CN102327138B - 内窥镜手术施夹器 - Google Patents
内窥镜手术施夹器 Download PDFInfo
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- CN102327138B CN102327138B CN201110282277.4A CN201110282277A CN102327138B CN 102327138 B CN102327138 B CN 102327138B CN 201110282277 A CN201110282277 A CN 201110282277A CN 102327138 B CN102327138 B CN 102327138B
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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
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
- A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0807—Indication means
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0814—Preventing re-use
Abstract
本发明提供了一种用于将手术夹子施加到体组织上的装置,尤其提供了一种内窥镜手术施夹器。所述装置包括:a)手柄组件;b)轴组件,其从所述手柄组件向远侧延伸并且限定了纵轴;c)多个手术夹子,其布置在所述轴组件内;d)钳口,其邻近所述轴组件的远端部安装,所述钳口包括能够在隔开位置和接近位置之间活动的一对钳口构件;e)夹子推杆,其被配置成在所述钳口构件处于隔开位置时单独地将手术夹子向远侧推进至所述钳口;f)驱动杆,其至少部分地布置在所述手柄组件和所述轴组件内,所述驱动杆能够响应于所述手柄组件的扳机的致动而纵向移动;以及g)驱动通道,其与第一和第二钳口构件相邻定位以将所述钳口构件移动至接近位置。
Description
本申请是申请号为200880009875.0、申请日为2008年3月26日、发明名称为“内窥镜手术施夹器”的专利申请的分案申请。
相关申请的引用
本申请要求享有于2007年3月26日提交的序列号为60/920,114的美国临时专利申请的权益和优先权,该临时申请的全部内容通过引用合并于此。
技术领域
本公开的技术领域涉及手术施夹器。本公开尤其涉及一种具有用于在插入手术夹子时固定钳口结构的机构的内窥镜手术施夹器。
背景技术
内窥镜缝合器和施夹器在本领域中是公知的并且用于多个不同且有用的手术程序。在腹腔镜手术程序的情况下,通过插入皮肤中的小进入切口的窄的管子或套管来获得到腹部的内部的通道。而在身体上的其它部位执行的微创程序通常一般被称作内窥镜程序。典型地,管子或者套管装置通过进入切口伸入患者的身体中,以便提供入口。此种入口允许外科医生利用套管针插入多个不同的手术器械并且用于在远离切口的地方执行手术程序。
在大多数的这些程序中,外科医生经常必须终止血液或另一种液体通过一根或多根脉管的流动。在程序中,外科医生经常会将手术夹子施加到血管或另一种导管上,以防止体液流过这些导管。内窥镜施夹器用于在进入体腔时施加单个夹子,这在本领域中是公知的。典型地,这样的夹子由生物相容性材料制成并且通常被压布在脉管上。一旦施加到脉管上,该被压布的夹子就终止液体通过导管的流动。
在共有的转让给格林(Green)等人的第5,084,057和5,100,420号美国专利中描述了在单独进入体腔中时能够在内窥镜或腹腔镜程序中施加多个夹子的内窥镜施夹器,上述两项专利的全部内容通过引用合并于此。在共有的转让给布拉德(Pratt)等人的第5,607,436号美国专利中公开了另一种复合内窥镜施夹器,该专利的全部内容同样通过引用合并于此。这些装置被典型地用在单个手术程序中,但这不是必须的。在序列号为08/515,341的美国专利申请,即现在授予给皮埃尔(Pier)等人的第5,695,502号美国专利中公开了一种可重复消毒的手术施夹器,该专利所公开的内容通过引用合并于此。该施夹器在单独插入体腔中时推进并形成多个夹子。所述可重复消毒的施夹器被配置成容纳并与可拆卸的弹夹合作,以便在单独进入体腔时推进和形成多个夹子。一个重要的设计目标是,在不对来自装载程序的夹子进行任何压缩的情况下将手术夹子装在钳口之间。在装载过程中的夹子的这些弯曲或扭转经常会有许多意想不到的后果。在装载时的这种压缩可能会略微地改变夹子在钳口之间的对准。这会使外科医生将夹子从钳口之间移除以便丢弃夹子。另外,这种预载压缩可能会轻微地压缩夹子的某些部分而改变夹子的几何形状。这会使外科医生将夹子从钳口之间移除以便丢弃夹子。
经常在远离切口的地方执行内窥镜或者腹腔镜程序。因此,对于位于装置近端的用户而言,视野或者触觉反馈的减小可能使夹子的施加复杂化。因此希望通过向用户提供单个夹子被发射的指示、包含在装载单元中的夹子的损耗或者任何其它手术事件的指示来改善器械的操作。还希望提供这样一种手术施夹器:其促进了夹子的成功负载并且分开该手术施夹器的钳口,然后将夹子装在钳口之间以便防止夹子的任何损坏或者过度压缩,并在发射前防止钳口对在夹子的压缩。
发明内容
本公开涉及内窥镜手术施夹器。
根据本公开的一个方案,提供了一种用于将手术夹子施加到体组织上的装置,所述装置包括:手柄组件;轴组件,其从手柄组件向远侧延伸并且限定了纵轴;多个手术夹子,其布置在轴组件内;钳口,其邻近轴组件的远端部安装,钳口包括能在隔开位置和接近位置之间活动的一对钳口构件;夹子推杆,其被配置成在钳口构件处于隔开位置时单独地将手术夹子向远侧推进至钳口;驱动杆,其至少部分地布置在手柄组件和轴组件内,驱动杆能够响应于手柄组件的扳机的致动而纵向移动;以及驱动通道,其与第一和第二钳口构件相邻定位以将钳口构件移动至接近位置。
所述装置进一步包括锁定系统,所述锁定系统被配置成选择性地与夹子推杆接合,以在多个夹子被基本排出时防止夹子推杆返回至原位置并防止扳机完成整个行程。
锁定系统可包括支撑在轴组件中的推杆闭锁机构。在使用中,当最后一个夹子被排出时,闭锁机构的锁定杆可被致动以与夹子推杆接合。锁定杆可以防止夹子推杆返回至原位置。
所述装置可进一步包括夹子输出器,所述夹子输出器可滑动地布置在轴组件内的多个夹子的近侧位置处。在使用中,当最后一个夹子被排出时,夹子输出器可推动推杆闭锁机构的锁定杆与夹子推杆接合。
锁定系统可包括:齿条,其具有多个棘轮齿并被固定在驱动通道上;以及棘轮爪,其具有至少一个齿并被布置在选择性地与齿条接合的位置处。棘轮爪可被偏置到与齿条接合。在使用中,随着驱动通道纵向地往复运动,所述多个齿可越过棘轮爪,并且棘轮爪可防止驱动通道在所述装置完全致动之前非故意的返回。
所述装置的锁定系统可包括能够通过操作被夹子推杆和驱动通道接合的闭锁构件。该闭锁构件可以包括:当夹子推杆处于原位置时,闭锁与驱动通道不接合的位置;以及当夹子推杆处于非原位置时,闭锁构件与驱动通道接合的位置。在使用中,当锁定杆防止夹子推杆返回至原位置时,闭锁构件与驱动通道接合并防止驱动通道向近侧移动,由此,齿条的多个齿与棘轮爪保持接合。
所述装置可进一步包括可滑动地支撑在轴组件中的楔形板。楔形板可包括远端,该远端被配置并尺寸设计为在钳口构件处于隔开位置时放置于钳口构件之间。在使用中,当驱动通道向远侧方向移动时,楔形板可向近侧方向移动以将其远端从钳口构件之间收回。
所述装置可进一步包括通过操作布置在楔形板和驱动通道之间的齿轮。在使用中,齿轮可将驱动通道的远侧移动转换成楔形板的近侧移动,而将驱动通道的近侧移动转换成楔形板的远侧移动。
所述装置可在驱动杆的远侧推进和驱动通道的远侧推进之间设置延迟。
