CN101675893A - 具有用于测量动作之间经过的时间的装置的外科器械 - Google Patents
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- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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Abstract
本发明公开了一种具有用于测量动作之间经过的时间的装置的外科器械。根据各种实施方式,该器械包括手柄组件和至少部分地通过手柄组件支撑的驱动系统。外科执行器可操作地连接到手柄组件,用于接收来自驱动系统的至少两种独立的驱动运动,以使外科执行器执行至少两种外科动作。该器械还可以包括定时指示器,其位于手柄组件和外科执行器中的至少一个上,以提供自施加控制运动中的一种起所经过的时间量的指示,在施加控制运动中的一种的同时保持在施加第一控制运动之后选择性地施加第二控制运动的能力。
Description
技术领域
本发明整体涉及具有可以执行多种外科手术或动作的外科执行器的外科器械,更具体地,涉及具有用于测量外科手术中各步骤之间经过的时间的装置的外科切割和紧固器械。
背景技术
已知的外科缝合器包括对组织进行纵向切开的同时向切口的相对侧上施加缝合线的端部执行器。端部执行器包括一对相互协作的钳口构件,如果器械被指定用在内窥镜或腹腔镜应用中,那么上述一对相互协作的钳口构件能够通过套管通道。钳口构件中的一个容纳具有至少两个横向间隔的缝钉排的钉仓。另一个钳口构件限定具有与钉仓中的缝钉排对准的缝钉成形凹窝的砧座。器械包括多个往复运动的楔形件,楔形件在被向远侧驱动时通过钉仓中的开口并且接合支撑缝钉的驱动器以朝向砧座执行缝钉的击发。
美国专利No.5465895中描述了适用于内窥镜应用的外科缝合器的一个例子,该美国专利的内容通过引用整体合并在此并且其公开了具有不同的闭合和击发动作的内切割器。使用该装置的临床医生能够在组织上闭合钳口构件以在击发之前定位组织。一旦临床医生确定钳口构件适当地抓持组织,临床医生然后可以在单个击发冲程或多个击发冲程(这依赖于装置)击发外科缝合器。击发外科缝合器致使切割和缝合组织。同时切割和缝合避免了在利用分别仅切割和缝合的不同的外科工具顺序执行这些动作时会出现的并发症。
能够在击发之前在组织上闭合的一个具体的优点是临床医生能够经由内窥镜证实已经达到用于切割的期望位置,包括在相对的钳口之间已经捕获了足量的组织。否则,相对的钳口可能被拉在一起过近,特别是在它们的远端夹紧,并由此不能有效地在被切割的组织中形成闭合的缝钉。在另一种极限中,夹钳过量组织会导致受束缚的和不完全的击发。
在使用这些器械的过程中可能遇到的另一个问题是临床医生无法使被夹钳在端部执行器中的组织内的液体在组织被切割和缝合之前排出组织。如果组织在被夹钳之后被过快切割,那么其中的液体会迅速地横向离开组织并且阻止缝钉的成形。
Viola等人的WO 2006/132992中公开的外科缝合器意于通过利用将缝钉击发延迟到在夹钳之后已经经过了预定量时间的控制器来解决这个问题。可以利用导向件、开关或机械构件提供听觉或视觉的警报,以通知临床医生用于压缩组织的预设的时间段已经过去并且可以开始击发。但是,如果临床医生期望在预定时间量经过之前击发装置,缝合器也不击发。这种不变性是不期望的。
因此,需要提供一种外科切割和缝合装置,该外科切割和缝合装置能够使临床医生监控外科手术过程中各动作或步骤之间经过的时间,同时仍保持随时致动器械的能力。
另外需要提供一种具有上述特征的外科切割和缝合装置,使得临床医生能够监控外科手术中各动作或步骤之间经过的时间量而不必把视野从手术部位转移开。
发明内容
在一个总的方面中,本发明涉及一种外科器械,该外科器械可以包括至少部分地支撑位于其中的控制系统的手柄组件。外科执行器可操作地连接到手柄组件,用于接收来自控制系统的至少两种控制运动,以使外科执行器执行至少两种外科动作。定时指示器可以设置在手柄组件和外科执行器中的至少一个上,以提供在施加一种控制运动之后经过的时间量的指示,在施加一种控制运动的同时保持选择性地施加另一种控制运动的能力。
根据本发明的另一种实施方式,提供了一种外科切割和紧固器械,该器械包括手柄组件和端部执行器。端部执行器可以包括细长通道,该细长通道具有可动地连接到其上的夹钳构件用于在打开和闭合位置之间运动。端部执行器还可以具有在细长通道内被可动地支撑用于穿过其选择性行进的切割器械。该器械还可以包括用于向夹钳构件选择性地施加闭合和打开运动的闭合系统以及用于向可动的切割器械选择性地施加驱动运动以使切割器械在细长通道内从近侧位置运动到远侧位置的驱动系统。定时指示器可以设置在端部执行器和手柄组件中的至少一个上,以提供在夹钳构件已经运动到锁定位置之后经过的时间量的指示,在夹钳构件已经运动到锁定位置的同时保持驱动系统向可动的切割器械选择性地施加驱动运动的能力。
本发明具体公开了如下内容:
(1).一种外科器械,包括:
手柄组件;
控制系统,其至少部分地由所述手柄组件支撑;
外科执行器,其可操作地连接到所述手柄组件,用于接收来自所述控制系统的至少两种控制运动,以使所述外科执行器执行至少两种外科动作;以及
定时指示器,其位于所述手柄组件和外科执行器中的至少一个上,以提供自施加所述控制运动中的一种起所经过的时间量的指示,在施加所述控制运动中的一种的同时保持在施加所述控制运动中的一种之后选择性地施加所述控制运动中的另一种的能力。
