓锁臂118沿着轭形件86的上表面120运动,直到落入在轭形件86的近侧下部部分中的向上的凹槽122中。释放弹簧112向外推压释放按钮30,该释放按钮将上栓锁臂118向下枢转成与向上的凹槽122接合,从而将闭合扳机26锁定在组织夹钳位置中,例如图8中所示。
可通过向内推动释放按钮30使栓锁臂118运动并脱离凹槽122,以释放砧座18。特别是,上栓锁臂118围绕第二基体部分52的销123向上枢转。然后响应于闭合扳机26的返回运动而允许轭形件86向近侧运动。
击发扳机复位弹簧124设置在手柄部分20中,其一端与第二基体部分52的销106连接,另一端与击发扳机28上的销126连接。击发复位弹簧124将复位的力施加到销126上,使击发扳机28沿着远离手柄部分20的手枪式把手24的方向偏置。还通过与偏压闭合扳机26的前表面130的击发扳机28的表面128接合使闭合扳机26偏置并偏离开手枪式把手24。
当闭合扳机26向着手枪式把手24运动时,其前表面130与击发扳机28上的接合表面128接合,引起击发扳机28运动到其“击发”位置。当处于其击发位置时,击发扳机28以大约45°角相对于手枪式把手24定位。钉击发后,弹簧124引起击发扳机28返回到其初始位置。在击发扳机28的返回运动过程中,其接合表面128推压闭合扳机26的前表面130,从而引起闭合扳机26返回到其初始位置。止动构件132从第二基体部分52延伸,以防止闭合扳机26旋转到其初始位置之外。
外科缝合和切割器械10另外还包括往复运动部分134、增益器136和驱动构件138。往复运动部分134包括执行部分22中的楔形滑动件(在图6-9中未显示)和金属驱动杆140。驱动构件138包括第一和第二齿条141和142。在驱动构件138上在第一和第二齿条141、142中间设置第一槽口144。在击发扳机28的复位运动期间,在钉击发之后,击发扳机28上的齿146与第一槽口144接合,以将驱动构件138返回到其初始位置。第二槽口148设置在金属驱动杆140的近端,用于将金属驱动杆140锁定在处于其未击发位置的释放按钮30的上栓锁臂118上。增益器136包括第一和第二整体式小齿轮150和152。第一整体式小齿轮150与在金属驱动杆140上设置的第一齿条154接合。第二整体式小齿轮152与在驱动构件138上设置的第一齿条141接合。第一整体式小齿轮150具有第一直径,第二整体式小齿轮152具有比第一直径小的第二直径。
图6、8和9分别示出了处于开始位置(打开并且未击发)、夹钳位置(闭合并且未击发)和击发位置的手柄部分20。击发扳机28设有扇形齿轮段156。扇形齿轮段156与驱动构件138上的第二齿条142接合,从而使击发扳机28的运动引起驱动构件138在图8中显示的第一驱动位置和图9中显示的第二驱动位置之间来回运动。为了防止在组织夹钳发生之前击发钉,释放按钮30上的上栓锁臂118与驱动构件138上的第二槽口148接合,使金属驱动杆140被锁定在最近的位置,如图6所示。当上栓锁臂118落入凹槽122中时,上栓锁臂118与第二槽口148脱离接合,以允许金属驱动杆140向远侧运动,如图9所示。
由于驱动构件138上的第一齿条141和金属驱动杆140上的齿条154与增益器136接合,击发扳机28的运动引起金属驱动杆140在图8中显示的第一往复运动位置和在图9中显示的第二往复运动位置之间往复运动。由于第一小齿轮150的直径比第二小齿轮152的直径大,增益器136使往复运动部分134运动的距离比驱动构件138通过击发扳机28运动的距离远。第一和第二小齿轮150和152的直径可被改变,以允许击发扳机28的冲程长度和使其运动所需的力可被改变。应理解,手柄部分20是示例性的,也可采用其它致动机构。例如,闭合和击发运动可由自动装置产生。
在图18、19和23-26中进一步详细示出了外科缝合和切割器械10的端部执行器12的一种实施方式。如上所述,手柄部分20产生了致动端部执行器12的独立且不同的闭合和击发运动。端部执行器12有利地保持这种独立且不同的闭合和击发(即,缝合及切割)的临床灵活性。另外,端部执行器12引入了前述的能力,以在医生定位并夹钳组织之后肯定地保持击发期间的闭合间隔。例如在夹钳的组织的量不足的情况下通过确保足够的间隔,以及在夹钳的组织的量过多的情况下通过增强夹钳,这些特征在方法上和结构上增强了外科缝合和切割器械10的能力。
图10示出了安装在端部执行器12中的本发明的钉仓300的实施方式,其中击发杆14处于其未击发的近侧位置。钉仓300具有仓主体302,其被从仓300的近端304向着锥形的外尖端306延伸的细长槽310分隔。多个钉容纳通道320a-320f在钉仓主体302中形成,并且排列成六个横向间隔开的纵排500、502、504、506、508、510,在细长槽310的每一侧上有三排。在钉容纳通道320a-320f中设置的是钉222。见图10和11。
仓300还包括四个横向间隔开的纵排钉驱动器330a、330b、370a和370b,如图11中所示。“第一”内侧钉驱动器330a可滑动地安装于相应的通道320b和320c中,使每个驱动器330a支撑两个钉222,一个在通道320b中,一个在通道320c中。同样地,“第二”内侧钉驱动器330b可滑动地安装于相应的通道320d和320e中,使每个驱动器330b支撑两个钉222,一个在通道320d中,一个在通道320e中。“外侧”驱动器370a和370b分别可滑动地安装在钉容纳通道320a和320f中。每个外侧驱动器370a和370b支撑单个钉222。这里驱动器370a指的是“第一”外侧驱动器,并且驱动器370b在这里指的是“第二”外侧驱动器。
图12显示了可与本发明的各种实施方式结合使用的钉222。钉222包括主体部分223和两个尖头225。尖头225每个具有长度“P”并且主体部分具有宽度“W”。读者应当理解,可采用各种不同类型的钉。例如,对于血管钉来说,“P”可以大约为0.102英寸;对于标准钉来说,“P”可以是大约0.134英寸;对于粗的组织钉来说,“P”可以是大约0.160英寸。对于所有的这类钉来说,“W”可以是大约0.120英寸。可按下面详细讨论的方式采用其它尺寸的钉222。
定位在细长槽310一侧上的内侧钉驱动器330a在这里指的是“第一”内侧钉驱动器,并且定位在细长槽310另一侧上的内侧钉驱动器330b在这里指的是“第二”内侧钉驱动器。如同将在下面进一步详细讨论的那样,在一种实施方式中,除了在仓主体302中它们各自的通道中的它们各自的朝向以外,第二内侧钉驱动器330b与第一内侧钉驱动器330a相同。
