CN101909526B - 手术器械 - Google Patents

手术器械 Download PDF

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CN101909526B
CN101909526B CN2008801236368A CN200880123636A CN101909526B CN 101909526 B CN101909526 B CN 101909526B CN 2008801236368 A CN2008801236368 A CN 2008801236368A CN 200880123636 A CN200880123636 A CN 200880123636A CN 101909526 B CN101909526 B CN 101909526B
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李佑镇
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Cambridge Endoscopic Devices Inc
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Abstract

一种医疗器械具有：由长形器械轴互联的近端控制手柄和远端工具，所述长形器械轴用于通入解剖体内部；通过所述器械轴分别互联近端控制手柄和远端工具的近端可动构件和远端可动构件；设置在所述可动构件之间的线缆控制装置；位于所述手柄处并用于通过所述可动构件控制所述远端工具的致动构件；以及用于使所述器械的轴部分与所述手柄部分选择性地接合或脱离接合的耦联装置。所述手柄具有远端接收器部分，并且位于所述近端运动构件上的轴连接器能够选择性地与所述接收器部分接合和从所述接收器部分释放。

Description

手术器械
技术领域
本发明总体涉及诊疗器械，更具体地涉及用于在微创手术或其它形式的手术或医疗过程或医疗技术中使用的手动操作的手术器械。在此说明的器械主要用于腹腔镜手术过程，但是，可以理解本发明的器械可广泛用于多种其它手术过程，包括腔内手术过程。
背景技术
目前市售的内窥镜和腹腔镜器械极难学会操作和使用，主要原因是这些器械在使用中缺乏灵活性。例如，当在手术期间使用一般的腹腔镜器械时，仅由目标和切口的位置来指示器械的工具的定向。这些器械一般通过利用患者自身切口区域作为支轴的支轴效应发挥功能。因此，诸如缝合、打结和精细解剖等普通任务变得难以掌控。多年来已开发出各种腹腔镜器械以克服此缺陷，往往通过提供通常由单独设置的控制构件进行控制的额外的铰接装置以便加强控制。但是，即使如此，这些器械仍然没有提供足够的灵活性以允许外科医生特别是以任意选定的定向执行诸如缝合等普通任务。此外，这类现有器械不能提供将器械保持在特定位置的有效方法。此外，现有器械需要使用双手以便有效地控制器械。
美国专利No.7,147,650示出了一种改进的器械，其具有增强的灵活性并且尤其包括具有近端和远端可弯曲构件的旋转特征。即使该器械具有改进的特征，但仍然需要一种更加经济可行的器械，并且需要一种其中手柄是可以重复使用而器械的端头是一次性的或可重新置换(reposable)的器械。
因此，本发明的一个目的是提供一种改进的腹腔镜或内窥镜器械，其中器械的一部分是可重复使用的且一部分是一次性的。在本文说明的实施方式中，器械的手柄端是可重复使用的，而器械的远端部分或端头是一次性的。通过能够重复使用手柄部分，该器械更加经济可行。
本发明的再一个目的是提供一种改进的腹腔镜或内窥镜手术器械，其允许外科医生以更大的灵活性操纵手术器械的工具端部。
本发明的又一个目的是提供一种改进的手术或医疗器械，其具有穿过切口、穿过身体的孔口或通过管腔内方式(intraluminally)的多种应用。
本发明的另一个目的是提供一种锁定特征，其作为用于器械的其它控制的重要附件，使外科医生能够一次将器械锁定在所需位置。这使得外科医生此后更容易执行手术过程，而无需同时将器械保持在特定的弯曲构形下。
本发明的又一个目的是提供一种改进的医疗器械，其特征在于能够将器械的位置锁定在预选定位置，同时使器械在锁定时其端头能够旋转。
本发明的再一个目的是提供一种改进的医疗器械，其可由使用者以单手有效地控制。
发明内容
根据本发明，提供了一种手术器械，包括：具有近端端部和远端端部的器械轴；设置于所述器械轴的远端端部的工具；耦联于所述器械轴的近端端部的控制手柄；用于将所述器械轴的远端端部耦联到所述工具的远端运动构件；用于将所述器械轴的近端端部耦联到所述手柄的近端运动构件；在所述远端运动构件和所述近端运动构件之间延伸的致动装置，用于将所述近端运动构件的运动耦联到所述远端运动构件以便控制所述工具的定位；所述手柄具有远端接收器部分；位于所述近端运动构件上的轴连接器，所述轴连接器能够选择性地与所述接收器部分接合以及从所述接收器部分释放；以及从所述轴连接器延伸到所述工具的致动线缆，用于控制对所述工具的致动。
根据本发明的其它方面，所述手术器械还包括旋转装置，所述旋转装置邻近所述控制手柄设置并能够相对于所述控制手柄旋转，用于引发所述器械轴和所述工具的对应旋转；至少所述近端运动构件包括近端可弯曲构件，所述旋转装置包括适于使所述工具绕远端工具滚动轴线旋转的旋转旋钮，并且所述旋转旋钮设置在所述控制手柄和所述近端可弯曲构件之间；致动杆可由所述手柄在所述手柄上的枢轴点处支撑，连杆机构由所述致动杆控制，线缆接合构件由所述连杆机构控制，用于俘住位于所述致动线缆的近端端部处的接头，从而控制所述致动线缆进而控制所述工具；所述连杆机构可包括棘齿与棘爪机构和多个连接连杆，所述棘齿与棘爪机构提供用于控制施加在所述工具上的力的连续的杆位置，所述多个连接连杆中的一个连接连杆包括其间具有偏压弹簧的拼合连杆；所述线缆接合构件可包括支撑门的滑架，所述门能够横向于所述滑架的纵向轴线移动，以便俘住所述线缆接头；用于偏压所述门的弹簧以及能够与所述门接合以打开所述门使得能够释放所述线缆接头的凸轮块；包括锁定机构，所述锁定机构用于固定位于选定位置处的所述工具的位置并且具有锁定状态和解锁状态，所述锁定机构包括围绕所述近端运动构件设置的球-窝装置和用于锁定所述球-窝装置的紧固构件；所述窝构件可包括拼合窝，并且所述紧固构件闭合所述拼合窝以将所述窝锁定在所述球上；包括一组夹紧块，所述线缆的所述接头的远端具有凸缘，所述凸缘由所述夹紧块俘获，所述夹紧块由位于所述手柄的近端端部处的释放构件进行操作；包括套筒构件和连杆构件，所述连杆构件用于通过所述释放构件来控制所述套筒构件的移动，所述套筒构件控制所述夹紧块朝向和远离彼此移动，从而在所述线缆凸缘处提供夹紧作用；包括由所述手柄在所述手柄上的枢轴点处支撑的致动杆，所述致