所述装置可进一步包括支撑在驱动杆上的解扣机构(trip mechanism)。解扣机构可包括解扣杆,该解扣杆被偏置到与夹子推杆相接触。在使用中,驱动杆的远侧移动可移动解扣机构,直到解扣机构的解扣杆与夹子推杆的唇缘接合从而向远侧移动夹子推杆。
所述装置可进一步包括剪切销,该剪切销通过操作连接在驱动杆上以在扳机移动时将轴向力传递给驱动杆,其中,剪切销包括至少一个强度减弱区。当在所述剪切销上施加最小预定剪切力时,剪切销可能在至少一个强度减弱区处可能中断。
根据本公开的另一个方案,提供了一种用于将手术夹子施加到体组织上的装置,所述装置包括:手柄组件;轴组件,其从手柄组件向远侧延伸;多个手术夹子,其布置在轴组件内,其中,每个夹子均具有外部宽度;以及钳口,其邻近轴组件的远端部安装,其中,所述钳口包括能在隔开位置和接近位置之间活动的一对钳口构件。所述一对钳口构件在处于隔开位置时具有外部宽度。
根据本公开的又一个方案,提供了一种用于将手术夹子施加到体组织上的装置。所述装置包括:a)手柄组件;b)轴组件,其从所述手柄组件向远侧延伸;c)多个手术夹子,其布置在轴组件内,每个夹子均具有外部宽度;以及d)钳口,其邻近轴组件的远端部安装,所述钳口包括能在隔开位置和接近位置之间活动的一对钳口构件,其中,当所述一对钳口构件处于隔开位置时,所述一对钳口构件具有外部宽度,其中,夹子的外部宽度与处于隔开位置的所述一对钳口构件的外部宽度的比小于或等于1∶1.8。
根据本公开的另一个方案,提供了一种从手术施夹器施加手术夹子的方法。所述方法包括下列步骤:提供手术施夹器,所述手术施夹器包括至少多个夹子、配置成容纳和形成所述夹子的钳口,以及扳机,所述扳机被配置成在用于容纳所述夹子的打开位置和用于形成所述夹子的闭合位置之间致动所述钳口。所述方法进一步包括下列步骤:将扳机从打开位置致动至闭合位置,以将第一夹子装入钳口中并将钳口从打开位置移动至闭合位置以形成所述第一夹子;然后,松开扳机以使扳机返回至打开位置并使钳口返回至打开位置。
扳机仅能在扳机已经被致动到完全闭合位置后返回至打开位置。所述方法可进一步包括提供连接在扳机上的驱动杆的步骤,并且其中,将扳机从打开位置致动至闭合位置的步骤则可导致驱动杆向远端移动。
所述方法可进一步包括提供选择性地连接在驱动杆上的推杆的步骤,并且其中,将扳机从打开位置致动至闭合位置的步骤则可导致推杆向远端移动。
使推杆向远侧移动的步骤可包括使推杆的远端接触最远侧夹子的后跨部(backspan)然后将最远侧夹子移动至钳口之间的位置中的步骤。所述方法可进一步包括然后使驱动杆从推杆脱离的步骤,由此,驱动杆继续向远侧移动。
所述方法可进一步包括在将所述最远侧夹子移动至钳口中的同时向远侧方向移动剩余夹子的步骤。
所述方法可进一步包括然后驱动杆与驱动通道接合以向远侧方向移动驱动通道的步骤。
所述方法可进一步包括然后向近侧方向移动推杆的步骤。
所述方法可进一步包括然后向近侧方向移动楔形板从而将楔形板的远端从钳口之间收回的步骤。
所述方法可进一步包括然后使驱动通道的远端与钳口接合从而使钳口从打开位置移动至闭合位置以形成布置于其中的夹子的步骤。
所述方法可进一步包括致动计数机构以显示已经发生的事件的步骤。
所述方法可进一步包括然后松开扳机以向近侧方向驱动杆和驱动通道并向远侧方向移动楔形板的步骤。
所述方法可进一步包括在将最后一个夹子放置于钳口中之后致动闭锁构件的步骤,闭锁构件与推杆接合并防止推杆移动至完全近侧位置。
附图说明
在此,参照附图公开了手术施夹器的一个特定实施例,其中:
图1是手术施夹器的立体图;
图2是图1所示的手术施夹器的进一步的立体图,图示了其细长管状构件的旋转;
图3是图1和图2所示的手术施夹器的钳口结构的放大立体图;
图4A是具有第一全长的手术施夹器的俯视图;
图4是图1至图3所示的具有第二全长的手术施夹器的俯视图;
图5是图1至图4所示的手术施夹器的侧视图;
图6是图1至图4所示的手术施夹器的手柄组件在从其中移去一半主体的情况下的左侧立体图;
图7是图1至图4所示的手术施夹器的手柄组件在从其中移去一半主体的情况下的右侧立体图;
图8是图1至图4所示的手术施夹器的手柄组件的分解立体图以及示出为与其通过操作关联的图1至图4所示的手术施夹器的轴组件的立体图;
图9是图1至图4所示的手术施夹器的轴组件的分解立体图;
图10是图1至图4所示的手术施夹器的触觉反馈构件的立体图;
图11是图9中显示的细节表示区域的分解立体图,图示了轴组件的解扣机构;
图12是图9中显示的细节表示区域的分解立体图,图示了轴组件的闭锁锁定器;
图13是图9中显示的细节表示区域的立体图,图示了轴组件的滑动接头(joint slider);
图14是图9中显示的细节表示区域的分解立体图,图示了轴组件的推杆闭锁机构;
图15是图9中显示的细节表示区域的分解立体图,图示了轴组件的楔形板齿条机构;
图16是图1至图4所示的手术施夹器的近端的局部分解的立体图,图示了布置在轴组件和手柄组件之间的连接细长部;
图17是图16所示的手术施夹器的近端在装配完毕之后的立体图,图示了布置在轴组件和手柄组件之间的连接细长部;
图18是图1至图4所示的手术施夹器沿图5中的18-18截取的后侧透视截面图;
图19是图18中显示的细节表示区域的放大图;
图20是图1至图4所示的手术施夹器沿图5中的20-20截取的后侧正视截面图;
图21是图1至图4所示的手术施夹器的轴组件在为图示目的而从其中移去外部管状构件的情况下的前视立体图;
图22是图21中显示的细节表示区域的放大立体图;
图23是图21中显示的细节表示区域的放大立体图;
图24是图1至图4所示的手术施夹器的轴组件在为图示目的而从其中移去上壳体的情况下的前视立体图;
图25是图24中显示的细节表示区域的放大立体图;
图26是图24中显示的细节表示区域的放大立体图;
图27是图24所示的轴组件的远端的放大立体图;
图28是图1至图4所示的手术施夹器的轴组件在从其中移去推杆、夹子推进机构和多个夹子的情况下的后视立体图;
图29是图28中显示的细节表示区域的放大立体图;
图30是图28中显示的细节表示区域的放大立体图;
图31是图1至图4所示的手术施夹器的轴组件在从其中移去下壳体、推杆、夹子推进机构和多个夹子的情况下的后视立体图;
图32是图31中显示的细节表示区域的放大立体图;
图33是图31中显示的细节表示区域的立体图;
图34是图1至图4所示的手术施夹器的轴组件在从其中移去下壳体的情况下的底部前视立体图;
图35是图34中显示的细节表示区域的放大立体图;
图36是图34中显示的细节表示区域的放大立体图;
图37是图1至图4所示的手术施夹器的轴组件在从其中移去驱动通道和楔形板的情况下的后视立体图;
图38是图34中显示的细节表示区域的放大立体图;
图39是图1至图4所示的手术施夹器的轴组件的远端的底部前视立体图,图示了处于装配状态的上壳体、楔形板以及驱动通道;
图40是轴组件在移去驱动杆的情况下的棘轮爪和齿条组件的放大的后视立体图;
图41是图39中显示的细节表示区域的放大立体图;
图42是图39中显示的细节表示区域的放大立体图;
图43是图39所示的轴组件的远端在从其中移去楔形板和驱动通道、夹子堆和输出器之后的底部前视立体图;
图44是图43中显示的细节表示区域的放大立体图;
图45是图43中显示的细节表示区域的放大立体图;
图46是图43中显示的细节表示区域的放大立体图;
图47是图1至图4所示的手术施夹器的纵向正视截面图;
图48是图47中显示的细节表示区域的放大的正视截面图;
图49是图47中显示的细节表示区域的放大的正视截面图;
图50是沿图49中的50-50截取的纵向截面图;
图51是沿图48中的51-51截取的横向截面图;
图52是图49中显示的细节表示区域的放大的正视截面图;
图53是沿图52中的53-53截取的纵向截面图;
图54是图49中显示的细节表示区域的放大的正视截面图;
图55是沿图54中的55-55截取的纵向截面图;
图56是图49中显示的细节表示区域的放大的正视截面图;