图13-15显示了用于支撑并驱动钉222的“第一”内侧双驱动器330a的一种实施方式。如可从那些附图中看到的那样,钉驱动器330a具有第一驱动器部分340和通过中央基体构件360与第一驱动器部分340连接的第二驱动器部分350。第一驱动器部分340具有第一驱动器基体342,其中具有沟槽343,该沟槽343适于与在仓主体302中的沿垂直方向延伸的相应的舌(未显示)配合,用于当驱动器330a在它们各自的通道中运动时导引并稳定驱动器330a。第一驱动器部分340还具有从第一驱动器基体342向上伸出的第一向前支撑柱344和第一向后支撑柱346。第一向前支撑柱344中具有第一向前钉容纳槽345,第一向后支撑柱346中具有第一向后钉容纳槽347。参见图13-15。第一向前支撑柱344和第一向后支撑柱346彼此间隔并共同形成第一钉托架348,用于将钉222的主体部分223支撑在直立位置(也就是尖头面对砧座)。类似地,第二驱动器部分350具有第二驱动器基体352和从第二驱动器基体352向外伸出的第二向前支撑柱354和第二向后支撑柱356。第二向前支撑柱354中具有第二向前钉容纳槽355,第二向后支撑柱356中具有第二向后钉容纳槽357。第二向前支撑柱354和第二向后支撑柱356彼此间隔并共同形成第二钉托架358,用于在其中支持另一个钉222的主体部分223。
如图13-15中所示,中央基体构件360具有倾斜的向后边缘362,其适于由相应的滑动件凸轮接合,见下面更详细的讨论。如图13和14所示,在该实施方式中,第二驱动器部分的第二向前支撑柱354相对于第一向后支撑柱346这样定向,即,使支撑于第二钉托架358中的钉222与第一钉托架348中的钉222沿纵向偏置。读者应当理解,第一内侧驱动器330a每个以一个朝向安装在设置于仓主体302中的细长槽310的一侧上的相应的一对通道320b和320c中。第二内侧钉驱动器330b(位于细长槽310的与第一内侧钉驱动器330a的相对侧)包括旋转180度的内侧驱动器330a,使它们各自的倾斜表面363面向仓300的近端304,从而使它们能够被安装在成对的相应通道320d和320e中。因此,在该实施方式中,仅仅采用一个内侧驱动器构造,从而消除了对细长槽310每侧上的通道的两种不同内侧钉驱动器构造的需要。
图16和17显示了“第一”外侧钉驱动器370a的一种实施方式。如可从那些附图中看到的那样,第一外侧钉驱动器370a具有第二基体372,该第二基体具有倾斜的向后部分374。从第二基体372向上伸出的是其中具有第二向前钉容纳槽376的第二向前支撑柱375。第二向后支撑柱377也以与第二向前支撑柱375成间隔关系从第二基体372向上伸出。第二向后支撑柱377中具有第二向后钉容纳槽378。支撑柱375、377共同形成第二钉托架379,该托架构造为将钉222支撑于直立位置,如图16和17所示。钉驱动器370a还具有横向突出的肋371,该肋容纳在仓主体302中相应的沟槽(未显示)内,用于当驱动器370a在各自的通道中运动时导引并稳定驱动器370a。
读者应理解,第一外侧驱动器370a被沿着一个方向安装在细长槽310一侧上的相应通道320a中。第二外侧钉驱动器370b(位于细长槽310的与第一外侧钉驱动器370a的相对侧)包括旋转180度的外侧驱动器370a,使其上的倾斜表面374’面向仓300的近端304,从而使其能够被安装在仓主体302的相应通道320f中。因此,在该实施方式中,仅仅采用一个外侧驱动器构造,从而避免了对细长槽310每侧上的通道的两种不同外侧钉驱动器构造的需要。图19和19A显示了安装在一种类型的端部执行器12中的本发明的钉仓的一种实施方式的横截面。在该实施方式中,端部执行器12采用图23-25中显示的“阶梯”砧座18的类型。然而,在另外的实施方式中,砧座底面是平面的并且不是阶梯形的。其它如图19A和23-25中所示,砧座18具有偏移或者与两个横向侧部分21、23不共面的中央部分19。因此,在该实施方式中,仓300的上表面306设有凹陷的中央部分307和两个横向侧部分309,当砧座18处于其闭合位置时,中央部分307和两个横向侧部分309分别适于与砧座18的相应部分19、21、23紧密配合。见图19A。
如图24中所示,在该实施方式中,砧座18的下表面200设有一系列成形凹槽202,其可与仓300中的成排通道对应地成排设置。也就是说,凹槽202的排205可与通道排500对应。凹槽的排207可与通道排502对应。凹槽202的排209可与通道排504对应。凹槽202的排211可与通道排506对应。凹槽202的排213可与通道排508对应。凹槽202的排215可与通道排510对应。每个凹槽202中具有至少一个成形面203,其适于与被在其中驱动的钉尖头225的末端接触,从而引起尖头225向内朝着彼此弯曲。在一种实施方式中,每个凹槽202具有两个相交的弧形成形面203,其如图14A中那样定向。每个弧形成形面具有顶点203’,该顶点限定了最大凹槽深度“Z”。然而,也可采用其它成形凹槽构造。
参照图18和19,可以看出,在一种实施方式中,仓主体302被安装在仓托盘224中。如图19所示,仓主体302形成有两个内侧的沿纵向延伸的槽390和两个外侧的沿纵向延伸的槽392。槽390和392从仓的近端304向着其锥形的外侧尖端306(在图10中显示)延伸。该实施方式还包括可滑动地支撑于仓托盘224上的楔形滑动件400。楔形滑动件400的一种实施方式包括一对内侧滑动件凸轮410,其中一个内侧滑动件凸轮410与一个内侧的沿纵向延伸的槽390对应,另一个内侧滑动件凸轮410与另一个内侧的沿纵向延伸的槽390对应。见图19,楔形滑动件400还包括一对外侧滑动件凸轮420,其中一个外侧滑动件凸轮420与一个外侧的沿纵向延伸的槽392对应,另一个外侧滑动件凸轮420与另一个外侧的沿纵向延伸的槽392对应,如图19所示。当装配时,仓托盘224将楔形滑动件400和驱动器330a、330b、370a、370b保持在仓主体302内侧。
如图18所示,细长通道16具有在近侧设置的连接腔226,其容纳位于框架34的远端上的通道锚固件228,用于将端部执行器12连接到手柄部分20。细长通道16还具有砧座凸轮槽230,其可枢转地容纳砧座18的砧座枢轴232。包围框架34的闭合套管32包括指向远端侧的接片234,其与砧座零件236接合,砧座零件236位于砧座18上的砧座枢轴232附近但更位于更远侧,从而使砧座18打开和闭合。击发驱动构件36显示为从通过销240与击发连接器238连接的击发杆14开始装配,该击发连接器又可旋转并在近侧连接到金属驱动杆140。击发杆14通过插入其中的带槽的导引件239在框架的远端被导引。
图20-23显示了本发明的楔形滑动件400的一种实施方式。如图20和23所示,楔形滑动件400包括在各内侧滑动件凸轮410之间延伸的中央定位片部分402。在中央定位片部分402上形成推动器滑块404,用于与击发杆14的中间销46接合。在图21中示出了一个内侧滑动件凸轮410的一种实施方式的侧面轮廓。如该附图所示,内侧滑动件凸轮410具有底面412、与底面412形成角度“G”的第一凸轮表面414以及延伸到顶面416的第二凸轮表面415。在一种实施方式中,角度“G”可以是35度,并且角度“G’”可以是20度。内侧凸轮表面410的高度(底面412和顶面416之间的距离)表示为“第一”滑动件凸轮高度“H”。在一种实施方式中,距离“H”大约为0.173英寸,顶面416的高度在实施方式之间可以改变。如随着具体实施方式部分的说明将更加明显的那样,第一滑动件凸轮高度代表在操作期间内侧滑动件凸轮410能够向着砧座18驱动相应的内侧驱动器330a、330b的垂直距离。