动线缆具有能够分离的近端线缆部分和远端线缆部分，所述近端线缆部分由所述致动杆控制，所述远端线缆部分能够相对于所述近端线缆部分选择性地接合或释放；包括用于接合所述线缆部分的线缆锁定机构和用于保持所述轴连接器的轴锁定机构；其中，所述线缆锁定机构可包括安装在所述手柄上的套筒和释放按钮以及位于所述近端线缆部分的远端端部处的连接器，所述连接器具有多个指状物，用于与所述远端线缆部分上的接头选择性地接合以便俘住所述线缆接头，并且其中，所述轴锁定机构包括安装在所述手柄上释放杆和门，所述门用于俘住位于所述远端线缆部分上的柱；所述工具可包括筒夹、容置在所述筒夹内的可拆卸工具构件以及用于保持所述工具构件的一组夹爪；所述工具构件可以是烧灼工具，并且所述手术器械进一步包括：电压源，所述电压源位于所述手柄处并用于向所述致动线缆耦联能量；以及致动杆，所述致动杆用于控制所述致动线缆进而控制所述一组夹爪，以便夹持所述工具构件；以及，其中所述工具包括旋转刀具，并且所述手术器械进一步包括：马达，所述马达位于所述手柄上并用于经由所述致动线缆控制所述旋转刀具；以及致动杆，所述致动杆用于控制所述致动线缆。
根据本发明，还提供了一种医疗器械，所述医疗器械具有：通过长形器械轴互联的近端控制手柄和远端工具，所述长形器械轴用于通入解剖体内部；通过所述器械轴分别互联所述近端控制手柄和所述远端工具的近端可动构件和远端可动构件；设置在所述可动构件之间的线缆控制装置；位于所述手柄处并用于通过所述可动构件控制所述远端工具的致动构件；用于选择性地接合或脱开所述远端工具的工具耦联器；以及安装在所述手柄处并用于控制所述工具耦联器的控制构件。
根据本发明医疗器械的其它方面，所述工具耦联器可包括筒夹和夹爪构件，所述夹爪构件相对于所述筒夹移动以便接收所述远端工具，并且，所述筒夹可附连到所述近端可动构件，所述近端可动构件包括近端可弯曲构件，并且所述夹爪构件包括从基部延伸的一组指状物。
在又一实施方式中，提供了一种控制医疗器械的方法，所述医疗器械具有包括控制手柄的近端端部和包括远端工具的远端端部，所述控制手柄和所述远端工具通过长形器械轴互联，并且所述工具由工具控制线缆致动，所述工具控制线缆由位于所述手柄处的致动杆进行操作，所述方法包括：提供近端可动构件和远端可动构件，所述近端可动构件和所述远端可动构件通过所述器械轴分别互联所述近端控制手柄和所述远端工具；将所述近端可动构件和所述远端可动构件互联，使得在所述近端可动构件处的运动控制所述远端可动构件；以及支撑所述近端可动构件，以便与位于所述手柄处的接收器部分以可拆卸的方式互锁。
根据其它方面，所述方法可包括将所述工具控制线缆分成分离的线缆节段并将所述分离的线缆节段互锁从而能够操作所述工具，或者从所述器械的近端端部手动地控制所述远端工具绕其纵向远端工具轴线的旋转。
在再一实施方式中，所述器械具有：通过长形器械轴互联的近端控制手柄和远端工具；通过所述器械轴分别互联所述近端控制手柄和所述远端工具的近端可动构件和远端可动构件；设置在所述可动构件之间使得在所述近端可动构件处的运动控制所述远端可动构件进而控制所述远端工具的装置；支撑在所述手柄处并用于控制所述远端工具的装置，所述装置包括在所述近端可动构件和所述远端工具之间延伸的工具控制线缆以及安装在所述手柄处的致动杆，所述手柄具有远端接收器部分；以及位于所述近端可动构件上的轴连接器，所述轴连接器能够选择性地与所述接收器部分接合以及从所述接收器部分释放。
根据其它方面，所述工具控制线缆可包括分离的控制线缆节段，所述分离的控制线缆节段适于呈接合状态和脱开状态中的一种状态，并且，在所述控制手柄处可包括控制构件，所述控制构件能够由使用者操纵以便经由所述近端可动构件和所述远端可动构件控制所述远端工具绕远端工具轴线的旋转。
附图说明
可通过参照附图根据本发明实现许多其它优点，其中：
图1是根据本发明构造的具有一次性轴部分和可重复使用手柄部分的手术器械的第一实施方式的立体图，并且示出了使用时的器械；
图2是图1的器械的横截面侧视图，其中致动杆停置且示出夹爪打开；
图3是图1中器械的放大的横截面侧视图，并且示出了使用时的夹爪至少部分关闭的器械；
图4是示出从手柄移除的轴的分解的局部剖视图；
图5是手柄的接合轴的端部的轴锁定装置的大体示意性横截面详图，并且其中线缆接合装置处于停置或未接合状态；
图5A是示出线缆接头被接合的图5中线缆接合装置的局部详图；
图6是与图5中所示相似但示出线缆接头向近端拉动的剖视图；
图7是示出线缆接头被释放且轴锁定装置与轴脱离接合的局部剖视图；
图8是与图7相似但示出器械轴被从手柄移除的分解剖视图；
图9是脱离接合的线缆接合装置和轴锁定装置的分解立体图；
图10是轴和线缆接合装置的部分断开的立体图；
图11是线缆接合装置自己且在使用中的部分断开的立体图；
图12是器械的适于用作烧灼工具且采用可拆卸端头的可选实施方式的示意性侧视图；
图12A是图12中工具夹紧或保持装置的端视图；
图12B是沿图12A的线12B-12B的横截面侧视图；
图13是图12的轴和线缆接合装置的局部横截面侧视图；
图14是沿图13的线14-14剖切并示出锁定的轴的剖视图；
图15是示出轴从手柄移除的图12的器械的分解剖视图；
图16是示出线缆接合装置自己且处于接合位置的可选器械的部分断开的立体图；
图17是与图16所示相似但示出释放的线缆接合装置的分解立体图；
图18是器械的适于用作旋转切割工具的另一个可选实施方式的示意性侧视图；
图18A是图18中工具夹紧装置的端视图；
图18B是沿图18A的线18B-18B的剖视图；
图18C是图18中线缆接合装置的局部横截面侧视图；
图19是图18的线缆接合装置自己且处于接合位置的部分断开的立体图；以及
图20是示出释放的图19的线缆接合装置的分解立体图。
具体实施方式
附图中示出了本发明，其为具有两个部分的手术器械，使得可拆卸器械轴部分可以是一次性的，而可重复使用的手柄部分可以进行消毒并且重复使用多次。这在允许具有较高质量的器械手柄部分的同时，保持器械具有合理的总体价格。
本发明的器械可用于执行微创手术过程。“微创手术过程”在此指的是外科医生经由一小刀口或切口进行手术的手术过程，该小切口用于通往手术部位。在一种实施方式中，切口长度在直径从1mm到20mm的范围，优选直径从5mm到10mm。该手术过程不同于那些需要大刀口以进到手术部位的手术过程。因此，优选使用挠性器械用于经由这样的小切口和/或经由身体的管腔或腔体插入，以便将器械定位在体内目标部位进行特定的手术或医疗过程。手术器械向解剖部位中的引入还可以是通过通向管腔、血管或腔体的经皮肤的通道或手术通道实现的，或是通过经由解剖部位中的天然孔口引入实现的。