图57是沿图56中的57-57截取的纵向截面图;
图58是沿图54中的58-58截取的横向截面图;
图59是沿图56中的59-59截取的横向截面图;
图60是图49中显示的细节表示区域的放大的正视截面图;
图61是沿图60中的61-61截取的纵向截面图;
图62是图1至图4所示的手术施夹器的纵向正视截面图,图示了手柄组件的扳机的初始行程的第一阶段;
图63是在手柄组件的扳机的初始行程的第一阶段期间的图49中显示的细节52的放大的正视截面图;
图64是沿图63中的64-64截取的纵向截面图;
图65和图66是在手柄组件的扳机的初始行程的第一阶段期间的图49中显示的细节60的放大的正视截面图;
图67是图1至图4所示的手术施夹器的纵向正视截面图,图示了手柄组件的扳机的初始行程的第二阶段;
图68是在手柄组件的扳机的初始行程的第二阶段期间的图67中显示的细节表示区域的放大的正视截面图;
图69是在手柄组件的扳机的初始行程的第二阶段期间的图49中显示的细节60的放大的正视截面图;
图70是在手柄组件的扳机的初始行程的第二阶段期间的图49中显示的细节52的放大的正视截面图;
图71是在手柄组件的扳机的初始行程的第二阶段期间的图49中显示的细节54的放大的正视截面图;
图72是沿图71中的72-72截取的纵向截面图;
图73是在手柄组件的扳机的初始行程的第二阶段期间的图49中显示的细节52的放大的正视截面图;
图74和图75是在手柄组件的扳机的初始行程的第二阶段期间的图49中显示的细节60的放大的正视截面图;
图76是在手柄组件的扳机的初始行程的第二阶段期间的图49中显示的细节52的放大的正视截面图;
图77是在手柄组件的扳机的初始行程的第二阶段期间的图49中显示的细节56的放大的正视截面图;
图78是沿图77中的78-78截取的纵向截面图;
图79是手术施夹器的具有插入其间的楔形板的钳口的前视立体图;
图80是手术施夹器的钳口的前视立体图,图示了楔形板从钳口之间收回的情况;
图81是图1至图4所示的手术施夹器的手柄组件的纵向正视截面图,图示了手柄组件的扳机的初始行程的第三阶段;
图82是图81中显示的细节表示区域的放大的正视截面图;
图83是图81中显示的细节表示区域的放大的正视截面图;
图84是在手柄组件的扳机的初始行程的第三阶段期间的手柄组件的后视立体局部截面图;
图85是在手柄组件的扳机的初始行程的第三阶段期间的图49中显示的细节54的放大的正视截面图;
图86是沿图85中的86-86截取的纵向截面图;
图87是手术施夹器的钳口的前视立体图,图示了与其通过操作关联的驱动通道和驱动板;
图88是图1至图4所示的手术缝合装置的轴组件的远端的纵向俯视截面图,图示了钳口的非接近位置;
图89是图1至图4所示的手术缝合装置的轴组件的远端的纵向俯视截面图,图示了钳口的接近位置;
图90是包括将图1至图4所示的手术缝合装置的夹子施加到其上的体脉管的立体图;
图91是沿图63中的64-64截取的纵向截面图,图示了图40所示的棘轮爪和齿条组件的操作;
图92和图93是图81中显示的细节83的放大的正视截面图,图示了触觉反馈元件的操作;
图94是沿图63中的64-64截取的纵向截面图,图示了棘轮爪和齿条组件的进一步操作;
图95是图1至图4所示的手术施夹器的手柄组件的纵向正视截面图,图示了手柄组件的扳机的松开行程;
图96是在手柄组件的扳机的松开行程期间的图49中显示的细节54的放大的正视截面图;
图97是图1至图4所示的手术缝合装置的轴组件的远端的纵向俯视截面图,图示了在手柄组件的扳机的松开行程期间的钳口的非接近位置;
图98是沿图77中的78-78截取的纵向截面图,图示了在手柄组件的扳机的松开行程期间的楔形板齿条机构的操作;
图99是手术施夹器的钳口的后视立体图,图示了楔形板被插入钳口之间的情况;
图100是图49中显示的细节60的放大的正视截面图,图示了在最后一个夹子已经被发射之后开始闭锁阶段的情况;
图101是在手柄组件的扳机的松开行程期间并且与闭锁机构接合的图49中显示的细节52放大的正视截面图;
图102是图64的纵向截面图,图示了在装置的闭锁阶段期间的棘轮爪和齿条组件的操作;
图103是手柄组件的放大的纵向截面图,图示了驱动组件在闭锁机构已经被接合之后的操作;以及
图104是手柄组件的放大的纵向截面图,图示了剪切销及驱动组件穿过闭锁机构的操作。
具体实施方式
现将参照附图详细描述根据本公开的手术施夹器的实施例,附图中相似的附图标记表示相似或相同的结构元件。如图所示及以下整个说明书所描述的,按照传统,当涉及手术器械上的相对定位时,术语“近侧”指装置的较靠近用户的一端,术语“远侧”指装置的较远离用户的一端。
现参照图1至图5,根据本公开的一个实施例的手术施夹器通常用100来指代。手术施夹器100通常包括手柄组件102和内窥镜部,该内窥镜部包括从手柄组件102向远侧延伸的轴组件104。
取决于预计的用途,轴组件104可具有各种外径例如约5mm或者约10mm。进一步地,取决于预计的用途诸如在肥胖病手术中,轴组件104可以具有各种伸长的长度(见图4A)或缩短的长度(见图4和图5)。在一个实施例中,在肥胖病手术中,细长管状构件104可具有在约30cm和约40cm之间的长度。然而,本领域内的技术人员应意识到,轴组件104可具有超过约30cm的任意长度,本公开不局限于以上提及的长度中的任意一个。
手术施夹器100包括安装在轴组件104的远端上并可由手柄组件102的扳机108致动的一对钳口106。一对钳口106由合适的生物相容性材料诸如不锈钢或钛制成。特别地,在某些实施例中,当一对钳口106相对于彼此处于打开或非接近的状态时,一对钳口106的最大宽度大体上小于或者等于轴组件104的外径以允许手术施夹器100的远端在内窥镜手术时通过套管针插入,或者在开放手术时通过身体中的开口或孔口插入。
一对钳口106安装于轴组件104的远端中,使得它们相对于该处纵向固定。旋钮110可以可旋转地安装在手柄组件102的远端上,并固定在轴组件104上以向轴组件104和一对钳口106传输和/或提供绕其纵轴的360°旋转(见图2)。暂时参照图3,一对钳口106在其之间限定了通道106a以用于将手术夹子(未示出)容纳于其中。
现参照图6至图8,示出了手术施夹器100的手柄组件102。手柄组件102包括壳体103,该壳体具有第一或右侧半部103a和第二或左侧半部103b。手柄组件102包括可枢转地支撑在右侧半部103a和左侧半部103b之间的扳机108。如以下将更详细讨论的,手柄组件102限定了形成于壳体103中的用于支撑和显示计数机构132a的窗口103c。手柄组件102的壳体103可由合适的塑料制成。
壳体103将驱动组件120支撑在右侧半部103a和左侧半部103b之间。驱动组件120包括叉形连杆122,该叉形连杆具有枢转地连接于扳机108的第一端和枢转地连接于轭状物124的第二端。如图6至图9所示,驱动组件120进一步包括可旋转地连接于轭状物124的柱塞134和支撑在柱塞134上的弹簧136。柱塞134限定了纵向狭槽134a(见图9),该纵向狭槽配置成并适于将驱动杆140的近端容纳在其中。
驱动杆140经由剪切销142固定在柱塞134上,剪切销142的结构和功能将在下文中进行更详细地描述。设置有帽144,驱动杆140贯穿该帽。设置有旋钮插件(knob insert)111,其被配置成并适于被旋转地支撑在壳体103的远端中并且将帽144支撑在其内。旋钮插件111连接到旋钮110上,从而,旋钮110的旋转引起旋钮插件111的伴随旋转。设置密封件146来建立驱动杆140和外管150之间的气密性密封