楔形滑动件400还包括分别在各内侧滑动件凸轮410和各外侧滑动件凸轮420之间延伸的横向定位片部分406,如图20和23所示。外侧滑动件凸轮420的一种实施方式的侧面轮廓在图22中示出。在该实施方式中,外侧滑动件凸轮420具有底面422、与底面422成角“I”的第一凸轮表面424以及达到顶面426的第二凸轮表面425。在一种实施方式中,角“I”可以是大约35度,并且角“I”可以是大约20度。外侧凸轮表面420的高度(底面412和顶面416之间的距离)表示为“第二”滑动件凸轮高度“J”。在一种实施方式中,距离“J”大约为0.163英寸,第二滑动件凸轮高度代表在操作期间外侧滑动件凸轮420能够向着砧座18驱动相应的外侧驱动器370a、370b的垂直距离。读者应当理解,上面所述的尺寸是一种实施方式的例子,在其它实施方式中可以改变。
特别参考图23,其中除去了钉仓300的一部分,以露出细长通道16的一部分,例如凹槽212、214,并露出处于它们的未击发位置的钉仓300的一些组成元件。具体地,除去了仓主体302(在图18中显示)。楔形滑动件400在其近侧未击发位置被显示,并且推动器滑块404与击发杆14的中间销46(在图23中未显示)接触。楔形滑动件400沿着纵向与仓托盘224滑动接触,并包括楔形滑动件凸轮410、420,当楔形滑动件400向远侧运动时所述楔形滑动件凸轮向上促动双驱动器330a、330b和单驱动器370a、370b。置于驱动器330a、330b、370a、370b上的钉222(在图23中未显示)因而也被向上促动成与砧座18中的砧座成形凹槽202接触,以形成封闭的钉。图中还示出了与钉仓300中的细长槽310对准的细长通道16的通道槽45。
图24示出了端部执行器12,其借助缩回的闭合套管32处于打开位置,并且钉仓300安装在细长通道16中。击发杆14处于其近端位置,并且上部销38以不会形成干扰的方式与砧座凹槽40对准。砧座凹槽40显示为与砧座18中的纵向砧座槽42连通。击发杆14的指向远端的切割边缘48与钉仓300中的垂直槽49对准并从近侧从其中移除,从而允许除去用过的仓并插入可“卡扣配合”到细长通道16中的未击发的仓。特别地,在该实施方式中,钉仓300的延伸零件316、318分别与细长通道16中的凹槽212、214(显示于图23中)接合。
图25示出了图23的端部执行器12,其中除去了钉仓300的所有部分,显示出击发杆14的中间销46,并除去了与通道槽45相邻的细长通道16的一部分,从而露出击发杆帽44。另外,移除了轴23的部分,以露出击发杆14的近侧部分。在枢轴附近从砧座18向下伸出的是一对相对的组织限位器244,它们用于防止在夹钳期间组织被定位得达到端部执行器12中太远。图26示出了处于闭合位置的端部执行器12,其中击发杆14处于未被击发位置。上部销38处于砧座凹槽40中并与砧座槽42垂直对准,用于在击发期间使击发杆14向远侧纵向运动。设置中间销46,以向远侧推动楔形滑动件400,从而使滑动件凸轮410、420分别接触并提升双驱动器330a、330b和单驱动器370a、370b,使它们朝着砧座18向上驱动。
如通过参考图14A、15A和19A能够理解的那样,在本发明的一种实施方式中,当砧座18处于闭合位置并且当内侧驱动器330a、330b被支撑于仓托盘224上时,形成第一钉托架349的第一钉容纳槽345、347底部和砧座18相应的成形凹槽202的成形表面203的顶点203’之间的距离在这里称为第一钉成形距离“A”。当砧座18处于闭合位置并且当内侧驱动器330a、330b被支撑于仓托盘224上时,形成第二钉托架379的第二钉容纳槽345、347的底部和砧座18相应的成形凹槽202的成形表面203的顶点203’之间的距离在这里称为第二钉成形距离“B”。在一种实施方式中,第一钉成形距离“A”与第二钉成形距离“B”彼此完全相同。在另外的实施方式中,这些距离“A”和“B”可以彼此不同。
如图16A和19A所示,当砧座18处于闭合位置并且当外侧驱动器370a、370b被支撑于仓托盘224上时,形成第二钉托架379的第二钉容纳槽376、378的底部和砧座18中相应的成形凹槽202的成形表面203的顶点203’之间的距离在这里称为“第二”钉成形距离“C”。
图27和28显示了支撑于一些第一外侧驱动器370a上的钉的形成。在图27中,楔形滑动件400的其中一个外侧滑动件凸轮420最初与其中一个外侧驱动器370a接触。当楔形滑动件400沿着由图28中的箭头“K”所示的驱动方向继伸行进时,外侧滑动件凸轮420引起外侧驱动器370a驱动所支撑的钉进入砧座18中的钉成形凹槽202中。同样地,当楔形滑动件400沿着驱动方向“K”被驱动时,内侧滑动件凸轮410与内侧驱动器330a、330b接触并从而引起它们驱动所支撑的钉222进入砧座18中相应的钉成形凹槽202中。
如上所述,在一些涉及变化的组织复合的区域的应用中,可能希望形成成排钉,其中与切割线距离最远的排中的钉的成形(最终)高度比那些与切割线最近的排中的钉的成形(最终)高度要大。在另外的应用中,可能希望,对于单排钉的成形高度,从钉到钉增加(或减少)。另一种临床优点是使在最外侧排中的钉的成形高度大于在内侧排中的钉成形高度。虽然在所有的排中采用了相同的钉,但本发明的各种实施方式可提供这些结果。
在以下的描述中,最外侧钉排520、530中的那些钉222(使用外侧钉驱动器370a、370b成形的那些钉)此后将称为钉222’,并且在最内侧钉排522、524、526、528中的那些钉(使用内侧钉驱动器330a、330b成形的那些钉)此后将称为钉222”。然而,应当理解,在通过本发明的各种实施方式成形之前,钉222’和钉222”彼此相同。也就是说,钉222’和222”每个具有相等的尖头长度“P”和宽度“W”。参照图14A-16A和21及22,上面所需的效果可通过改变相对彼此的钉成形距离“A”、“B”及“C”和/或滑动件凸轮高度“H”和“J”来得到。例如,在本发明的一种实施方式中,每个内侧滑动件凸轮410的高度“H”与每个外侧滑动件凸轮420的滑动件高度“J”基本上相等,见图21和22。在该实施方式中,钉成形距离“A”和“B”彼此基本上相等,但是距离“A”和“B”小于钉成形距离“C”。第一钉容纳槽345、347的底部和第一驱动器基体342的底面342’之间的距离与第二钉容纳槽356、357的底部和第二驱动器基体352的底面352’之间的距离基本上相等。见图15。仍在该实施方式中,第二钉容纳槽376、378的底部和外侧驱动器370a、370b(图16)的第三基体372的底面373之间的距离“F”小于距离“D”和“E”(图15)。由于成形距离“C”大于成形距离“A”和“B”,由外侧驱动器370a、370b支撑并形成的钉222被压缩得与由内侧驱动器330a、330b支撑并形成的钉不同。应当理解,可通过采用内侧驱动器330b和外侧驱动器370b的相同设置和尺寸在细长槽310的相对侧和在组织中形成的切割线600上获得相同的结果。在一种备选实施方式中,可通过改变与驱动器330a和370b对应的成形凹槽202的深度使成形距离“C”大于成形距离“A”和“B”来达到同样的效果。也就是说,与外侧驱动器370a和370b对应的那些成形凹槽202的深度(在图16A中的距离“Z′”)可大于与内侧驱动器330a和330b对应的成形凹槽202的深度(在图14A中的距离“Z”)。