(2).如第(1)项所述的外科器械,其中,所述定时指示器在每个所述外科动作之后开始重新计算。
(3).如第(1)项所述的外科器械,其中,所述定时指示器包括:
定时装置;以及
电连接到所述定时装置的一连串的至少两个指示灯,其中,一个所述指示灯在一个所述外科动作开始时启动,另一个所述指示灯在一个所述外科动作开始之后经过第一预定时间量之后启动。
(4).如第(3)项所述的外科器械,其中,所述一连串的指示灯包括至少三个指示灯,第三个所述指示灯在所述另一个所述指示灯启动之后经过第二预定时间量之后启动。
(5).如第(4)项所述的外科器械,其中,所述一连串的指示灯包括至少四个指示灯,第四个指示灯在所述第三个指示灯启动之后经过第三预定时间量之后启动。
(6).如第(5)项所述的外科器械,其中,所述一连串的指示灯包括至少五个指示灯,第五个指示灯在所述第四个指示灯启动之后经过第四预定时间量之后启动。
(7).如第(6)项所述的外科器械,其中,所述第一预定时间量、第二预定时间量、第三预定时间量和第四预定时间量均包括大约5秒钟。
(8).如第(3)项所述的外科器械,其中,所述定时装置支撑在所述手柄组件中。
(9).如第(1)项所述的外科器械,其中,每个所述指示灯包括发光二极管。
(10).一种用于处理外科执行器的方法,所述方法包括:
获取如第(1)项所述的外科执行器;
对所述外科执行器进行消毒;和
将所述外科执行器储存在无菌容器中。
(11).一种外科切割和紧固器械,包括:
手柄组件;
端部执行器,该端部执行器包括:
细长通道;
夹钳构件,其可动地连接到所述通道,用于在打开位置和闭合位置之间选择性地运动;以及
切割器械,其可动地支撑在所述细长通道内用于穿过细长通道选择性地行进;
闭合系统,其用于向所述夹钳构件选择性地施加闭合和打开运动;
驱动系统,其用于向所述可动的切割器械选择性地施加驱动运动,以使所述切割器械在所述细长通道内从近侧位置运动到远侧位置;以及
定时指示器,其位于所述端部执行器和所述手柄组件中的至少一个上,以提供在所述夹钳构件已经运动到所述闭合位置之后经过的时间量的指示,在所述夹钳构件运动到所述闭合位置的同时保持所述驱动系统向所述可动的切割器械选择性地施加所述驱动运动的能力。
(12).如第(11)项所述的外科切割和紧固器械,其中,所述定时指示器在施加所述驱动运动时开始重新计算。
(13).如第(12)项所述的外科切割和紧固器械,其中,所述定时指示器在已经中止施加所述驱动运动时开始重新计算。
(14).如第(11)项所述的外科切割和紧固器械,其中,所述定时指示器包括:
定时装置;以及
电连接到所述定时装置的一连串的至少两个指示灯,其中,一个所述指示灯在所述夹钳构件已经运动到所述闭合位置时启动,另一个所述指示灯在所述夹钳构件已经运动到所述闭合位置之后经过第一预定时间量之后启动。
(15).如第(14)项所述的外科切割和紧固器械,其中,所述一连串的指示灯包括至少三个指示灯,第三个所述指示灯在所述另一个所述指示灯启动之后经过第二预定时间量之后启动。
(16).如第(15)项所述的外科切割和紧固器械,其中,所述一连串的指示灯包括至少四个指示灯,第四个指示灯在所述第三个指示灯的启动之后经过第三预定时间量之后启动。
(17).如第(16)项所述的外科切割和紧固器械,其中,所述一连串的指示灯包括至少五个指示灯,第五个指示灯在所述第四个指示灯的启动之后经过第四预定时间量之后启动。
(18).如第(17)项所述的外科切割和紧固器械,其中,所述第一预定时间量、第二预定时间量、第三预定时间量和第四预定时间量均包括大约5秒钟。
(19).如第(14)项所述的外科切割和紧固器械,其中,所述定时装置支撑在所述手柄组件中。
(20).一种外科切割和紧固器械,包括:
手柄组件;
端部执行器,该端部执行器包括:
细长通道;
夹钳构件,其可动地连接到所述通道,用于在打开位置和闭合位置之间选择性地运动;以及
切割器械,其可动地支撑在所述细长通道内用于穿过细长通道选择性地行进;
用于向所述夹钳构件选择性地施加闭合和打开运动的装置;
用于向所述可动的切割器械选择性地施加至少一种驱动运动以使所述切割器械在所述细长通道内从近侧位置运动到远侧位置的装置;以及
位于所述端部执行器和所述手柄组件中的至少一个上的装置,其用于提供在所述夹钳构件已经运动到所述闭合位置之后经过的时间量的指示,在所述夹钳构件运动到所述闭合位置的同时保持所述装置向所述可动的切割器械选择性地施加所述驱动运动的能力。
附图说明
合并在本说明书中并构成本说明书一部分的附图示出了本发明的实施方式,附图与上面给出的本发明的总的描述以及以下给出的实施方式的详细描述一起用于解释本发明的原理。
图1和2是根据本发明的各种实施方式的外科切割和紧固器械的透视图;
图3至5是根据本发明的各种实施方式的器械的端部执行器和轴的分解图;
图6是根据本发明的各种实施方式的端部执行器的侧向剖视图;
图7是根据本发明的各种实施方式的器械的手柄组件的分解图;
图8和9是根据本发明的各种实施方式的手柄组件的局部透视图;
图10是根据本发明的各种实施方式的手柄组件的一部分的侧视图;
图11和12示出了根据本发明的各种实施方式可以使用的比例传感器;
图13是根据本发明的各种实施方式的器械中使用的电路的示意图;
图14是根据本发明的各种实施方式的器械中使用的另一种电路的示意图;
图15是本发明的各种实施方式的端部执行器的透视图;
图16是本发明的各种实施方式的另一种外科器械的透视图;以及
