CN102525639B - 血管密封器械 - Google Patents

血管密封器械 Download PDF

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CN102525639B
CN102525639B CN201110309635.6A CN201110309635A CN102525639B CN 102525639 B CN102525639 B CN 102525639B CN 201110309635 A CN201110309635 A CN 201110309635A CN 102525639 B CN102525639 B CN 102525639B
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jaw members
high frequency
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electric knife
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瑞安·C·阿塔勒
杰弗里·M·罗伊
托尼·莫厄
丹尼斯·W·布彻
威廉·J·迪克汉斯
丹尼尔·A·约瑟夫
卢克·瓦勒
辛西娅·M·佩里
梅格罕·柯林斯·朗
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
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    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
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    • A61B2018/00309—Means for providing haptic feedback passive, e.g. palpable click when activating a button
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    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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    • A61B90/06—Measuring instruments not otherwise provided for

Abstract

本发明公开了一种双极高频电刀器械，其包括第一和第二轴，其各自具有由其远侧端部延伸出的钳夹构件。每个钳夹构件用于连接到高频电刀能量源，从而钳夹构件能够选择性地通过在其间被抓取的组织传导能量。刀槽被配置为使切割机构沿其往复运动。致动器选择性地推进切割机构。开关布置在第一轴上且配置为根据与布置在第二轴上的机构交界面的偏置接合，在第一位置和至少一个后续位置之间被压下。开关的第一位置向使用者传递对应于在组织上需要的压力的信息，且至少一个后续位置被配置为激活高频电刀能量源以向钳夹构件供应高频电刀能量。本发明尤其涉及一种血管密封器械。

Description

血管密封器械
技术领域
本发明涉及一种用于开放式外科手术的手术钳。具体而言，本发明涉及一种应用高频电刀(electrosurgical)电流以密封组织的手术钳。
背景技术
止血器或手术钳是简单的钳状工具，它使用其钳夹之间的机械作用以收缩血管，且其通常是用在开放式外科手术中以抓取、解剖和/或夹紧组织。高频电刀手术钳同时采用机械夹紧动作和电能以通过加热组织和血管以凝结、烧灼和/或密封组织，从而实现止血。