图29显示了利用本发明的该实施方式在切割线600的每一侧上形成的成排钉,其中成形距离“A”和“B”彼此相等,而成形距离“C”大于成形距离“A”和“B”。例如,如果成形距离“C”比成形距离“A”和“B”大0-020英寸,排520和530中的外侧钉222’的成形高度(在图30中以尺寸“L”表示)将比排522、524、526、528中的内侧钉222”的成形高度(在图31中以尺寸“M”表示)大0.020英寸。
可利用本发明的另一种实施方式得到相同的结果,其中成形距离“A”、“B”和“C”本质上相等。然而,在该实施方式中,每个内侧滑动件凸轮410的高度(图21中的距离“H”)大于每个外侧滑动件凸轮420的高度(图22中的距离“J”)。因此,由于内侧滑动件凸轮410的高度“H”大于外侧滑动件凸轮420的高度“J”,内侧滑动件凸轮410将向着砧座使相应的内侧驱动器330a、330b驱动得比外侧滑动件凸轮420驱动相应的外侧驱动器370a、370b更远。所述驱动动作将引起由内侧驱动器330a、330b支撑的钉被压缩的程度比那些由外侧驱动器370a、370b支撑的钉被压缩的程度更大。例如,如果距离“H”比距离“J”大0.020英寸,在线520、530中的钉222’的成形高度将比线522、524、526、528中的钉222″的成形高度大0.020英寸。
当采用本发明的再一种实施方式时,钉222’的外侧排520、530和钉222”的内侧排522、528可形成为比内侧排524、526中的钉222”的成形高度大的高度。参见图32。可通过使成形距离“C”大于成形距离“A”以及使成形距离“A”大于第二成形距离“B”得到这种结果。
本发明的另一实施方式可用于希望在单排中成形高度可变化的地方安装钉。一种所述设置在图33中示出。如图33所示,当分别从每排520、530的近端521、531分别运动到每排520、530的远端523、533时,在外侧排520、530中的钉222’的成形高度增加。可通过减少每个后续驱动器370a、370b的成形距离“C”来达到这种效果。也就是说,最接近仓300的近端的驱动器370a的尺寸将被设置成建立大于通过相邻驱动器370a得到的成形距离“C”的成形距离“C”,如此继续,以达到每个后续钉222’(沿着从仓300的近端向远端运动的方向)将具有更大的成形高度的状况。这种结果还可通过类似地改变由每个驱动器330a、330b得到的成形距离“A”和/或“B”而在排522、524、526、528中的钉222”中得到。同样地,当分别从每排520、530的近端521、531分别运动到每排520、530的远端523、533时,在外侧排520、530中的钉222’的成形高度可降低。这种结果可通过增加每个后续驱动器370a、370b的成形距离得到。也就是说,最靠近仓300的近端的驱动器370a可具有比邻近驱动器370a的成形距离“C”小的成形距离“C”,如此继续,以达到其中每个后续钉222’(沿着从仓的近端向远端运动的方向)可具有更小的成形高度的状况。见图34。
在使用时,如图1-2及35-41所示,图中显示了使用的外科缝合和切割器械10。在图1-2中,器械10处于其开始位置,未击发的满载的钉仓300卡扣配合到细长通道16的末端中。两个扳机26、28都向前并且端部执行器12打开,例如可典型地在经套管针或者其它开口将端部执行器12插入到体腔之后那样。然后由医生操纵器械10使待缝合及切割的组织248被定位在钉仓300和砧座18之间,如图35所示。参照图36和37,然后医生向近侧运动闭合扳机26直到直接定位在手枪式把手24附近,将手柄部分20锁定在闭合和夹钳位置。在端部执行器12中的回缩的击发杆14不是要阻止端部执行器12的选择性打开和闭合,而是停留在砧座凹槽40中。随着砧座18的闭合和夹钳,使E形梁击发杆14对准,用于通过端部执行器12击发。特别地,使上部销38与砧座槽42对准,并且细长通道16通过中间销46和击发杆帽44围绕通道槽45有利地接合。
参照图38和39,在发生组织夹钳后,医生向近侧移动击发扳机28,引起击发杆14向远侧运动到端部执行器12中。特别地,中间销46经击发驱动槽47进入钉仓300,以借助经楔形滑动件400向着砧座18击发钉222(在图38和39中未显示)。最下部的销,或者击发杆帽44与中间销46合作使击发杆14的切割边缘48滑动定位来切割组织。两个销44、46还将击发杆14的上部销38定位在砧座18的纵向砧座槽42中,在其向远侧的击发运动期间确定地保持砧座18和细长通道16之间的间隔。
参照图40和41,医生连续运动击发扳机28,直到靠近闭合扳机26和手枪式把手24。从而,由于钉222与砧座18接合,所有钉222的端部都被弯曲。击发杆帽44抵靠向着通道槽45的远端伸出的击发杆止动器250。切割边缘48完全横过组织。通过释放击发扳机28,然后压下释放按钮30,同时挤压闭合扳机26打开端部执行器12来完成该过程。
图42-43示出滑动件400的内侧滑动件凸轮410和外侧滑动件凸轮420,滑动件400具有不同的高度,使得钉在成形时可以具有不同的成形高度。具体而言,如图42所示,外侧滑动件凸轮420可以矮于内侧滑动件凸轮410。以此方式,外侧钉可以比内侧钉具有更大的成形高度。图42是针对内侧滑动件凸轮410和外侧滑动件凸轮420的具有不同高度的滑动件400的透视图。图43是端部执行器12的侧视图,示出使用滑动件400驱动钉222的各个阶段,针对内侧滑动件凸轮410和外侧滑动件凸轮420,滑动件400具有不同的高度。如图43所示,成形钉222b可以比成形钉222a具有更大的成形高度,因为钉222b由外侧滑动件凸轮420驱动,而钉222a由更高的内侧滑动件凸轮410驱动。
在另一种实施方式中,如图44所示,双驱动器330的驱动器部分342、352的高度可以不同,使得钉在成形时可以具有不同的高度。具体而言,如图44所示,第二驱动器部分352(高度为“E”)可以短于第一驱动器部分342(高度为“D”)。以此方式,由第二驱动器部分352驱动的钉222a的成形高度可以大于由第一驱动器部分342驱动的钉222b的成形高度。在各种实施方式中,一些或者所有的内侧双驱动器330可以具有不同高度的第一和第二驱动器部分342和352。此外,高度差不需要都相同。不同的内侧双驱动器330可以具有不同的高度差。
此外,第一和第二驱动器部分342、352的高度可以与外侧钉驱动器370的驱动器部分372的高度相同或者不同。就是说,在各种实施方式中,外侧钉驱动器部分372的驱动器高度可以:(1)当驱动器部分342、352具有相同的高度时,上述驱动器高度可以不同于内侧双驱动器330的驱动器部分342、352两者的高度;(2)当驱动器部分342、352具有不同的高度时,上述驱动器高度可以不同于驱动器部分342、352两者的高度;或者(3)当驱动器部分342、352具有不同的高度时,上述驱动器高度可以与驱动器部分342、352中一个的高度相同。此外,外侧钉驱动器370的驱动器部分372的高度不需要相同。不同的外侧钉驱动器370可以具有不同的高度。