图17是本发明的各种实施方式的另一种外科器械的透视图。
具体实施方式
图1和2示出了根据本发明的各种实施方式的外科切割和紧固器械10。示出的实施方式是内窥镜器械,并且总的来说,这里描述的器械10的实施方式是内窥镜外科切割和紧固器械。然而,应当注意,根据本发明的其它实施方式,器械可以是非内窥镜外科器械,例如腹腔镜器械。另外,还可以理解,其它形式的外科器械也是可以想到的。
图1和2中描述的外科器械10包括手柄组件6、轴8以及在关节运动枢轴14处可枢转地连接到轴8上的关节运动外科执行器或端部执行器12。关节运动控制器16可以设置在手柄6附近,以使端部执行器12围绕关节运动枢轴14进行旋转。在所示实施方式中,外科执行器或端部执行器12能够用作用于夹钳、切割和缝合组织的内切割器。但在其它实施方式中,可以使用不同类型的外科执行器和端部执行器,例如抓持器、切割器、缝合器、夹子施用器、接近装置、药物/基因治疗装置、超声、RF或激光装置等,在这些不同类型的外科执行器和端部执行器中,希望临床医生能够监控由器械执行的外科手术过程中各动作或步骤之间经过的时间量,同时也能够控制器械的各种控制系统。
器械10的手柄组件6可以包括闭合触发器18和用于致动端部执行器12的击发触发器20。可以理解,具有用于不同外科任务的外科执行器或端部执行器的器械可以具有不同数量或类型的触发器或者用于操作端部执行器12的其它适当的控制器。端部执行器12被示出为通过优选的细长轴8与手柄组件6分开。在一种实施方式中,临床医生或器械10的操作者可以通过利用关节运动控制器16使端部执行器12相对于轴8关节运动,如Geoffrey C.Hueil等人于2006年1月10日提交的题为“Surgical Instrument Having An ArticulatingEnd Effector”、公开号为No.2007/0158385A1的公开美国专利申请中更加详细描述的,该专利申请公开文献的全部内容通过引用合并在此。但是,非关节运动装置也是可以想到的并且可以有效地利用本发明的各种实施方式的独特和新颖特征。因此,提供给本发明的各种实施方式的保护不应被限制到可关节运动的器械。
在该例子中,端部执行器12包括能够在其中支撑钉仓34的细长通道22等。可枢转地移动的夹钳构件,例如砧座24以确保有效缝合和切割夹钳在端部执行器12中的组织的间隔可动地支撑在细长通道22上。手柄组件6可以包括手枪式握把26,临床医生可以朝向手枪式握把26枢转地拉动闭合触发器18,以使砧座24朝向钉仓34夹钳或闭合,由此夹钳定位在砧座24和钉仓34之间的组织。在该实施方式中,击发触发器20位于闭合触发器18的外侧较远处。一旦闭合触发器18锁定在闭合位置,击发触发器20可以朝向手枪式握把26稍稍旋转,使其能够由操作者的一只手够到。然后,操作者可以朝向手枪式握把26枢转地拉动击发触发器20,以缝合和切割端部执行器24中夹钳的组织。在其它实施方式中,可以使用除了砧座24之外的不同类型的夹钳构件,例如相对的钳口等。
可以理解,这里使用的术语“近侧”和“远侧”是参考抓握器械10的手柄6的临床医生而言的。因此,端部执行器12相对于更近侧的手柄组件6位于远侧。还可以理解,出于方便和清楚的目的,这里使用的空间术语例如“竖直”和“水平”是相对于附图而言。但是,外科器械可以在许多方向和位置上使用,因此这些术语并不是限制性的和绝对的。
图3是根据本发明的各种实施方式的端部执行器12的分解图。如图示的实施方式所示,除了之前提及的通道22和砧座24之外,端部执行器12可以包括切割器械32、滑架33、可拆卸地安置在通道22中的钉仓34,以及螺旋轴36。切割器械32例如可以是刀。砧座24可以在连接到通道22的近端上的枢转点25处可枢转地打开和闭合。砧座24也可以包括位于其近端处的翼片27,该翼片插入到机械闭合系统(以下进一步说明)的部件中以打开和闭合砧座24。当闭合触发器18被致动,即由器械10的使用者向内拉动时,砧座24可以围绕枢转点25枢转到夹钳或闭合位置中。如果端部执行器12的夹钳是令人满意的,操作者可以致动击发触发器20,如以下更加详细的描述的,这使得刀32和滑架33沿着通道22纵向地行进,由此切割被夹钳在端部执行器12中的组织。滑架33沿着通道22的运动使得钉仓34的缝钉被驱动穿过被切割的组织并且抵靠闭合的砧座24,这使缝钉转动以紧固被切割的组织。在各种实施方式中,滑架33可以是钉仓34的一体化部件。题为“Surgical Stapling InstrumentIncorporating an E-beam Firing Mechanism”的美国专利6978921对这种二冲程切割和紧固器械进行了更详细的描述,该专利通过引用整体结合在此。滑架33可以是钉仓34的一部分,使得当刀32在切割操作之后缩回时,滑架33不缩回。
应当注意到,虽然这里描述的器械10的实施方式利用缝合被切割的组织的端部执行器12,但在其它实施方式中,可以利用用于紧固或密封被切割的组织的不同技术。例如,也可以利用使用RF能量或粘合剂以紧固被切割的组织的端部执行器。Yates等人的题为“Electrosurgical Hemostatic Device”的美国专利No.5709680和Yates等人的题为“Electrosurgical Hemostatic Device With Recessed and/orOffset Electrodes”的美国专利No.5688270公开了利用RF能量来密封被切割的组织的内窥镜切割器械,所述美国专利中的每一个的全部内容通过引用合并在此。Jerome R.Morgan等人的序列号为No.11/267811的美国专利申请和Frederick E.Shelton,IV等人的序列号为No.11/267383的美国专利申请公开了一种使用粘合剂紧固被切割组织的内窥镜外科器械,上述美国专利申请中的每一个的全部内容通过引用合并在此。因此,虽然这里的描述涉及切割/缝合操作等,但应当认识到,这是一种示例性的实施方式并且不意味着是限制性的。本发明的各种实施方式所带来的优点结合其它形式的外科执行器和端部执行器可以同等地实现。
