CN102106745A - 手术装置 - Google Patents
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/2812—Surgical forceps with a single pivotal connection
- A61B17/282—Jaws
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00199—Electrical control of surgical instruments with a console, e.g. a control panel with a display
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
- A61B2017/07214—Stapler heads
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2933—Transmission of forces to jaw members camming or guiding means
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- A—HUMAN NECESSITIES
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- A61B2017/2926—Details of heads or jaws
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- A61B2017/2933—Transmission of forces to jaw members camming or guiding means
- A61B2017/2936—Pins in guiding slots
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- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2939—Details of linkages or pivot points
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2944—Translation of jaw members
Abstract
一种手术装置,包括第一钳夹和相对于第一钳夹能够在第一位置和第二位置之间移动的第二钳夹,在所述第一位置中第一和第二钳夹在一个平面内对准,在所述第二位置中第二钳夹相对于所述平面非平行。该手术装置可以包括:布置在第一钳夹内的手术元件,例如切割和/或钉合元件;和被配置成使所述手术元件沿平行于所述平面的方向的相对运动的第二驱动器。第一和第二钳夹可以包括被配置成使第二钳夹在第一和第二位置之间移动的凸轮装置。所述凸轮装置可以包括沿着第一和第二钳夹中的至少一个或两者的至少一部分布置的沟槽,滚珠布置在所述沟槽内。
Description
本申请是申请号为200680035667.9、申请日为2006年7月26日、发明名称为“手术装置”的专利申请的分案申请。
相关申请的相互参照
本申请涉及2000年2月22日申请的、序列号为09/510,923的美国专利申请,即现在于2003年2月11日公开的美国专利No.6,517,565,2000年11月28日申请的、序列号为09/723,715的美国专利申请,2001年4月17日申请的、序列号为09/836,781的美国专利申请,2001年6月22日申请的、序列号为09/887,789的美国专利申请,和2001年12月4日申请的、序列号为60/337,544的美国临时专利申请,2002年12月4日申请的、序列号为10/309,532的美国专利申请,2002年3月8日申请的、序列号为10/094,051的美国专利申请,每个前述申请的全部内容清楚地通过援引并入本申请。
技术领域
本发明涉及手术装置。更具体而言,本发明涉及具有可旋转钳夹的夹紧、切割和钉合装置。
背景技术
手术装置的描述在文献中到处可见。这些手术装置中的一些在下列专利中被描述:Sjostrom等人的美国专利No.4,705,038;Ams等人的美国专利No.4,995,877;Mallaby等人的美国专利No.5,249,583;Byrne等人的美国专利No.5,395,033;Tsuruta等人的美国专利No.5,467,911;Hooven的美国专利Nos.5,383,880,5,518,163,5,518,164和5,667,517;Young等人的美国专利No.5,653,374;Alesi等人的美国专利No.5,779,130;和Viola等人的美国专利No.5,954,259。
一种类型的手术器械是直线型钉合装置,其是用于切割和钉合一部分组织的铡刀式装置。图1(a)示出了如美国专利No.3,494,533中所述的这样的装置的例子。图1(a)中所示的装置包括彼此对应地平行移动的相对钳夹。第一钳夹具有布置于其内的缝合钉的布置,而第二钳夹提供用于接收和闭合缝合钉的钉砧。推钉器位于第一钳夹内并且从第一钳夹的近端延伸到第一钳夹的远端。耦联到第一钳夹和推钉器的驱动轴位于第一钳夹和推钉器的运动平面中。当致动时,驱动轴驱动推钉器以同时推动所有缝合钉靠在第二钳夹的钉砧中的缝合钉导槽上。
手术装置的其他例子在美国专利No.4,442,964,美国专利No.4,671,445和美国专利No.5,413,267中被描述。这样的手术钉合器包括彼此对应地平行移动的相对钳夹,其中第一钳夹具有布置在其中的缝合钉的布置,而第二钳夹提供用于接收和闭合缝合钉的钉砧。推钉器位于第一钳夹内并且从第一钳夹的近端延伸到第一钳夹的远端。耦联到第一钳夹和推钉器的驱动轴位于第一钳夹和推钉器的运动平面中并且当致动时,驱动轴驱动推钉器以同时推动所有缝合钉靠在第二钳夹的钉砧中的缝合钉导槽上。
另一种类型的手术装置是例如在美国专利No.6,264,087中描述的线性夹紧、切割和钉合装置。这样的装置可以用在手术操作中从胃肠道切除癌变或异常组织。在图1(b)中以透视图示出了一种常规线性夹紧、切割和钉合器械。该装置包括具有细长轴和远端部分的手枪把式结构。远端部分包括一对剪刀式夹紧元件,其夹紧闭合结肠的敞开端。两个剪刀式夹紧元件中的一个,即钉砧部分,相对于总体结构移动或枢转,而另一夹紧元件相对于总体结构保持固定。该剪切装置的致动——即钉砧部分的枢转——受布置在手柄中的扳机控制。除了剪切装置之外,远端部分还包括钉合机构。剪切机构的固定夹持元件包括钉盒容置区域和用于抵靠钉砧部分驱动缝合钉穿过组织的被夹紧端由此密封先前敞开的端部的机构。剪切元件可以与所述轴形成为一体或者可以是可拆卸的使得各个剪切和钉合元件可以是可互换的。
一般而言,以下列方式利用这些手术装置:一旦识别胃肠道中的癌变或其他异常组织(和一旦确定癌变组织位于结肠中的一个位置),则一开始先打开患者的腹部以暴露肠。然后外科医生切掉癌变组织的两侧的结肠的管道,并且用缝合钉闭合肠的两个敞开端(朝着肛门的远端,和最接近下肠的近端)。执行该临时闭合是为了最小化暴露腹部受到肠内容物污染。更特别地,当结肠放置在手术装置的钳夹之间时实现肠的两个敞开端的该临时闭合。通过致动第一驱动机构,外科医生使钳夹靠拢。然后致动第二驱动机构以驱动一系列的缝合钉和一个切割刀片通过结肠的夹紧端,由此闭合和横切所述端部。通常,在癌变或异常组织的另一侧重复一次该操作。
前述手术装置的一个问题在于所述装置可能难以操纵。由于这些装置可能在身体内使用——例如在患者身体的内部使用,因此装置应当被配置成能够在患者身体的内部操纵。例如在图1(a)和1(b)中所示的常规手术装置难以操纵,尤其是在患者的身体内部难以操纵。
前述手术装置的另一问题在于所述装置可能难以令人满意地定位在患者的身体内。例如,当常规装置用于夹紧、切割和钉合紧邻肛门残端的一部分组织时,理想的情况是尽可能靠近肛门定位所述装置,并且夹紧、切割和钉合一部分组织,然而,常规装置有可能不能随心所欲地被定位成尽可能靠近肛门残端,原因是手术装置的钳夹当处于打开位置时需要大空间并且不能令人满意地由患者身体内部和围绕肛门残端的组织定位。
发明内容
本发明根据其中的一个示例性实施例涉及一种手术装置。所述手术装置包括第一钳夹。所述手术装置还包括相对于第一钳夹在第一位置和第二位置之间可移动的第二钳夹,在所述第一位置中第一和第二钳夹在一个平面内对准,在所述第二位置中第二钳夹对应于所述平面非平行。照这样,第二钳夹相对于第一钳夹能够在闭合位置和打开位置之间移动——例如转动。例如,在操作期间,当第二钳夹相对于第一钳夹移动第一距离时第二钳夹可以在所述平面内移动,并且当第二钳夹相对于第一钳夹移动第二距离时可以至少部分地移动——例如转动——到所述平面之外。所述手术装置可以包括被配置成使第一钳夹和第二钳夹相对运动的第一驱动器,所述第一驱动器与驱动轴接合,所述驱动轴能够绕相对于所述平面平行地或非平行地——例如垂直地——设置的旋转轴线旋转。
所述手术装置也可以包括:布置在第一钳夹内的手术元件——例如切割和/或钉合元件;和被配置成使所述手术元件沿平行于所述平面的方向的相对运动的第二驱动器。第二驱动器可以被配置成与第二驱动轴接合,所述第二驱动轴能够绕相对于所述平面平行地或非平行地——例如垂直地——设置的旋转轴线转动。机电驱动器可以用于旋转可旋转的第一驱动轴,使得可旋转的第一驱动轴沿第一方向旋转以实现钳夹的伸展和沿与第一方向相反的第二方向旋转以实现钳夹的闭合。在一个示例性实施例中,第一驱动器至少包括:彼此呈转动啮合关系的正齿轮、蜗杆和蜗轮;以及带外螺纹的螺钉,其与第二钳夹的内螺纹孔啮合并且一端固定连接到所述蜗轮,由此齿轮的旋转使第一钳夹和第二钳夹相对运动。
另外,所述机电驱动器可以用于旋转可旋转的第二驱动轴,使得可旋转的第二驱动轴沿第一方向旋转以伸展所述手术元件和沿与第一方向相反的第二方向旋转以缩回所述手术元件。在一个示例性实施例中,第二驱动器至少包括:正齿轮和蜗杆,其彼此呈转动啮合关系并且与一对附加蜗轮呈转动啮合关系,所述一对附加蜗轮的每一个具有居中布置的内螺纹孔,所述内螺纹孔分别与固定连接至所述手术元件的一对带外螺纹的螺钉中的一个啮合,由此齿轮的旋转使得所述手术元件相对运动。所述机电驱动器可以包括适于驱动可旋转的第一和第二驱动轴中的每一个的至少一个马达装置。
在一个示例性实施例中,第二钳夹的内螺纹孔布置在臂内,所述臂被配置成在附连到第一钳夹的套筒内和相对于所述套筒纵向地移动,所述套筒和所述臂具有被配置成在第一和第二位置之间移动第二钳夹的凸轮装置。所述凸轮装置可以包括沿着所述臂和所述套筒中的至少一个布置的沟槽,滚珠布置在所述沟槽内。