图45示出的实施方式具有不同高度的驱动器(例如第一驱动器部分342高于第二驱动器部分352)和不同深度的砧座凹槽202。砧座凹槽202的不同深度也能够影响成形钉的高度。在其他都相同的情况下,较深的凹槽能够形成较长的成形钉。在图示的实施方式中,对应于第一驱动器部分342的凹槽202比对应于第二驱动器部分352的凹槽202更深。用于各个钉排500-510的凹槽202中的一些或者全部可以更深。此外,深度差不需要相同。不同幅度的深度可以用于单个排500-510或者经过多个排500-510。
此外,如图46所示,可以使用具有不同预成形尖头高度(“P”)的钉222。在图示的实施方式中,与由第一驱动器部分342驱动的钉222b相比,较长的钉222a用于内侧双驱动器330的较短的第二驱动器部分352。预成形的钉尖头长度可以在钉排500-510中改变或者经过多个钉排改变。就是说,例如,内侧排504-506中的所有钉可以具有相同的预成形尖头长度x,中间排502、508中的所有钉可以更长(例如长度为1.10x),外侧排500、510中的所有钉可以更加长(例如长度为1.20x)。如图47所示,砧座凹槽202可以具有相同的深度。在其他实施方式中,可以使用深度不同的砧座凹槽。
图48是在外侧钉驱动器370具有不同高度的实施方式中的端部执行器12的侧视图。具体而言,在图示的实施方式中,第一钉驱动器370’高于第二钉驱动器370”。在图示的实施方式中,钉222具有相同的预成形尖头长度,相应的砧座凹槽202具有相同的深度。由此,用第二外侧钉驱动器370”形成的成形钉222”长于用第一外侧钉驱动器370’形成的成形钉222’。
图49是端部执行器12的侧视图,其中对于由内侧双驱动器330驱动的钉222,砧座18具有不同深度的凹槽202。在图示的实施方式中,对应于第一驱动器部分342的凹槽202比对应于第二驱动器部分352的凹槽202深。在该实施方式中,第一和第二驱动器部分342、352具有相同的高度,并且钉222具有相同的预成形尖头长度。第一驱动器部分342的顶部和对应砧座凹槽202的顶部之间的距离是高度“A”,用于第二驱动器部分352的对应高度是高度“B”,其中“A”比“B”大高度差“h’”。对于第一驱动器部分342这将导致更长的成形钉,如图50所示。
图51和60示出根据其他实施方式的端部执行器12的各个方面,其可以用于形成具有不同成形长度的钉。在图示的实施方式中,通过位于多个楔形带组710、712、714远端处的多个致动器楔形凸轮709分阶段驱动钉驱动器330、370。在图示的实施方式中,每个楔形带组包括四个楔形带(图56中最好地示出):其中两个带720用于致动内侧驱动器330a、330b,两个带722用于致动外侧驱动器370a、370b。楔形带组710、712、714的楔形带可以被顺序致动,并可以以堆叠的方式彼此紧连,以分阶段顺序驱动钉驱动器330a、330b和370a、370b(并因此驱动钉222)。例如,最下侧致动器楔形带组710的楔形带可以被首先击发(或致动),并可以部分展开钉222。如图53至56所示,靠在最下侧楔形带组710顶部上的中间楔形带组712可以被随后致动,其可以具有开始成形钉222的效果。然后,靠在中间楔形带组712上的最上侧楔形带组714可以被致动,其完成钉222的成形。图56示出该操作。在图56中,最下侧楔形带组710已经被击发,中间楔形带组712已经被部分击发,并且最上侧楔形带组714还没有被击发。由此,这样的实施方式可以包括多个(在本示例中是四个)堆叠的楔形带组,每个堆叠包括最下侧楔形带组710、中间楔形带组712和最上侧楔形带组714。
然后,具有E形梁击发机构14的击发杆716可以被击发,以切割由端部执行器12夹钳的组织。可以在横杆719处连接到框架34上的限位弹簧(hold down spring)718可以接合击发杆716并向下驱动击发杆716。
如图54和56最好地示出的,内侧排楔形带堆叠720的累计高度可以大于外侧排楔形带堆叠722的高度(高度差为h’)。以此方式,外侧排的钉222可以比内侧排的成形钉具有更大的成形高度,如图55的示例所示,外侧排的钉222a的成形高度大于内侧排的钉222b。如图61的示例所示,根据一种实施方式,最下侧和中间楔形带组710、712的楔形带可以具有相同的高度,并且外侧排楔形带堆叠722的最上侧楔形带组714的高度可以小于内侧排楔形带堆叠720的最上侧楔形带组714的高度,以对于不同的楔形带堆叠提供高度差。
该实施方式中的端部执行器12也可以包括滑动件400,但是没有滑动件凸轮410、420,以保持击发机构14不被锁定在通道中(参见图3-4以及相关的文字描述)。
内侧和外侧的楔形带堆叠720、722可以紧密地位于框架34中。由此,端部执行器12还可以包括相应的致动器楔形带引导件702,用于在它们进入端部执行器12时展开楔形带堆叠720、722,以与钉驱动器330、370对齐。楔形带引导件702可以包括用于内侧和外侧楔形带堆叠720、722的楔形带通道。就是说,在图示的实施方式中,楔形带引导件702可以包括四个楔形带通道:用于内侧排720的两个和用于外侧排722的两个。图58-60更详细地示出楔形带引导件702的一个侧面。如图60所示,楔形带通道730、732可以在楔形带堆叠720、722进入端部执行器12时对其施加向外的力。内侧楔形带通道730可以引导内侧楔形带堆叠720使得内侧楔形带堆叠720与内侧钉驱动器330对齐,外侧楔形带通道730可以引导外侧排楔形带堆叠722使得外侧楔形带堆叠与外侧钉驱动器370对齐。在图示的实施方式中,通道730、732是直的。在其他实施方式中,通道730、732中的一个或者两个可以包含弯曲的部分。
图62是根据这种实施方式的轴组件10的剖视图。如图62所示,每个楔形带组710-714可以具有其自己的致动(或击发)杆。最下侧致动杆740可以致动最下侧楔形带组710的楔形带,中间致动杆742可以致动中间楔形带组712的楔形带,最上侧致动杆744可以致动最上侧楔形带组714的楔形带。用于致动切割器械14的击发杆716可以连接到最上侧楔形带组714,使得用最上侧(最后的)楔形带组714来致动切割器械14。在其他实施方式中,击发杆716可以具有其自己的致动机构,使得其可以被单独致动。
在实践中,临床医生可以在致动击发杆716以切割组织之前选择(选定)致动比所有楔形带组710-714少的部分,以由此对待成形的钉的长度进行选择。例如,在各种实施方式中,临床医生可以在切割之前选择致动最下侧和中间的楔形带组710、712,而不是最上侧楔形带组714。
图63-69示出了开放式直线型缝合和切割装置800的实施方式,其可以使用多个堆叠的楔形带组来形成具有不同成形长度的钉。在图示的实施方式中,砧座810位于通道809之下。由此,钉被向下驱动穿过夹钳在端部执行器12中的组织,这是缝合操作的一部分。
装置800可以包括上部主体件801和下部主体件804。上部主体件802可以包括其中可以插入钉仓809的通道806。砧座810可以连接到下部主体件804并面对钉仓809,使得可以抵靠砧座810的钉成形表面812成形钉222。当临床医生对于组织在仓809和砧座810之间的位置满意时,临床医生可以使用连接到上部主体件802上的夹钳杆组件816的夹钳杆814来锁定装置800。