如图6至图8、图48、图62、图67、图81、图83、图84、图92、图93以及图95所示,手柄组件102进一步包括听觉/触觉反馈构件126,该反馈构件与扳机108通过操作关联以便与扳机108一起绕着共同的轴旋转。反馈构件126包括可偏转臂126a。在操作中,随着扳机108被致动,反馈构件126的臂126a在肋状物103d上方和/或沿着肋状物103d行进,所述肋状物形成在右侧半部103a和左侧半部103b中的至少一个中。如在下文将更详细讨论的,当臂126a到达肋状物103d的端部时,臂126a卡扣在肋状物103d的端部上,并且当臂126a与右侧半部103a和左侧半部103b的表面103f相接触时,臂126a产生可听到的声音/卡嗒声和/或可触知的振动。
如图6至图8所示,壳体103进一步将致动板128支撑在右侧半部103a上。致动板128包括突出部128a,该突出部被配置成并适于与限定在壳体103的右侧半部103a中的狭槽103e可滑动的接合。致动板128在其中限定了纵向定位的狭槽128b,狭槽128b用于可滑动地容纳叉形连杆122的凸台122a。致动板128进一步限定了用于可滑动地与计数致动杠杆130的臂130b接合的计数致动表面128c。计数致动杠杆130被可枢转地支撑在壳体103内。
如图6至图8、图48、图62、图67、图81、图82以及图95所示,计数致动杠杆130包括第一臂130a,第一臂130a被配置成并适于通过操作选择性地与计数机构132接合,该计数机构被支撑在壳体103中并通过限定在壳体103中的窗口103c可见。计数致动杠杆130进一步包括第二臂130b,第二臂130b被配置成并适于通过操作可滑动地与致动板128的致动表面128c接合。设置呈弹簧139形式的偏置构件以使计数致动杠杆130的第二臂130b偏置为抵靠在致动板128的计数致动表面128c上。
在操作中,如以下将更详细描述的,随着扳机10被挤压,扳机108使得叉形连杆122向远侧推进,从而使得轭状物124向远侧推进。当叉形连杆122的凸台122a到达致动板128的狭槽128b的端部时,凸台122a向远侧方向推动致动板128,从而致动计数致动杠杆130以激活计数机构132。特别地,当致动板128向远侧移动足够距离时,计数致动杠杆130的第二臂130b无接触地通过(clear)致动板128的计数致动表面128c,并被弹簧139沿着第一或顺时针方向推动,导致计数致动杠杆130的第一臂130a与计数机构132接合。当致动板128向近侧移动足够距离时,计数致动杠杆130的第二臂130b被致动板128的计数致动表面128c用凸轮带动,并被沿着第二或逆时针方向推动,从而导致计数致动杠杆130的第一臂130a脱离计数机构132。
计数机构132包括显示器132a、处理器132b和呈电池等形式的能源132c。
显示器132a可以是本领域已知的任何器件以提供事件的指示。所述事件可以涉及施夹器100的程序或操作。显示器132a可以是液晶显示器(LCD)、等离子显示器、一个或多个发光二极管(LED)、发光显示器(luminescentdisplay)、彩色显示器、数字显示器、模拟显示器、被动式显示器(passivedisplay)、主动式显示器(active display)、所谓的“扭曲向列(twistednematic)”液晶显示器、所谓的“超扭曲向列”液晶显示器、“双扫描”显示器、反射式显示器、背光式显示器、字母数字显示器、单色显示器、所谓的“低温多晶硅薄膜晶体管(LPTS TFT)”显示器,或者显示与程序或施夹器100相关的参数、信息或者图像的任何其它合适的显示器132a。
在一个实施例中,显示器132a是液晶显示器,其可以是向外科医生显示施夹器100的一个或多个操作参数的黑白或彩色显示器。在一个实施例中,显示的操作参数可以是剩余夹子的数量(amount)或数目(number)、已经使用的夹子的数目、位置参数、手术使用时间或程序的任何其它参数。显示器132a可以显示文本、图像或者这两者的组合。
在一个实施例中,计数机构132可以具有布置在电池或能源132c和处理器132b的触头之间的凸片,该凸片防止电池或能源132c在存储期间变得耗尽,其优选地由聚脂薄膜(Mylar)或另一种聚合的绝缘材料制成。该凸片可从手术施夹器100的壳体103伸出以便允许凸片易于从那里移去。一旦凸片被移去,则电池或能源132c与处理器132b的触头电接触,从而使显示器132a通电。
显示器132c可包括用于放大显示于其上的参数的棱镜等。显示器132a的棱镜可将显示器放大至任意希望的尺寸,以使外科医生易于从远处阅读显示器。
在一个实施例中,计数机构可以是包括光源以及和光源合作使用的光学传感器的数字计数器。光学传感器可包括电子眼或光导纤维(fiber opticlead),电子眼或光导纤维产生显示于探测器上的恒定的红外光束,使得红外光束或者红外光束的中断能被转换成电信号。
现转至图9至图46,示出了手术施夹器100的轴组件104,下面对其进行描述。轴组件104及其部件可由合适的生物相容性材料诸如不锈钢、钛、塑料等制成。轴组件104包括外管150,外管150具有支撑在旋钮插件111内的近端150a、远端150b和贯穿其中的内腔150c。轴组件104进一步包括均布置在外管150的内腔150c内的上壳体152a和下壳体152b。外管150被突出部111c固定于旋钮插件111内,所述突出部从旋钮插件111a、111b的内表面伸出并与形成在外管150中的孔150d接合(见图9)。解扣块154布置在外管150内并位于上壳体152a的近侧。如图43和图45所示,解扣块154包括形成于其上表面中的窗口154a。
轴组件104进一步包括可滑动地插在外管150、上壳体152a和解扣块154之间的推杆156。推杆156包括限定了推动器156c的远端156a,推动器156c被配置成并适于选择性地进入形成于上壳体152a中的窗口153a中(见图21和图22)并且接合/移动(即,向远侧推进)存储在手术施夹器100中的夹子。推杆156进一步包括近端156b,近端156b通过操作固定到解扣块154上(见图21和图23)。推杆156限定了远侧窗口156d以及近侧窗口156e。
如图23所示,推杆156被偏置元件158例如压缩弹簧偏置到相对于解扣块154而言的近侧位置,所述偏置元件插在从解扣块154伸出的凸台154a和推杆156的表面之间。在一个实施例中,如图23所示,弹簧158被支撑在形成于推杆156的窗口156g中的尖头156f上,其中尖头156f的远端可滑动地贯穿解扣块154的凸台154a。弹簧158布置在尖头156f的基座和解扣块154的短杆154a之间。
从图9、图12、图43以及图44中清楚地看出,轴组件104进一步包括闭锁锁定器160,闭锁锁定器160通过操作被支撑在限定于解扣块154的下侧中的通道154b内(见图44)。闭锁锁定器160包括闭锁构件162和偏置构件164:闭锁构件162被枢转地支撑在解扣块154的通道154b中;偏置构件164固定地连接在解扣块154的通道154b内并且通过操作连接在闭锁构件162上以便将闭锁构件162沿所示的逆时针方向偏置到第一状态。闭锁构件162包括限定了台肩(shoulder)的远侧部162a以及限定了导圆角表面162b的近侧部162b。偏置构件164包括臂164a,该臂与闭锁构件162的远侧部162a相接触并作用于该远侧部以径向向内推动闭锁构件162的远侧部162a(即,如所示的朝着或沿着逆时针方向),并且径向向外推动闭锁构件162的近侧部162b(即,如所示的离开或者沿着逆时针方向)的压力。
从图9、图14、图43以及图46中清楚地看出,轴组件104进一步包括推杆闭锁机构166,推杆闭锁机构166通过操作被支撑在限定于上壳体152a的下侧中的通道153b内(见图46)。推杆闭锁机构166包括锁定杆168和偏置构件170:锁定杆168被枢转地支撑在上壳体152a的通道153b中;偏置构件170固定地连接在上壳体152b的通道153b内并且通过操作连接在锁定杆168上以便将锁定杆168沿所示的顺时针方向偏置到第一状态。锁定杆168包括通过操作连接在偏置构件170上的远侧部168a以及限定了掣子(catch)的近侧部168b。偏置构件170包括近侧部170b,该近侧部与锁定杆168的远侧部168a相接触并作用于该远侧部以径向向外推动锁定杆168的远侧部168a(即,如所示的离开下壳体152b或沿着顺时针方向),同样地,径向向内推动锁定杆168的近侧部168b(即,如所示的朝着下壳体152b或者沿着顺时针方向)。