某些外科手术需要密封和切断血管或血管组织。一些杂志文章已公开了使用高频电刀密封小血管的方法。一篇1991年7月发表在J.Neurosurg.，75卷上题为“StudiesonCoagulationandtheDevelopmentofanAutomaticComputerizedBipolarCoagulator”的文章介绍了一种用于密封小血管的双极凝结器。该文称不可能安全地凝结直径大于2至2.5mm的动脉。另一篇文章题为“AutomaticallyControlledBipolarElectrocoagulation-“COA-COMP””，发表在Neurosurg.Rev.(1984)，187-190页中，其描述了一种终止至血管的高频电刀能量的方法从而避免血管壁的炭化。
通过使用高频电刀手术钳，外科医生可以通过控制应用于组织的高频电刀能量的强度、频率和持续时间，从而烧灼、凝结/脱水、减少或延缓出血和/或密封血管。一般来说，高频电刀手术钳的电气配置可分为两类：1)单极高频电刀手术钳；和2)双极高频电刀手术钳。
单极手术钳利用一个关联到夹紧末端执行器的手术电极和通常向外连接到患者的远程患者回路电极或极板。当施加高频电刀能量时，所述能量由手术电极移动到手术部位，通过患者然后至回路电极。
双极高频电刀手术钳利用两个常规的相对电极，它们位于末端执行器的内部相对表面上，且电耦合到高频电刀发生器。每个电极充电到不同的电压。由于组织是电能的导体，在利用执行器抓取其间的组织时，电能可以选择性地通过组织传输。
为了实现对较大血管的合适的密封，必须精确控制两个主要的机械参数——血管上施加的压力和在电极之间的间隙，这两者都会影响密封的血管的厚度。特别是，压力的准确施加对于对抗血管壁是很重要的，以将组织的阻抗减少到足够低的值，以允许足够的高频电刀能量通过组织，从而克服在组织加热期间的扩张力，并有助于端部组织厚度(这是良好密封的指示)。已经确定融合的血管壁在0.001和0.006英寸之间是最合适的。在此范围以下，密封可能被撕碎或被撕裂，且在此范围以上时，内腔可能不能被正确地或有效地密封。
对于较小的血管，施加在组织上的压力则不那么相关，而在导电表面之间的间隔距离对于有效密封更为重要。换言之，随着血管越来越小，在活化期间两个导电表面接触的机会增加。
高频电刀方法可能能够使用合适的高频电刀功率曲线以及能够向血管壁施加较大的闭合力的器械来密封较大的血管。一般认为凝结小血管的过程与高频电刀血管密封有根本上的不同。对于本文的目的，“凝结”被定义为使组织脱水的过程，其中，组织细胞破裂并干燥，且血管密封被定义为在组织中液化胶原蛋白从而其重组成为熔体的过程。因此，小血管的凝结足以使其永久封闭。较大的血管需要被密封以确保永久封闭。
在过去的各种开放手术中已经提出许多双极高频电刀手术钳。然而，这些设计中的一些可能无法向血管提供统一的重复性压力，并可能导致无效或不统一的密封。例如，授予Willis的美国专利第2176479号；授予Hiltebrandt的美国专利第4005714和4031898号；授予Boebel等的美国专利第5827274，5290287和5312433号，授予Lottick的美国专利第4370980，4552143，5026370和5116332号；授予Stern等的美国专利第5443463号；授予Eggers等的美国专利第5484436号；以及授予Richardson等的美国专利第5951549号都涉及高频电刀器械，用以凝结、切割和/或密封血管或组织。
许多这些器械包括能够以机械方式和/或电机械方式简单地切割组织而对于血管密封的目的则相对没有效果的刀片构件或剪切构件。其他器械仅依靠夹紧压力获得合适的密封厚度，且并未设计为考虑到作为参数的间隙容差和/或平行性和平整度的要求，即，如果控制得当，所述参数可以保证一致并有效的组织密封性。例如，已知难以通过单独控制夹紧压力而适当地控制所得的密封组织的厚度，这是因为以下原因之一：1)如果施加太大的力，则两极有可能接触，从而能量将不通过组织传输，而导致无效的密封；或者2)如果施加太小的力，则建立的是更厚且不可靠的密封。