仓809中的钉驱动器820可以使用多阶段的楔形带堆叠来分阶段致动。因为在该实施方式中钉222被向下驱动,所以最上侧楔形带组822的楔形带可以首先被致动以部分展开钉222。然后,靠着(rideon)最上侧楔形带组822的中间楔形带组824的楔形带可以被致动以开始成形钉222。然后,靠着中间楔形带组824的最下侧楔形带组826的楔形带可以被致动,其完成钉222的成形。
在图示的实施方式中,其远端具有刀830的击发杆828连接到最下侧楔形带组826,并用最下侧楔形带组826来击发。限位弹簧832可以接合并向上驱动击发杆828。刀保持器834可以用最下侧楔形带组826来保持击发杆828。
如图67-68最好地示出的,临床医生可以使用三件式致动滑杆840来致动楔形带组。上侧件842可以致动最上侧(初始)楔形带组822。中间件844可以致动中间楔形带组824。下侧件846可以致动最下侧(最后)楔形带组826。
为了成形具有不同成形高度的钉,钉推动器820可以具有不同的高度。例如,如图66所示,一组钉推动器820a可以短于另一组钉推动器820b。由此,由较短的钉推动器820a形成的成形钉222a可以比由较长的钉推动器820b形成的成形钉222b具有更大的成形长度。在其他实施方式中,钉222可以具有不同的长度或者丝径,以形成不同长度的成形钉,且/或砧座810中的凹槽202可以具有不同的深度以形成不同长度的成形钉。此外,楔形带堆叠的累计高度可以不同。
根据本发明的各种实施方式,钉驱动器可以具有钉驱动器接口,其允许使用各种丝径的钉。例如,如图78-83的实施方式所示,外侧钉驱动器370a、370b可以在其上表面上具有凸出的凸部(raiseddimple)构造,用于支撑具有不同丝径的钉。如图示实施方式所示,凸部构造可以包括内侧的两组向外突出的凸部(或者凸起)620a、620b以及外侧的两组凸部622a、622b。每组凸部限定了接收区域,在该接收区域,钉222可以位于直立的位置,如图81-83所示。内侧组的凸部620a、620b可以大于外侧组的凸部622a、622b,使得内侧组凸部620a、620b的接收区域小于外侧组凸部622a、622b。但是,由于凸部的凸出特性,可以容纳不同粗细线径的钉222,如图82和83所示。例如,凸部可以被构造成使得钉驱动器370能够容纳丝径为0.006英寸到0.012英寸的钉,或者丝径为一些其他范围例如0.004英寸到0.008英寸或者0.006英寸到0.008英寸等的钉。同样,不同粗细线径的钉可以用在单个仓300中。在其他都相同的情况下(例如相同的驱动/变形距离、相同的凹槽深度等),不同的丝径将形成不同的成形钉高度。此外,如图78最好地示出的,用于内侧驱动器330的钉支架(cradle)可以包括锋利的部分624,该锋利的部分624可以损伤正在被缝合的组织。外侧钉驱动器370上的凸部构造没有这样的锋利部分,这将使对被缝合组织的创伤最小化。
在图示的实施方式中,外侧钉驱动器370a、370b具有凸出的凸部构造,以容纳不同丝径的钉,而内侧钉驱动器342、352的钉支架仅能够支撑一种通用丝径的直立钉。在其他实施方式中,内侧钉驱动器342、352中的一个或者两个也可以或者替代地具有凸出的凸部构造。此外,除了使用凸出的凸部构造,可以使用V形钉通道349、379。这样的V形通道也可以容纳不同丝径的钉。此外,具有容纳不同钉丝径的钉接口的钉推动器可以与除图78-83所示的内侧双钉驱动器和外侧单钉驱动器以外的其他类型钉驱动器一起使用。
图70-77是根据本发明各种实施方式的端部执行器12的正面剖视图。在图70所示的实施方式中,砧座18是阶梯状的,其具有相对于两个横向侧面部分21、23偏移(或者不共面)的中间部分19。此外,仓300的上表面306具有凹入的中间部分307和两个横向侧面部分309(见图19A)。所有的钉222具有相同的预成形尖头高度,相应的砧座凹槽202具有相同的深度。但是,由于砧座18的阶梯状特性,砧座18的两个横向侧面部分21、23上的凹槽202相对于砧座的中间部分19中的凹槽偏移。使钉成形凹槽202的竖向位置偏移能够影响成形钉202的长度。在其他都相同的情况下,通过被提高的钉成形凹槽成形的钉将比用没有被提高的钉成形凹槽成形的钉具有更长的成形长度。此外,在该实施方式中,双内侧驱动器330a、330b的第一和第二驱动器部分342、352具有相同的高度,并且外侧钉驱动器370a、370b的驱动器部分372的高度大于双内侧钉驱动器330a、330b的驱动器部分342、352的高度。此外,在此实施方式中,内侧和外侧滑动件凸轮410、420具有相同的高度。
图71示出其中端部执行器12在仓300的底部处具有阶梯状仓托盘224以与通道16中的阶梯进行匹配的实施方式。具体而言,在图示的实施方式中,仓托盘224具有中间部分602和横向外侧部分604,双内侧钉驱动器330a、330b位于中间部分602上,外侧钉驱动器370a、370b位于横向外侧部分604上。如图71所示,仓托盘224的中间部分602被升高到横向外侧部分604之上。同样,滑动件400被构造成使得外侧滑动件凸轮420定位成低于内侧滑动件凸轮410,使得外侧滑动件凸轮420能够接合靠下的外侧驱动器部分370a、370b。
图72所示的实施方式类似于图71所示的实施方式,除了在图72中,仓300不包括仓托盘224。而是钉驱动器330、370直接位于通道16上。这样的实施方式可能是有利的,因为与具有仓托盘224的类似实施方式(例如如图71所示)相比,其可以允许在位置A和B处在通道16中具有更多的材料(例如金属)。
图73所示的实施方式也类似于图71所示的实施方式,除了在图73中,与图71所示的实施方式相比,仓托盘224相对于通道16的底部略微凸出。与图71所示的实施方式相比,这样的实施方式允许在位置A和B处在通道16中具有更多的材料(例如金属)。根据其他实施方式,砧座18的高度可以被减小,以允许在位置A和B处在通道16中具有更多的材料。
图74的实施方式与图73的类似,除了没有仓托盘224被包含在图74的实施方式中。
图75的实施方式类似于图70,除了在图75中,外侧排的凹槽202形成在砧座18的柔性材料部分610中。柔性材料部分610由比砧座18的其余部分更加具有柔性的材料制成。例如,柔性材料部分610可以由塑性材料或者塑性合成材料制成,而凹槽的其他部分可以限定在砧座18的较少柔性的材料例如不锈钢中。较少柔性的砧座部分有时被称作“非柔性部分”以使其区别于柔性材料部分610,但是应当认识到所谓的非柔性部分也可以具有一定程度的柔性,只是柔性小于柔性材料部分610。在其他都相同的情况下,通过在砧座18的柔性材料部分610中形成的外侧凹槽202成形的钉将长于通过在砧座18的非柔性(例如金属)部分中成形的钉,因为在钉成形过程中,柔性材料部分610将压缩更多。