如图27和图46所示,偏置构件170的远侧部170a被容纳于形成在保持板172中的孔穴中。保持板172通过操作被支撑在上壳体152a的通道153b中并且包括一对隔开的弹性远侧柄脚172a。保持板172的柄脚172a被配置成并适于选择性地与保持在手术施夹器100内的一堆手术夹子“C”中的最远侧手术夹子“C1”(未显示在图46中)的后跨部接合。
如图9、图24、图25以及图27所示,一堆手术夹子“C”以便于在上壳体152a的通道153b内滑动和/或沿通道153b滑动的方式被装载和/或保持在通道153b内。如上所述,一堆手术夹子“C”中的最远侧手术夹子“C1”选择性地被保持板172的柄脚172a保持在适当的位置。
轴组件104进一步包括夹子输出器180,夹子输出器180被可滑动地支撑和/或保持在上壳体152a的通道153b内。夹子输出器180包括头部180a,该头部布置在一堆手术夹子“C”中的最近侧手术夹子“C2”的后方并与该手术夹子“C2”相接触。夹子输出器180进一步包括尾部180b,该尾部从头部180a向近侧方向延伸。头部180a在靠近其近端的位置限定了坡道180c。在操作中,如在下文中将更详细讨论的,随着夹子输出器180向远侧推进,其头部180a将与推杆闭锁机构166的锁定杆168接触并且接合,使得夹子输出器180的头部180a的坡道180c向着径向向外的方向(即,如所示的朝着上壳体152a或者沿着逆时针方向)用凸轮带动或推动锁定杆168的远侧部168b。
呈压缩弹簧形式的偏置构件182围绕夹子输出器180的尾部180b布置。偏置构件182的作用在于将夹子输出器180向远侧方向偏置,从而在一堆夹子“C”上施加远侧定向的力。保持块184包括凸缘184b,凸缘184b插在上壳体152a和解扣块154之间。
如图9和图24至图26所示,轴组件104进一步包括夹子保持板186,夹子保持板186被配置成并适于位于一堆手术夹子“C”、夹子输出器180以及保持块184的至少一部分的上方/下方。从图27中清楚地看出,夹子保持板186包括靠近其远端形成的坡道186a。如在下文中将更详细描述的,夹子保持板186的坡道186a的作用在于随着最远侧夹子“C1”被推杆156推进而与最远侧夹子“C1”的后跨部接合。夹子保持板186利用与元件153j接合的凸起186b卡扣配合/或压入配合地接合到上壳体152a的通道153中(见图9)。
如图9、图27、图31至图35、图41和图42所示,轴组件104进一步包括位于夹子保持板186的上方/下方的楔形板188。楔形板188包括通过操作选择性地插在钳口106之间的大体锥形的远端188a。如图33和图42所示,楔形板188限定了从其下表面突出的翼片或凸片188b。
如图9、图28至30、图34、图35、图39、图41和图42所示,轴组件104进一步包括与楔形板188相邻定位的驱动通道190。驱动通道190包括从其后跨部190b沿离开楔形板188的方向悬垂而下并且进入由下壳体152b限定的通道153c中的一对侧壁190a。驱动通道190进一步包括从后跨部190b沿侧壁190a的方向延伸的凸起190c(见图39和图41)、形成在后跨部190b中的细长狭槽190d(见图39和图42)以及形成在侧壁190a中的一个中的凹口190e(见图39和图42)。
如图9、图11、图24、图26、图28、图29、图31、图37和38所示,并如上所述,轴组件104包括驱动杆140,驱动杆140具有延伸到手柄组件102中的近端140b以及在楔形板188的近端的下方和/或邻近楔形板188的近端延伸的远端140a。驱动杆140包括鹅颈弯140c(见图11),使得驱动杆140的远端140a与其近端140b在不同的平面上/中,并且使得远端140a的至少一部分位于驱动通道190的下方或邻近驱动通道190。驱动杆140的远端140a限定了形成于其中的细长狭槽140d。驱动杆140的远端140a进一步包括止挡140h,止挡140h形成在远端140a中的狭槽140d的近侧位置处并且沿离开下壳体152b的方向延伸。驱动杆140的近端140b包括形成和/或结构140f(见图11),该形成或结构被配置成并适于将解扣机构192支撑和/或保持在其上。
如图9、图11、图24、图26和图43所示,轴组件104进一步包括以上述方式支撑在驱动杆140的近端140b中的解扣机构192。特别地,解扣机构192包括解扣块194和解扣杆196:解扣块194被配置成并适于保持在驱动杆140的形成和/或结构140f中或者支撑在驱动杆140的形成和/或结构140f上;解扣杆196可枢转地连接到解扣块194上。解扣机构192进一步包括偏置构件198,该偏置构件以压缩弹簧的形式插在解扣块194和解扣杆196的自由端之间,用于将解扣杆196的自由端朝着解扣块154的方向(即,如所示的顺时针方向)偏置。如图11所示,解扣杆196限定了沿其上表面形成的掣子196a。
如图9、图13、图34、图37和图38所示,轴组件104进一步包括滑动接头200,滑动接头200可滑动地插在下壳体152b的通道153c和驱动杆140的远端140a之间。滑动接头200包括主体部202和从其伸出的杆204。当滑动接头200的杆204适当地插在下壳体152b的通道153c和驱动杆140的远端140a之间时,其沿大体远侧的方向延伸。滑动接头200的杆204可滑动地通过形成在下壳体152b的通道153c中并从通道153c延伸的短轴153d(见图38)。轴组件104进一步包括偏置构件206,该偏置构件以压缩弹簧的形式被支撑在杆204上并插在下壳体152b的短轴153d和滑动接头200的主体部202之间。
滑动接头200的主体部202包括凸起202a,该凸起靠近主体部202的近端形成,并被配置成并适于在驱动杆140的细长狭槽140d中可滑动地接合(见图37和图38)。滑动接头200的主体部202进一步包括窝眼202b,该窝眼靠近主体部202的远端形成,并被配置成并适于将驱动通道190的凸起190c容纳在其中(见图29)。
如图9、图15、图34、图35和图37所示,轴组件104进一步包括楔形板齿条机构210,该楔形板齿条机构通过操作插在下壳体152b的通道153c和驱动通道190之间。楔形板齿条机构210包括可滑动地布置在下壳体152b的通道153c内的楔形板齿条212。楔形板齿条212包括主体部212a、从主体部212a向远侧延伸的齿条212b、从主体部212a向近侧延伸的尾部或杆212c、形成于主体部212a的上表面中的窝眼212d以及从主体部212a的底面延伸的短杆212e。
楔形板齿条212的短杆212e在凹槽(未示出)内行进,所述凹槽形成在下壳体152b的通道153c的表面中。楔形板齿条212的尾部或杆212d可滑动地通过形成在下壳体152b的通道153c中并从通道153c延伸的短轴153e(见图9和图37)。楔形板齿条机构210进一步包括偏置构件214,该偏置构件以压缩弹簧的形式被支撑在杆212d上并插在下壳体152b的短轴153e和楔形板齿条212的主体部212a之间。如图33所示,楔形板188的翼片或凸片188b布置在形成于楔形板齿条212的主体部212a的上表面中的窝眼212d内。
楔形板齿条机构210进一步包括枢转地连接到下壳体152b上的齿轮216。齿轮216包括一组齿216a和对置齿216b:一组齿216a通过操作与楔形板齿条212的齿条212b接合;对置齿216b可以通过操作与形成在驱动通道190的侧壁190a中的一个中的凹口190e接合(见图35)。在操作中,如在下文中将更详细讨论的,随着驱动通道190向远侧方向轴向地移动,驱动通道190使得齿轮216旋转(即,沿如所示的顺时针方向)并因此使得楔形板齿条212向近侧方向轴向地移动,反之亦然。