发明内容
根据本发明的一个实施方式，双极高频电刀器械包括第一和第二轴，它们各自具有由其远侧端部延伸出的钳夹构件以及位于其近侧端部的手柄，所述手柄用于实现钳夹构件绕枢轴相对于彼此从第一位置到第二位置的运动，其中在第一位置中钳夹构件相对于彼此位于间隔关系，在第二位置中钳夹构件相配合以抓取组织。每个钳夹构件适用于连接到高频电刀能量源，从而钳夹构件能够选择性地通过在其间被抓取的组织传导能量，从而实现组织密封。至少一个钳夹构件包括沿其长度方向限定的刀槽。该刀槽配置为使切割机构沿其往复运动，从而切割在钳夹构件之间抓取的组织。该器械还包括致动器，用于选择性地将切割机构从该切割机构布置为接近于钳夹构件之间抓取的组织处的第一位置推进至至少一个后续位置，在至少一个后续位置中该切割机构布置为远离在钳夹构件之间抓取的组织处。该器械还包括位于第一轴上的开关。该开关配置为根据钳夹构件从第一位置至第二位置的移动，根据与位于第二轴上的机械交界面的偏置接合，在第一位置和至少一个后续位置之间被压下。开关的第一位置向使用者传递对应于在钳夹构件之间抓取的组织上需要的压力的信息，且至少一个后续位置被配置为激活高频电刀能量源以向钳夹构件供应高频电刀能量。
根据本发明的另一个实施方式，双极高频电刀器械包括第一和第二轴，它们各自具有由其远侧端部延伸出的钳夹构件以及位于其近侧端部的手柄，所述手柄便于实现钳夹构件绕枢轴相对于彼此从第一位置到第二位置的运动，其中在第一位置中钳夹构件相对于彼此位于间隔关系，在第二位置中钳夹构件相配合以抓取组织。每个钳夹构件适于连接到高频电刀能量源，从而钳夹构件能够选择性地通过在其间被抓取的组织传导能量，从而实现组织密封。沿一个或两个钳夹构件的长度方向限定有刀槽。该刀槽配置为使切割机构沿其往复运动，从而切割在钳夹构件之间抓取的组织。该器械还包括致动器，用于选择性地将切割机构从该切割机构布置为接近于钳夹构件之间抓取的组织处的第一位置推进至至少一个后续位置，在至少一个后续位置中该切割机构布置为远离在钳夹构件之间抓取的组织处。该器械还包括位于第一轴上的开关。该开关配置为根据钳夹构件从第一位置至第二位置的移动，在根据与第二轴偏置接合的至少两个位置之间被压下。开关根据向该开关第一位置的运动产生第一触觉反应，以及根据向该开关的至少一个后续位置的运动产生后续触觉反应。第一触觉反应向使用者传递对应于在钳夹构件之间抓取的组织上预定的压力的信息，且后续触觉反应被配置为激活高频电刀能量源以向钳夹构件供应高频电刀能量。
根据本申请的另一个实施方式，进行高频电刀手术的方法包括：使双极手术钳的第一轴和第二轴接近以抓取在与第一和第二轴相关联的第一和第二钳夹构件之间的组织的步骤。该方法还包括根据第一和第二轴的接近下压开关至第一位置的步骤，以向使用者传递对应于在钳夹构件之间抓取的组织上施加的预定的抓取压力的信息，以及下压开关至至少一个后续位置的步骤，以激活高频电刀能量源以向钳夹构件供应高频电刀能量。
附图说明
在此将参考附图详述发明器械的不同实施方式，其中：
图1是根据本发明的一个实施方式的手术钳的右侧立体图；
图2为图1的手术钳的分解图；
图3A为图1的手术钳的末端执行器组件的分解图；
图3B为图1的手术钳的末端执行器组件的横截面图；
图4A为移除了部分部件的图1的手术钳的侧视图，以显示出在开关和末端执行器组件之间的电连接；
图4B为图1的末端执行器组件的钳夹构件的左侧立体图；
图4C为图1的末端执行器组件的钳夹构件的左侧立体图；以及
图5A至5C为图1的手术钳的侧视图，图示说明了其在开启和闭合位置之间的动作；以及
图6是根据本发明的一个实施方式用于图1的手术钳的刀的侧视图。
具体实施方式