本发明根据其中的一个示例性实施例涉及一种包括第一钳夹和第二钳夹的手术装置。第二钳夹耦联到第一钳夹并且相对于第一钳夹能够在闭合位置和中间打开位置之间移动。在闭合位置和中间打开位置之间,第一和第二钳夹的夹紧表面限定相对于彼此平行对应的第一和第二平面。另外,第二钳夹相对于第一钳夹能够进一步在中间打开位置和完全打开位置之间移动。在中间打开位置和完全打开位置之间,由第一和第二钳夹的夹紧表面限定的第一和第二平面移动脱离彼此平行对应的关系。例如,在中间打开位置和完全打开位置之间,第二钳夹相对于第一钳夹能够围绕垂直于所述平面的轴线枢转。在闭合位置中,第一钳夹和第二钳夹可以布置在第三平面中,并且被配置成使第一钳夹和第二钳夹产生相对运动的第一驱动器可以被配置成与能够围绕旋转轴线旋转的可旋转的第一驱动轴接合,所述旋转轴线相对于第三平面平行地或非平行地设置。所述手术装置也可以包括手术元件,例如切割和/或钉合元件或安装切割和/或钉合元件的推板,所述手术元件布置在第一钳夹内,其中第二驱动器被配置成使所述手术元件沿平行于第三平面的方向相对运动。第二驱动器可以与能够围绕旋转轴线旋转的第二驱动轴接合,所述旋转轴线相对于第三平面平行地或非平行地设置。机电驱动器可以用于旋转可旋转的第一和/或第二驱动轴。
附图说明
图1(a)是常规手术装置的侧视图;
图1(b)是常规线性夹紧、切割和钉合装置的透视图;
图2是根据本发明的一个示例性实施例的机电手术系统的透视图;
图3是根据本发明的一个示例性实施例的切割和钉合附件处于打开位置的透视图;
图4是图3中所示的切割和钉合附件处于关闭位置的侧视图;
图5是图3和图4中所示的切割和钉合附件的侧视图,其中手术元件处于缩回位置;
图6是图3-5中所示的切割和钉合附件的侧视图,其中手术元件处于伸展位置;
图7是图3和图4中所示的切割和钉合附件的俯视图;
图8(a)是根据本发明的一个示例性实施例的钉盒组件的分解图;
图8(b)是根据本发明的另一示例性实施例的推板部件的分解图;
图8(c)是根据本发明的一个示例性实施例的钉砧部件的分解图;
图8(d)是根据本发明的另一示例性实施例的侧板部件的分解图;
图8(e)是根据本发明的另一示例性实施例的切割和钉合附件的部分分解透视图;
图9是图8(a)-8(e)中所示的切割和钉合附件的组装好的透视图,其处于打开位置;
图10是图2中所示的机电手术装置的挠性轴的部分剖切侧视图;
图11是沿着图10中所示的线11-11获得的挠性轴的横截面图;
图12是图10中所示的挠性轴的第一耦联器的后端视图;
图13是图10中所示的挠性轴的第二耦联器的前端视图;
图14是图2中所示的机电手术系统的马达装置的示意图;
图15是图2中所示的机电手术系统的示意图;
图16是图10中所示的挠性轴的编码器的示意图;
图17是根据本发明的一个示例性实施例的线性夹紧、切割和钉合装置的存储装置的示意图;
图18是图2中所示的机电手术系统的无线遥控单元的示意图;和
图19是图2中所示的机电手术系统的有线遥控单元的示意图。
图20(a)-(c)是根据本发明又一示例性实施例的切割和钉合附件的各种视图。
具体实施方式
根据本发明的手术装置11的一个示例性实施例在图3-7中示出。参考图3和图4,示出了手术装置11的一个示例性实施例,例如夹紧、切割和钉合装置。在该示例性实施例中,手术装置11包括相对于第一钳夹80可移动的第二钳夹50。第二钳夹50的第一端50a机械地耦联到第一钳夹80的第一端80a。
图3是示出处于打开位置的手术装置11的透视图,其中第二钳夹50和第一钳夹80在它们的第一端50a和80a彼此接触。在该打开位置,第一钳夹80保持在图3中所示的x和y轴所限定的纵向平面中,而第二钳夹50至少部分地移动——例如旋转——到由x和y轴所限定的纵向平面之外。具体而言,手术装置11被配置成使得第二钳夹50除了相对于第一钳夹80垂直地移动之外,第二钳夹50的远端50b移动与第一钳夹80b的远端80b对齐和脱离对齐。
齿轮箱255安装在第一钳夹80a的侧面上。齿轮箱255包括耦联到第一驱动器150的第一驱动插座180,为了清楚起见其示意性地被示出。第一驱动器150耦联到第二钳夹50的第一端50a以打开和闭合第一钳夹80和第二钳夹50。另外,齿轮箱255还包括第二驱动插座310。
图4示出了处于闭合位置的手术装置11。在该闭合位置,第二钳夹50和第一钳夹80在它们的第一端50a和80a并且也在它们的第二端50a和50b彼此接触。因而,在图3和图4中所示的打开和闭合位置之间,第二钳夹50的远端50b移动到与第一钳夹80的远端80b对准。在闭合位置,一部分组织可以被夹紧在第二钳夹50和第一钳夹80之间。
图5和图6也示出了处于闭合位置的手术装置11。图5和图6示出了齿轮箱255的、耦联到第二驱动器261的第二驱动插座310,其示意性地被示出。第二驱动器261耦联到手术元件262。手术元件262可以包括切割和钉合组件262,还可以设置其他类型的手术元件。
第二驱动器261耦联到切割和钉合组件262以将切割和钉合组件262从如图5中所示的第一缩回位置移动到如图6中所示的第二伸展位置。尽管示出两个驱动插座——例如第一驱动插座180和第二驱动插座310,和两个相应的驱动轴——例如第一驱动轴630和第二驱动轴632(参见下文),但可以设置任何合适数量的驱动插座和驱动轴。例如,可以设置单一驱动轴以驱动手术装置。
图7是图3-6中所示的手术装置11的俯视图。图7示出了例如以可拆卸方式或永久地耦联到机电驱动部件610的手术装置11。图7示出了包括第一驱动器150的手术装置11,所述第一驱动器150通过第一驱动插座180由第一驱动轴630耦联到系统610的第一马达680。当与系统610接合时第一驱动器150操作以相对于第二钳夹50打开和闭合第一钳夹80。另外,图7示出了该手术装置11包括第二驱动器261,所述第二驱动器261通过第二驱动插座310由第二驱动轴632耦联到系统610的第二马达676。当与系统610接合时第二驱动器261操作以驱动切割和钉合组件262。如图7中所示,第一驱动插座180和第二驱动插座310布置在手术装置11上使得第一驱动轴630和第二驱动轴632可以与图3中所示的x-y平面成一个角度——例如垂直——地耦联到手术装置11。也就是说,第一驱动轴630和第二驱动轴632例如可以沿图7中所示的z轴的方向耦联到手术装置11。
图8(a)-8(e)是根据本发明的一个示例性实施例的手术装置11的各种分解图,并且图9是组装后的手术装置11的透视图。
图8(a)是钉盒组件507的分解图。钉盒组件507包括推钉器514。推钉器514附连到推板502(在下文解释)的底面5022。推钉器514包括向下布置的齿5143的平行排5141和5142,每一排与钉砧505(在下文解释)的缝合钉导槽5053对应和对准。具有面向下的切割刃5191的刀具519布置在推钉器514的向下布置的齿5143的平行排之间。
缝合钉座513布置在推钉器514的下方。缝合钉座513包括具有垂直布置的槽5132的钉盒,每个槽与推钉器514的向下布置的齿5143和钉砧505的缝合钉导槽5053对应和对准。包括叉脚5281的缝合钉528设在每个槽5132中。缝合钉座513还包括纵向布置的槽5131,其延伸穿过缝合钉座513并且刀具519可以穿过其中。缝合钉座513包括邻近一端5134的孔5133。
缝合钉座513的邻近缝合钉座513的一端5134的孔5133被配置成容置销518的一端5181。在该示例性实施例中,销518保持在基本竖直的姿势以垂直于缝合钉座513。销518包括在其另一端5184的居中布置的内孔5183,内孔5183被配置用来容置弹簧524。销518的端部5184还设置有垂直地附连到销518的杆5182。弹簧524将销518的端部5181偏压到钉砧505(在下文解释)的孔口5057中。
钉盒帽515例如通过焊接附连到缝合钉座513的端部5134。钉盒帽515的销5151,5152和5153分别与缝合钉座513的开口5135,5136和5137接合。钉盒帽515还包括设置于内部的孔5154,孔5154配置成容置销518。钉盒帽515的孔5154包括与其连通的槽5153,槽5153被配置成导引销518的杆5182。在一个示例性实施例中,钉盒帽515的设置于内部的孔5154并不延伸贯通钉盒帽515的顶面5155;相反地,它将弹簧524保持在设置于内部的孔5154内。弹簧524的偏压力将销518的端部5181推到缝合钉座513的孔5133中并且确保缝合钉座513定位成使得槽5132与推钉器514的向下布置的齿5143和钉砧505的缝合钉导槽5053对准。钉盒帽515也由覆盖缝合钉座513的钉盒套筒526保持就位。存储单元5011安装在钉盒套筒的槽5261内。
图8(b)是推板部件5031的分解图。推板部件5031包括螺钉503和504。螺钉503和504例如通过焊接固定地耦联到推板502的顶面5021。
图8(c)是钉砧部件504的分解图。根据该示例性实施例,钉砧部件504包括例如通过焊接耦联到钉砧旋转臂509的钉砧505。钉砧旋转臂509包括沿纵向贯通延伸的、竖直设置的内螺纹孔5051。钉砧旋转臂509还包括位于其外表面上的凸轮装置,例如沟槽5052。沟槽5052沿着钉砧旋转臂509的外表面的下部纵向地延伸,然后如图8(c)中所示沿着钉砧旋转臂509的外表面的上部弯曲。另外,钉砧505包括沿着钉砧505的、与第一钳夹80相对应的区域5054平行布置的多个钉坑或导槽5053。在多个缝合钉导槽5053之间设置有刀具垫520。
图8(d)是侧板部件560的分解图。侧板部件560具有顶板5601和侧板5602。顶板5601具有第一槽5603和第二槽5604,每个槽均具有侧向布置的敞开端。而且,顶板5601具有第三槽5605,该第三槽具有后向布置的敞开端。旋转臂套筒570例如通过焊接安装到侧板部件560,旋转臂套筒570具有贯通延伸的、纵向布置的内孔5701。孔5701的一部分被切去以形成竖直布置的槽5702。孔5701的内表面具有开口,凸轮装置的一部分——例如诸如滚珠这样的凸轮随动件571一体地安装在所述开口中。
图8(e)是根据本发明的一个示例性实施例的手术装置11的部分分解透视图。根据该示例性实施例,第二钳夹50包括钉砧部件504。相对于图8(c)中所示的分解图,钉砧部件504在图8(e)被显示成已组装好。
第一钳夹80包括第二侧板部件506。第二侧板部件506的外表面5062具有用于安装齿轮箱255的装置。齿轮箱255通过紧固件例如螺钉533安装到第二侧板部件506的外表面5062。
快速连接耦联器511安装在齿轮箱255上并且通过一组弹簧被偏压。齿轮箱255包括第一驱动插座180和第二驱动插座310。在该示例性实施例中,第一驱动插座180包括第一小齿轮508a(未示出),其一端延伸通过齿轮箱255的开口2551并且其另一端包括正齿轮齿。第二驱动插座310包括第二小齿轮508b(未示出),其一端延伸通过齿轮箱255的第二开口2552并且其另一端包括接合端。存储模块501布置在齿轮箱255中并且包括连接器,该连接器延伸穿过齿轮箱255的开口或者通过齿轮箱255的开口能够够到。存储模块501由内侧和外侧垫片保持在齿轮箱255内适当位置。存储模块501也由弹簧539偏压在其位置。