除在腹腔镜手术过程中使用之外，本发明的器械可在各种其它医疗或手术过程中使用，其中包括但不限于结肠镜手术过程、上消化道手术过程、关节镜手术过程、窦手术过程、胸部手术过程、前列腺手术过程、阴道手术过程、骨科手术过程和心脏手术过程。取决于具体的手术过程，器械轴可以是刚性的、半刚性的或挠性的。
尽管在此称为“手术器械”，但可以想到本发明的原理还适用于其它诊疗器械，不一定用于手术，并且包括但不限于诸如导管以及诊断和治疗器械和器具等其它器具。
有许多独特特征体现在本文说明的器械中。比如，提供了一种锁定机构，其利用绕随弯曲动作运动的近端运动构件设置的球-窝装置进行构造，并且其中使用环形紧固环(cinch ring)来将球-窝装置保持在固定的特定位置，并且因此还将近端和远端可弯曲构件保持在特定的弯曲状态下、或者换句话说锁定在那个位置。紧固环包括锁定杆，该锁定杆方便地邻近器械手柄定位并易于操纵以锁定和解锁紧固环，进而锁定端部执行器的位置和解除对其的锁定。紧固环还优选能够旋转，使得能够方便地定位锁定杆或能够在使用左手的使用者与使用右手的使用者之间转换(旋转)。这种锁定控制使得外科医生能够在执行某些任务时减少一个要关注的自由度。这样通过将可弯曲部分锁定在特定位置使外科医生能够具有更多地空出手来控制器械的其它自由度，比如操纵旋转旋钮，进而控制端部执行器的定向。
本发明的主要特性涉及器械的部分是一次性的和部分可重复使用的性能。这样，由于不必每次手术过程都更换整个器械因此器械成本大大减小。在早先的器械构造中，近端弯曲构件一直是直接安装到旋转旋钮上，但此处连接器和相关联的接收器使得能够从旋转旋钮移除弯曲构件。在一种实施方式中，在手柄的远端运动构件、工具、器械轴和近端运动构件可从器械手柄上分离的位置处设置有断开装置。这使得远端组件能够是可与手柄接合、断开接合或可从手柄释放的。由于器械的手柄部分是可重复使用的，因此器械的这一部分的成本实质上分散到多个器械的使用中。
图1是本发明的手术器械10的一种实施方式的立体图。图2-11提供该实施方式的更多细节。图12-17示出了本发明的第二实施方式，其中该器械适于用作烧灼工具并采用可拆卸端头。图18-20示出了本发明的第三实施方式，其中该器械适于用作旋转切割工具。
在图1的实施方式中，工具和手柄运动构件或可弯曲构件均能在任意方向上弯曲。它们通过线缆(优选四根线缆)相互连接，这样近端构件处的弯曲动作使远端构件处具有相关弯曲。近端弯曲通过由器械的使用者使控制手柄运动或偏转来控制。换句话说，外科医生握住手柄并且一旦器械就位，那么手柄处的任意运动(偏转)就会立即控制近端可弯曲构件，进而经由线缆控制远端可弯曲构件处的相应弯曲或偏转。该动作又控制了远端工具的定位。
优选地，近端构件一般比远端构件大以便提供增强的人体工效学控制。在图示实施方式中，近端和远端可弯曲构件的直径比可以在3比1的量级。在根据本发明的一种形式中，可以提供远端可弯曲构件与近端可弯曲构件沿相同方向弯曲的弯曲作用。在一种可选实施方式中，可弯曲、可回转或挠性的构件可布置成通过使致动线缆旋转经过180度而在相反方向上弯曲，或者可控制成实际上能够在任意其它方向上弯曲，取决于线缆的近端和远端支撑点之间的关系。
如上所述，远端弯曲构件处产生的弯曲运动的量由近端可弯曲构件的尺寸与远端可弯曲构件的尺寸的比较决定。在所述实施方式中，近端可弯曲构件一般大于远端可弯曲构件，因此，远端可弯曲构件处产生的运动幅度大于近端可弯曲构件处的运动幅度。近端可弯曲构件可在任意方向上(大约360度)弯曲，从而控制远端可弯曲构件在相同或相反的方向上但同时又在相同的平面内弯曲。此外，如图1所述，外科医生能够仅通过使轴向旋转旋钮24绕图1中由旋转箭头R1所指示的旋转方向转动而使器械的工具绕其纵向轴线弯曲或转动成任意定向。
在本说明书中这些构件被称为可弯曲构件。这些构件还可被称为可回转构件、可弯曲部分或挠性构件。在本文的描述中，诸如“可弯曲部分”、“可弯曲段”、“可弯曲构件”或“可回转构件”等术语指的是器械的相较于在接头处枢转的元件能够以可控方式弯曲的元件。术语“可动构件”被认为是类属于可弯曲部分和接头。本发明的可弯曲元件使得能够制造出这样的器械：可在任意方向上弯曲而不会有任意奇点，而且其特征还在于具有准备在任意方向弯曲的能力，全部优选具有单一整体式结构或一体式结构。“整体式”或“一体式”结构的定义是仅由单个整体构件构造的结构而非由多个组装或相配的组件形成的结构。
这些可弯曲构件的定义是形成为控制装置或受控装置并能够被拉力或压力迫压成以由直线偏离成没有任何明显的断点或尖角的弯曲构形的器械元件。可弯曲构件可以是整体结构的形式，比如本文图3中所示的近端可弯曲构件的类型，可由可接合圆盘或类似物构造，可包括波纹管配置或者可包括活动环组件。在本文的图2中，整体式可弯曲结构包括其间限定有槽口132的一系列交替的挠性圆盘130。“整体”或“一体”式结构可定义为构造用于成单件使用且不需要组装部件的结构。连接肋131被示为在相邻圆盘130之间延伸。两个可弯曲构件优选都具有肋形式，其中肋以从一个肋到相邻肋优选成60度变化的方式设置。对于多种形式的可弯曲构件，请参考2005年7月20日提交的申请号为No.11/185,911、2006年8月16日提交的申请号为11/505,003和2006年9月19日提交的申请号为11/523,103的共同待决申请，在此将它们全部内容以参考的方式引入。
图1示出本发明的器械的一种实施方式。图2至11示出更多细节。图1以立体图示出手术器械10，其可能出现在手术过程中。比如，该器械可用于穿过腹壁4的腹腔镜手术。为此提供了设置有插管或套管针的插入部位。器械10的轴14适用于穿过在6处示意性地示出的插管或套管针，以便将器械的远端端部设置在手术部位。在图1中示出了端部执行器16。图1所示器械的实施方式一般与覆盖远端构件20的护套98一起使用以防止体液进入远端弯曲构件20。
可临时使用分离的护套(未示出)覆盖整个远端可弯曲构件和端部执行器。这种护套仅用于运输器械，并且一旦器械在手柄上就位即被丢弃。护套将夹爪保持在打开位置，如图2所示，并还将远端可弯曲构件保持在基本为挺直的位置。对于更加详细的临时护套构造，请参见2007年9月11日提交的相关申请No.11/900,417，在此以参见方式将其全文并入。这样，致动线缆被保持在特定的对准位置并准备与器械的手柄部分接合。替代使用预形成护套，可选择地，能够使用器械中的偏置装置来保持器械线缆处于预定位置，通常为夹爪保持打开的位置。
通过本发明的器械可实施转动。这可通过使旋转旋钮24相对于手柄12绕纵轴轴线旋转而实现。这在图1中由旋转箭头R1表示。当沿任一方向旋转该旋转旋钮24时，这会引起器械轴14的相应旋转。这在图1中由旋转箭头R2表示。该运动还使得远端可弯曲构件和端部执行器16绕对应于器械端头的轴线旋转，在图1中示出为绕纵向端头或工具轴线P旋转。在图1中参见器械端头处的旋转箭头R3。