如图9、图34、图36和图40所示,轴组件104进一步包括棘轮爪和齿条组件220,该组件通过操作插在下壳体152b的通道153c和驱动杆140的近端140b之间。棘轮爪和齿条组件220包括固定于驱动杆140的下侧上的齿条222(即,插在驱动杆140的近端140b和下壳体152b的通道153c之间),使得齿条222能够与驱动杆140一起移动。齿条222包括插在远侧凹槽222b和近侧凹槽222c之间的多个齿222a(见图36)。设置凹槽222b和222c以允许棘轮爪在齿条222在近侧移动和远侧移动之间变化时逆转并返回至齿条222的齿222a上。
棘轮爪和齿条组件220包括棘轮爪224,在棘轮爪224通过操作与齿条222大体接合的位置处,棘轮爪224通过爪销226枢转地连接到下壳体152b上。棘轮爪224包括棘轮爪齿224a,该棘轮爪齿能够选择性地与齿条222的齿222a接合。棘轮爪齿224a能够与齿条齿222b接合以限制齿条222的纵向移动,从而限制轴组件104内的驱动杆140和手柄组件102的扳机108。
棘轮爪和齿条组件220进一步包括爪簧228,该爪簧被配置并定位为使棘轮爪224偏置到通过操作与齿条222接合。
如全部附图尤其是图34和图35所示,轴组件104进一步包括一组钳口106,该组钳口通过操作被支撑在轴组件104的远端中。钳口106包括近侧部106b和一对钳口构件106c:近侧部106b布置在驱动通道190的远端内;一对钳口构件106c从上壳体152a和下壳体152b的远端伸出。钳口构件106c中的每一个均限定了一个凸轮表面106d,当驱动通道190向远侧推进时,驱动通道190的远侧边缘将与凸轮表面106d接合以推动钳口构件106c朝向彼此。一组钳口106可以被配置为便于弯曲或向外张开,以便收纳和/或容纳比钳口构件106c的静止状态下的内部宽度更宽的夹子“C”。这样,一组钳口106能够通过5mm、10mm或者固定尺寸的套管或套管针并能够容纳相对较宽的夹子“C”以便与相对较宽的脉管“V”接合。
从图9、图27和图88中清楚地看出,每个夹子“C”具有预成型或未成型的外部宽度,而钳口106具有已制成的外部宽度,其中,钳口106的外部宽度相对于夹子“C”的外部宽度的比值大约小于或等于1比1.8(例如,1∶1.8)。可在夹子“C”处于钳口106内或未处于钳口106内时设定或确定该比值。
如图9、图34和图35所示,轴组件104进一步包括大体U形的通道230,该通道布置于下壳体152b内且通过操作连接到驱动通道190的远端上。U形通道230的作用是在手术施夹器100的操作期间将钳口构件106c保持在大体对齐的位置。
如图16和图17所示,手术施夹器100可包括细长连接壳体232,该细长连接壳体通过操作插在轴组件104的上壳体152a和下壳体152b与手柄组件102之间。这样,可以修改手术施夹器100以用于需要将钳口106插入更深的手术程序例如肥胖病手术中。
可以预想到用手术施夹器100来操作具有不同尺寸的一堆夹子“C”。例如,包括一堆夹子“C”的夹子可具有相对窄的尺寸或者相对宽的尺寸。
现将对操作手术施夹器100以在诸如脉管的目标组织的周围卷曲手术夹子进行描述。参照图47至图61,扳机108通常处于未压缩或未致动的状态。这样,驱动组件120的轭状物124处于缩回位置,因此,柱塞134和驱动杆140也处于缩回位置。
如图52所示,解扣机构192的解扣杆196的掣子196a定位于推杆156的窗口156e内,推杆156的近端使闭锁锁定器160的闭锁构件162保持偏置。推杆156被偏置构件158偏置到最近侧位置。而且,如图53所示,棘轮爪和齿条组件220的棘轮爪226的齿224a布置于齿条222的远侧凹槽222b内。
如图54、图55和图58所示,滑动接头200的主体部202的凸起202a定位于驱动杆140的细长狭槽140d的最远端。驱动杆140的细长狭槽140d的长度限定了手术施夹器100的停歇期“d”。
如图56、图57和图59所示,楔形板188位于最远侧位置,楔形板齿条机构210的楔形板齿条212处于最远侧位置,并且楔形板齿条机构210的齿轮216的齿216b布置在形成于驱动通道190的侧壁190a中的一个中的凹口190e内。
如图60和图61所示,楔形板188的远端188a插在钳口106的钳口构件106c之间。而且,一堆手术夹子“C”的最远侧手术夹子“C1”被保持板172的柄脚172a保持在适当的位置。如图60所示,推杆闭锁机构166的锁定杆168的近侧部168b布置在推杆156的下方并且同样被偏置构件170偏置。
现转到图62至图66,在初始行程的第一阶段期间,如上所述,随着扳机108从初始位置起被挤压或致动,扳机108使得叉形连杆122向着远侧方向移动轭状物124,而这使得柱塞134向远侧移动并经由剪切销142向远侧移动驱动杆140。如图63所示,由于解扣机构192的解扣杆196的掣子196a定位于推杆156的窗口156e内,因而随着驱动杆140向远侧移动,推杆156也向远侧移动。与此同时,齿条222向远侧移动,使得其齿222a移过棘轮爪226的齿224a并从齿条222的远侧凹槽222b中移出。
如图63所示,闭锁锁定器160的闭锁构件162的远侧部162a由于偏置构件164的臂164a的推动而被枢转到形成于驱动杆140中的窗口140g中。
如图65和图66所示,随着推杆156向远侧推进,其推动器156c与最远侧夹子“C1”的后跨部接合并推进最远侧夹子“C1”越过夹子保持板186的坡道186a而进入钳口106的钳口构件106c的通道106a中。
现转到图67至图80,如上所述,随着扳机108从初始行程的第一阶段起被进一步挤压或致动通过初始行程的第二阶段,扳机108使得叉形连杆122进一步向着远侧方向移动轭状物124,而这使得柱塞134进一步向远侧移动且经由剪切销142进一步向远侧移动驱动杆140。
如图67和图68所示,随着驱动杆140进一步向远侧推进,驱动杆140用凸轮带动闭锁锁定器160的闭锁构件162的远侧部162a,从而使闭锁构件162的远侧部162a枢转出形成在驱动杆140中的窗口140g。如图69和图70所示,解扣机构192的解扣杆196的掣子196a仍然位于推杆156的窗口156e内,推杆156进一步向远侧移动。如图69所示,随着推杆156进一步向远侧推进,其推动器156c进一步将所述最远侧夹子“C1”推进到钳口106的钳口构件106c的通道106a中。
如图70所示,解扣块154的凸轮表面154b和154c克服偏置构件198的偏置力用凸轮向下带动解扣机构192的解扣杆196,使得解扣杆196的掣子196a脱离推杆156的窗口156e。
如图69和图71所示,随着最远侧夹子“C1”推进到钳口106的钳口构件106c中,一堆夹子“C”由于夹子输出器180作用于其上的远侧力而向远侧推进,夹子输出器180由于偏置构件182施加在夹子输出器180的头部180a上的偏置力而向远侧推进。
如图72所示,随着驱动杆140向远侧移动,滑动接头200的主体部202的凸起202a平移通过驱动杆140的细长狭槽140d,从而减小了停歇期“d”的长度和/或尺寸。如图71和图72所示,驱动杆140向远侧推进,直到驱动杆140的止挡140h紧靠驱动通道190的最近端,并直到台肩140h紧靠驱动通道190的侧壁190a的最近端。
如图73至75所示,一旦解扣杆196的掣子196a从与推杆156的窗口156e的接合中移出,则推杆156由于偏置构件158施加于其上的偏置力而向近侧方向缩回。推杆156缩回,直到其推动器156a定位于一堆夹子“C”的最远侧手术夹子的后跨部的近侧。
如图76所示,随着推杆156被偏置到缩回位置,推杆156用凸轮带动闭锁锁定器160的闭锁构件162,从而使闭锁构件162的远侧部162a枢转(例如,所示的顺时针方向)出形成于驱动杆140中的窗口140g。