第一和第二小齿轮508a和508b分别啮合正齿轮529a和耦联元件529b。第一正齿轮529a包括内孔5293(以虚线显示),该内孔与第一蜗杆523a的端部5231以不可旋转的方式接合。耦联元件529b包括内孔5294,该内孔与第二蜗杆523b的端部5234以不可旋转的方式接合并且与第二小齿轮508b的接合端以不可旋转的方式接合。如图8(e)中所示,孔5293和5294,端部5231,5234,和第二小齿轮508b的接合端例如可以是矩形。应当理解孔5293,5294,端部5231,5234,和第二小齿轮508b的接合端可以具有能在它们之间提供不可旋转的接合的任何形状或配置。
在该示例性实施例中,第一蜗杆523a具有与第一正齿轮529a的内孔5293以不可旋转的方式接合的一端5231,和包括沿周向设置的螺纹(一条或多条)5233的第二端5232。第二蜗杆523b具有与耦联元件529b的内孔5294以不可旋转的方式接合的一端5234,和包括沿周向设置的螺纹5236的第二端5235。第一蜗杆523a的第二端5232延伸通过侧板部件560的侧板5602中的孔5607,并且蜗杆523a的端部5231与第一正齿轮529a接合。第二蜗杆523b的第二端5235延伸通过侧板部件560的侧板5602中的孔5606,并且蜗杆523b的端部5234与耦联元件529b接合。
在手术装置11内还设置有蜗轮522。蜗轮522具有沿周向布置的齿5221,所述齿与蜗杆523a的第二端5232的螺纹(一条或多条)5233啮合。蜗轮522包括内孔,穿过该内孔布置有螺钉521。螺钉521具有头部5211,在该头部的下方形成周向凹槽5222。螺钉521与蜗轮522的内孔接合成不可旋转。蜗轮522和螺钉521可以独立地或一体地形成。头部5211和凹槽5222被配置成安装和保持在侧板部件560的槽5605内。螺钉521具有外螺纹5214,所述外螺纹5214与旋转臂509的内螺纹孔5051接合。
手术装置11内还设置有蜗轮516和蜗轮517。蜗轮516和蜗轮517被定位在蜗杆523b的两相对侧上。具体而言,蜗轮516包括与蜗杆523b的第一侧啮合的沿周向布置的轮齿5161,并且蜗轮517包括与蜗杆523b的第二侧啮合的沿周向布置的轮齿5171。蜗轮516包括头部5162,在该头部的下方形成周向凹槽5163。头部5162和凹槽5163被配置成安装和保持在侧板部件560的槽5606内,使得蜗轮516围绕其竖直中心轴线可旋转。蜗轮517包括头部5172,在该头部的下方形成周向凹槽5173。头部5172和凹槽5173被配置成安装和保持在侧板部件560的槽5607内,使得蜗轮517围绕其竖直中心轴心可旋转。
推板组件5031(相对于图8(b)中所示的分解图,其在图8(e)被显示成已组装)的带外螺纹的螺钉504穿过蜗轮516的内螺纹孔5164设置。带外螺纹的螺钉503穿过蜗轮517的内螺纹孔5174设置。由于蜗轮516和517位于蜗杆523b的两相对侧上并且与两相对侧啮合,蜗轮516和517的内螺纹孔5164和5174,以及带外螺纹的螺钉504和503,可以相对于彼此具有相反的螺旋方向。在所示的示例性实施例中,蜗轮516的内螺纹孔5164可以具有右旋螺纹,该右旋螺纹接合螺钉504的右旋外螺纹,并且蜗轮517的内螺纹孔5174可以具有左旋螺纹,该左旋螺纹接合螺钉503的左旋外螺纹。如上所述,螺钉503和504固定地耦联到推板502的顶面5021。
相对于图8(a)中所示的分解图如图8(e)中所示的组装好的钉盒组件507设置成使得推钉器514被定位在推板502的底面5022的下方。缝合钉座513布置在推钉器514的下方。
为了组装手术装置11,钉盒组件507的近端5071与旋转臂套筒570的槽5702的侧面上的表面5073配合。所述齿轮布置在推板部件5031和侧板部件560的顶板5601之间并且部分地通过它们与侧板部件560的槽和开口的接合——例如通过头部(例如头部5162,5172和5211)接合在侧板部件560的槽(例如槽5603,5604和5605)内——而被保持就位。螺钉521的螺纹5214与旋转臂509的内螺纹孔5051接合。旋转臂509位于旋转臂套筒570的中心孔5701内。凸轮随动件571保持在旋转臂套筒的孔5071内并且在孔5071的内部延伸使得凸轮随动件571的一部分在旋转臂509的沟槽5052内。
第二侧板部件506例如通过螺钉599附连到侧板部件560使得齿轮、推板部件5031、钉盒组件507和旋转臂509(其位于旋转臂套筒570内)布置在两者之间。齿轮箱255例如通过螺钉533附连到第二侧板部件506。
图9是完全组装好的、处于打开位置的手术装置11的透视图。应当理解尽管图3-9中所示的本发明的示例性实施例包括钉合和切割元件的铡刀式布置,但在另一示例性实施例中,钉合和切割元件在手术装置11的近端和远端之间移动。例如,手术装置11的可替代的示例性实施例可以包括耦联到在手术装置11的近端和远端之间移动的钉合和切割元件的齿轮,所述齿轮由相对于第一钳夹80和第二钳夹50的运动平面非平行地——例如垂直地——耦联的驱动轴驱动。
此外,应当理解尽管在图3-9中所示的本发明的示例性实施例包括的布置中驱动插座180,310被配置成分别与能够围绕相对于x-y平面(例如参见图3)非平行地(例如垂直地)设置的旋转轴进行旋转的驱动轴——例如驱动轴630和632——接合,而在另一示例性实施例中,手术装置11可以提供这样一种布置,其中:驱动插座180,310被配置成分别与能够围绕相对于x-y平面平行地设置的旋转轴进行旋转的驱动轴——例如驱动轴630和632——接合。
再进一步地,应当理解用于相对于第一钳夹80旋转第二钳夹50的凸轮装置可以具有各种不同配置。例如,被显示和描述成在旋转臂509上的沟槽5052可以布置在旋转臂和旋转臂套筒570之一或两者上。此外,旋转臂509的沟槽5052可以具有不同于上文所述的形状。相反地,本发明可以包括被配置成将第二钳夹50移动到相对于第一和第二钳夹处于闭合位置时所限定的平面非平行的位置的任何凸轮装置。
再进一步地,应当理解尽管在图3-9中所示的本发明的示例性实施例包括的布置中第一和第二钳夹的夹紧表面限定了在操作期间相对于彼此保持平行的平面,但在另一示例性实施例中,手术装置11可以提供这样一种布置,其中:第一和第二钳夹的夹紧表面限定的平面在操作期间并不相对于彼此保持平行。例如,在一个示例性实施例中,手术装置11可以提供一种布置,其中第一和第二钳夹至少部分地以剪刀方式打开和闭合,第一和第二钳夹在它们各自的近端例如通过铰链等连接。例如,手术装置可以提供这样一种布置,其中:第二钳夹耦联到第一钳夹并且相对于第一钳夹能够在闭合位置和中间打开位置之间移动,其中在闭合位置和中间打开位置之间,第一和第二钳夹的夹紧表面限定相对于彼此保持平行对应的第一和第二平面。另外,第二钳夹相对于第一钳夹可以进一步地在中间打开位置和完全打开位置之间移动,其中在中间打开位置和完全打开位置之间,第一和第二钳夹的夹紧表面所限定的第一和第二平面移动彼此不再平行对应,例如在中间打开位置和完全打开位置之间第一和第二钳夹以类似剪刀方式移动。例如在图20(a)一(c)中示出了这样的布置,所述图是根据本发明的另一示例性实施例的切割和钉合附件的各种视图。具体而言,图20(a)是具有这样的布置的装置的透视图。图20(b)是穿过导向螺钉获得的该装置的横截面图。图20(c)是穿过凸轮销获得的该装置的横截面图。
再进一步地,应当理解尽管在图3-9中所示的本发明的示例性实施例包括的布置中第一和第二钳夹在操作的一部分期间相对于彼此至少可旋转地移动使得第二钳夹移动到当第一和第二钳夹处于完全闭合位置时由第一和第二钳夹所限定的平面之外,但在一个示例性实施例中,手术装置11可以提供这样一种布置,其中:当第一和第二钳夹处于完全闭合位置时第一和第二钳夹并不相对于彼此至少可旋转地移动到第一和第二钳夹所限定的平面之外。例如,在一个示例性实施例中,手术装置11可以提供一种布置,其中第一和第二钳夹至少部分地以剪刀方式打开和闭合,第一和第二钳夹在它们各自的近端例如通过铰链等连接,使得当第一和第二钳夹处于完全闭合位置时第二钳夹保持在第一和第二钳夹所限定的平面中。例如,手术装置可以提供一种布置,其中第二钳夹耦联到第一钳夹并且相对于第一钳夹能够在闭合位置和中间打开位置之间移动,其中在闭合位置和中间打开位置之间,第一和第二钳夹保持在当第一和第二钳夹处于完全闭合位置时由第一和第二钳夹所限定的平面内。另外,第二钳夹相对于第一钳夹能够进一步在中间打开位置和完全打开位置之间移动,其中在中间打开位置和完全打开位置之间,第一和第二钳夹以类似剪刀方式移动并且保持在当第一和第二钳夹处于完全闭合位置时由第一和第二钳夹所限定的平面内。
根据本发明的一个示例性实施例,手术装置11可以被配置成附连到机电手术系统例如机电驱动部件610的附件,或者可以与其一体化。在另一示例性实施例中,手术装置可以是附连到机械驱动系统的附件,或者可以与其一体化。
图2是根据本发明的机电驱动部件610的一个示例性实施例的透视图。这样的机电驱动部件的例子例如在美国专利申请No.09/723,715,美国专利申请No.09/836,781和美国专利申请No.09/887,789中有所描述,上述每个申请的全部内容通过援引并入本申请。机电驱动部件610例如可以包括远程动力控制台612,动力控制台612包括具有前面板615的外壳614。前面板615上安装显示装置616和指示器618a,618b。挠性轴620可以从外壳614延伸并且可以通过第一耦联器622以可拆卸方式附连到外壳614。挠性轴620的远端624可以包括第二耦联器626,该第二耦联器适于以可拆卸方式将例如上述的手术装置11附连到挠性轴620的远端624。第二耦联器626也可以适于以可拆卸方式附连不同的手术器械或附件。在另一示例性实施例中,挠性轴620的远端624可以永久地附连手术器械或与其一体化。
参考图10,可以看到挠性轴620的部分剖切侧视图。根据一个示例性实施例,挠性轴620包括管状套628,该管状套可以包括涂层或其他密封装置,所述的涂层或其他密封装置被配置成提供挠性轴620的内部通道640和外界环境之间的流体密封。套628可以由能与组织兼容的、无菌弹性材料形成。套628也可以由耐高压加热的材料形成。可旋转的第一驱动轴630,可旋转的第二驱动轴632,第一转向电缆634,第二转向电缆635,第三转向电缆636,第四转向电缆637和数据传送电缆638可以布置在挠性轴620的内部通道640内,并且沿着其整个长度延伸。图11是沿着图10中所示的线11-11获得的挠性轴620的横截面图并且进一步示出了所述的这几个电缆630,632,634,635,636,637,638。转向电缆634,635,636,637的各自远端固定到挠性轴620的远端624。所述的这几个电缆630,632,634,635,636,637,638均可以容纳在各自的套内。
可旋转的第一驱动轴630和可旋转的第二驱动轴632例如可以被配置成高挠性驱动轴,例如编织或螺旋缠绕的驱动电缆。应当理解这样的高挠性驱动电缆可以具有有限的扭矩传递特性和能力。也应当理解连接到挠性轴620的手术装置11或其他附件可能需要比驱动轴630,632可传递的扭矩更高的扭矩输入。驱动轴630,632因此可以被配置成高速地传递低扭矩,高速度/低扭矩由例如布置在手术器械或附件中和/或远程动力控制台612中的挠性轴620的远端和/或近端处的齿轮装置转换成低速度/高扭矩。应当理解这样的齿轮装置(一个或多个)可以设在沿外壳614中的马达和连接到挠性轴620的附连手术器械或其他附件之间的传动系的任何合适位置。这样的齿轮装置(一个或多个)例如可以包括正齿轮装置,行星齿轮装置,谐波齿轮装置,摆线齿轮驱动装置,周转齿轮装置等。