首先参考图1和图2，用于开放式外科手术的手术钳10包括细长的轴部12a和12b，其各自分别具有近侧端部14a、14b和远侧端部16a和16b。在下文的附图和说明书中，如常规使用的，术语“近侧”指的是手术钳10较靠近使用者的一端，而术语“远侧”指的是较远离使用者的一端。
手术钳10包括末端执行器组件100，其分别附着到轴12a和12b的远侧端部16a和16b上。末端执行器组件100包括一对相对的钳夹构件110和120，它们枢转连接并可以绕枢轴65(图2)相对于彼此运动以抓取组织。如下文详细所述，枢轴65布置在钳夹构件120的近侧端部上，并包括布置在槽126(图4C)的相对两侧上的相对两半65a和65b，所述槽126被配置为便于切割机构或者刀85通过其往复运动(图2)。
每个轴12a和12b分别包括布置在其近侧端部14a和14b的手柄15和17。每个手柄15和17分别限定了指孔15a和17a，可以通过其容纳使用者的手指。手柄15和17便于轴12a和12b相对于彼此运动，进而使钳夹构件110和120由打开位置枢转到夹紧或闭合位置，在打开位置中钳夹构件110和120相对于彼此处于间隔关系，在夹紧或闭合位置中钳夹构件110和120配合以抓取其中的组织。
最佳如图2所示，轴12a由两个组件构成，即12a1和12a2，它们联结在一起以形成轴12a。相似地，轴12b由两个组件构成，即12b1和12b2，它们联结在一起以形成轴12b。在一些实施方式中，半组件12a1和12a2以及半组件12b1和12b2为在多个不同的焊接点超声焊接在一起的，和/或可以通过任何合适的方法(包括嵌合、粘合、扣紧等)机构联结在一起。
轴12b的配置与轴12a有些不同之处。特别地，轴12a通常是空心的以容纳刀85和致动机构40。致动机构40可操作地关联到具有位于轴12a的相对两侧的手柄构件45a和45b的扳机45，以便于扳机45的左手操作和右手操作。扳机45可操作地相关联到一系列合适的中间配合元件(例如，图2显示出扳机连杆43、推刀连杆41、弹簧49和反部署连杆(anti-deploymentlink)47)，所述中间配合元件配置为机械地配合(未清晰显示)以根据扳机45的致动而致动刀85通过在钳夹构件110和120之间抓取的组织。手柄构件45a和45b以相同的方式操作，从而使用手柄构件45a和45b之一即可操作扳机45以使刀85通过刀槽115往复运动(图5C)。此外，轴12b的近侧端部14b包括从轴12b的面向内侧的表面23b突出的开关腔13，且该开关腔13配置为在其中放置一可压下的开关50(以及与之相关联的电气组件)。开关50与轴12a的近侧端部14a的相对的面向内侧的表面23a对准，从而根据轴12a和12b彼此相互接近，开关50被压下至与轴12a的近侧端部14a的相对的面向内侧的表面23a偏置接合。
如图1所示，在其近侧端部具有插头200的高频电刀电缆210连接手术钳10与高频电刀发生器(未显示)。具体而言，电缆210的远侧端部通过近侧轴连接器19牢固地保持到轴12b上，且电缆210的近侧端部包括具有尖头202a、202b和202c的插头200，所述尖头配置为与高频电刀发生器电气地和机械地接合。
钳夹构件110和120的组织抓取部分通常是对称的，且包括相似的组件特征，其配合以允许绕枢轴65的较轻的旋转以实现抓取和密封组织。因此，除非另有提及，钳夹构件110和与其相关联的操作特征首先在此被详细描述，且关于钳夹构件120相关的相似组件特征以下将简单总结。
参考图3A和3B，钳夹构件110包括外壳116a，第一和第二非导电塑料绝缘体108a和114a，以及导电密封表面112a。第一和第二绝缘体108a和114a以两步包覆成型工艺围绕钳夹外壳116a包覆成型。具体而言，第一绝缘体108a是围绕钳夹外壳116a包覆成型以使钳夹外壳116a与密封表面112a电绝缘，且第二绝缘体114a是围绕钳夹外壳116a包覆成型以在其上固定导电密封表面112a。这可以通过冲压、包覆成型、在冲压的密封表面包覆成型和/或通过在金属注塑模制的密封表面包覆成型得到。钳夹构件110和120是由导电材料制成的。在一些实施方式中，钳夹构件110和120是由绝缘涂层粉末涂覆的以减少密封期间的杂散电流集中。