图4和5是根据各种实施方式的端部执行器12和轴8的分解图,图6是其侧向剖视图,所述实施方式示出了可以用于使砧座24在打开位置和闭合位置之间运动的一种形式的闭合系统39。如图示的实施方式所示,闭合系统39可以包括通过枢转连接件44可枢转地连接的近侧闭合管40和远侧闭合管42。远侧闭合管42可以包括开口45,砧座24上的翼片27插入在开口45中以便打开和闭合砧座24,如下面进一步说明的。在闭合管40、42的内侧可以设置近侧脊管46。在近侧脊管46的内侧可以设置驱动系统47的一部分,该部分例如可以包括经由锥齿轮组件52与辅助(或远侧)驱动轴50联接的主旋转(或近侧)驱动轴48。辅助驱动轴50连接到接合螺旋轴36的近侧驱动齿轮56的驱动齿轮54。竖直锥齿轮52b可以被支撑在近侧脊管46的远端中的开口57内。远侧脊管58可以用于包围辅助驱动轴50和驱动齿轮54、56。主驱动轴48、辅助驱动轴50和关节运动组件(例如锥齿轮组件52a-c)合起来在这里有时被称为形成驱动系统47的一部分的“主驱动轴组件”。
定位在缝钉通道22的远端处的支承件38接收螺纹钉36,使得螺纹钉36能够相对于通道22自由转动。参照图6。螺旋轴36可以与刀32中的螺纹开口(未示出)连接,使得轴36的转动致使刀32向远侧或向近侧(取决于转动方向)穿过缝钉通道22移动。因此,当主驱动轴48由于击发触发器20的致动而转动时(如下面更加详细的说明),锥齿轮组件52a-c使得辅助驱动轴50转动,这又由于驱动齿轮54、56的接合,使得螺旋轴36转动,这使得刀驱动构件32沿着通道22纵向行进以切割被夹钳在端部执行器中的任何组织。滑架33例如可以由塑料制成,并且可以具有倾斜的远侧表面。随着滑架33横过通道22,倾斜的前表面可以向上推或驱动钉仓中的缝钉穿过被夹钳的组织并使其抵接砧座24。砧座24使缝钉成形,由此缝合被切割的组织。当刀32缩回时,刀32和滑架33可以脱离接合,由此将滑架33留在通道22的远端处。2007年5月30日提交的题为“Articulatable Drive Shaft Arrangements For Surgical Cutting andFastening Instruments”的公开美国专利中请公开文献No.US2007/0233053A1公开了马达驱动的内切割器的一种示例性的实施方式,该内切割器可以利用本发明的各种实施方式的独特和新颖优点,该美国专利申请公开文献的全部内容通过引用合并在此。
闭合系统39和驱动系统47在此被称为“控制系统”,用于向外科执行器12的各种部件施加“控制运动”。因此,由闭合系统39施加的打开和闭合运动是“控制运动”,由驱动系统施加的击发运动是“控制运动”。
不论使用何种类型的外科执行器或端部执行器,许多上述类型的端部执行器在使用中被用于执行多于一种动作。例如,可以首先使用端部执行器12来抓持和操作组织。一旦目标组织已经被识别操作并定位在砧座和钉仓之间,那么通过锁定如前述美国专利公开文献No.US2007/0233053A1中描述的闭合触发器来将目标组织夹钳在砧座和钉仓之间。如上述所示,期望在切穿组织之前经过预定的时间量,例如大约5-20秒或更长。在组织上执行其他动作之前,也可以使用其他端部执行器来夹钳或以其他方式操作组织,其中,可能希望在这些动作之间经过特定的时间量(甚至少于5秒钟)。因此,虽然现在将参考上述端部执行器12对本发明的实施方式的各种特征和优点进行说明,但本领域技术人员将容易地理解本发明的各种特征在利用其他形式的端部执行器时可以找到同等的应用。因此,针对本发明的各种实施方式的保护范围不应局限于这里具体描述的特定类型的端部执行器。
图7至10示出了马达驱动的内切割器特别是其手柄的一种示例性的实施方式,其提供关于端部执行器中的切割器械的展开和加载力的使用者反馈。另外,该实施方式可以利用使用者在缩回击发触发器20时提供的动力来向装置施加“控制运动”(所谓的“动力辅助”模式)。但是,可以利用各种不同的内切割器驱动装置。如图示的实施方式所示,手柄6包括外部下侧件59、60和外部上侧件61、62,其配合在一起形成大致手柄组件6的外部。电池64、例如锂离子电池可以设置在手柄组件6的手枪式抓握部分26中。电池64向设置在手柄组件6的手枪式抓握部分26的上部中的马达65等供电。根据各种实施方式,马达65可以是具有大约5000RPM的最大转速的直流电刷驱动马达。马达64可以驱动包括第一锥齿轮68和第二锥齿轮70的90°锥齿轮组件66。锥齿轮组件66可以驱动行星齿轮组件72。行星齿轮组件72可以包括连接到驱动轴76上的小齿轮74。小齿轮74可以驱动配合的环形齿轮78,环形齿轮78经由驱动轴82驱动螺旋齿轮鼓80。环84可以螺旋连接在螺旋齿轮鼓80上。因此,当马达65转动时,环84借助于插入的锥齿轮组件66、行星齿轮组件72和环形齿轮78沿着螺旋齿轮鼓80行进。