现在参考图12,可以看到第一耦联器622的后端视图。第一耦联器622包括第一连接器644,第二连接器648,第三连接器652和第四连接器656,每个连接器以可旋转的方式固定到第一耦联器622。每个连接器644,648,652,656包括各自的凹部646,650,654,658。如图12中所示,每个凹部646,650,654,658可以为六角形。然而应当理解凹部646,650,654,658可以具有适于将连接器644,648,652,656以不可旋转的方式耦联和刚性地附连到包含在外壳612内的马达装置的相应驱动轴的任何形状和配置。应当理解在马达装置的相应驱动轴上可以设置互补的突出部,由此驱动挠性轴620的驱动元件。也应当理解凹部可以设在驱动轴上而互补突出部可以设在连接器644,648,652,656上。可以设置被配置成将连接器644,648,652,656和马达装置的驱动轴以不可旋转但可释放的方式耦联的任何其他耦联装置。
连接器644,648,652,656中的一个以不可旋转的方式固定到第一驱动轴630,并且连接器644,648,652,656中还有一个以不可旋转的方式固定到第二驱动轴632。连接器644,648,652,656中的其余两个与被配置成在转向电缆634,635,636,637上施加张力以使挠性轴620的远端624转向的传动元件接合。数据传送电缆638与数据连接器660电学上逻辑连接。数据连接器660例如包括电触点662,所述电触点在数量上对应和等于包含在数据电缆638中的各电线的数量。第一耦联器622包括键结构642,该键结构被配置成将第一耦联器622正确地定向到布置在外壳612上的配合和互补耦联装置。这样的键结构642可以设在第一耦联器622和布置在外壳612上的配合和互补耦联装置之一或两者上。第一耦联器622可以包括快速连接式连接器,该快速连接式连接器可以通过简单的抵推动作将第一耦联器622接合到外壳612。可以提供与所有这几个连接器644,648,652,656,660相结合的密封件以提供第一耦联器622的内部和外界环境之间的流体密封。
现在参考图13,可以看到挠性轴620的第二耦联器626的前端视图。在该示例性实施例中,第二耦联器626包括第一连接器666和第二连接器668,每个连接器以可旋转的方式固定到第二耦联器626并且以不可旋转的方式固定到第一和第二驱动轴630,632中的相应的一个的远端。快速连接式接头664设在第二耦联器626上从而以可拆卸方式将手术装置11固定到第二耦联器626。快速连接式接头664例如可以是旋转快速连接式接头,卡口式接头等。键结构674设在第二耦联器626上并且被配置成将手术装置11正确地对准第二耦联器626。被配置成将手术装置11正确地对准挠性轴620的键结构或其他装置可以设在第二耦联器626和手术装置11之一或两者上。另外,快速连接式接头可以如图8(e)中所示作为快速连接耦联器511设在手术装置11上。第二耦联器626中还设置具有电触点672的数据连接器670。类似于第一耦联器622的数据连接器660,第二耦联器626的数据连接器670包括触点672,所述触点电学上逻辑连接到数据传送电缆638的相应电线和数据连接器660的触点662。可以与连接器666,668,670结合设置密封件以提供第二耦联器626的内部和外界环境之间的流体密封。
机电驱动元件布置在远程动力控制台612的外壳614内,其被配置成驱动驱动轴630,632和转向电缆634,635,636,637,由此操作机电驱动部件610和附连到第二耦联器626的手术装置11。在图14中示意性所示的示例性实施例中,五个均通过电源操作的电动机676,680,684,690,696可以布置在远程动力控制台612中。然而应当理解可以提供任何合适数量的马达,并且马达可以通过电池动力,线路电流,DC电源,电子控制的DC电源等操作。也应当理解马达可以连接到DC电源,所述DC电源又连接到线路电流并且将工作电流供应给马达。
图14示意性地示出了马达的一种可能布置。当第一耦联器622——因而挠性轴620——与外壳614接合时第一马达676的输出轴678与第一耦联器622的第一连接器644接合,由此驱动第一驱动轴630和第二耦联器626的第一连接器666。类似地,当第一耦联器622——因而挠性轴620——与外壳614接合时第二马达680的输出轴682接合第一耦联器622的第二连接器648,由此驱动第二驱动轴632和第二耦联器626的第二连接器668。当第一耦联器622——因而挠性轴620——与外壳614接合时第三马达684的输出轴686接合第一耦联器622的第三连接器652,由此通过第一滑轮装置688驱动第一和第二转向电缆634,635。当第一耦联器622——因而挠性轴620——与外壳614接合时第四马达690的输出轴692接合第一耦联器622的第四连接器656,由此通过第二滑轮装置694驱动第三和第四转向电缆636,637。第三和第四马达684,690可以固定在托架1100上,所述托架通过第五马达696的输出轴698能够选择性地在第一位置和第二位置之间移动以选择性地使第三和第四马达684,690与各自的滑轮装置688,694接合和脱离接合,由此允许挠性轴620根据需要变得拉紧和可转向或柔软。应当理解其他机械的、电学的和/或机电一体化的机构等可以用于选择性地接合和脱离接合所述转向机构。例如可以如2000年2月22日申请的、发明名称为“一种用于控制挠性轴内转向丝线机构的托架组件(A Carriage Assembly for Controlling a Steering Wire Mechanism Within a Flexible Shaft)”的美国专利申请No.09/510,923,即现在于2003年2月11日公开的美国专利No.6,517,565中所述地布置和配置马达,该专利的全部内容通过援引并入本申请。
应当理解马达676,680,684,690,696中的任何一个或多个例如可以是高速/低扭矩马达,低速/高扭矩马达等。如上所述,可旋转的第一驱动轴630和可旋转的第二驱动轴632可以被配置成传递高速和低扭矩。因而,第一马达676和第二马达680可以被配置成高速/低扭矩马达。可替代地,第一马达676和第二马达680可以被配置成低速/高扭矩马达,并且在第一马达676和第二马达680与相应的可旋转的第一驱动轴630和可旋转的第二驱动轴632之间设置扭矩减小/速度增加齿轮装置。这样的扭矩减小/速度增加齿轮装置例如可以包括正齿轮装置,行星齿轮装置,谐波齿轮装置,摆线齿轮驱动装置,周转齿轮装置等。应当理解任何这样的齿轮装置可以布置在远程动力控制台612内或挠性轴620的近端中——例如第一耦联器622中。应当理解所述齿轮装置(一个或多个)可以设在可旋转的第一驱动轴630和/或可旋转的第二驱动轴632的远端和/或近端以防止其卷起和断裂。
现在参考图15,可以看到机电驱动部件610的示意图。控制器1122设在远程动力控制台612的外壳614中,并且被配置成控制机电驱动部件610和附连到挠性轴620的线性夹紧、切割和钉合装置11或其他手术器械或附件的所有功能和操作。设置有存储单元1130,并且存储单元1130可以包括存储装置,例如ROM部件1132,RAM部件1134等。ROM部件1132通过线路1136与控制器1122电学上逻辑通信,并且RAM部件1134通过线路1138与控制器1122电学上逻辑通信。RAM部件1134可以包括任何类型的随机存取存储器,例如磁存储装置,光存储装置,磁光存储装置,电子存储装置等。类似地,ROM部件1132可以包括任何类型的只读存储器,例如可移动存储装置,例如PC卡或PCMCIA型装置。应当理解ROM部件1132和RAM部件1134可以被配置成单一单元或者可以是分开的单元并且ROM部件1132和/或RAM部件1134可以以PC卡或PCMCIA型装置的方式被提供。
控制器1122进一步连接到外壳614的前面板615,并且更特别地,通过线路1154连接到显示装置616和分别通过线路1156,1158连接到指示器618a,618b。线路1116,1118,1124,1126,1128将控制器1122分别电学上逻辑连接到第一、第二、第三、第四和第五马达676,680,684,690,696。有线遥控单元(“RCU”)1150通过线路1152电学上逻辑连接到控制器1122。还设置无线RCU 1148,并且无线RCU 1148通过无线链路1160与接收/发送单元1146通信,所述接收/发送单元1146通过线路1144连接到收发器1140。收发器1140通过线路1142电学上逻辑连接到控制器1122。无线链路1160例如可以是光链路(例如红外链路),无线电链路或任何其他形式的无线通信链路。
例如可以包括DIP开关阵列的开关装置1186可以通过线路1188连接到控制器1122。开关装置1186例如可以被配置成选择用于在显示装置616上显示消息和提示的多种语言中的一种。消息和提示例如可以涉及机电驱动部件610和/或附连到机电驱动部件610的手术装置11的操作和/或状态。
根据本发明的该示例性实施例,第一编码器1106设在第二耦联器626内并且被配置成响应和根据第一驱动轴630的旋转输出信号。第二编码器1108也设在第二耦联器626内并且被配置成响应和根据第二驱动轴632的旋转输出信号。每个编码器1106,1108所输出的信号可以代表相应的驱动轴630,632的旋转位置及其旋转方向。这样的编码器1106,1108例如可以包括霍耳效应装置,光学装置等。尽管编码器1106,1108被描述成布置在第二耦联器626内,应当理解编码器1106,1108可以设在马达系统和手术装置11之间的任何位置。应当理解将编码器1106,1108设在第二耦联器626内或挠性轴620的远端可以精确确定驱动轴的旋转。如果编码器1106,1108布置在挠性轴620的近端,第一和可旋转的第二驱动轴630,632的卷起会导致测量误差。
图16是包括霍耳效应装置的编码器1106,1108的示意图。具有N极1242和S极1244的磁体1240以不可旋转的方式安装在驱动轴630,632上。编码器1106,1108进一步包括第一传感器1246和第二传感器1248,所述传感器相对于驱动轴630,632的纵向或旋转轴线分开大约90°布置。传感器1246,1248的输出是持续的并且根据传感器的检测范围中磁场的极性变化改变其状态。因而,基于来自编码器1106,1108的输出信号,可以确定驱动轴630,632在四分之一转内的角位置并且可以确定驱动轴630,632的旋转方向。每个编码器1106,1108的输出通过数据传送电缆638的相应线路1110,1112传输到控制器1122。通过基于来自编码器1106,1108的输出信号跟踪驱动轴630,632的角位置和旋转方向,控制器1122由此可以确定连接到机电驱动部件610的手术装置的部件的位置和/或状态。也就是说,通过对驱动轴630,632的转数进行计数,控制器1122可以确定连接到机电驱动部件610的手术装置的部件的位置和/或状态。