当器械锁定(或解锁)时旋转旋钮24的任意旋转会使器械端头保持在相同角位置，但却使端头(工具)的定向旋转。为了进一步说明端头的旋转特征，请参考2005年12月14日提交的共同待决申请No.11/302,654，特别是图25-28，在此以参考的方式将其全文引入。
通过近端可弯曲构件18，可使手柄12与器械轴纵向中心轴线成角度倾斜。这种倾斜、偏转或弯曲是三维的。通过线缆，该动作使得远端可弯曲构件20处相应地弯曲到端头沿一轴线并与器械轴纵向中心轴线成对应角度指向的位置。外科医生从手柄12通过在基本上的任意方向上操纵手柄来控制近端可弯曲构件18处的弯曲，该任意方向包括进出图1中纸平面的方向。这种操纵直接控制近端可弯曲构件处的弯曲。对于与弯曲和锁定特征有关的进一步说明，请参考2006年9月27日提交的申请号为No.11/528,134和2007年1月2日提交的申请号为11/649,352的共同待决申请，在此以参考的方式将它们的全文引入。
由此，对手柄处的控制用于使器械在近端运动构件处弯曲，进而控制远端运动构件和工具的定位。工具的“位置”主要由该弯曲或运动动作决定，并且可以被认为是远端运动构件的远端端部处的坐标位置。实际上，可考虑在近端和远端运动构件以及器械端头处具有坐标轴。这种定位是三维的。当然，器械定位在一定程度上还受外科医生在切口点或者在插管或套管针处枢转器械的能力的控制。另一方面，对工具的“定向”涉及从近端旋转控制构件(旋钮24)绕所示出的远端端头或工具轴线P对工具的旋转定位。
附图中示出了一组夹爪，但是其它工具或装置可容易地适于与本发明的器械一起使用。这些包括但不限于摄像机、检测器、光学器件、观测仪器、液体输送装置、注射器等等。工具可包括各种铰接工具，比如：夹爪、剪刀、夹具、针夹持器、微解剖器、吻合器施放装置(stapleappliers)、修补器(tackers)、抽吸冲洗工具和夹置放器。此外，工具可包括非铰接工具，比如：切割刀片、探针、冲洗器、导液管或抽吸管口。
图1的手术器械示出根据本发明的手术器械10的一种实施方式，其在使用中并可在插入部位经由插管穿过患者皮肤插入。在此示出的许多组件，比如器械轴14、端部执行器16、远端弯曲构件20以及近端弯曲构件18可与2005年7月20日提交的共同待决美国申请No.11/185,911中所述的器械组件相似并以与这些组件相同的方式相互作用，在此将该该申请的全部内容以参引方式结合进来。在此示出的一些其它组件、特别是位于器械的手柄端处的组件可与2006年9月27日提交的共同待决美国申请No.11/528,134中所述的组件相似，因而在此将该申请的全部内容以参引的方式结合进来。此外还以参引方式将以下申请的全部内容结合进来：2004年4月12日提交的美国申请No.10/822,081、2005年10月3日提交的美国申请No.11/242,642以及2005年12月14日提交的美国申请No.11/302,654，所有这些申请都共同归本受让人所有。
比如，如图1-3所示，通过弯曲控制线缆100提供近端可弯曲构件18和远端可弯曲构件20之间的控制。在图示实施方式中，可设置四个这种控制线缆100以便提供所需各个方向的弯曲。但是，在本发明的其它实施方式中，可以采用更少数目的弯曲控制线缆。弯曲控制线缆100延伸穿过器械轴14并穿过近端和远端可弯曲构件。弯曲控制线缆100可基本上沿其整个长度被约束以便促进“推动”和“拉动”作用，如在上述于2007年1月2日提交的共同待决申请No.11/649,352进一步详细描述的那样。线缆100优选地在它们穿越近端可弯曲构件的圆锥形线缆引导部分和穿过近端可弯曲构件本身时受到约束。
锁定装置与球-窝装置相互作用以锁定和解锁对线缆的定位，这又控制近端弯曲构件的角度进而控制远端可弯曲构件和端部执行器的角度。该锁定控制使外科医生在执行某些任务时能够少一个要关注的自由度。通过将可弯曲部分锁定在特定位置，使外科医生能够更多地空出手来控制器械的其它自由度，比如操纵旋转旋钮24继而操纵端部执行器的定向。
图1所示的器械被认为是手枪握把式。但是，本发明的原理也可应用于其它形式的把手，比如直线式手柄。在图1中，示出了主要包括杆22的夹爪夹紧或致动装置30，杆22可在万向球27中具有单指孔。球27安装在杆22的自由端。外科医生利用球27来控制杆22。在一个可选实施方式中，球27是可选择的，取代它的是位于杆22的自由端处的简单的通孔或盲孔。还可具有直接通过杆22控制的或通过分离的释放按钮控制的相关释放功能。释放功能用于释放器械的端头，用于互换。
在所示器械中，当近端可弯曲构件被构造并设置成优选地能够进行全360度弯曲时，器械的手柄端则可在任意方向上倾斜或偏转。手柄相对于器械轴的这种运动使器械在近端可弯曲构件18处弯曲。随后，该动作又通过弯曲控制线缆100使远端可弯曲构件在相同方向上弯曲。如前所述，可通过使控制线缆旋转经过180度或从其一端扭转经过180度到其另一端而获得相反方向的弯曲。
在此说明的主要实施方式中，手柄12为手枪握把的形式并包括角柄13以便于在外科医生的手的动作和器械之间形成舒适的交界面。图1示出工具致动杆22以可枢转的方式附连在手柄的基部处。杆22致动控制工具致动线缆38的连杆机构(见图2和3)。线缆38控制夹爪的打开和关闭，杆的不同位置控制施加到夹爪上的力。
器械10具有手柄部分12和可拆卸轴部分14，如图1所示。器械的许多组件与2007年1月2日提交的申请No.11/649,352中所示的组件相似，特别是可弯曲构件、器械轴、端部执行器、旋转构件和锁定机构的构造。器械10包括用于使轴和近端可弯曲构件能够在支承装置或支承表面208和210(图3)内旋转的装置。支承装置208连接在转接器26和球120之间，而支承面210位于颈部部分206和器械轴之间。在存储或运输之前，分离的部分12和14或可选择地组装的器械可密封在无菌包装或多个包装内。
现在还参考2007年9月11日提交的共同待决申请No.11/900,417(在此将其全部内容以参考的方式引入)用于对包括可释放轴的相关器械结构的说明。本发明针对其他特征，特别是与用于轴和用于线缆接头的锁定装置相关的特征。用于线缆的锁定装置由致动杆驱动，并包括用于将恒定的夹爪压力施加到不同厚度的工具或组织上的弹簧加载的补偿装置或构件152(见图5)以及用以保持所施加的压力的棘齿装置154。下面对构件152和154作进一步的详细论述。
图2示出处于停置位置的器械，其中器械的远端部件包括器械轴14，器械轴14与包括控制手柄12的器械的近端部分相结合。另一方面，图3示出处于使用位置的器械，其中杆22至少部分地被压下(沿箭头22A的方向朝手柄移动)。在这两个视图中，器械的远端部分与器械的近端部分相结合，并且认为致动线缆是互锁或接合的，使得对杆22的操作控制致动线缆的运动进而控制对端部执行器16的致动。图4是示出已从控制手柄(器械手柄部分)移除的器械的远端部分(器械轴部分)的分解的局部剖视图。