手柄组件6也可以包括与击发触发器20连接的马达运转传感器110,以检测击发触发器20何时已经被操作者朝着手柄组件6的手枪式抓握部分26向内拉(或者“闭合”),由此通过端部执行器12致动切割/缝合操作。传感器110可以是比例传感器,例如滑线电阻器或可变电阻器。当击发触发器20被向内拉时,传感器110检测该运动并且发送指示待供应给马达65的电压(或者功率)的电信号。当传感器110是可变电阻器等时,马达65的转动可以与击发触发器20的运动量基本成比例。即,如果操作者仅拉动或闭合击发触发器20很小的量,那么马达65的转速相对较小。当击发触发器20被充分向内拉(或者处于完全闭合位置)时,马达65以最大速度转动。换句话说,使用者越用力拉动击发触发器20,供应给马达65的电压越多,使得转动速率更大。
手柄组件6可以包括靠近击发触发器20的上部的手柄中间件104。手柄6还可以包括连接在手柄中间件104和击发触发器20上的柱子之间的偏压弹簧112。偏压弹簧112可以将击发触发器20偏压到其完全打开位置。这样,当操作者释放击发触发器20时,偏压弹簧112将击发触发器20拉动到其打开位置,由此解除对传感器110的致动,从而使马达65停止转动。此外,借助于偏压弹簧112,使用者在任何时间闭合击发触发器20,使用者将经受对闭合操作的阻碍,由此向使用者提供关于由马达65施加的旋转量的反馈。此外,操作者可以停止缩回击发触发器20,由此从传感器110移除力,进而使马达65停止。这样,使用者可以停止端部执行器12的展开,由此向操作者提供切割/紧固操作控制的测量。
螺旋齿轮鼓80的远端包括用于驱动环形齿轮122的远侧驱动轴120,环形齿轮122与小齿轮124配合。小齿轮124连接到主驱动轴组件的主驱动轴48上。这样,马达65的转动使得主驱动轴组件转动,这使得端部执行器12致动,如上所述。
螺纹连接在螺旋齿轮鼓80上的环84可以包括设置在开槽臂90的槽88中的柱子86。开槽臂90在其相对端94具有开口92,开口92接收连接在手柄外部侧件59、60之间的枢转销96。枢转销96也穿过击发触发器20中的开口100和手柄中间件104中的开口102设置。
另外,手柄组件6可以包括马达反向(或者冲程停止)传感器130和马达止动(或者冲程开始)传感器142。在各种实施方式中,马达反向传感器130可以是位于螺旋齿轮鼓80的远端处的限位开关,使得螺纹连接在螺旋齿轮鼓80上的环84在环84到达螺旋齿轮鼓80的远端时接触并使马达反向传感器130跳闸。马达反向传感器130在被致动时向马达65发送信号以使其转动方向反向,由此在切割操作后收回端部执行器12的刀32。
马达止动传感器142例如可以是常闭限位开关。在各种实施方式中,其可以位于螺旋齿轮鼓80的近端处,使得环84在其到达螺旋齿轮鼓80的近端时使开关142跳闸。
在操作中,当器械10的操作者向回拉动击发触发器20时,传感器110检测击发触发器20的展开并且向马达65发送信号以使马达65例如以与操作者向回拉动击发触发器20的程度成比例的速率向前转动。马达65的向前转动又使位于行星齿轮组件72的远端处的环形齿轮78转动,由此使螺旋齿轮鼓80转动,使螺纹连接在螺旋齿轮鼓80上的环84沿着螺旋齿轮鼓80向远侧行进。螺旋齿轮鼓80的转动也驱动上述主驱动轴组件,这又施加控制运动(例如使刀32在端部执行器12中展开)。即,使刀32和滑架33沿纵向横过通道22,由此切割夹钳在端部执行器12中的组织。同样,在使用缝合类型的端部执行器的实施方式中,引起端部执行器12的缝合操作。
当端部执行器12的切割/缝合操作完成时,螺旋齿轮鼓80上的环84已经到达螺旋齿轮鼓80的远端,由此使马达反向传感器130跳闸,这向马达65发送信号以使马达65的转动反向。这又使刀32缩回,并且也使螺旋齿轮鼓80上的环84向回运动到螺旋齿轮鼓80的近端。
手柄中间件104包括如图8和9最好地示出的与开槽臂90接合的背侧肩部106。手柄中间件104也具有与击发触发器20接合的向前运动止动部107。开槽臂90的运动通过马达65的转动如上所述得到控制。当开槽臂90随着环84从螺旋齿轮鼓80的近端行进到远端来转动CCW时,手柄中间件104将自由转动CCW。因此,随着使用者向内拉动击发触发器20,击发触发器20将接合手柄中间件104的向前运动止动件107,使得手柄中间件104转动CCW。然而,由于背侧肩部106与开槽臂90接合,手柄中间件104仅能够转动开槽臂90所允许的CCW。这样,如果马达65基于一些原因应当停止转动,那么开槽臂90将停止转动,并且由于手柄中间件104因为开槽臂90不会自由转动CCW,因此使用者不能进一步向内拉动击发触发器20。
图11和12示出了可以用作根据本发明的各种实施方式的马达运转传感器110的可变传感器的两种状态。传感器110可以包括表面部分280、第一电极(A)282、第二电极(B)284和位于电极282、284之间的可压缩电介质材料286(例如EAP)。传感器110可以被定位成使得表面部分280接触缩回时的击发触发器20。因此,当击发触发器20缩回时,电介质材料286被压缩,如图12所示,使得电极282、284更近地靠在一起。由于电极282、284之间的距离“b”与电极282、284之间的阻抗直接相关,因此距离越大,阻抗越大,并且距离越近,阻抗越小。这样,电介质材料286由于击发触发器20的缩回被压缩的量(在图12中表示为力“F”)与电极282、284之间的阻抗成比例,其可以用于成比例地控制马达65。