例如,第一钳夹80和第二钳夹50与推板502之间的前进距离随相应的驱动轴630,632的旋转而变化并且能够基于所述旋转而确定。通过确定在一个时刻第二钳夹50和推板502的绝对位置,基于编码器1106、1108的输出信号和螺钉521和螺钉503和504的已知螺距,第二钳夹50和推板502的相对位移可以用于确定在其后所有时刻的第一钳夹80和推板502的绝对位置。第二钳夹50和推板502的绝对位置可以在手术装置11最一开始耦联到挠性轴620时被固定和确定。可替代地,第二钳夹50和推板502例如相对于第一钳夹80的位置可以基于来自编码器1106,1108的输出信号被确定。
如图8(e)中所示,手术装置11可以进一步包括数据连接器1272,该数据连接器在尺寸和配置上适于电学上逻辑连接到第二耦联器626的连接器670。在该示例性实施例中,数据连接器1272包括触点,所述触点在数量上等于连接器670的导线672的数量。存储模块501与数据连接器1272电学上逻辑连接。存储模块501例如可以采用EEPROM,EPROM等的形式,并且例如可以包含在手术装置11的第二钳夹50内。
图17示意性地示出了存储模块501。如图17中所见,数据连接器1272包括触点1276,每个触点通过相应的线路1278电学上逻辑连接到存储模块501。存储模块501可以被配置成存储例如序列号数据1180,附件类型标识符(ID)数据1182和使用状况数据1184。存储模块501可以附加地存储其他数据。序列号数据1180和ID数据1182都可以被配置成只读数据。序列号数据1180和/或ID数据1182可以存储在存储模块501的只读部分中。在该示例性实施例中,序列号数据1180可以是唯一标识特定手术装置的数据,而ID数据1182可以是标识附件类型的数据,例如在系统610中的附件类型的数据,其中在所述系统610中可附连其他类型的手术器械或附件。使用状况数据1184反映特定附件的使用状况,例如手术装置11的第一钳夹80打开和闭合的次数,或手术装置11的推板的前进次数。使用状况数据1184可以存储在存储模块501的读/写部分中。
应当理解的是,可附连到挠性轴620的远端624的附件例如手术装置11可以被设计和配置成一次性或多次使用。所述附件也可以被设计和配置成使用预定次数。因此,使用状况数据1184可以用于确定手术装置11是否被使用和使用次数是否超出了允许使用的最大次数。如下面更全面地所述,在达到允许使用的最大次数之后试图使用附件将会产生错误(ERROR)状态。
再次参考图15,控制器1122被配置成当手术装置11初始连接到挠性轴620时从手术装置11的存储模块501读取ID数据1182。存储模块501通过数据传送电缆638的线路1120电学上逻辑连接到控制器1122。基于读取的ID数据1182,控制器1122被配置成从存储单元1130读取或选择与连接到挠性轴620的手术器械或附件的类型对应的操作程序或算法。存储单元1130被配置成存储用于各可用类型的手术器械或附件的操作程序或算法,控制器1122根据从附连的手术器械或附件的存储模块501读取的ID数据1182从存储单元1130选择和/或读取操作程序或算法。如上所述,存储单元1130可以包括可移动ROM部件1132和/或RAM部件1134。因而,必要时可以升级、增加、删除、改进或以另外方式修正存储在存储单元1130中的操作程序或算法。存储在存储单元1130中的操作程序或算法可以基于例如用户的特定需要进行定制。数据录入装置——例如键盘,鼠标,点击装置,触摸屏等——例如可以通过数据连接端口连接到存储单元1130以便于定制操作程序或算法。可替代地或附加地,操作程序或算法可以在远离机电驱动部件610的存储单元1130中进行定制和预编程。应当理解序列号数据1180和/或使用状况数据1184也可以用于确定从存储单元1130读取或选择的是多个操作程序或算法中的哪一个。应当理解操作程序或算法可以可替代地存储在手术装置11的存储模块501中并且通过数据传送电缆638被传送到控制器1122。一旦合适的操作程序或算法被读取或选择或传输到控制器1122,控制器1122使得根据由用户通过有线RCU 1150和/或无线RCU 1148执行的操作而执行操作程序或算法。如上文所述,控制器1122分别通过线路1116,1118,1124,1126,1128与第一、第二、第三、第四和第五马达676,680,684,690,696电学上逻辑连接,并且被配置成根据读取的、选择的或传输的操作程序或算法分别通过线路1116,1118,1124,1126,1128控制这样的马达676,680,684,690,696。应当理解的是,关于存储单元501的上述特征和操作也可以适用于对应于钉盒组件507的存储单元5011,例如参见图8(a)。
现在参考图18,可以看到无线RCU 1148的示意图。无线RCU 1148包括转向控制器1300,该转向控制器具有布置在四路摇杆装置1310的下方的多个开关1302,1304,1306,1308。通过摇杆装置1310使开关1302,1304操作则通过第三马达684控制第一和第二转向电缆634,635的操作。类似地,通过摇杆装置1310使开关1306,1308操作则通过第四马达692控制第三和第四转向电缆636,637的操作。应当理解摇杆装置1310和开关1302,1304,1306,1308设置成使得开关1302,1304的操作使挠性轴620沿南北方向转向,开关1306,1308的操作使挠性轴620沿东西方向转向。这里所述的“南”、“北”、“东”和“西”是针对一相对坐标系而言。可替代地,可以设置数字操纵杆、模拟操纵杆等来代替摇杆装置1310和开关1302,1304,1306,1308。也可以使用电位计或任何其他类型的致动器来代替开关1302,1304,1306,1308。
无线RCU 1148进一步包括转向接合/脱离接合开关1312,该开关的操作控制第五马达696的操作以选择性地与转向机构接合和脱离接合。无线RCU1148还包括双路摇杆装置1314,该双路摇杆装置具有可操作的第一和第二开关1316,1318。这些开关1316,1318的操作根据对应于附连装置11的操作程序或算法来控制机电驱动部件610和附连到挠性轴620的任何手术器械或附件例如手术装置11的特定功能。例如,双路摇杆装置1314的操作可以控制手术装置11的第一钳夹80和第二钳夹50的打开和闭合。无线RCU 1148带有另一开关1320,该开关的操作可以根据对应于附连装置的操作程序或算法进一步控制机电驱动部件610和附连到挠性轴620的装置11的操作。例如,开关1320的操作可以启动手术装置11的推板502的前进。
无线RCU 1148包括控制器1322,该控制器通过线路1324与开关1302,1304,1306,1308,通过线路1326与开关1316,1318,通过线路1328与开关1312和通过线路1330与开关1320电学上逻辑连接。无线RCU 1148可以包括对应于前面板615的指示器618a,618b的指示器618a′,618b′,和对应于前面板615的显示装置616的显示装置616′。如果设置的话,指示器618a′,618b′分别通过线路1332,1334电学上逻辑连接到控制器1322,并且显示装置616′通过线路1336电学上逻辑连接到控制器1322。控制器1322通过线路1340电学上逻辑连接到收发器1338,并且收发器1338通过线路1344电学上逻辑连接到接收器/发射器1342。电源例如电池可以设在无线RCU 1148中以为其供电。因而,无线RCU 1148可以用于通过无线链路1160控制机电驱动部件610和附连到挠性轴620的装置11。
无线RCU 1148可以包括通过线路1348连接到控制器1322的开关1346。开关1346的操作将数据信号通过无线链路1160发射到发射器/接收器1146。数据信号包括唯一标识无线RCU 1148的标识数据。该标识数据由控制器1122使用以防止机电驱动部件610的擅自操作和防止另一无线RCU干扰机电驱动部件610的操作。无线RCU 1148和机电手术装置610之间的每个后续通信可以包括该标识数据。因而,控制器1122可以辨别无线RCU并且由此仅仅允许单一的、可识别的无线RCU 1148来控制机电驱动部件610和附连到挠性轴620的装置11的操作。
基于根据编码器1106,1108的输出信号而确定的附连到挠性轴620的装置的部件的位置,控制器1122可以选择性地允许或禁止由对应于附连装置的操作程序或算法所限定的机电驱动部件610的功能。例如,对于手术装置11,由开关1320的操作控制的致动功能被禁止,除非确定第二钳夹50和第一钳夹80之间的空隙或间隙在可接受的范围内。
现在参考图19,可以看到有线RCU 1150的示意图。在该示例性实施例中,有线RCU 1150包括与无线RCU 1148基本相同的控制元件并且省略了这样的元件的进一步描述。类似元件在图19中用附带的撇号指示。应当理解机电驱动部件610和附连到挠性轴620的装置例如手术装置11的功能可以由有线RCU 1150和/或由无线RCU 1148控制。例如在无线RCU 1148中出现电池故障的情况下,可以使用有线RCU 1150来控制机电驱动部件610和附连到挠性轴620的装置的功能。
如上文所述,外壳614的前面板615包括显示装置616和指示器618a,618b。显示装置616可以包括字母数字显示装置,例如LCD显示装置。显示装置616也可以包括音频输出装置,例如扬声器,蜂鸣器等。控制器1122根据对应于附连到挠性轴620的装置例如手术装置11的操作程序或算法操作和控制显示装置616。如果没有这样附连的手术器械或附件,则可以由控制器1122读取或选择缺省操作程序或算法或将缺省操作程序或算法传输到控制器1122,由此控制显示装置616的操作以及机电驱动部件610的其他方面和功能。如果手术装置11附连到挠性轴620,则显示装置616例如可以显示指示第二钳夹50和第一钳夹80之间的间隙的数据,该数据根据编码器1106,1108的输出信号被确定,如上文更全面地所述。
类似地,控制器1122根据对应于附连到挠性轴620的装置11例如手术装置11的操作程序或算法操作和控制指示器618a,618b。指示器618a和/或指示器618b可以包括音频输出装置,例如扬声器,蜂鸣器等,和/或视觉指示装置,例如LCD,灯泡,灯等。如果手术装置11附连到挠性轴620,指示器618a例如可以指示机电驱动部件610处于通电状态,并且指示器618b例如可以指示是否确定第二钳夹50和第一钳夹80之间的间隙在可接受的范围内。应当理解尽管描述了两个指示器618a,618b,必要时可以提供任何数量的附加指示器。另外,应当理解尽管描述了单一显示装置616,必要时可以提供任何数量的附加显示装置。
类似地控制器1322,1322′根据附连到挠性轴620的装置的操作程序或算法分别控制有线RCU 1150的显示装置616′和指示器618a′,618b′以及无线RCU 1148的显示装置616″和指示器618a″,618b″。