如图4和8所示，通过释放紧固环200能够容易地将轴部分14从手柄部分12分离。对于轴部分释放的更多细节，请参考2007年9月11日提交的共同待决申请No.11/900,417。轴部分14包括轴连接器212(见图4)。轴部分14的近端凸缘210被俘于旋转旋钮24的轴接收器部分34中。夹紧块182俘住近端凸缘210。轴连接器212线性锁定，但轴锁定装置或构件150允许轴部分相对于手柄部分旋转。线缆接头40通过其与线缆接合装置84的接合而被俘住。
该器械包括如图1-4所示的角度锁定装置140。该角度锁定装置包括拼合毂202，拼合毂202构造并布置成使得能够将球120和整个远端轴部分拉出拼合毂202。紧固环200用于锁住和解锁拼合毂202，如稍后更详细说明的，并且如在2007年9月11日提交的共同待决申请No.11/900,417中进一步说明的。
拼合毂202包括多个部分或毂瓣，每个部分或毂瓣均优选具有锥形表面以便起到坡道(ramp)的作用，从而当在将轴部分插入手柄部分的过程中抵压坡道向近端推动球120时迫使毂瓣分开。所述多个部分的这些内向表面或边缘是倾斜的或锥形的以使球能够更容易通过。拼合毂202由手柄通过撑架230支承，撑架230变薄以便起到挠性活动铰链的作用，从而允许毂瓣更易于扩张。该结构有助于轴部分和手柄部分之间的接合和脱离接合。
紧固环200可具有两个凸缘，两个凸缘跨接(ride)在设置于拼合毂202的外表面上的相应的周向槽内。这种界面俘住紧固环，同时允许沿直线拼合毂分开。紧固环200基本上由角度锁定构件或装置140控制。角度锁定构件140与紧固环200以可枢转的方式附连。角度锁定构件140主要包括控制紧固环200的长度或外圆周的释放/锁定杆220。角度锁定构件140构造并布置成使紧固环200不仅能够足够松弛以调整轴相对于手柄的角度而且还能够扩张到一定的尺寸，该尺寸足以允许拼合毂部分充分扩张，从而使得能够将球120(以及整个远端轴部分)从拼合毂202中移除或插入拼合毂202中。这使轴部分能够容易地与手柄部分脱离接合。对于紧固环构造的其它细节，请参考2007年1月2日提交的申请号为No.11/649,352和2007年9月11日提交的申请号为No.11/900,417的共同待决申请。
紧固环200通过偏心锁定杆220操作，偏心锁定杆220通过相应的销连接到紧固环200的端部。当杆220被释放时紧固环200能够自由地绕拼合毂202旋转。这样允许用左手或右手操作器械。当锁定杆220移动到其锁定位置时，这样会使紧固环200受压而缩小，从而抵靠球构件120的球形外表面204闭合毂。这样抵靠球构件120锁定手柄，从而将球构件120保持在当锁定发生时球构件所处的任何位置。这样通过将球构件保持在固定位置而同样将近端可弯曲构件保持在特定位置并固定在该位置。这样又将远端可弯曲构件和工具保持在固定位置，但是可以通过控制旋转旋钮而控制器械定向，旋转旋钮通过使远端可弯曲构件和工具绕端头轴线P(见图3)旋转而控制器械端头的定向。
第一实施方式所示器械的另一个特征是采用了如图2和3所示的单独轴释放杆160。杆160操作连杆机构，连杆机构又控制轴锁定构件150。套筒176由连杆机构控制并控制夹紧块182的打开和闭合。这些夹紧块182俘住柱214和整个轴部分。在一个可选实施方式中，夹紧块能够以不同的方式俘住线缆，比如通过使每个夹紧块上的凸起接合线缆中的槽口或孔。
本发明的器械提供了重复使用器械手柄部分的性能而远端部分或轴部分是一次性的或可重新置换的。这是通过基本上在近端可弯曲构件处设置断开装置实现的。例如，如图4所示，轴部分14包括附连于近端可弯曲构件18的轴连接器212。正是轴连接器212可与旋转旋钮24的接收器部分34接合或可从该接收器部分34释放。轴连接器212可安置在旋转旋钮的接收器部分34中，并通过连接器212的花键238和接收器部分34的座部246中的凹槽240栓连接到旋转旋钮24。对于进一步的细节还请参见图8和9。轴连接器212的直径缩小部分242经接收器部分34的座部246中的隙孔244穿过，并邻接夹紧块182(见图6)，夹紧块182闭合时围绕穿过半圆形内孔184向近端延伸的柱214松配合。柱214端部处的近端凸缘210由夹紧块相对松弛地俘住，从而允许轴连接器212旋转但不允许其轴向移动。参照图7和9。
推/拉线缆38的近端连结到管39，管39能在柱214的内孔41中自由滑动，如图5所述。管39能够以诸如通过胶粘剂、焊接或束缚的许多不同方式中的任意一种方式附连到线缆38。没有将管39示为沿任意特定方向(向近端或远端)被偏压，但是管39可以是向近端或远端地加载弹簧的，以将夹爪(或其它端部执行器)偏压到所需的“停置”位置。例如，如在图5中，孔41中可设置弹簧。管39具有适用于被线缆接合装置84俘住的接头40。线缆接合构件84主要包括门260。位于手柄部分处的门260由致动杆22控制。接头40具有锥形部42以有助于将轴插入手柄中并为门260提供间隙。当杆22最初被握紧并且向近端拉动滑架82时，门260卡住接头40，如图5A中最佳示出的，此时门260的槽口271接合接头40。门260在滑架82中的引导槽口262内上下移动。如图11中最佳示出的，门由弹簧264偏压到关闭位置。该弹簧由向下螺纹连接到滑架82顶部的臂266保持。弹簧的下端安置在门中的井孔268内。当门位于关闭位置时，其间具有间隙271的两个半圆形凸缘270延伸到滑架82中的中心孔272内，从而将线缆接头40俘在凸缘之间的间隙内。
如图11所示，内孔272在其远端端部处具有锥形部274以在将轴插入手柄内时引导接头40就位。门260在对应于引导槽口262的端部的位置276处降至最低点从而容许凸缘270和管39之间存在径向间隙，以使接头和管能够在滑架82内自由旋转。门260上的坡道278在滑架行程的远端端部处与凸轮块86相互作用以在杆22停置时推动门打开从而释放接头40。这意味着每当杆22被释放或停置、比如处于图4所示位置时，线缆接头40通常允许轴的移除。
当杆22被握紧时，将滑架82沿箭头279的方向向近端拉动(见图3、5A、6和11)，坡道278沿凸轮块86向下滑动，近端凸缘270越过接头40的锥形边缘42，同时远端凸缘270接触接头40的远端表面。该动作使得开始在方向279上拉动接头40。当行程大约到达图11的位置时，坡道278从凸轮块86落下，并且线缆接头40完全被俘住。进一步朝手柄握紧杆22引起棘齿装置154的操作。然后能够完全握紧杆22以释放棘齿构件154和线缆接合装置84。该动作使滑架82在来自弹簧71的偏压作用下返回，直到滑架的锥形部274套在凸缘210的锥形部216上，这样将接合装置84与接头40对准。