图7至10还示出了用于通过使闭合触发器18缩回而向端部执行器12的砧座24施加另一种控制运动(闭合或夹钳)的示例性的闭合系统的部件。在所示实施方式中,闭合系统包括通过销251连接到闭合触发器18的轭形件250,销251穿过闭合触发器18和轭形件250中的对准开口插入。枢转销252穿过闭合触发器18中的另一个开口插入,闭合触发器18围绕枢转销252枢转,该开口与销251穿过闭合触发器18插入的位置偏离。因此,闭合触发器18的缩回使得闭合触发器18的上部转动CCW,轭形件250经由销251连接到闭合触发器18的上部。轭形件250的远端经由销254连接到第一闭合支架256上。第一闭合支架256连接到第二闭合支架258。闭合支架256、258共同限定开口,近侧闭合管40的近端(参见图4)被安置并保持在该开口中,使得闭合支架256、258的纵向运动导致近侧闭合管40的纵向运动。器械10还包括设置在近侧闭合管40内侧的闭合杆260。闭合杆260可以包括窗口261,位于手柄外部侧件的一个(例如在所示实施方式中的外部下侧件59)上的柱子263设置在窗口261中,以将闭合杆260固定地连接到手柄6。这样,近侧闭合管40能够相对于闭合杆260沿纵向运动。闭合杆260也可以包括远侧轴环267,该远侧轴环267配合在近侧脊管46中的腔269内并且被帽271固定在其中(参见图4)。
在操作中,当轭形件250由于闭合触发器18的缩回而转动时,闭合支架256、258使得近侧闭合管40向远侧运动(即,远离器械10的手柄端),这导致远侧闭合管42向远侧运动,又导致砧座24围绕枢转点25转动到夹钳位置或闭合位置。当闭合触发器18从锁定位置被解锁时,使得近侧闭合管40向近侧滑动,这使远侧闭合管42向近侧滑动,又借助插入在远侧闭合管42的窗口45中的翼片27使得砧座24围绕枢转点25枢转到打开或未夹钳位置。这样,通过缩回和锁定闭合触发器18,操作者可以夹钳砧座24和通道22之间的组织,并且可以在切割/缝合操作之后通过将闭合触发器20从锁定位置解锁来放开组织。
图13是根据本发明的各种实施方式的器械10的电路的示意图。当操作者在锁定闭合触发器18之后初始地向内拉动击发触发器20时,传感器110被致动,允许电流流过。如果常开马达反向传感器开关130打开(意味着未到达端部执行器冲程的末端),电流将流向单极双投继电器132。由于马达反向传感器开关130未关闭,因此继电器132的感应器134将不被供应能量,使得继电器132处于其未供能状态。电路也包括钉仓闭锁传感器136。如果端部执行器12包括钉仓34,传感器136处于闭合状态,允许电流流动。否则,如果端部执行器12不包括钉仓34,那么传感器136将打开,由此阻止电池64向马达65供电。
当设有钉仓34时,传感器136闭合,这向单极单投继电器138供能。当继电器138被供以能量时,电流流经继电器136、流经可变电阻器传感器110,并经由双极双投继电器140流向马达65,由此向马达65供电并允许马达65沿向前方向转动。
当端部执行器12到达其冲程的末端时,马达反向传感器130被致动,由此闭合开关130并向继电器134供能。这使得继电器134呈现其被供能状态(图13中未示出),这使得电流绕过钉仓闭锁传感器136和可变电阻器110,并且替代地使得电流流向常闭的双极双投继电器142并经由继电器140以使得马达65的转动方向反向的方式流回马达65。
由于马达止动传感器开关142是常闭的,电流将流回继电器134以保持其闭合直到开关142打开。当刀32被完全缩回时,马达止动传感器开关142被致动,使得开关142打开,由此从马达65移走功率。
在其他实施方式中,替代比例类型的传感器110,可以使用开关类型的传感器。在这种实施方式中,马达65的转动速率不与操作者施加的力成比例。而是,马达65以大致恒定的速率转动。但是,由于击发触发器20连接到齿轮传动系,因此操作者仍然可体验力反馈。
器械10还可以包括控制电路,总体上用500表示,其可以利用微控制器或前述专利公开文献No.US2007/0233053A1中描述的一些其他类型的集成电路来执行。如图14所示,控制电路500能够接收来自传统闭合触发器传感器502的信号,传感器502可以被支撑在手柄部分26内,以检测何时闭合触发器18已经锁定在闭合位置。闭合触发器传感器502例如可以包括传统的限位开关,该限位开关是常开的并且在闭合触发器18被锁定在闭合位置时闭合。但是,可以利用其他形式的传感器。控制电路500还可以具有与一连串指示灯610连接的定时部件510。可以利用各种数量和布置的指示灯。在所示的实施方式中,例如,可以使用第一指示灯612、第二指示灯614、第三指示灯616、第四指示灯618和第五指示灯620。如图15所示,指示灯612、614、616、618、620可以设置在远侧闭合管42上,使得临床医生可以在观察端部执行器12的同时观察它们。然而,在其他实施方式中,灯612、614、616、618、620可以安装在手柄组件6(图16)上或安装在轴8的近端部分中(图17)。在各种实施方式中,灯612、614、616、618、620可以设置成相同的颜色或不同的颜色,以有助于临床医生将它们区别开。还如图14所示,传统的解码器630可以结合控制电路500和定时器510使用,以便以下述的方式顺序激活灯612、614、616、618、620。