如上所述,手术装置11可以被配置成夹紧、切割和钉合一部分组织。现在将结合患者的肠中组织的癌变或异常部分的去除过程描述手术装置11的操作,这仅仅是组织的一种类型和可以使用手术装置11执行的手术的一种类型。一般而言,在操作中,在胃肠道中的癌变或异常组织被定位之后,初始打开患者的腹部以暴露肠。根据机电驱动部件610所提供的远程致动,第一驱动器将手术装置11的第一和第二钳夹50,80驱动到打开位置。如上所述,手术装置11可以一开始就保持在打开位置,由此消除了一开始要将手术装置11驱动到打开位置的需要。将肠的邻近癌变组织的一侧的管道邻近第一钳夹80放置。第二钳夹50处于例如图9中所示的旋转位置。通过远程致动,第一驱动器被反向啮合,使得第二钳夹50朝着第一钳夹80移动。一开始,第二钳夹50移动但仍处在该旋转位置,直到钳夹在打开和闭合位置之间时,第二钳夹50旋转到与第一钳夹80对准。一旦钳夹相对于彼此垂直对准,则第一和第二钳夹继续朝着彼此移动,直到第一钳夹80贴紧第二钳夹50,将该部分肠夹在它们之间。一旦肠被充分夹紧,则第二驱动器被啮合,这使得推板(其上安装有推钉器和刀具)在如图5中所示的第一位置和如图6中所示的第二位置之间移动,由此切割和钉合肠。然后第二驱动器然后被反向啮合,这使得推钉器和刀具移回到如图5中所示的第一位置。第一驱动器然后被啮合以驱动手术装置11的第一钳夹80和第二钳夹50回到打开位置。然后在癌变组织的另一侧重复这些步骤,由此去除包含癌变组织的肠部分,所述肠部分在两端被钉合以防止肠内物质溢流到敞开的腹部中。
更具体而言,根据本发明的该示例性实施例,手术装置11耦联到机电驱动部件610的附件耦联器626使得第一驱动插座180与机电驱动部件610的第一驱动轴630接合并且第二驱动插座310与机电驱动部件610的第二驱动轴632接合。因而,通过机电驱动部件610的相应驱动轴630的旋转,使得第一驱动插座180旋转;通过第一驱动插座180的旋转,使得小齿轮508a(未示出)旋转。小齿轮508a的顺时针或逆时针旋转取决于马达680的旋转方向。通过机电驱动部件610的相应驱动轴632的旋转,使得第二驱动插座310旋转;通过第二驱动插座310的旋转,使得小齿轮508b(未示出)旋转。小齿轮508b的顺时针或逆时针旋转取决于马达676的方向。
当手术装置11处于如图4中所示的初始闭合位置时,第一马达680操作以使手术装置位于打开位置。具体而言,启动对应于与第一驱动插座180接合的第一驱动轴630的第一马达680,由此使得小齿轮508a沿第一旋转方向——例如逆时针旋转方向转动。由于小齿轮508a的沿周向布置的轮齿与正齿轮529a的沿周向布置的轮齿5291啮合,小齿轮508a的旋转导致正齿轮沿与小齿轮508a的旋转方向相反的第一旋转方向——例如顺时针方向旋转。第一正齿轮529a的内孔5293与第一蜗杆523a的端部5231接合从而使得第一蜗杆523a沿与第一正齿轮529a相同的方向例如顺时针旋转。蜗杆523a的螺纹(一条或多条)5233与蜗轮522的轮齿5221接合从而使得蜗轮522沿第一方向——例如俯视时为逆时针方向旋转。蜗轮522的内孔与螺钉521以不可旋转的方式接合,由此使得螺钉521沿第一方向——例如俯视时为逆时针方向旋转。螺钉521的外螺纹(一条或多条)5214与旋转臂509的内螺纹孔5051的螺纹啮合,由此使得旋转臂509和与旋转臂509附连的钉砧505沿向下方向——例如远离第一钳夹80的方向移动。当旋转臂套筒内的凸轮随动件571与旋转臂509的沟槽5052的弯曲部分接合时,旋转臂509和与之附连的钉砧505旋转脱离与第一钳夹80的对准。马达以该方式连续操作最终将手术装置11置于打开状态,从而提供如图3中所示的第一钳夹80和第二钳夹50之间的空间。
接着,将一部分组织放置在第一钳夹80和第二钳夹50之间。反向操作第一马达680以便将手术装置置于闭合位置。具体而言,启动对应于与第一驱动插座180接合的第一驱动轴630的第一马达680,由此使得小齿轮508a沿第二旋转方向——例如顺时针旋转方向转动。由于小齿轮508a的沿周向布置的轮齿(未示出)与正齿轮529a的沿周向布置的轮齿5291啮合,小齿轮508a的旋转使得正齿轮529a沿与小齿轮508a的旋转方向相反的第二方向——例如逆时针方向旋转。第一正齿轮529a的内孔5293与第一蜗杆523a的端部5231接合,从而第一正齿轮529a的旋转使得第一蜗杆523a沿与第一正齿轮529a相同的方向例如逆时针旋转。蜗杆523a的螺纹(一条或多条)5233与蜗轮522的轮齿5221啮合,从而第一蜗杆523a的旋转使得蜗轮522沿第二方向例如俯视时为顺时针方向旋转。蜗轮522的内孔与螺钉521以不可旋转的方式啮合,从而蜗轮522的旋转使得螺钉521沿第二方向例如俯视时为顺时针方向旋转。螺钉521的外螺纹(一条或多条)5214与旋转臂509的内螺纹孔5051的螺纹接合,从而螺钉521的旋转使得旋转臂509和与旋转臂509附连的钉砧505沿向上方向——例如朝着第一钳夹80移动。再次地,旋转臂套筒570内的滚珠571与旋转臂509的沟槽5052接合使得当钉砧505朝着第一钳夹80垂直移动时,旋转臂509和与之附连的钉砧505旋转到与第一钳夹80对准。销518的端部5181插入钉砧505的孔口5057中并且根据弹簧524的偏压保持在该插入位置以将一部分组织保持在钳夹之间。马达以该方式连续操作最终将手术装置11置于如图4中所示的闭合状态,其中组织被夹紧在第一钳夹80和第二钳夹50之间。在该闭合状态下,待钉合和切割的一部分组织被夹紧在缝合钉座513和钉砧505之间。
为了开始钉合和切割过程,致动第二马达676以便将推板502从第一升高位置——例如缩回位置移动到第二降低位置——例如伸展位置。具体而言,致动对应于第二驱动轴632的第二马达676。第二驱动轴632与第二驱动插座310接合,从而第二驱动轴632沿第一方向例如顺时针的旋转使得小齿轮508b沿第一旋转方向例如顺时针旋转方向旋转。小齿轮508b的接合端与耦联元件529b的内孔5294以不可旋转的方式接合,从而小齿轮508b的旋转使得耦联元件529b沿与小齿轮508b的旋转方向相同的第一方向例如顺时针方向旋转。耦联元件529b的内孔5294与第二蜗杆523b的端部5234接合,从而耦联元件529b的旋转使得第二蜗杆523b沿与耦联元件529b相同的方向例如顺时针旋转。蜗杆523b的螺纹5236与蜗轮516的蜗轮齿5161啮合,从而第二蜗杆523b的旋转使得蜗轮516沿第一方向例如俯视时为逆时针方向旋转。蜗轮516的内螺纹孔5164的螺纹(一条或多条)与螺钉504的螺纹(一条或多条)接合。由于螺钉504以不可旋转的方式耦联到推板502,螺钉504和推板502沿向下方向一起移动。同时,蜗杆523b的螺纹5236与蜗轮517的蜗轮齿5171啮合,使得蜗杆523b的旋转导致蜗轮517沿第一方向例如俯视时为顺时针方向旋转。蜗轮517的内螺纹孔5174的螺纹(一条或多条)与螺钉503的螺纹(一条或多条)接合。由于螺钉503以不可旋转的方式耦联到推板502,螺钉503和推板502也沿向下方向一起移动。因而,推板502以连续方式降低,并且安装到推板502的底面5022的推钉器514和刀具519也以连续方式降低。
当推钉器514降低时,推钉器514的向下布置的齿5143被推动穿过缝合钉座513的槽5132。初始布置在缝合钉座513的槽5132内的缝合钉528被向下推动并从槽5132的下开口推出且穿过被夹紧的组织,直到缝合钉528的叉脚5281接触钉砧505的相应缝合钉导槽5053。缝合钉导槽5053弯曲和闭合缝合钉528的叉脚5281,由此钉合该组织。同时,安装到推板502的底面5022的刀具519穿过缝合钉座513的纵向布置的槽5131直到接触钉砧505的刀具垫520,由此切割被夹紧的组织。
执行钉合和切割过程之后,致动第二马达676以将推板502从第二降低位置移动到第一升高位置。具体而言,致动对应于与第二驱动插座310接合的第二驱动轴632的第二马达676。第二驱动轴632的旋转使得小齿轮508b沿第二方向例如逆时针方向旋转。小齿轮508b的接合端与耦联元件529b的内孔5294以不可旋转的方式接合,从而小齿轮508b的该旋转使得耦联元件529b沿第二方向例如逆时针方向旋转。耦联元件529b的内孔5294也与第二蜗杆523b的端部5234接合,从而耦联元件529b的旋转使得第二蜗杆523b沿第二方向例如逆时针方向旋转。蜗杆523b的螺纹(一条或多条)5236与蜗轮516的周向设置的蜗轮齿5161啮合,从而蜗杆523b的旋转使得蜗轮516沿第二方向例如俯视时为顺时针方向旋转。蜗轮516的内螺纹孔5164的螺纹(一条或多条)与螺钉504的螺纹(一条或多条)接合,并且由于螺钉504以不可旋转的方式耦联到推板502,螺钉504和推板502沿向上方向一起移动。同时,蜗杆523b的螺纹(一条或多条)5236与蜗轮517的蜗轮齿5171啮合,从而蜗杆523b的旋转使得蜗轮517沿第二方向例如俯视时为逆时针方向旋转。蜗轮517的内螺纹孔5174的螺纹(一条或多条)与螺钉503的螺纹接合,并且由于螺钉503以不可旋转的方式耦联到推板502,因此螺钉503和推板502沿向上方向一起移动。因而,推板502以连续方式升高,并且安装到推板502的底面5022的推钉器514和刀具519也以连续方式升高到它们的初始缩回位置。
执行完组织的切割和钉合以及将刀具519返回到其缩回位置之后,致动第一马达680以将手术装置置于打开位置。具体而言,启动对应于第一驱动轴630的第一马达680。第一驱动轴630与第一驱动插座180接合,从而第一驱动轴630的旋转使得小齿轮508a沿第一旋转方向例如逆时针旋转。小齿轮508a的轮齿与正齿轮529a的轮齿5291啮合,从而小齿轮508a的旋转使得正齿轮沿第一方向例如顺时针方向旋转。第一正齿轮529a的内孔5293与第一蜗杆523a的端部5231接合,从而第一正齿轮529a的旋转使得第一蜗杆523a沿与第一正齿轮529a相同的方向例如顺时针旋转。蜗轮523a的螺纹(一条或多条)5233与蜗轮522的蜗轮齿5221啮合,从而蜗轮523a的旋转使得蜗轮522沿第一方向——例如俯视时为逆时针方向旋转。蜗轮522的内孔与螺钉521以不可旋转的方式接合,从而蜗轮522的旋转使得螺钉521沿第一方向——例如俯视时为逆时针方向旋转。螺钉521的外螺纹(一条或多条)5214与旋转臂509的内螺纹孔5051的螺纹(一条或多条)接合,从而螺钉521的旋转使得旋转臂509和与旋转臂509附连的钉砧505沿向下方向——例如远离第一钳夹80移动,并且旋转脱离与第一钳夹80的对齐。因而,第二钳夹50与第一钳夹80分离,直到手术装置11再次处于如图3中所示的打开位置。
其后,手术装置11可以与机电驱动部件分离并且用另一手术装置11代替使得可以在组织的不同部分上——例如在异常或癌变组织的另一侧执行相同的夹紧、切割和钉合过程。一旦肠的第二端也被夹紧、切割和钉合,手术装置11可以与机电驱动部件610分离。必要时,操作者可以丢弃附件或对它们进行消毒以供再使用。