现在说明图5和6最佳示出的补偿装置152。补偿构件152提供偏压力，同时适应位于端部执行器处的不同尺寸的针或其它物体。为简单起见，图1-4中未示出补偿装置。补偿装置或构件主要包括连杆79，其由两个相对滑动部分79A和79B构造而成。连杆79支撑在部分79A上的引导装置290中，从而使得能够在近端通过弹簧292将部分79A朝部分79A偏压。部分79B上的台肩294用作止动装置。如图2和3所示，连杆79的一端由曲柄76在销80处支撑，而相对端由滑架82在销81处支撑。曲柄76在销78处枢转。连杆74在销77处附连到曲柄76并位于销77和78中间。销80从曲柄76支撑连杆79。当握紧杆22时，端部执行器16的夹爪44、46接近针45。接触针之后连杆部分79A停止运动，而部分79B继续在弹簧292的拉力下在近端方向上被拉动，从而在补偿了针的厚度的同时向夹爪施加恒定的夹持力。
棘齿机构154包括以单向棘齿作用的方式作用在齿条158上的弹簧加载的棘爪156。齿条158紧固到手柄的内表面。注意在图2和5中棘爪156尚未与齿条158相接合。图3示出了杆基本上被压下而棘爪156接近其行程端部。棘爪沿齿条移动，直到其通过齿条，这就是正好越过图6所示位置的状态。然后棘爪156自由枢转越过齿条158的齿，并且由此释放曲柄76从而在杆复位弹簧71的作用下使其回复到图5的起始位置。一旦棘爪经过其行程的端部，其就会在复位弹簧71的控制下自动返回到图5的位置。该动作还将门260打开，从而使得更远端的轴部分得到释放。
轴部分释放
释放紧固环200，因此可从拼合毂202拉出轴部分14的球120。通过操作杆220释放紧固环。通过在手柄基部处沿图3所示箭头161的方向推动杆160释放轴锁定装置或构件150，使得杆160沿顺时针方向绕枢转柱162枢转。该动作通过连杆装置164传递，连杆装置164的一端通过销166连接到杆160，而相对端连接到曲拐168，曲拐168通过销169连接到连杆164(见图5)。当致动杆160时，曲拐168绕销170逆时针方向枢转，并且曲拐内的槽口171驱动销172，进而沿如图4、5、7和9所示的箭头163的远端方向驱动支架174。支架174(还请见图10)通过螺钉或铆钉175安装于矩形套筒176。套筒176具有带坡道的槽口178(见图9和10)，其抵靠安装在夹紧块182中的销180作用。该动作促使夹紧块182沿图7和9中所示的箭头165的方向分开(张开)。跨接在夹紧块中的内孔188内的引导销186防止夹紧块182横向运动。引导销186支撑在臂90(见图5和6)上，臂90通过定位销91和螺钉92紧固于处于固定位置的支撑管94。引导销186穿过套筒176中的槽口190，如图11所示。
顶部臂90还支撑柱88，凸轮块86安装在柱88上。柱86也穿过套筒176中的槽口190。夹紧块182的打开为轴连接器212的近端凸缘210留出间隙，以便其经由夹紧块内的半圆形内孔184所形成的通道退回(图7和9)。然后轴连接器212可从旋转旋钮24的轴接收器部分34移出，同时轴的球部分120被拉出拼合毂202，如图4和7-9所示。
轴部分插入
以下描述涉及轴部分14的插入顺序。当插入轴部分时，球120通过拼合毂202的远端边缘。该远端边缘可如图4所示呈锥形以有助于插入并提供一定的引导。轴连接器212至少通过轴接收器部分34上的锥形部36以及轴连接器212的花键238上的锥形部239引导就位。图6和8还示出近端凸缘210的锥形部216如何通过与锥形部274接合而促进插入。此外，每个夹紧块182均设置有锥形部183以促进轴部分14的对准，如图9所示。这些各种锥形部有助于线缆接头40在其通入滑架82时中进行对中，如图7所述。
当花键238的端部接触座部246(见图9)时，则能够旋转轴部分14，直到花键238与凹槽240对准。轴连接器212可一直插入到接收器部分34内，直到座部246通过接触连接器212的台肩248而阻止进一步向近端移动。轴连接器212的台肩250同时接触夹紧块182的面252。然后可向近端拉动轴释放杆160(沿与图3中的箭头161相反的方向)，从而导致套筒176沿图10中的箭头167的方向向近端移动，进而围绕柱214闭合夹紧块182，从而俘住环形凸缘210。图10和11所示的箭头173说明了该闭合和对凸缘210的俘获。释放杆160可设有定位装置以便将其保持在夹紧或释放位置，使得轴部分不会被错误地释放。一旦将轴部分14俘获在手柄部分12中，则可用杆22来控制对端部执行器的致动。例如，图3示出了杆至少部分地被压下并且滑架82向近端移动且夹爪44、46闭合从而夹持针45。
烧灼工具实施方式
图12示出本发明的一个可选实施方式，其中器械310特别适用于手术中执行的烧灼术。图13-17中示出了更多细节。该实施方式还提供了带有不同释放机构的可替换轴，如下所述。在本文描述的前一实施方式中，示出了一组夹爪。在该实施方式中，端部执行器已被筒夹机构316取代，筒夹机构316可释放的攥住烧灼工具320并提供与工具的电触头322(见图12B)的电连接，用于能够选择性的触发烧灼工具。线缆38用于使筒夹316夹紧以及提供电流以加热烧灼工具。线缆被分成两部分，一个部分38A与轴314成整体并通过护套315(见图12B)电绝缘，护套315还优选由低摩擦材料构造以使线缆能够在护套315内容易地滑动。线缆部分38B也具有绝缘护套317(见图13)。线缆部分38B穿过护套317并且其更近端的端部在套管66处连接到滑动器28。
在此未详细示出手柄的内部，但是已经以参引的方式结合在本文中的早期申请公开了可用于致动线缆38的滑动器和套管布置的更多细节。比如，参见2005年7月20日提交的申请No.11/185,911；2005年12月14日提交的申请No.11/302,654；2006年8月16日提交的申请No.11/505,003；2006年9月27日提交的No.11/528,134以及2007年1月2日提交的No.11/649,352。在一个可选实施方式中，由于线缆38A能够在连接器384处独立地自由旋转，因此可以不需要套管66且线缆可直接夹紧到滑动器上。线缆38B的近端端部则通入附连到手柄12的端部的手柄延长部324内。手柄延长部324容置有管状电触头326，电触头326允许线缆向近端和远端滑动，同时与可变电压源328保持电连接，可变电压源328又通过挠性线缆332在节点330处连接到触头326。开关(未示出)可方便地支撑在延长部或可变电压源处或邻近其支撑，使得能够将电压有选择地施加到工具320。