图76和77共同示出了另一种实施方式。在该实施方式中,通道16包括位于外侧驱动器370下方的柔性材料部分612。柔性材料部分612例如可以是塑性材料或者是合成塑性材料。内侧驱动器330可以位于较少柔性(或者“非柔性”)的通道16上,通道16可以由金属(例如不锈钢)制成。当相对于通道16上的内侧驱动器330成形钉时,外侧滑动件凸轮420可以略微压缩位于外侧驱动器370下方的柔性材料部分612,由此在外侧排中成形稍长的钉。在其他实施方式中,如果需要使内侧钉具有更大的成形长度,柔性材料部分612可以位于内侧驱动器330之下。
根据其他的实施方式,不同材料的钉可以用于形成具有不同成形长度的钉。不同的材料可以具有不同的弹性模量,使得它们在相同的驱动力下不同地成形。在相同的驱动力下,具有较高弹性模量的钉变形较少,由此易于形成具有更长成形长度的钉。用于钉222的不同材料可以包括钛、不锈钢、合金等。
本发明还涉及能够形成具有不同高度的成形钉的其他类型外科切割装置。例如,图84-89图示了能够以不同的成形高度来成形钉的圆形缝合器900。如图84所示,圆形缝合器900包括头部902、砧座904、调节旋钮组件906和扳机908。头部902通过弓形轴组件912连接到手柄组件910。扳机908由手柄组件910可枢转地支撑,并且用于在安全机构(未示出)被释放时操作缝合器900。当扳机908被致动时,击发机构(图84中未示出)在轴组件912中操作,使得钉914从头部902排出并与砧座904成形接触。同时,可操作地支撑在头部902中的刀916切割夹钳在头部902和砧座904中的组织。然后,缝合器900被从组织取出,并将被缝钉的组织留在原处。
图85和86示出可以与本发明的各种实施方式一起使用的砧座904和头部902的一种形式。如这些图所示,砧座904可以具有圆形的主体部分920,其具有用于将套管针(未示出)连接至其上的砧座轴922。砧座主体902上具有钉成形表面924,并可以具有安装到其远端上的护罩926。砧座904还可以设置有一对套管针保持夹或者板簧928,它们用于可释放地保持套管针与砧座轴922接合。塑料刀板930可以配合到砧座主体904中的腔932中。
头部902可以包含壳体构件940,壳体构件940将圆形钉驱动器组件942形式的仓支撑组件支撑在其中,仓支撑组件适于与圆形钉仓944接合并驱动支撑于其中的钉914,以与砧座904的钉成形表面924进行成形接触。圆形刀构件916也布置在钉驱动器组件942的中央。壳体构件940的近端可以通过远侧套圈构件948连接在弓形轴组件912的外侧管状护罩946上。关于圆形缝合器的更多细节参见F.Shelton等人的于2006年9月29日提交的题为“Surgical Cuttingand Stapling Device with Closure Apparatus for Limiting MaximumTissue Compression Force”的美国专利申请No.11/541151,通过引用将其包含在这里。
如图85-89所示,钉驱动器组件942可以包括外圈的钉驱动器950和内圈的钉驱动器952。相应地,砧座904可以包括钉成形凹槽202的两个同心环。手柄组件910的击发扳机908的致动使得轴组件912的压缩轴(未示出)向远侧移动,由此向远侧驱动钉驱动器组件942以击发钉914,使其与砧座904的钉成形表面924进行成形接触。由此,当外侧钉驱动器950被缝合器900的驱动机构致动时,其将外圈的钉914驱动到被夹钳的组织中并通过砧座904的钉成形表面924进行成形。类似地,当内侧钉驱动器952被缝合器900的驱动机构致动时,其驱动内圈的钉914进入被夹钳的组织,并通过砧座904的钉成形表面924进行成形。
钉驱动器950、952可以具有不同的高度,以形成不同长度的成形钉(在其他都相同的情况下)。例如,如图示的实施方式所示,外侧钉驱动器950可以短于内侧钉驱动器952,使得外侧的成形钉长于内侧的成形钉,如图88所示。当然,在其他实施方式中,内侧钉驱动器952可以短于外侧钉驱动器950。此外,外侧钉驱动器950可以不是均一的高度,而是在外侧钉驱动器950之间可以具有高度变化。类似地,在内侧钉驱动器952之间也可以具有高度变化。
此外,可以使用具有不同预成形尖头高度的钉。此外,砧座904的钉成形表面924中的钉成形凹槽202可以具有不同的深度,以改变成形钉的长度。此外,如上所述,钉驱动器950、952中的一些或者全部可以在它们与钉914的接口处具有凸部构造,以容纳不同丝径的钉,或者可以具有能够容纳不同丝径的钉的一些其他构造(例如V形钉通道)。此外,砧座1006中的一些凹槽202可以形成在砧座1006的柔性材料部分中。此外,钉914可以由具有不同弹性模量的材料制成。
在其他实施方式中,如图90-95所示,本发明涉及能够成形具有不同高度的钉的直线型缝合器1000。图90-95集中于用于这种直线型缝合器1000的端部执行器1002。端部执行器1002可以包括可替换的钉仓1004和直线型砧座1006。仓1004包括钉,当装置1000被致动时,钉被驱动到砧座1006并通过其成形。不像之前描述的内镜切割器,在直线型缝合器1000中,砧座1006可以是非旋转的。为了将组织夹钳在端部执行器1002中,使用者可以挤压夹钳扳机(未示出),这使得仓1004从打开位置朝向砧座1006向远侧滑动到闭合位置。关于直线型缝合器的操作和部件的更多信息参见M.Burdorff的题为“Linear Stapler With Imporved Firing Stroke”的美国专利No.5697543(‘543专利),通过引用将其包含在这里。通常,这样的直线型缝合器不包含切割器械。
图92-93示出端部执行器1002,其中仓1004的外部盖被移除。如这些图所示,钉仓1004可以包括钉驱动器组件1010,钉驱动器组件1010包括一排内侧钉驱动器1012和一排外侧钉驱动器1014。钉驱动器1012、1014可以具有不同的高度,以形成不同长度的成形钉(在其他都相同的情况下)。例如,如图所示,外侧钉驱动器1014可以短于内侧钉驱动器1012,使得外侧的成形钉222b长于内侧的成形钉222a,如图94-95所示。当然,在其他实施方式中,内侧钉驱动器1012可以短于外侧钉驱动器1014。此外,外侧钉驱动器1014可以不是均一的高度,在外侧钉驱动器1014之间可以存在高度变化。类似地,在内侧钉驱动器1012之间可以存在高度变化。此外,仓1004例如可以包括三排钉,外侧的两排钉可以具有较短的钉驱动器,而内侧的一排钉可以具有较长的钉驱动器。
此外,可以使用具有不同预成形尖头长度的钉1008。此外,砧座1006的钉成形表面1016中的钉成形凹槽202可以具有不同的深度,以改变成形钉的长度。此外,如上所述,钉驱动器1012、1014中的一些或者全部可以在它们与钉1008的接口处具有凸部构造,以容纳不同丝径的钉,或者可以具有能够容纳不同丝径的钉的一些其他构造(例如V形钉通道)。此外,砧座1006中的一些凹槽202可以形成在砧座1006的柔性材料部分中。此外,可以使用不同材料的钉1008。