如图71、图72、图77和图78所示,当驱动杆140的止挡140h紧靠驱动通道190的最近端且台肩140h紧靠驱动通道190的侧壁190a的最近端时,驱动杆140进一步向远侧推进导致驱动通道190向远侧推进。随着驱动通道190向远侧推进,形成于驱动通道190的侧壁190a中的凹口190e用凸轮带动楔形板齿条机构210的齿轮216的齿216b并且推动齿轮216旋转,即所示的顺时针方向旋转。由于齿轮216的一组齿216a与楔形板齿条212的齿条212b的相互啮合,齿轮216的旋转导致楔形板齿条机构210的楔形板齿条212的主体部212a向近侧移动。
随着楔形板齿条212向近侧移动,偏置构件214被压缩在楔形板齿条212的主体部212a和形成在下壳体152b的通道153c中并从通道153c伸出的短轴153e之间。与此相随,主体部212a也向近侧方向移动楔形板188的凸片188b,因而,如图79和图80所示,使得楔形板188的远端188a从钳口106的钳口构件106c之间收回。参照图79,当楔形板188的远端188a插在钳口构件106c之间时,楔形板188的远端188a的作用是使钳口构件106c保持相互隔开以便将手术夹子“C1”(见图80)容纳在钳口构件106c之间并防止侧载压力阻碍夹子的装载。参照图80,当楔形板188的远端188a从钳口构件106c之间收回时,钳口构件106c能够彼此相向接近以形成布置于其间的手术夹子“C1”。
现转到图81至图94,如上所述,随着扳机108从初始行程的第二阶段起被进一步挤压或致动通过初始行程的第三阶段,扳机108使得叉形连杆122进一步向着远侧方向移动轭状物124,而这使得柱塞134进一步向远侧移动且经由剪切销142进一步向远侧移动驱动杆140。如图81所示,偏置构件136现在被完全压缩在轭状物124和帽144之间。
如图81和图82所示,随着扳机108被致动通过初始行程的第三阶段,致动板128以如上所述的方式向远侧推进,从而致动杆130的杆130b可滑动地围绕计数致动表面128c作凸轮运动。在这种情况下,致动杆130顺时针方向旋转以与处理器132b的杆或电子触头132d相接触,从而使处理器132b改变显示器132a上的图像。例如,显示器132a上的图像可以显示手术夹子“C”已从手术施夹器100中发射或者排出。
如图81至图84、图92和图93所示,随着扳机108被致动,听觉/触觉反馈构件126的作用在于产生可听到的卡搭声和/或可触知的振动,从而向用户显示手术施夹器100的扳机108已经经过完整行程。特别地,随着扳机108被致动,触觉反馈构件126的臂126a在肋状物103d上方和/或沿着肋状物103d行进,所述肋状物形成在右侧半部103a和左侧半部103b的至少一个中。当臂126a到达肋状物103d的端部时,臂126a卡扣在肋状物103d的端部上并且与右侧半部103a和左侧半部103b的表面103f相接触,从而在臂126a与表面103f相接触时产生可听到的声音和可触知的振动。
如图85至图89所示,随着扳机108被致动通过初始行程的第三阶段时,驱动杆140进一步向远侧推进,从而使得驱动通道190以上述方式进一步向远侧推进。如图85和图86所示,随着驱动通道190进一步向远侧推进,驱动通道190的延伸到滑动接头200的主体部202的窝眼202b中的凸起190c向远侧方向拉动或者推动滑动接头200的主体部202,从而将偏置构件206压缩在主体部202和下壳体152b的短轴153d之间。
而且,如图88和图89所示,随着驱动通道190进一步向远侧推进,驱动通道190的远侧边缘与钳口构件106c的凸轮表面106d接合,从而使钳口构件106c彼此相向接近并形成插在其间的手术夹子“C1”。由于U形通道230固定在驱动通道190上并与其一起移动,因此U形通道230的作用在于盖在驱动通道190上以便在钳口构件106c的接近期间将钳口构件106c保持在驱动通道190内。如图90所示,手术夹子“C1”可以被形成或卷曲到脉管“V”或任何其它生物组织上。
如图91所示,随着驱动通道190进一步向远侧推进,棘轮爪和齿条组件220的齿条222向远侧移动,直到棘轮爪224的棘轮爪齿224a布置于齿条222的近侧凹槽222c内。
如图94所示并如在下文中将更详细讨论的,随着驱动通道190朝着近侧方向收回,棘轮爪和齿条组件220的齿条222向近侧方向移动使得棘轮爪224的棘轮爪齿224a从齿条222的近侧凹槽222c中移出并与齿条222的齿222a接合。而且,棘轮爪224围绕爪销226倾斜、旋转或者摆动,使得偏置构件228偏斜。偏置构件228的作用在于不仅使棘轮爪224的齿224a与齿条222的齿222a保持接合,而且将棘轮爪224保持在旋转或倾斜的位置。
现在转到图95至图99,示出了扳机108返回至未挤压或未致动的位置。偏置构件136通过偏置动作和施加在柱塞134上的力来帮助扳机108返回至未挤压或未致动的位置。
如图95所示,随着扳机108返回至未挤压位置,叉形连杆122向近侧方向移动轭状物124,从而使得柱塞134向近侧移动并经由剪切销142向近侧移动驱动杆140。如图95所示,随着驱动杆140向近侧移动,驱动杆140的远侧边缘140h和止挡140e从滑动接头200的主体部202的凸起202a后退,从而使凸起202a平移通过驱动杆140的细长狭槽140d并增加停歇期“d”的长度和/或尺寸。随着驱动杆140向近侧缩回,偏置构件206向近侧方向推动滑动接头200,从而作用在驱动通道190的凸起190c上以向近侧方向推动驱动通道190。
如图97所示,随着驱动通道190向近侧方向移动,钳口106的钳口构件106c由于其固有的弹性偏置力而返回至它们的非接近状态。如图98所示,随着驱动通道190向近侧方向移动,形成在驱动通道190的侧壁190a中的凹口190e使得齿轮216旋转,即所示的逆时针方向旋转。由于偏置构件214的力以及齿轮216的一组齿216a与楔形板齿条212的齿条212b的相互啮合,齿轮216的旋转导致楔形板齿条机构210的楔形板齿条212的主体部212a向远侧移动。随着楔形板齿条212向远侧移动,主体部212a也向远侧方向移动楔形板188的凸片188b,从而,如图99所示,使得楔形板188的远端188a被插入或再次引入钳口106的钳口构件106c之间。
现转到图100至图102,示出了手术施夹器100的配置,其后是最后一个手术夹子“C”的施加。如图100所示,当最后一个手术夹子“C”被推杆156推进到钳口106中时,夹子输出器180的头部180a由于偏置构件182的推动而处于最远侧位置。当夹子输出器180的头部180a处于最远侧位置时,头部180a的坡道180c沿所示的逆时针方向朝着推杆156用凸轮带动并推动推杆闭锁机构166的锁定杆168的远侧部168b并进入推杆156的远侧窗口156d中。在锁定杆168的远侧部168b定位于推杆156的远侧窗口156d中的情况下,当推杆156缩回时,防止推杆156向近侧移动至完全缩回位置。
如图101所示,如上所述,由于锁定杆168的远侧部168b防止了推杆156向近侧移动至完全缩回位置,因此闭锁构件162的远侧部162a通过偏置构件164的臂164a如所示的逆时针方向旋转到驱动杆140的窗口140g中。近侧部162b紧靠轴组件104和/或外管150的内表面防止了闭锁构件162完全旋转。闭锁构件162的远侧部162a有效地阻止了驱动杆140的近侧移动,因此防止了驱动杆140返回至完全近侧位置。
在防止驱动杆140返回至完全近侧位置的情况下,如图102所示,防止了棘轮爪和齿条组件220的齿条222返回至完全近侧位置。因而,棘轮爪224的齿224a不能被容纳在齿条222的远侧凹槽222b内,因此不能复位。因此,棘轮爪224的齿224a与齿条222的齿222a保持接合,并且棘轮爪224相对于齿条222保持倾斜。因而,因为齿条222被棘轮爪224楔入并且不能复位其本身,所以防止了齿条222向远侧方向移动。