在图12A和12B中示出筒夹机构316，并且该筒夹机构316用于接收不同尺寸、形状、类型等的工具320。根据具体手术过程，工具通常呈弯曲构形设置。根据本发明，并非必须利用对应于每种类型的不同的整体器械，可使用单个器械，而为了改变工具类型、尺寸或形状仅在器械的顶端更换不同的器械端头。筒夹360用诸如硬塑料的电绝缘材料制成并附连到远端可弯曲构件20和线缆100的远端端部。触发夹爪364以夹持和松开工具320。在所公开的实施方式中使用了四个这样的夹爪，但是，应当理解可以采用不同的数目的夹爪。夹爪364的基部362容置可以焊接到线缆38A的远端端部上的电触头366。触头366与烧灼工具上的触头322相配。如图12B所示，基部362可由金属材料构造并可焊接在368处，以提供线缆38A和烧灼工具的触头322之间进一步的电接触。
烧灼工具适于由图12A和12B中所示的筒夹和夹爪结构夹持和释放。该夹持或释放通过致动线缆38控制。由于烧灼工具是非铰接工具，因此不需要主线缆用于工具致动，而主线缆用于选择性地俘住烧灼工具本身。烧灼工具320被推进松弛的夹爪中，直到工具的触头322达到最低点抵靠基部362内的触头366。然后，可以握紧杆22(向内朝手柄压下)从而使得线缆38A将夹爪364拉入筒夹360内。夹爪和筒夹之间的相对运动基本上使夹爪抵靠工具紧紧闭合。这在图12B中以箭头369的方向示出。因此烧灼工具被紧固在筒夹360内并电连接到电压源328。带电能的夹爪364和触头322从绝缘筒夹360的远端端部凹进以免电击患者。杆22可设置有一个或多个定位装置，使得能够将杆保持在或者锁定或者释放的特定的所需位置。
本发明的该实施方式还公开了接合器械的轴部分的可选方法。图13-17中示出可选线缆接合装置或构件284。该实施方式还示出具有肋的近端可弯曲构件18，该肋限定出如在结合在本文中的申请中所示的前述器械中的相邻槽口。该实施方式中的许多组件与本文第一实施方式中所示的相同，比如轴连接器212、球120、旋转旋钮24以及近端凸缘210。主要地，在此进一步详细地论述可选线缆接合构件384。在本文描述的第一实施方式中，轴部分的俘获涉及在位于手柄最近端端部处的释放杆160处的动作。在该第二实施方式中，采用包括线缆释放按钮388和释放杆430的单独构件。按钮388用于接合线缆节段之间的接触部，而杆430用于将轴部分314相对于手柄锁定就位。
如图13和15所示，可滑动套筒386支撑在手柄支撑管394内。套筒386用作控制夹紧指状物392的筒夹，其连接于释放按钮388并由释放按钮388操作。套筒386能够在形成为手柄一部分的支撑管394内向近端和向远端滑动。位于套筒386远端端部处的锥形部387(还请见图16和17)围绕接头340打开或闭合指状物392。当在接合或释放烧灼工具的过程中通过杆22拉动或释放线缆38B时，套筒386用作连接器390的滑道。为了与接头340进行电传导，指状物392可由金属材料制成。如在图13中395处所示，指状物392的基部393可焊接到金属型芯396，型芯396由在397处焊接到线缆38B的裸露端。弹簧398形式的电触头可附连到型芯396以确保与金属接头340良好的电接触，金属接头340可焊接到线缆38A上或以任意其它适当的方式附连。具有用于容纳指状物392的槽口402的塑料插入体400包括座部404(见图17)，用于接合接头340上的锥形部342。
插入体400在远端端部处也具有锥形部406(见图17)，以在将轴插入器械内时有助于接头340与连接器390的对准。图16中可以看到，线缆接头340在连接器390内自由旋转但保持与线缆38B电接触。释放按钮388通过狭窄颈部408(图15)附连到套筒386，狭窄颈部408突出穿过手柄中槽口410。释放按钮388滑进和滑出手柄顶部中的恰好位于角柄13之后的凹部412。按钮388凸块413，在锁定和解锁位置凸块413都卡合到凹部412中的定位槽414中。当沿图15所述的方向389拉动按钮388时，这个动作将套筒386从指状物392拉回，从而使指状物展开，从而为移除或插入接头340提供间隙。当其处于该外部或伸展位置时，按钮388明显地突出于手柄的表面之上，如图15中实线轮廓所示，作为线缆未锁定就位的清晰指示。如果按钮388向远端移动，这个动作使得套筒386抵靠连接器390滑动，并因此在指状物392处锁定线缆，如图13中实线轮廓所示。
在350处示出了轴锁定装置的一个可选实施方式，现在如图12-15中所示进行说明。替代如在本文所述的第一实施方式中那样夹紧块围绕颈部214闭合，具有半圆形边缘422(见图14)的门420俘住轴连接器212上的凸缘210。门420跨接在形成于支撑管394中的引导槽口424中。位于槽口底部处的止动部426(见图15)保持边缘422不与柱214接触。门420顶部上的凸台428通过销432与释放杆430相连。杆430安置在位于角柄13下侧上的槽口434中并在销436上枢转。杆430上的凸块438在解锁和锁定位置中都卡合在位于槽口434侧部上的定位槽440内。可通过在槽口的顶部处插入拇指指甲并向下推动而使用杆430。当杆处于图13中以虚线示出而图15中以实线示出的解锁位置时，明显地指示轴未锁定就位。当按钮388和杆430都处于其凹进位置时，器械处于备用状态。
旋转切割工具实施方式
图18示出手术器械的用作旋转切割工具的可选实施方式。其它细节在图18A、18B、18C、19和20中示出。端部执行器516具有保持诸如在本具体实施方式中为旋转刀具520的工具的筒夹夹紧机构516。可以理解，还可使用其它形式的旋转工具以及其它形式的固定工具。筒夹夹紧机构516允许筒夹560和线缆部分38A自由旋转。线缆部分38A穿过主器械轴中的低磨擦护套515(见图18B)并通过线缆接合装置或构件584连接到线缆部分38B。机构584将两个线缆部分以可旋转的方式且侧向地栓连接在一起。然后线缆部分38B经加强管64中的低磨擦护套517(见图18)通到滑动器28，只是在此处加强管和护套端部缺少套管66。然后，暴露的线缆被夹紧至套管66。套管66由低摩擦材料制成以便当线缆38B由马达526驱动时套管66能够在滑动器28内自由旋转。然后，线缆38B穿过护套的另一个短节段(未示出)，穿过手柄的端部通到位于马达526的马达轴524上的带花键的卡盘522。线缆被连接到卡盘522。花键卡盘522允许线缆有限的侧向运动，同时传递来自马达的旋转力，马达可由电池驱动或外连接到电源并可通过开关528控制。马达526、开关528以及电池和/或外部电源连接器容置在壳体延长部530内。
现在说明图18A-18C所示的筒夹机构516。该机构用于锁定和/或释放位于器械远端端头处的工具。为了这一目的，筒夹560支承在外壳564内的轴承562中，外壳564又连接到远端可弯曲构件20和线缆100，如图18B所示。当通过握紧杆22而拉动由正方形接头570紧固到夹爪基部568上的线缆38A时，四个夹爪566夹紧工具520。该动作将工具拉入筒夹内从而牢固地保持工具。杆22可设置有一个或多个定位装置，使得能够将杆保持在或者锁定或者释放的特定的所需位置。于是显示为锉刀的工具520可通过马达526高速旋转。