当临床医生使闭合触发器18运动到完全闭合和锁定的位置时,第一指示灯612可以被供电。此时,定时部件510开始计时。在经过第一预定时间量,例如大约5秒钟之后,控制器500和解码器630向第二指示灯614供电。此时,第一指示灯612可以不被供电或者可以保持供电。定时部件510继续计时,并且在经过第二预定时间量,例如在经过第一预定时间量之后大约附加的5秒钟之后,控制器500和解码器630向第三指示灯616供电。此时,第一指示灯612和第二指示灯614可以保持被供电或它们可以不被供电。因此,在该例子中,在闭合触发器18已经运动到完全闭合和锁定位置之后经过大约10秒钟之后,第三指示灯616被供电。定时部件510继续计时,并且在第三预定时间量(附加的5秒钟)之后,控制器500/解码器630向第四指示灯618供电。此时,第一指示灯612、第二指示灯614和第三指示灯616可以保持被供电或者可以不被供电。因此,在该例子中,在闭合触发器18已经运动到完全闭合和锁定位置之后经过大约15秒钟之后,第四指示灯618将被供电。在定时部件510确定已经过第四预定时间量(附加的大约5秒钟),控制器500/解码器630向第五指示灯620供电。此时,第一指示灯612、第二指示灯614、第三指示灯616和第四指示灯618可以保持被供电或者可以不被供电。
因此,临床医生可以通过观察指示灯612、614、616、618、620来确定自组织被夹钳在端部执行器12中开始已经经过了大约多长时间。在该过程中,如果临床医生希望致动驱动系统以使刀32和滑架33在整个时间段经过之前横过通道22,那么临床医生可以通过闭合击发触发器20来实现。在各种实施方式中,第二驱动传感器700可以用于检测击发触发器20何时已经朝向手柄组件6的手枪式抓握部分26向内拉动或闭合。如图14所示,在各种实施方式中,第二驱动传感器700可以包括“常闭”开关,使得当击发触发器20未被致动时,第二驱动传感器700保持在闭合位置,并且当击发触发器20被致动时,第二驱动传感器700打开。当第二驱动传感器打开时,控制器500重新设置定时部件510,并且所有的指示灯612、614、616、618、620不被供电。在各种实施方式中,为了向指示灯612、614、616、618、620重新供电,临床医生必须释放闭合触发器18并随后使其返回到闭合和锁定位置。在其他实施方式中,第五指示灯620(在其他实施方式中,所有的指示灯612、614、616、618、620)将保持被供电,直到闭合触发器18运动到未锁定位置以释放被夹钳的组织。在其他实施方式中,当第二驱动传感器700打开时,定时部件510可以开始重新计算从致动驱动系统已经经过的时间量,以使临床医生能够监控击发过程的持续时间。再次,控制电路解码器630可以如上所述以5秒的间隔或者如果希望可以是其他的时间间隔来控制指示灯612、614、616、618、620的发光过程,。在其他实施方式中,定时部件510可以在驱动运动的施加已经中止或者中断时开始重新计算,以向临床医生提供自驱动运动中止开始已经经过的时间量的指示。
其他实施方式可以利用用于施加各种控制运动的不同的驱动系统装置和/或不同的传感器装置。例如,可供选择的实施方式可以利用与控制电路500连接的编码器来计算刀32在端部执行器12中的展开阶段。即,控制电路可以计算刀32是否被充分展开、充分缩回还是在中间阶段。如果希望的话,控制器500可以向灯612、614、616、618、620或者第二组这样的灯(未示出)发送信号,以随着端部执行器中的刀32从细长通道22的近端横向运动至远端向临床医生提供刀的位置的指示。
虽然上述实施方式利用具有传统定时部件或系统的控制电路或控制器,在不脱离本发明的精神和范围的条件下,也可以使用其他传统的定时装置。图1、2和15中描述的实施方式示出了在远侧管部件42上应用指示灯612、614、616、618、620。这种设置允许临床医生在观察位于手术部位中的端部执行器12时观察灯。因此,临床医生不必将视野从手术部位移开以确定在动作之间使用了多长时间。在图16所示的实施方式中,指示灯612、614、616、618、620安装在图17中描述的手柄组件6和器械10”中,指示灯612、614、616、618、620安装在轴8的近端中。
在本文中描述的端部执行器12特别适用于夹钳和操作组织以及切割和切断组织。但是,指示灯装置和它们的等同结构可以结合各种不同的端部执行器和外科执行器有效地使用,其中,执行器用于执行多种“动作”并且期望临床医生知晓在开始动作之后经过了多长时间,同时保持致动外科器械的能力。例如,外科执行器可以是非切割、非缝合的内窥镜器械,例如抓持器、缝合器、夹子施用器、接近装置、药物/基因治疗输送装置、利用超声、RF、激光等的能量装置。
在本文中公开的装置可被设置成在单次使用后被处理,或者它们可被设计成多次使用。但是,在任一情况下,装置在至少一次使用后可被再生以便重新使用。再生可包括装置的拆卸、接着清洁或替换特定部件以及随后重新组装的步骤的任一组合。特别是,装置可被拆卸,并且装置的任意数目的特定部件或部分可选择性地以任何组合被替换或者除去。当清洗和/或替换特定部分时,装置可在再生工厂或者由手术团队在外科手术前立即被重新组装以便随后的使用。本领域技术人员将会理解,装置的再生可利用用于拆卸、清洗/替换以及重新组装的各种技术。所述技术的使用以及获取的再生装置都落入本发明的范围内。
优选地,在本文中公开的本发明将在外科手术前被处理。首先,获取新的或者使用过的器械并在需要的情况下对其进行清洁,该器械然后可被灭菌。在一种灭菌技术中,器械被放置在闭合并密封的容器中,诸如塑料袋或袋(高密度聚乙烯合成纸袋)中。容器和器械然后被放置在可穿透容器的辐射场中,诸如γ射线、x射线或者高能电子。辐射杀死器械上以及容器中的细菌。灭菌的器械然后可被储存在灭菌容器中。密封的容器保持器械处于灭菌状态,直到其在医学场合下被打开。