最佳如图3B的横截面图所示，钳夹构件110的导电密封表面112a与钳夹外壳116a和第二绝缘体114a明显区别，从而在钳夹构件110和120处于闭合位置时，由相对的导电密封表面112a和112b抓取组织。
同样地，钳夹构件120包括与钳夹构件110相对应的相似元件，包括：外壳116b，第一和第二塑料绝缘体108b和114b，以及与钳夹外壳116b和第二绝缘体114b明显区别的导电密封表面112b。如上面关于钳夹构件110所述的，第一绝缘体108b使钳夹外壳116b和密封表面112b电绝缘，且第二绝缘体114b将密封表面112b固定至钳夹外壳116b。绝缘体114a和114b沿钳夹构件110和120的整个长度分别延伸，以减少密封期间的交流电流或者杂散电流路径。在一些实施方式中，各个密封表面112a和112b可包括具有这样的半径的外围边缘：各个绝缘体114a和114b沿相邻的边界接触各自的密封表面112a和112b，所述相邻的边界通常是与半径相切和/或沿半径接触。
如图3A和3B所示，至少一个钳夹构件，例如，钳夹构件120包括位于导电密封表面112b和/或112a的面向内侧的表面上的至少一个止挡构件750。可选地或者另外，止挡构件750也可以布置为与导电密封表面112a、112b相邻或者紧邻枢轴65。止挡构件750便于组织的抓取和操作，且在组织的密封和切割期间在相对的钳夹构件110和120之间限定了间隔。在一些实施方式中，止挡构件750在相对的钳夹构件110和120之间保持一段约0.001英寸(～0.03毫米)至约0.006英寸(～0.015毫米)范围内的间隔距离。
如图2所示，轴12b包括位于其中并在手柄15和钳夹构件110之间延伸的梁57。在一些实施方式中，梁57由有弹性的钢构成以允许使用者在钳夹构件110和120之间抓取的组织上产生额外的密封压力。具体而言，一旦末端执行器组件100绕组织闭合，轴12a和12b可以互相挤压以利用梁57的弹性在钳夹构件110和120之间产生足够的闭合压力。在此情况下，通过与梁57关联的压缩力而实现的机械利益促进并确保了围绕在钳夹构件110和120之间抓取的组织的一致、均匀和准确的闭合压力(例如，在约3kg/cm2至约16kg/cm2之间的工作压力范围内)。通过控制施加在组织上的高频电刀能量的强度、频率和时间，使用者可以密封组织。在一些实施方式中，在密封期间在相对的密封表面112a和112b之间的间隔距离为约0.001英寸至约0.005英寸之间。
在一些实施方式中，密封表面112a和112b是相对平坦的以防止在锐利边缘处的电流集中以及防止在最高点之间的电弧。此外，由于接合时组织的反作用力，各个钳夹构件110和120可以制造为抗弯曲的，例如，沿其长度方向为锥形的以对于平行处恒定的组织厚度提供恒定的压力，且钳夹构件110和120的较厚的近侧部分可以防止由于组织的反作用力导致的弯曲。
如图3A、3B、4B和4C所示，钳夹构件110和120的至少一个分别包括位于其间的刀槽115a和/或115b，配置为允许刀85通过其中往复运动。在所示的实施方式中，当与各自的钳夹构件110和120相关联的两个相对的半刀槽115a和115b在抓取组织时合并到一起时形成了完整的刀槽115。每个塑料绝缘体108a和108b分别包括凹槽121a和121b，其分别与相对的半刀槽115a和115b垂直对准，从而刀85在通过刀槽115往复运动时并不接触或者切割塑料绝缘体108a和108b。在一些实施方式中，刀槽115a和115b和它们相应的凹槽121a和121b的宽度可以沿其整个长度上相等。