应当注意在致动手术装置11之前,可以手动或自动地执行校准过程。在2001年12月4日申请的美国临时专利申请No.60/337,544、2002年12月4日申请的美国专利申请No.10/309,532中描述了根据本发明的几个示例性实施例可由手术装置11使用的各种校准过程,上述申请的全部内容通过援引并入本申请。
根据图8(a)-8(e)中所示的本发明的示例性实施例,手术装置11可以是不可再装的——例如钉盒组件507或其一部分例如缝合钉座513不可以由操作者从手术装置11卸除以为该手术装置11再装填后续的缝合钉523阵列或再使用该手术装置11用于相同或其他患者或用于相同或其他手术操作。因而,在手术装置11被致动过一次以使用缝合钉座513中的缝合钉528钉合一部分组织之后,手术装置11不能被再次致动以使用一组新缝合钉528或新缝合钉座513来钉合另一部分组织。通过将手术装置11配置成不可再装,减小了污染或感染的风险,原因是手术装置11不会有意地或无意地用在两个不同患者身上并且不会在一个患者身上再次使用。不过,根据本发明的一个示例性实施例,手术装置11也可以是可再装的。例如,在该示例性实施例中,手术装置11可以被配置成使得某些部件能够从手术装置11卸除并且相对于手术装置11替换。例如,根据一个示例性实施例,钉盒组件507以可拆卸方式附连到手术装置11内并且在使用之后可以从外壳506卸除以便由另一钉盒组件替换。可替换的钉盒能够在上钳夹80和下钳夹50处于完全打开位置时进行卸除,以防止当上钳夹80和下钳夹50夹紧在待切割和钉合的一部分组织上时钉盒意外地卸除。在一个示例性实施例中,钉盒组件507或其某个部分例如缝合钉座513能够滑动进出手术装置11,使得当使用第一组缝合钉528之后用户可以将具有一组新缝合钉528的新钉盒组件507或缝合钉座513滑动到手术装置11中。可替代地,当使用过缝合钉座513中的第一组缝合钉528之后,操作者可以替换相同缝合钉座513中的缝合钉528并且再使用相同缝合钉座513。在一个示例性实施例中,销518可以退出缝合钉座513的孔5133使得钉盒帽515可以以可拆卸方式或可移动方式连接到外壳506。
根据本发明的另一示例性实施例,手术装置11可以提供有限的可再装性。例如,手术装置11可以被配置成允许缝合钉座513被替换一次,使得可以在一个患者上——例如在组织的癌变部分的两相对侧执行两次的夹紧、切割和钉合操作,但是不允许缝合钉座513被替换两次以上。
在本发明的另一示例性实施例中,手术装置11可以被配置成将两组缝合钉528保持在缝合钉座513内,第一组缝合钉用在组织的癌变部分的一侧,另一组缝合钉用在组织的癌变部分的另一侧。应当理解手术装置11可以被配置成用于许多应用并且可以根据使用状况数据1184确定使用状况。也就是说,存储模块501和/或5011可以被配置成存储代表手术装置11的再装次数的数据。因而,根据操作程序,机电驱动部件610可以根据存储在存储模块501和/或5011中的使用信息限制再装手术装置11可以致动的次数。
被配置成可再装的手术装置11可以以类似于上述不可再装手术装置11的方式操作。然而,手术装置11的可再装性允许操作者在手术装置11的操作期间执行附加步骤。例如,一旦手术装置11初始放置在打开位置,缝合钉座513可以由操作者接触到并且可以被检查以确定缝合钉528是否准备好用于手术操作和/或是否需要用更合适的缝合钉座513替换缝合钉座513。类似地,在夹紧、切割和钉合操作被执行并且一组缝合钉528被使用之后,缝合钉座513可以由操作者再次接近以便用另一缝合钉座513替换该缝合钉座513或将另一组缝合钉528插入该同一缝合钉座513中。
根据图8(a)和8(b)中所示的本发明的示例性实施例,手术装置11可以被配置成在一个以上的操作范围中操作。该特征可以提供的优点是手术装置11可以更合适地容纳具有不同厚度的组织部分。这样的特征的各种例子例如在2002年1月8日申请的美国临时专利申请No.60/346,656,和2002年3月8日申请的美国专利申请No.10/094,051中被描述,上述专利的全部内容通过援引并入本申请。
根据其各种示例性实施例,手术装置11也可以利用或使用操作手术装置11的各种操作程序。这样的操作程序的例子例如在2002年1月8日申请的美国临时专利申请No.60/346,656,和2002年3月8日申请的美国专利申请No.10/094,051中被描述,上述专利的全部内容通过援引并入本申请。
常规手术装置11的一个问题是它们会限制使用装置的接近角。如先前所述,常规手术装置典型地利用垂直于待切割或钉合的这部分组织的器械轴。当在身体上——例如在患者的身体内使用常规手术装置时,该装置被限制到用于切割和钉合该部分组织的单一接近角。
与之相比,手术装置11可以不限制装置在使用时的接近角。如先前所述,根据其各种示例性实施例,手术装置11包括以与第一钳夹80相对于第二钳夹50的运动平面呈特定角度——例如垂直——地耦联到第一钳夹80的驱动轴630和632。因而,当在身体上——例如在患者的身体内使用该手术装置11时,手术装置11可以不限制到只有单一接近角。相反地,可以使用多种接近角,这可以允许操作者在各个组织部分上更有效地使用该手术装置。
常规手术装置的另一问题是它们在患者的身体内难以操纵。例如,当常规手术装置用于夹紧或钉合不容易操纵的一部分组织时,必须改为操纵该手术装置。例如,在所述一部分组织是位于肛门残端附近的一部分胃肠组织的情况下,在执行操作之前或期间可能不可操纵该部分组织。常规手术装置不能用于这样的位置,原因是操作者使用所需的接近角会干涉患者的骨盆。此外,常规手术装置不能令人满意地定位在这样的位置,原因是当处于打开位置时手术装置的钳夹需要很大的空间并且由于患者身体内的周围紧挨的组织而不能定位。
与之相比,根据其各种示例性实施例的手术装置11可以不太困难地在患者的体内操纵。例如,在上述位于肛门残端附近的一部分胃肠组织的情况下,手术装置11可以定位在最靠近肛门的这部分胃肠组织的端部。因而,驱动轴630和632相对于第一钳夹80关于第二钳夹50的运动平面的成角例如垂直布置可以提高手术装置11在患者身体内的可操纵性。此外,本发明的可旋转钳夹减小了当处于打开位置时钳夹所需的空间。当本发明的手术装置11处于完全打开位置时,只有第一钳夹80定位在手术装置11的远端,第二钳夹50旋转脱离与第一钳夹80的对准。以夹紧、切割和钉合在肛门残端的一部分组织的手术操作为例,由于第二钳夹50旋转离开紧靠肛门残端的组织,因此第一钳夹80可以比常规手术装置更靠近肛门残端定位。当该手术装置移动到闭合位置时,第二钳夹50逐渐旋转到与第一钳夹80对准。当第二钳夹50最终与第一钳夹80对准时,两个钳夹所需的空间小于两个钳夹在完全打开位置时被对准所需的空间。这样,手术装置11可以改善在患者体内的定位。
因而,最有效地实现了本发明的几个前述目标和优点。本领域的技术人员将理解可以对上文所述的典型示例性实施例作出许多修改而不脱离本发明的精神和范围。尽管在这里详细描述和公开了本发明的各种典型示例性实施例,应当理解本发明决不这样被限制并且它的范围由附带权利要求的范围确定。
Claims (61)
1.一种手术装置,其包括:
第一钳夹;和
第二钳夹,其耦联到所述第一钳夹并且相对于所述第一钳夹能够在闭合位置和中间打开位置之间移动,其中所述第一钳夹和所述第二钳夹布置在共同平面内,所述第二钳夹相对于所述第一钳夹能够进一步绕位于所述共同平面内的轴线至少旋转地在所述中间打开位置和完全打开位置之间移动。
2.根据权利要求1所述的手术装置,其中在所述完全打开位置中,所述第一钳夹和所述第二钳夹中的至少一个没有布置在所述共同平面内。
3.根据权利要求2所述的手术装置,其中套筒和臂具有被配置成使所述第二钳夹至少在所述中间打开位置和所述完全打开位置之间移动的凸轮装置。
4.根据权利要求1所述的手术装置,其中在所述中间打开位置和所述完全打开位置之间,所述第二钳夹相对于所述第一钳夹能够进一步朝横向于所述共同平面的方位移动。
5.根据权利要求4所述的手术装置,其进一步包括第一驱动器,所述第一驱动器被配置成使所述第一钳夹和所述第二钳夹相对运动。
6.根据权利要求4所述的手术装置,其中所述第一驱动器被配置成与驱动轴接合,所述驱动轴能够围绕相对于所述共同平面平行地或非平行地设置的旋转轴线旋转。
7.根据权利要求1所述的手术装置,其进一步包括:
手术元件,其布置在所述第一钳夹内;和
第二驱动器,其被配置成使所述手术元件沿平行于所述共同平面的方向相对运动。
8.根据权利要求7所述的手术装置,其中所述第二驱动器被配置成与第二驱动轴接合,所述第二驱动轴能够围绕相对于所述共同平面非平行地设置的旋转轴线旋转。
9.根据权利要求7所述的手术装置,其中所述第二驱动器被配置成与第二驱动轴接合,所述第二驱动轴能够围绕相对于所述共同平面平行地设置的旋转轴线旋转。
10.根据权利要求7所述的手术装置,其中所述手术元件包括下述构件中的一个:切割元件;钉合元件;以及安装切割元件和钉合元件的推板。
11.根据权利要求5所述的手术装置,其进一步包括被配置成使可旋转的第一驱动轴旋转的机电驱动器。
12.根据权利要求5所述的手术装置,其中可旋转的第一驱动轴的旋转轴线垂直于所述第一钳夹和所述第二钳夹的所述共同平面。
13.根据权利要求5所述的手术装置,其中可旋转的第一驱动轴沿第一方向旋转以实现所述钳夹的伸展,并且沿与所述第一方向相反的第二方向旋转以实现所述钳夹的闭合。
14.根据权利要求4所述的手术装置,其中所述第一驱动器至少包括:彼此呈转动啮合关系的正齿轮、蜗杆和蜗轮;和带外螺纹的螺钉,所述带外螺纹的螺钉与所述第二钳夹的内螺纹孔接合并且其一端固定连接到所述蜗轮,由此齿轮的旋转使得所述第一钳夹和所述第二钳夹相对运动。
15.根据权利要求8所述的手术装置,其中可旋转的第二驱动轴沿第一方向旋转以使所述手术元件伸展,并且沿与所述第一方向相反的第二方向旋转以使所述手术元件缩回。
16.根据权利要求7所述的手术装置,其中所述第二驱动器至少包括:正齿轮和蜗杆,其彼此呈转动啮合关系并且与一对附加蜗轮呈转动啮合关系,所述一对附加蜗轮中的每一个具有居中布置的内螺纹孔,所述内螺纹孔分别与固定连接至所述手术元件的一对带外螺纹的螺钉中的一个接合,由此齿轮的旋转使得所述手术元件相对运动。
17.根据权利要求5所述的手术装置,其进一步包括机电驱动器,所述机电驱动器包括适于驱动第一驱动器的可旋转的第一驱动轴和适于驱动第二驱动器的可旋转的第二驱动轴。
18.根据权利要求14所述的手术装置,其中所述第二钳夹的所述内螺纹孔布置在臂内,所述臂被配置成在与所述第一钳夹附连的套筒内相对于所述套筒纵向地移动。
19.根据权利要求3所述的手术装置,其中所述凸轮装置包括沿着所述臂和所述套筒中的至少一个布置的沟槽,凸轮随动件可滑动地布置在所述沟槽内,其中所述沟槽包括螺旋部分。
20.一种手术装置,其包括:
能够围绕旋转轴线旋转的第一驱动轴;
第一钳夹;
耦联到第一钳夹的第二钳夹;通过第一驱动轴的旋转,所述第二钳夹能够相对于所述第一钳夹在闭合位置和中间打开位置之间移动,其中所述第一钳夹和所述第二钳夹布置在共同平面内,所述第二钳夹相对于所述第一钳夹能够进一步绕位于所述共同平面内的轴线至少旋转地在所述中间打开位置和完全打开位置之间移动。