所述被部分或全部引用于此作为参考的任何专利、公开文献或其他公开资料仅仅在被引用的材料不会与本公开中存在的定义、声明或上述其他公开资料相冲突的程度上被引用于此。因而,并且必要时,在这里清楚阐述的公开内容替代被引用于此作为参考的任何冲突资料。所述引用于此作为参考,但是与现有的定义、声明或在此阐述的其他公开资料相冲突的任何资料或其一部分,将仅仅在被引用资料和现有的公开资料之间不产生冲突的程度上被引用。
希望得到保护的本发明不应当被解释成局限于所公开的特定实施方式。因此,所述实施方式应当被认为是示例性的而不是限制性的。在不脱离本发明精神的情况下,任何人可以对本发明进行改变和变化。因此,明确地希望落入由权利要求书限定的本发明的精神和范围内的所有这样的等同物、改变和变化被包含于此。
Claims (10)
1.一种外科器械,包括:
手柄组件;
控制系统,其至少部分地由所述手柄组件支撑;
外科执行器,其可操作地连接到所述手柄组件,用于接收来自所述控制系统的至少两种控制运动,以使所述外科执行器执行至少两种外科动作;以及
定时指示器,其位于所述手柄组件和外科执行器中的至少一个上,以提供自施加所述控制运动中的一种起所经过的时间量的指示,在施加所述控制运动中的一种的同时保持在施加所述控制运动中的一种之后选择性地施加所述控制运动中的另一种的能力。
2.如权利要求1所述的外科器械,其中,所述定时指示器在每个所述外科动作之后开始重新计算。
3.如权利要求1所述的外科器械,其中,所述定时指示器包括:
定时装置;以及
电连接到所述定时装置的一连串的至少两个指示灯,其中,一个所述指示灯在一个所述外科动作开始时启动,另一个所述指示灯在一个所述外科动作开始之后经过第一预定时间量之后启动。
4.如权利要求3所述的外科器械,其中,所述一连串的指示灯包括至少三个指示灯,第三个所述指示灯在所述另一个所述指示灯启动之后经过第二预定时间量之后启动。
5.如权利要求4所述的外科器械,其中,所述一连串的指示灯包括至少四个指示灯,第四个指示灯在所述第三个指示灯启动之后经过第三预定时间量之后启动。
6.如权利要求5所述的外科器械,其中,所述一连串的指示灯包括至少五个指示灯,第五个指示灯在所述第四个指示灯启动之后经过第四预定时间量之后启动。
7.如权利要求6所述的外科器械,其中,所述第一预定时间量、第二预定时间量、第三预定时间量和第四预定时间量均包括大约5秒钟。
8.如权利要求3所述的外科器械,其中,所述定时装置支撑在所述手柄组件中。
9.如权利要求1所述的外科器械,其中,每个所述指示灯包括发光二极管。
10.一种用于处理外科执行器的方法,所述方法包括:
获取如权利要求1所述的外科执行器;
对所述外科执行器进行消毒;和
将所述外科执行器储存在无菌容器中。
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JP (1) | JP5646152B2 (zh) |
CN (1) | CN101675893B (zh) |
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WO2014117312A1 (zh) * | 2013-01-29 | 2014-08-07 | 北京中法派尔特医疗设备有限公司 | 电动外科装订器械的控制方法与控制装置 |
CN113766886A (zh) * | 2019-04-30 | 2021-12-07 | 西拉格国际有限公司 | 外科器械上的关节运动定向灯 |
CN114617596A (zh) * | 2020-12-11 | 2022-06-14 | 江苏风和医疗器材股份有限公司 | 压榨时间获取方法和外科器械 |
WO2022122002A1 (zh) * | 2020-12-11 | 2022-06-16 | 江苏风和医疗器材股份有限公司 | 压榨时间获取方法和外科器械 |
CN114115434A (zh) * | 2022-01-28 | 2022-03-01 | 极限人工智能(北京)有限公司 | 延时检测方法、装置、电子设备及存储介质 |
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CN101675893B (zh) | 2014-02-26 |
JP2010069305A (ja) | 2010-04-02 |
RU2009134905A (ru) | 2011-03-27 |
JP5646152B2 (ja) | 2014-12-24 |
EP2165655A1 (en) | 2010-03-24 |
PL2165655T3 (pl) | 2016-10-31 |
BRPI0904825B1 (pt) | 2019-07-16 |
CA2679180A1 (en) | 2010-03-18 |
US20100069942A1 (en) | 2010-03-18 |
CA2679180C (en) | 2017-11-28 |
EP2165655B1 (en) | 2016-04-20 |
RU2526968C2 (ru) | 2014-08-27 |
BRPI0904825A2 (pt) | 2011-02-08 |
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