最佳如图4A中所示，电缆210的内部容纳导线71a、71b和71c。导线71a、71b和71c由插头200通过电缆210延伸并从轴12b的近侧连接器19内引出电缆210的远侧端部。具体而言，导线71a使尖头202b和开关50的第一端子75a互相连接。导线71b使尖头202c和焊接套管73a互相连接，其转而连接导线71b和RF导线71d，并通过连接导线71f连接到开关50的第二端子75b。RF导线71d携带了从导线71b向密封表面112a的高频电刀能量的第一电压。导线71c使尖头202a和焊接套管73b互相连接，其转而连接导线71c和RF导线71e。RF导线71e携带了从导线71c向密封表面112b的高频电刀能量的第二电压。
参考图4B，导线槽77限定在钳夹构件110的近侧端部内以提供导线71d的通道以连接到由密封表面112a的近侧端部延伸出的交叉点311a(图3A)。导线槽77的近侧端部开向电缆管70，其包括常规的具有狭窄的近侧端部72和较宽的远侧端部74的细长配置，所述较宽的远侧端部74限定了弧形侧壁68。导线71d的路线为沿通过电缆管70的近侧端部72且进一步通过导线槽77以连接到交叉点311a的路径。
参考图4C，半枢轴65a和65b布置在槽126的相对侧以便于刀85通过其中平移(图5A～5C)。半枢轴65a和65b布置为剖分的球面配置，且各自包括相应的基部165a和165b，所述基部165a和165b在其上分别支撑有延伸部分166a和166b。延伸部分166a和166b配置为分别接合相应尺寸的孔67a和67b，所述孔67a和67b布置为穿过枢转板66以可枢转地将钳夹构件110固定到钳夹构件120上。在钳夹构件120的近侧端部内限定导线槽109以提供导线71e的通道从而连接到由密封表面112b的近侧端部延伸出的交叉点311b。导线71e的路线为沿通过电缆管70，且进一步在相对的半枢轴65a和65b之间并通过导线槽109以连接交叉点311b的路径。
参考图5A至5C，随着使用者在轴12a和12b上施加闭合压力以压下开关50(图5B)，满足了对应于施加在开关50上的闭合力的第一个阈值，作为开关50的移动功能引起开关50产生对应于位于钳夹构件110和120之间组织被完全抓取的第一触觉反应。第一触觉反应以后，随着使用者在轴12a和12b上施加额外的闭合压力(图5C)，满足了对应于施加在开关50上的闭合力的第二个阈值，作为开关50的移动功能引起开关50产生第二触觉反应，所述第二触觉反应对应于向高频电刀发生器产生信号以向密封表面112a和112b提供高频电刀能量。具体而言，第二触觉反应表明在开关端子75a和75b之间通常是开路的电路已闭合，从而在导线71a和71b之间确立了电连接。作为在导线71a和71b之间的电连接的结果，高频电刀发生器感应到在尖头202b和202c之间的电压降，从而响应于此，通过导线71d和71e分别向密封表面112a和112b供应高频电刀能量。
在一个实施方式中，第一触觉反应向使用者表明，在末端执行器100通电之前，已经达到了最大抓取压力，使用者可以按需求自由接近、操作并抓取组织。在此情况下，第二触觉反应向使用者表明末端执行器100的高频电刀的激活。如以下详述的，在上述的第一和第二触觉反应之间和/或在第二触觉反应之后，开关50可包括多个其他的触觉反应，它们对应于手术钳10的特别的功能，如刀85和/或致动组件40的操作，与致动组件40相关联的安全锁定机构的操作。
如图4A所示，手术钳10可包括布置在轴12a、12b中的一个或两个中的计量器或者传感器元件87，从而通过末端执行器100施加到目标组织上的夹紧力或抓取力可以被测量和/或检测到。例如，在一些实施方式中，传感器元件87可以为可操作地与一个或者两个钳夹构件110、120相关联的应变计量器87。传感器元件87可以是一个或多个霍尔效应传感器或者应变计量器，例如，金属应变计量器、压阻应变计量器，其可能布置在轴12a和12b的一个或两个中和/或布置在钳夹构件110和120的一个或两个中以检测组织压力。金属应变计量器是基于这样的原理运行：由于机械应力，导电材料的几何形状(例如，长度、宽度、厚度等)发生变化，从而导电材料的电阻作为其函数改变。此电阻的改变被用来检测应变或者施加的机械应力，如通过钳夹构件110和120施加到组织上的机械应力。压阻应变计量器是基于这样的原理运行：半导体的电阻率由于施加的机械应力而变化。