图18-20示出线缆锁定装置或构件584，其与线缆锁定装置384相似但改为将旋转力从线缆部分38A传递到线缆部分38B，而不是传递电流。连接器590由与图12-17中的在前实施方式所示的套筒386和锥形部387相似的可滑动套筒586和锥形部587支撑和操作。指状物592由基部593支承。这些指状物592具有略微凸起的缘边594和595，它们充当抵靠套筒586的支承表面。它们主要用于在当马达运转时连接器在套筒内旋转的时候减少旋转磨擦。由于它们不必有电流穿过，因此可以由金属或塑料制成。
指状物和基部安装在金属或塑料材质的型芯596上，型芯596紧固到线缆部分38B的端部。型芯596具有用于相应的指状物592的槽口602，槽口602允许指状物穿过但卡住接头件540。型芯596具有用于容置接头件540和锥形部606的座部604，以有助于在插入时引导接头。型芯具有带有锥形部610的端部敞开的槽口608。该槽口和锥形部引导并俘住具有锥形部546的四个接头544，锥形部546位于每个线缆接头544的圆周上。图19示出接头构件540，其每个接头544被俘于对应的槽口608中而指状物592受压，从而俘住接头构件540。缘边594形成抵靠套筒586的内表面的支承装置。另一方面，图20示出释放的机构584，其中指状物592展开并且接头构件540与指状物脱离接合。机构584部分地伸出套筒586。
到目前已说明了与本发明的原理有关的有限实施方式，现在对本领域技术人员来说显而易见，本发明的许多其它实施方式和改型都可被认为是落在如所附权利要求限定的本发明的范围内。比如，在本文公开的第一实施方式中，线缆通过线缆接头40和门260之间的接合而被接合。在可选实施方式中，替代接头，可在线缆中设置凹部，并且替代门中的槽口或缝隙，可采用凸起用于与凹部接合。此外，相应的连杆装置和滑动器机构可在本文说明的各种实施方式之间互换。

Claims (15)

1.一种手术器械，包括：
具有近端端部和远端端部的器械轴；
设置于所述器械轴的远端端部的工具；
耦联于所述器械轴的近端端部的控制手柄；
用于将所述器械轴的远端端部耦联到所述工具的远端运动构件；
用于将所述器械轴的近端端部耦联到所述手柄的近端运动构件；
在所述远端运动构件和所述近端运动构件之间延伸的致动装置，用于将所述近端运动构件的运动耦联到所述远端运动构件以便控制所述工具的定位；
远端接收器部分；
位于所述近端运动构件上的轴连接器，所述轴连接器能够选择性地与所述接收器部分接合以及从所述接收器部分释放；
致动线缆，用于从安装在所述控制手柄处的致动杆控制对所述工具的致动；以及
安装在所述控制手柄处的旋转旋钮，所述旋转旋钮适于使所述器械轴和所述工具绕远端工具滚动轴线旋转；
至少所述近端运动构件包括近端可弯曲构件；
所述旋转旋钮承载所述远端接收器部分，所述轴连接器构造并设置成能够与所述远端接收器部分接合或能够从所述远端接收器部分释放；
并且，所述致动线缆具有能够分离的近端线缆部分和远端线缆部分，所述近端线缆部分由所述致动杆控制，所述远端线缆部分能够相对于所述近端线缆部分选择性地接合或释放。
2.如权利要求1所述的手术器械，其中，所述旋转旋钮设置在所述控制手柄和所述近端可弯曲构件之间。
3.如权利要求1所述的手术器械，其中，所述致动杆由所述手柄在所述手柄上的枢轴点处支撑；由所述致动杆控制的连杆机构；以及由所述连杆机构控制的线缆接合构件，用于俘住位于所述致动线缆的近端端部处的接头，从而控制所述致动线缆进而控制所述工具。
4.如权利要求3所述的手术器械，其中，所述连杆机构包括棘齿与棘爪机构和多个连接连杆，所述棘齿与棘爪机构提供用于控制施加在所述工具上的力的连续的杆位置，所述多个连接连杆中的一个连接连杆包括其间具有偏压弹簧的拼合连杆。
5.如权利要求3所述的手术器械，其中，所述线缆接合构件包括支撑门的滑架，所述门能够横向于所述滑架的纵向轴线移动，以便俘住所述线缆接头。
6.如权利要求5所述的手术器械，包括用于偏压所述门的弹簧以及能够与所述门接合以打开所述门从而能够释放所述线缆接头的凸轮块。
7.如权利要求1所述的手术器械，包括锁定机构，所述锁定机构用于固定位于选定位置处的所述工具的位置并且具有锁定状态和解锁状态，所述锁定机构包括围绕所述近端运动构件设置的球-窝装置和用于锁定所述球-窝装置的紧固构件。
8.如权利要求7所述的手术器械，其中，所述窝构件包括拼合窝，并且所述紧固构件闭合所述拼合窝以将所述窝锁定在所述球上。
9.如权利要求3所述的手术器械，包括一组夹紧块，所述线缆的所述接头的远端具有凸缘，所述凸缘由所述夹紧块俘获，所述夹紧块由位于所述手柄的近端端部处的释放构件进行操作。
10.如权利要求9所述的手术器械，包括套筒构件和连杆构件，所述连杆构件用于通过所述释放构件来控制所述套筒构件的移动，所述套筒构件控制所述夹紧块朝向和远离彼此移动，从而在所述线缆凸缘处提供夹紧作用。
11.如权利要求1所述的手术器械，包括用于接合所述线缆部分的线缆锁定机构和用于保持所述轴连接器的轴锁定机构。
12.如权利要求11所述的手术器械，其中，所述线缆锁定机构包括安装在所述手柄上的套筒和释放按钮以及位于所述近端线缆部分的远端端部处的连接器，所述连接器具有多个指状物，用于与所述远端线缆部分上的接头选择性地接合以便俘住所述线缆接头，并且其中，所述轴锁定机构包括安装在所述手柄上释放杆和门，所述门用于俘住位于所述远端线缆部分上的柱。
13.如权利要求1所述的手术器械，其中，所述工具包括筒夹、容置在所述筒夹内的可拆卸工具构件以及用于保持所述工具构件的一组夹爪。
14.如权利要求13所述的手术器械，其中，所述工具构件是烧灼工具，并且所述手术器械进一步包括：电压源，所述电压源位于所述手柄处并用于将能量耦连至所述致动线缆；以及致动杆，所述致动杆用于控制所述致动线缆进而控制所述一组夹爪以便夹持所述工具构件。
15.如权利要求13所述的手术器械，其中，所述工具包括旋转刀具，并且所述手术器械进一步包括：马达，所述马达位于所述手柄上并用于经由所述致动线缆控制所述旋转刀具；以及致动杆，所述致动杆用于控制所述致动线缆。
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CA2710251A1 (en) 2009-07-16
KR20100110801A (ko) 2010-10-13
JP2011509112A (ja) 2011-03-24
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CN101909526A (zh) 2010-12-08
US20090171147A1 (en) 2009-07-02

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