CN103096827A - 具有单独的闭合件和切割构件的电外科器械 - Google Patents

具有单独的闭合件和切割构件的电外科器械 Download PDF

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CN103096827A
CN103096827A CN2011800358016A CN201180035801A CN103096827A CN 103096827 A CN103096827 A CN 103096827A CN 2011800358016 A CN2011800358016 A CN 2011800358016A CN 201180035801 A CN201180035801 A CN 201180035801A CN 103096827 A CN103096827 A CN 103096827A
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jaw
cutting element
closed beam
surgical instruments
respect
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CN103096827B (zh
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T·G·迪茨
D·A·威特
M·E·穆图
黄志凡
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Ethicon Endo Surgery Inc
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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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • 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
    • A61B18/08—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
    • A61B18/082—Probes or electrodes therefor
    • A61B18/085—Forceps, scissors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • 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
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/76—Manipulators having means for providing feel, e.g. force or tactile feedback
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • 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
    • A61B2018/00345—Vascular system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • 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
    • A61B2018/00345—Vascular system
    • A61B2018/00404—Blood vessels other than those in or around the heart
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00601—Cutting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00607—Coagulation and cutting with the same instrument
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00619—Welding
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/0063—Sealing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • 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
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/1412—Blade
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • 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
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
    • A61B2018/1455—Probes having pivoting end effectors, e.g. forceps including means for cutting having a moving blade for cutting tissue grasped by the jaws

Abstract

在各种实施例中，提供了下述外科器械，所述外科器械可包括用于例如在组织上执行外科手术的端部执行器。端部执行器可包括一对钳口、闭合梁和切割构件。闭合梁和切割构件可通过联锁构件可释放地耦接在一起，使得切割构件的运动可使得闭合梁也相对于钳口运动并且使得例如钳口闭合并夹持组织。联锁构件可随后解锁，从而允许切割构件穿过夹持组织并且相对于闭合梁运动。另外，可通过单个触发器来操作切割构件和闭合梁，触发器能够在各个阶段处为用户提供触觉反馈。此外，可对钳口供电以递送能量和/或密封夹持组织。