可以并入霍尔效应传感器以根据检测到的磁场强度(在钳夹构件110和120之间的)和距离(在钳夹构件110和120之间的)之间的关系，确定在钳夹构件110和120之间的间隔。
在一些实施方式中，如图4A中所示，可以在轴12a和12b中并入一个或多个簧片开关81a、81b以确定其相对于彼此接近。具体而言，簧片开关可以由位于一个轴(例如，轴12a)中的开关81a和位于相对轴(例如，轴12b)中的磁性元件81b(例如，电磁铁、永磁铁、线圈等)组成，从而根据轴12a和12b的接近，簧片开关81a通过磁性元件81b的磁场被激活或关闭，同样地，随着轴12a和12b彼此相互远离，磁场的缺乏导致簧片开关81a的去激活或打开。在此情况下，轴12a和12b的接近，以及由此的钳夹构件110和120的接近可以根据簧片开关81a对磁性元件81b的反应而确定。
可以在电路中并入任何上述的传感器、开关和/或应变计量器，从而由应变计量器检测的应变改变通过电路的电信号。由此目的，应变计量器和开关50和/或高频电刀发生器(未显示)之间的电路允许信息的通信，例如其中所需的组织压力。此信息可以与开关50的激活联系，从而直到根据应变计量器的检测，实现了在钳夹构件110和120之间抓取的组织上的想要的和/或预定的压力时，该开关才被激活。因此，可以计划在手术钳10上，例如，在钳夹构件110、120的一个或多个上设置应变计量器，从而在钳夹构件110和120之间抓取的组织上施加的压力影响所述应变计量器。
在使用时可以校准手术钳10，从而使开关50的特定的触觉反应(例如，第一触觉反应)对应于通过上述的传感器、开关和/或应变计量器的一个或多个的使用而确定的在组织上的预定的抓取压力。在一个实施方式中，围绕组织的预定的抓取压力在约3kg/cm2至约16kg/cm2的范围内，在另一个实施方式中，为约7kg/cm2至约13kg/cm2的范围内。在一些实施方式中，开关50可以产生多个触觉反应，每一个各自对应于不同的预定的抓取力。对于力的感测和/或测量装置，例如测力传感器、应变计量器等的更详细的讨论，可以参考2006年4月21日提交的共有的美国申请第11/409,154号。
如图2、4B和4C中所示，枢轴65通过穿过钳夹构件120限定的孔125连接并与位于围绕孔125的外围限定的圆周边缘或者凸缘78(图4B)中的枢转板66配对接合，从而枢轴65在孔125中可旋转运动，以使钳夹构件110和120在打开位置和闭合位置之间运动。
在一些实施方式中，刀85的致动是与开关50的激活相关联的。例如，传感器87可以表现为位置传感器，配置为检测刀85相对于钳夹构件110和120和/或相对于其中抓取的组织的位置。另外或者可选择地，传感器87可以配置为检测开关50的第一和第二触觉反应中的一个，并据此允许或者防止刀85的致动。例如，如以下详述的，根据从传感器87的反馈，可以使任何与致动机构40相关联的中间配合元件或锁定机构通电或断电以允许或者防止刀85的致动。
如图6所示，刀85包括台阶86，其减少了刀85向其远侧端部的纵断面。刀85的远侧端部具有台阶88，其增加了刀85向其锐利的远侧切割边缘89的纵断面。刀85包括倒角部分(chamferedportion)84，在此处锐利的远侧切割边缘89与台阶88交会以便于刀85通过刀槽15顺利地收回。