在锁定杆168的远侧部168b定位于推杆156的远侧窗口156d中、闭锁构件162的远侧部162a被旋转到驱动杆140的窗口140g中,以及棘轮爪224的齿224a与齿条222的齿222a保持接合的情况下,防止了手术施夹器100的扳机108向远侧和/或近侧移动并且所述机构被锁定。
如图103和图104所示,如果手术施夹器100的用户试图将额外的力施加在扳机108上,则该额外的力将经由柱塞134传递给剪切销148。由于防止了驱动杆140向远侧移动,因此柱塞134上额外的力被传递给剪切销148,使得剪切销148在其环形凹槽148a处中断或者折断。一旦剪切销148折断,则柱塞134能够向远侧方向移动,但是没有力能够经由剪切销148传递给驱动杆140。
如图6至图8所示,手术施夹器100包括布置于手柄组件102内的弹性止挡138,该弹性止挡在手术施夹器100被保持在垂直方向上时阻止致动板128向远侧/近侧下落。特别地,弹性止挡138被固定地安装在致动板128上并包括弹性臂138a,弹性臂138a摩擦地或卡扣配合地接合壳体103内的表面。这样,由于致动板128被弹性止挡138保持在适当的位置,因此,随着手术施夹器100向垂直方向移动,致动板128不会向远侧或近侧方向自由地移动。
应该理解,以上描述仅仅是本公开的说明。本领域技术人员可以在不背离本公开的情况下做出各种替换和改进。因此,本公开旨在包含所有这些替换、改进和变化。参照附图所描述的实施例仅为证明本公开的特定示例而呈现。与上述和/或所附的权利要求无实质不同的其它元件、步骤、方法和技术也在本公开的范围内。
Claims (11)
1.一种用于将手术夹子施加到体组织上的装置,所述装置包括:
a)手柄组件;
b)轴组件,其从所述手柄组件向远侧延伸并且限定了纵轴;
c)多个手术夹子,其布置在所述轴组件内;
d)钳口,其邻近所述轴组件的远端部安装,所述钳口包括能够在隔开位置和接近位置之间活动的一对钳口构件;
e)夹子推杆,其被配置成在所述钳口构件处于隔开位置时单独地将手术夹子向远侧推进至所述钳口;
f)驱动杆,其至少部分地布置在所述手柄组件和所述轴组件内,所述驱动杆能够响应于所述手柄组件的扳机的致动而纵向移动,所述驱动杆包括布置在远侧部中的狭槽以及布置在所述狭槽的近侧并且沿离开所述轴组件的下壳体的方向延伸的止挡;以及
g)驱动通道,其与第一和第二钳口构件相邻定位以将所述钳口构件移动至接近位置,所述驱动杆向远侧推进,直到所述驱动杆的止挡紧靠所述驱动通道的最近端。
2.根据权利要求1所述的装置,进一步包括计数致动杠杆,所述计数致动杠杆包括第一臂,所述第一臂被配置成并适于通过操作选择性地与计数机构接合,所述计数机构被支撑在所述手柄组件的壳体中并通过限定在所述壳体中的窗口可见。
3.根据权利要求2所述的装置,其中,所述壳体进一步将致动板支撑在右侧半部上,所述计数致动杠杆进一步包括第二臂,所述第二臂被配置成并适于通过操作可滑动地与所述致动板的计数致动表面接合,以便当所述致动板向远侧移动足够距离时,所述计数致动杠杆的所述第一臂与所述计数机构接合,并且当所述致动板向近侧移动足够距离时,所述计数致动杠杆的所述第一臂脱离所述计数机构。
4.根据权利要求3所述的装置,其中,当所述致动板向远侧移动足够距离时,所述计数致动杠杆的所述第二臂无接触地通过所述致动板的所述计数致动表面,并且当所述致动板向近侧移动足够距离时,所述计数致动杠杆的所述第二臂被所述致动板的所述计数致动表面用凸轮带动。
5.根据权利要求3所述的装置,其中,设置偏置构件以使所述计数致动杠杆的所述第二臂偏置为抵靠在所述致动板的所述计数致动表面上。
6.根据权利要求1所述的装置,进一步包括:
a)楔形板齿条,其可滑动地布置在所述下壳体的通道内;以及
b)齿轮,其枢转地连接到所述下壳体,所述齿轮包括通过操作与所述楔形板齿条的齿条接合的一组齿以及能够通过操作与形成在所述驱动通道的一个侧壁中的凹口接合的对置齿。
7.根据权利要求6所述的装置,其中,所述驱动通道的所述凹口适于在所述驱动通道轴向地移动时与所述齿轮的所述对置齿接合以使所述齿轮旋转。
8.根据权利要求7所述的装置,其中,所述楔形板齿条适于在所述齿轮旋转时轴向地移动。
9.根据权利要求1所述的装置,进一步包括滑动接头,所述滑动接头可滑动地插在所述轴组件的所述下壳体的通道和所述驱动杆的远端之间,所述滑动接头包括主体部,所述主体部包括凸起,所述凸起靠近所述主体部的近端形成,并被配置成并适于与所述驱动杆的狭槽可滑动地接合。
10.根据权利要求1所述的装置,其中,所述驱动杆的远端位于所述驱动通道的下方或邻近所述驱动通道。
11.根据权利要求1所述的装置,其中,当所述驱动杆向远侧推进时,所述驱动杆的所述止挡紧靠所述驱动通道的最近端,并且所述止挡的台肩紧靠所述驱动通道的侧壁的最近端。
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CN201110282277.4A Active CN102327138B (zh) | 2007-03-26 | 2008-03-26 | 内窥镜手术施夹器 |
Family Applications Before (1)
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CN2008800098750A Active CN101641051B (zh) | 2007-03-26 | 2008-03-26 | 内窥镜手术施夹器 |
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US (5) | US8382773B2 (zh) |
EP (2) | EP3189796B1 (zh) |
JP (2) | JP5571545B2 (zh) |
CN (2) | CN101641051B (zh) |
AU (1) | AU2008230841B2 (zh) |
CA (2) | CA2868909A1 (zh) |
ES (1) | ES2645490T3 (zh) |
WO (1) | WO2008118928A2 (zh) |
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2008
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ES2645490T3 (es) | 2017-12-05 |
EP2157920A2 (en) | 2010-03-03 |
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US8382773B2 (en) | 2013-02-26 |
US8747423B2 (en) | 2014-06-10 |
EP2157920B1 (en) | 2017-09-27 |
CN101641051B (zh) | 2011-11-23 |
US8814884B2 (en) | 2014-08-26 |
JP2013135916A (ja) | 2013-07-11 |
US20130190780A1 (en) | 2013-07-25 |
EP3189796A1 (en) | 2017-07-12 |
CA2679523A1 (en) | 2008-10-02 |
EP2157920A4 (en) | 2013-08-07 |
AU2008230841B2 (en) | 2013-09-12 |
CA2868909A1 (en) | 2008-10-02 |
AU2008230841A1 (en) | 2008-10-02 |
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