21.根据权利要求20所述的手术装置,其中在所述完全打开位置中,所述第一钳夹和所述第二钳夹中的至少一个没有布置在所述共同平面内。
22.根据权利要求21所述的手术装置,其中套筒和臂具有被配置成使所述第二钳夹至少在所述中间打开位置和所述完全打开位置之间移动的凸轮装置。
23.根据权利要求20所述的手术装置,其中在所述中间打开位置和所述完全打开位置之间,所述第二钳夹相对于所述第一钳夹能够进一步朝横向于所述共同平面的方位移动。
24.根据权利要求23所述的手术装置,其进一步包括第一驱动器,所述第一驱动器被配置成使所述第一钳夹和所述第二钳夹相对运动。
25.根据权利要求23所述的手术装置,其中第一驱动器被配置成与所述第一驱动轴接合,所述第一驱动轴的旋转轴线相对于所述共同平面平行地或非平行地设置。
26.根据权利要求20所述的手术装置,其进一步包括:
手术元件,其布置在所述第一钳夹内;和
第二驱动器,其被配置成使所述手术元件沿平行于所述共同平面的方向相对运动。
27.根据权利要求26所述的手术装置,其中所述第二驱动器被配置成与第二驱动轴接合,所述第二驱动轴能够围绕相对于所述共同平面非平行地设置的旋转轴线旋转。
28.根据权利要求26所述的手术装置,其中所述第二驱动器被配置成与第二驱动轴接合,所述第二驱动轴能够围绕相对于所述共同平面平行地设置的旋转轴线旋转。
29.根据权利要求26所述的手术装置,其中所述手术元件包括下述构件中的一个:切割元件;钉合元件;以及安装切割元件和钉合元件的推板。
30.根据权利要求20所述的手术装置,其进一步包括被配置成使可旋转的第一驱动轴旋转的机电驱动器。
31.根据权利要求20所述的手术装置,其中可旋转的第一驱动轴的旋转轴线垂直于所述第一钳夹和所述第二钳夹的所述共同平面。
32.根据权利要求20所述的手术装置,其中可旋转的第一驱动轴沿第一方向旋转以实现所述钳夹的伸展,并且沿与所述第一方向相反的第二方向旋转以实现所述钳夹的闭合。
33.根据权利要求23所述的手术装置,其中第一驱动器至少包括:彼此呈转动啮合关系的正齿轮、蜗杆和蜗轮;和带外螺纹的螺钉,所述带外螺纹的螺钉与第二钳夹的内螺纹孔接合并且其一端固定连接到所述蜗轮,由此齿轮的旋转使得所述第一钳夹和所述第二钳夹相对运动。
34.根据权利要求26所述的手术装置,其中可旋转的第二驱动轴沿第一方向旋转以使所述手术元件伸展,并且沿与所述第一方向相反的第二方向旋转以使所述手术元件缩回。
35.根据权利要求26所述的手术装置,其中所述第二驱动器至少包括:正齿轮和蜗杆,其彼此呈转动啮合关系并且与一对附加蜗轮呈转动啮合关系,所述一对附加蜗轮中的每一个具有居中布置的内螺纹孔,所述内螺纹孔分别与固定连接至所述手术元件的一对带外螺纹的螺钉中的一个接合,由此齿轮的旋转使得所述手术元件相对运动。
36.根据权利要求23所述的手术装置,其进一步包括机电驱动器,所述机电驱动器包括适于驱动第一驱动器的可旋转的第一驱动轴和适于驱动第二驱动器的可旋转的第二驱动轴。
37.根据权利要求35所述的手术装置,其中所述第二钳夹的所述内螺纹孔布置在臂内,所述臂被配置成在与所述第一钳夹附连的套筒内相对于所述套筒纵向地移动。
38.根据权利要求37所述的手术装置,其中凸轮装置包括沿着臂和套筒中的至少一个布置的沟槽,凸轮随动件可滑动地布置在所述沟槽内,其中所述沟槽包括螺旋部分。
39.一种手术装置的操作方法,其包括以下步骤:
相对于第一钳夹在闭合位置和中间打开位置之间移动第二钳夹,其中所述第一钳夹和所述第二钳夹布置在共同平面内;和
相对于所述第一钳夹至少围绕位于所述共同平面内的轴线旋转地、在所述中间打开位置和完全打开位置之间移动所述第二钳夹。
40.根据权利要求39所述的操作方法,其中,在所述完全打开位置中,所述第一钳夹和所述第二钳夹中的至少一个没有布置在所述共同平面内。
41.根据权利要求40所述的操作方法,其中套筒和臂具有被配置成使所述第二钳夹至少在所述中间打开位置和所述完全打开位置之间移动的凸轮装置。
42.根据权利要求39所述的操作方法,其进一步包括以下步骤:
围绕旋转轴线旋转第一驱动轴,所述第一驱动轴被配置成在所述闭合位置、所述中间打开位置和所述完全打开位置之间移动第二钳夹。
43.根据权利要求42所述的操作方法,其进一步包括以下步骤:
旋转第二驱动轴;和
根据可旋转的第二驱动轴的旋转,沿平行于所述共同平面的方向移动布置在第一钳夹内的手术元件。
44.根据权利要求43所述的操作方法,其中所述手术元件包括切割元件和钉合元件中的至少一个。
45.根据权利要求42所述的操作方法,其中可旋转的第一驱动轴由机电驱动器旋转。
46.根据权利要求42所述的操作方法,其中可旋转的第二驱动轴由机电驱动器旋转。
47.根据权利要求42所述的操作方法,其中第一钳夹和第二钳夹包括凸轮装置,所述方法进一步包括当第一钳夹和第二钳夹在所述中间打开位置和所述完全打开位置之间移动时接合所述凸轮装置的步骤。
48.根据权利要求47所述的操作方法,其中所述凸轮装置包括沿着所述臂和所述套筒中的至少一个布置的沟槽,凸轮随动件布置在所述沟槽内,其中所述沟槽包括螺旋部分。
49.一种手术装置,其包括:
第一钳夹;和
第二钳夹,其耦联到所述第一钳夹并且相对于所述第一钳夹能够在闭合位置和中间打开位置之间移动,其中所述第一钳夹和所述第二钳夹布置在第一平面内并且在所述第一平面内相对于第一轴线运动,所述第二钳夹相对于所述第一钳夹能够进一步绕所述第一轴线至少旋转地在所述中间打开位置和完全打开位置之间移动,其中所述第一轴线位于所述第一平面内。
50.根据权利要求49所述的手术装置,其中,在所述完全打开位置中,所述第一钳夹和所述第二钳夹中的至少一个没有布置在共同平面内。
51.根据权利要求50所述的手术装置,其中套筒和臂具有被配置成使所述第二钳夹至少在所述中间打开位置和所述完全打开位置之间移动的凸轮装置。
52.根据权利要求49所述的手术装置,其中在所述中间打开位置和所述完全打开位置之间,所述第二钳夹相对于所述第一钳夹能够朝横向于共同平面的方位移动。
53.根据权利要求52所述的手术装置,其进一步包括第一驱动器,所述第一驱动器被配置成使所述第一钳夹和所述第二钳夹相对运动。
54.根据权利要求53所述的手术装置,其中所述第一驱动器被配置成与驱动轴接合,所述驱动轴能够围绕相对于所述共同平面平行地或非平行地设置的旋转轴线旋转。
55.根据权利要求49所述的手术装置,其进一步包括:
手术元件,其布置在所述第一钳夹内;和
第二驱动器,其被配置成使所述手术元件沿平行于共同平面的方向相对运动。
56.根据权利要求55所述的手术装置,其中所述第二驱动器被配置成与第二驱动轴接合,所述第二驱动轴能够围绕与所述共同平面非平行地设置的旋转轴线旋转;并且当可旋转的第二驱动轴沿第一方向旋转时所述手术元件伸展,并且当可旋转的第二驱动轴沿与所述第一方向相反的第二方向旋转时所述手术元件缩回。
57.根据权利要求55所述的手术装置,其中所述第二驱动器被配置成与第二驱动轴接合,所述第二驱动轴能够围绕与所述共同平面平行地设置的旋转轴线旋转。
58.根据权利要求55所述的手术装置,其中所述手术元件包括下述构件中的一个:切割元件;钉合元件;以及安装切割元件和钉合元件的推板。
59.根据权利要求53所述的手术装置,其进一步包括被配置成使可旋转的第一驱动轴旋转的机电驱动器。
60.根据权利要求53所述的手术装置,其中可旋转的第一驱动轴的旋转轴线垂直于所述第一钳夹和所述第二钳夹的共同平面。
61.根据权利要求53所述的手术装置,其中可旋转的第一驱动轴沿第一方向旋转以实现所述钳夹的伸展,并且沿与所述第一方向相反的第二方向旋转以实现所述钳夹的闭合。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US11/191,665 US7770773B2 (en) | 2005-07-27 | 2005-07-27 | Surgical device |
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Cited By (3)
Publication number | Priority date | Publication date | Assignee | Title |
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CN108451598A (zh) * | 2018-03-20 | 2018-08-28 | 广州德脉医疗器械有限公司 | 一种电驱动的包皮环切机构及包皮缝合环切器 |
CN108451598B (zh) * | 2018-03-20 | 2024-01-02 | 广州德脉医疗器械有限公司 | 一种电驱动的包皮环切机构及包皮缝合环切器 |
TWI772784B (zh) * | 2020-04-28 | 2022-08-01 | 明基三豐醫療器材股份有限公司 | 固定機構 |
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US8851353B2 (en) | 2014-10-07 |
EP3245957A1 (en) | 2017-11-22 |
US20140046354A1 (en) | 2014-02-13 |
JP2009502351A (ja) | 2009-01-29 |
EP1912572A4 (en) | 2013-11-27 |
WO2007016288A2 (en) | 2007-02-08 |
US20120136380A1 (en) | 2012-05-31 |
US7770773B2 (en) | 2010-08-10 |
IL189047A (en) | 2014-08-31 |
CA2617041C (en) | 2014-01-07 |
CN101272740B (zh) | 2011-05-11 |
EP3245957B1 (en) | 2022-08-31 |
US8381828B2 (en) | 2013-02-26 |
US20100276470A1 (en) | 2010-11-04 |
CN102106745B (zh) | 2013-06-19 |
WO2007016288A3 (en) | 2007-11-01 |
JP5059001B2 (ja) | 2012-10-24 |
US20140374463A1 (en) | 2014-12-25 |
EP1912572B1 (en) | 2017-07-05 |
US9186139B2 (en) | 2015-11-17 |
US8132704B2 (en) | 2012-03-13 |
CA2617041A1 (en) | 2007-02-08 |
EP1912572A2 (en) | 2008-04-23 |
US20070023476A1 (en) | 2007-02-01 |
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