在一些实施方式中，手术钳10可包括具有一系列合适的中间配合元件(例如，反部署连杆47，扳机连杆43)的安全锁定机构，所述中间配合元件一起运转以防止在钳夹构件110和120位于打开位置时，刀85的非故意的启动。通常，反部署连杆47与扳机连杆43机械配合以防止刀85的推进，直到钳夹构件110和120围绕组织闭合。在2010年10月1日提交的题为“BladeDeploymentMechanismsforSurgicalForceps”的共有美国申请第12/896,100号中描述了一种这样的与手术钳10一起使用的安全锁定机构。
在一些实施方式中，所述安全锁定机构的任意一个或多个中间配合元件(例如，反部署连杆47)可以与开关50电连接，并包含合适的机电组件(例如，弹簧、杆、螺线管等)，其配置为可以通过开关50(例如，通过导线71a、71b、71c、71d、71e的任意一个)的激活而通电，以机械地操作安全锁定机构。例如，随着通过导线71d和71e的电的传导而向末端执行器100中通电，反部署连杆47被通电以引起其致动，从而安全锁定机构脱离以允许刀85的选择性致动。在此情况下，例如，可以防止刀85的选择性脱离，直到开关50被压下，以产生至少第一触觉反应。
虽然在附图中已显示出一些公开的实施方式，但并不意味着本公开限于这些内容，本公开意图以本领域允许的和说明书中所述的最宽的范围为准。因此，上述说明书不应被认为是限定，而仅仅是特殊实施方式的示例性说明。本领域技术人员将可以设想在所附的权利要求的范围和实质以内的其他修改。

Claims (8)

1.一种双极高频电刀器械，其包括：
第一和第二轴，它们各自具有由其远侧端部延伸出的钳夹构件以及布置在其近侧端部的手柄，所述手柄用于实现所述钳夹构件绕枢轴相对于彼此从第一位置到第二位置的运动，在所述第一位置中所述钳夹构件相对于彼此位于间隔关系，在所述第二位置中所述钳夹构件相配合以抓取其间的组织，每个钳夹构件适于连接到高频电刀能量源，从而所述钳夹构件能够通过其间抓取的组织选择性地传导能量以实现组织密封；
至少一个钳夹构件包括沿其长度限定的刀槽，所述刀槽定尺寸为使切割机构沿其往复运动以切割在所述钳夹构件之间抓取的组织；
致动器，其用于选择性地使所述切割机构通过钳夹构件之间抓取的组织往复运动；以及
开关，其布置在第一轴上，且配置为在钳夹构件从第一位置向第二位置移动时，当开关与布置在第二轴上的机械交界面偏置接合时，所述开关被压下至第一位置和压下至至少一个后续位置，其中，开关的第一位置对应于位于钳夹构件之间的组织被完全抓取，且所述至少一个后续位置激活器械以向所述钳夹构件供应高频电刀能量。
2.根据权利要求1所述的双极高频电刀器械，其中，所述开关根据其向第一位置的运动产生第一触觉反应，并且根据其向所述至少一个后续位置的运动产生后续触觉反应。
3.根据权利要求1所述的双极高频电刀器械，其中，所述钳夹构件配置为向所抓取的组织施加在约3kg/cm2至约16kg/cm2之间的压力。
4.根据权利要求1所述的双极高频电刀器械，其中，开关的第一位置对应于第一和第二轴的初始闭合压力，且开关的至少一个后续位置对应于第一和第二轴的比所述初始闭合压力大的后续闭合压力。
5.根据权利要求1所述的双极高频电刀器械，其进一步包括安全锁定机构，其配置为防止在钳夹构件位于第一位置中时切割机构的往复运动。
6.根据权利要求1所述的双极高频电刀器械，进一步包括含有第一和第二导线的电缆，第一导线负载第一电压，第二导线负载第二电压，所述第一和第二导线分别可操作地联结到第一和第二轴中的一个上。
7.根据权利要求6所述的双极高频电刀器械，其中，第一和第二导线中的至少一个布置为通过所述枢轴。
8.根据权利要求1所述的双极高频电刀器械，其中，各个钳夹构件包括导电密封表面，且至少一个钳夹构件包括布置在导电密封表面上的至少一个不导电的止挡构件，其配置为当组织在相对的导电密封表面之间被抓取时，控制所述相对的导电密封表面之间的距离。
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