在操作中,如‘543专利中更详细描述的那样,当使用者使夹钳扳机回缩时,使砧座1006朝向钉仓1004向近侧滑动到闭合位置,以将组织夹钳在端部执行器1002中。仓1004可以包括向远侧延伸的组织保持销1020,其在端部执行器1002处于闭合位置时接合砧座中的开口1022,以将组织保持在仓1004和砧座1006之间。当临床医生缩回分开的击发扳机(未示出)时,向远侧延伸的击发杆(未示出)被致动,这使得钉驱动器1010被致动以驱动钉1008。
在另一种实施方式中,直线型缝合器1000可以被构造成当夹钳扳机被致动时使钉仓1004朝向砧座向远侧滑动。
应当认识到,根据本发明的缝合装置可以结合这里描述的一些特征用于形成具有不同成形长度的钉。例如,对于具有不同钉变形距离的实施方式,钉可以所有都具有相同的预成形尖头长度或者一些钉可以具有不同的预成形尖头长度。此外,所有钉可以由相同材料制成,或者可以使用由具有不同弹性模量的不同材料制成的钉。此外,钉的丝径可以全部相同或者一些可以不同。
这里公开的装置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。这种技术的使用以及形成的整修的装置都在本申请的范围内。
优选地,这里描述的发明的各种实施方式可在外科手术之前处理。首先,得到新的或者使用过的器械并且在需要的时候对其进行清洁。器械然后可被灭菌。在一种灭菌技术中,器械被设置在闭合和密封容器中,诸如塑料或者TYVEK袋中。容器和器械然后设置在可穿透容器的辐射场中,诸如γ射线或者高能电子束。辐射杀死器械和容器中的细菌。灭菌的器械然后可存储在无菌容器中。密封的容器保持器械无菌直到其在医疗场合被打开。
优选地,装置被消毒。这可以采用本领域已知的其他技术来灭菌,包括伽马和贝塔射线、环氧乙烷、蒸汽。
虽然已经通过几种实施方式的说明示例性描述了本发明,并且已经相当详细地描述了示例性的实施方式,但是申请人不是想要将后附权利要求的范围限制或以任何方式限制到这样的细节。其它优点和变化对本领域普通技术人员来说是可以想到的。本发明的各种实施方式代表了对在单个仓中需要不同尺寸的钉来获得具有不同成形(最终)高度的钉的现有缝合方法的显著改进。
因此,已经根据内窥镜手术和器械对本发明进行了讨论。然而,这里使用的术语例如“内窥镜的”不应当被解释为将本发明限制为仅仅与内窥镜管(即套管针)结合使用的外科缝合和切割器械。相反,本发明可用于进口被限制为小切口的任何手术中,包括但不限于腹腔镜手术以及开放式手术。而且,在不背离本发明的精神和范围的条件下,当与其它形式的缝合器械结合使用时,本发明的各个钉仓实施方式的独特和新颖的方面具有实用性。
Claims (10)
1.一种外科缝合装置,包括:
端部执行器,所述端部执行器包括:
具有钉成形表面的砧座;和
面对所述砧座的钉成形表面的钉仓,其中所述钉仓还包括:
多个钉;和
可移动地支撑在所述钉仓中的多个钉驱动器,每个钉驱动器与所述多个钉中的一个接触,并被构造成使得当所述钉驱动器被致动时,所述钉驱动器驱动所述钉穿过所述钉仓,以通过抵靠所述砧座的钉成形表面来成形所述钉;
和
多个堆叠的可致动楔形带组,每个堆叠的楔形带组包括至少两个不同高度的楔形带,用于轴向穿过所述端部执行器,其中,每个楔形带包括位于其远端处的楔形凸轮,用于在所述楔形带被致动时驱动所述钉驱动器中的一些,堆叠中的两个楔形带中的第一个靠在堆叠中的两个楔形带中的第二个上,使得当所述至少两个楔形带被顺序驱动时,通过所述楔形带来顺序驱动所述钉驱动器,其中,所述多个堆叠的楔形带组中的第一组的累计高度小于所述多个堆叠的楔形带组中的第二组的累计高度。
2.根据权利要求1所述的外科缝合装置,其中,每个堆叠的楔形带组包括三个堆叠的楔形带。
3.根据权利要求2所述的外科缝合装置,其中,所述多个堆叠的可致动楔形带组包括:
外侧的两个堆叠的楔形带组,用于驱动外侧的两排钉驱动器;和
内侧的两个堆叠的楔形带组,用于驱动内侧的两排钉驱动器。
4.根据权利要求1所述的外科缝合装置,其中,所述多个钉驱动器中的第一数量个钉驱动器具有第一高度,所述多个钉驱动器中的第二数量个钉驱动器具有第二高度,所述第一高度小于所述第二高度。
5.根据权利要求1所述的外科缝合装置,其中,所述端部执行器还包括切割器械,用于轴向穿过所述端部执行器以切割夹钳在所述端部执行器中的组织。
6.根据权利要求5所述的外科缝合装置,还包括用于击发所述切割器械的击发杆。
7.根据权利要求6所述的外科缝合装置,还包括:
连接到所述端部执行器上的轴组件;和
连接到所述轴组件上的手柄组件。
8.根据权利要求7所述的外科缝合装置,其中,所述轴组件容纳所述堆叠的楔形带。
9.根据权利要求8所述的外科缝合装置,还包括位于所述轴组件的远端处的楔形带引导件,其具有通道,用于在所述楔形带被致动时将所述楔形带引导至所述端部执行器中。
10.根据权利要求1所述的外科缝合装置,其中,所述多个钉驱动器中的至少一个具有上侧钉支撑表面,其将不同丝径的钉支撑在直立位置。
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US11/712,315 US7500979B2 (en) | 2005-08-31 | 2007-02-28 | Surgical stapling device with multiple stacked actuator wedge cams for driving staple drivers |
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- 2008-02-27 EP EP08250667A patent/EP1964527B1/en not_active Not-in-force
- 2008-02-27 DE DE602008005802T patent/DE602008005802D1/de active Active
- 2008-02-27 AT AT08250667T patent/ATE503426T1/de not_active IP Right Cessation
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Also Published As
Publication number | Publication date |
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US7500979B2 (en) | 2009-03-10 |
CN101254125A (zh) | 2008-09-03 |
DE602008005802D1 (de) | 2011-05-12 |
JP2008212675A (ja) | 2008-09-18 |
ATE503426T1 (de) | 2011-04-15 |
EP1964527A2 (en) | 2008-09-03 |
JP5143588B2 (ja) | 2013-02-13 |
EP1964527A3 (en) | 2009-06-17 |
EP1964527B1 (en) | 2011-03-30 |
US20070262116A1 (en) | 2007-11-15 |
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