Description

具有单独的闭合件和切割构件的电外科器械
背景技术
本发明涉及医疗装置和方法，并且更具体地，本发明涉及用于密封和离断组织的电外科器械和方法。
在许多情况下，外科器械能够向组织施加能量，以便处理和/或破坏该组织。在某些情况下，外科器械可包括一个或多个电极，该电极可抵靠组织定位和/或相对于组织定位，使得电流可从一个电极流过组织而流到另一个电极。外科器械可包括电气输入端、与电极电连接的供电导体、和/或回路导体，所述回路导体能够例如允许电流从电气输入端流过供电导体，流过电极和组织，然后流过回路导体而流到例如电气输出端。在许多情况下中，可通过流过组织的电流产生热，其中热可使得在组织内和/或组织之间形成一个或多个止血密封。此类实施例可特别用于例如密封血管。该外科器械还可包括切割构件，切割构件可相对于组织和电极运动，以便离断组织。
以举例的方式，由外科器械施加的能量可为射频(“RF”)能量的形式。RF能量为可在300千赫兹(kHz)至1兆赫兹(MHz)频率范围内的电能形式。在应用中，RF外科器械通过电极发射低频无线电波，无线电波引起离子搅动或摩擦，从而增加组织的温度。由于在受影响的组织与围绕的组织之间形成明显的边界，因此外科医生能够以高水平的精确度和控制性进行操作，而不需要太多地牺牲相邻的正常组织。RF能量的低操作温度使得外科医生能够对软组织进行移除、收缩或造型，而同时密封血管。RF能量尤其奏效地适用于结缔组织，结缔组织主要由胶原构成并在接触热时收缩。
另外，在多种开放式和腹腔镜式外科手术中，可能需要凝结、密封或熔合组织。一种密封组织的方式取决于向被捕获在外科器械的端部执行器内的组织施加电能，以便在该组织内形成热效应。已为此类目的开发了多种单极和双极RF钳口结构。通常，将RF能量递送到捕获的组织提升了该组织的温度，因此，该能量可使组织内的蛋白质至少部分地变性。此类蛋白质(例如胶原)可例如变性为蛋白质性混合物，其在蛋白质复性时混合和熔合或“焊接”在一起。当处理部位随时间推移而愈合时，这种生物“焊接”可通过身体的伤口愈合过程被重新吸收。
在双极射频(RF)钳口的某些设置中，外科器械可包括相对的第一钳口和第二钳口，其中每个钳口的表面可包括电极。在使用中，组织可被捕获在钳口表面之间，使得电流可在相对的钳口中的电极之间流动并流过定位在电极之间的组织。这种器械可能不得不密封或“焊接”多种类型的组织，例如具有含不规则或厚的纤维性内容物的壁的解剖结构、成束的不同解剖结构、显著较厚的解剖结构和/或具有厚筋膜层的组织，例如大直径血管。例如，尤其对于密封大直径血管，此类应用可能需要在后处理立即进行高强度组织焊接。
以上讨论仅仅旨在说明本发明所属领域的现状，而不应视为是对权利要求范围的否定。
发明内容
在各种实施例中，提供了一种外科器械。在至少一个实施例中，所述外科器械可包括端部执行器，所述端部执行器包括限定通道的第一钳口、第二钳口、闭合梁和切割构件。在这些实施例中，第一钳口和第二钳口能够被可操作地耦接在一起，使得第一钳口可相对于第二钳口在打开位置和闭合位置之间运动。另外，在这些实施例中，闭合梁的尺寸和构造可设定成至少部分地装配在通道内，并且闭合梁能够沿通道在第一位置和第二位置之间平移。此外，在这些实施例中，当闭合梁处于第二位置时，第一钳口可处于闭合位置。另外，在这些实施例中，切割构件的尺寸和构造可设定成至少部分地装配在通道内。此外，切割构件能够沿通道并相对于闭合梁平移。
在至少一个实施例中，提供了下述外科器械，所述外科器械可包括端部执行器，所述端部执行器包括具有组织接触表面的第一钳口、第二钳口、可操作地接触第一钳口的闭合梁、以及限定纵向轴线的切割构件。在这些实施例中，第一钳口和第二钳口能够被可操作地耦接在一起，使得第一钳口可相对于第二钳口在打开位置和闭合位置之间运动。另外，在这些实施例中，闭合梁能够相对于第一钳口在第一位置和第二位置之间平移。此外，在这些实施例中，当闭合梁处于第二位置时，可通过闭合梁将第一钳口推压到闭合位置。另外，在这些实施例中，切割构件能够相对于第一钳口在回缩位置和完全推进位置之间平移。另外，在这些实施例中，切割构件能够相对于闭合梁平移。此外，在这些实施例中，当闭合梁处于第二位置并且切割构件处于完全推进位置时，垂直于切割构件的纵向轴线的平面可横切第一钳口的组织接触表面、闭合梁和切割构件。
在至少一个实施例中，提供了下述外科器械，所述外科器械可包括端部执行器，所述端部执行器包括第一钳口、第二钳口、可操作地接触第一钳口的闭合梁、能够相对于第一钳口平移的切割构件、以及联锁构件。在这些实施例中，第一钳口和第二钳口能够被可操作地耦接在一起，使得第一钳口可相对于第二钳口在打开位置和闭合位置之间运动。另外，在这些实施例中，闭合梁能够相对于第一钳口在第一位置和第二位置之间平移。另外，在这些实施例中，当闭合梁处于第二位置时，可通过闭合梁将第一钳口推压到闭合位置。此外，在这些实施例中，切割构件能够相对于闭合梁平移。此外，在这些实施例中，联锁构件能够将切割构件和闭合梁选择性地保持在一起，使得切割构件和闭合梁可相对于第一钳口沿至少一个方向彼此同步平移。
上述讨论不应当视为对权利要求范围的否定。
附图说明
本文所述的实施例的各个特征在所附权利要求书中进行了详细描述。然而，根据结合如下附图的以下描述，可理解各种实施例(对手术的组织和方法来讲皆是如此)及其优点。
图1为根据非限制性实施例的外科器械的透视图。
图2为图1的外科器械的柄部的侧视图，其中移除了柄部主体的一半，以示出其内的一些组件。
图3为图1的外科器械的端部执行器的透视图，其示出为处于开口构型；闭合梁的远端示出为处于回缩位置。
图4为图1的外科器械的端部执行器的透视图，其示出为处于闭合构型；闭合梁的远端示出为处于完全推进位置。
图5为图1的外科器械的端部执行器的一部分的透视剖面图。
图6为图1的外科器械的端部执行器的切割构件和闭合梁的部分的透视剖面图。
图7为图1的外科器械的远侧部分的示意性侧视图，其中示出了正通过切割构件推进到打开的钳口对的闭合梁。
图8为图1的外科器械的远侧部分的示意性侧视图，其中示出了完全推进到现已闭合的钳口中的一者内的闭合梁。
图9为图6的外科器械的远侧部分的示意性侧视图，其中示出了下述切割构件，所述切割构件在远侧回缩以释放可旋转地安装到闭合梁的弹簧支承式制转杆。
图10为根据非限制性实施例的夹持组织的外科器械的远侧部分的透视图；其中示出了各个内部组件并且为清楚起见已省去了一些组件。
图11-13为图10的外科器械的钳口、闭合梁、制转杆和切割构件的部分的各种构型的侧视图。
图14-21为图10的外科器械的钳口、闭合梁、制转杆、以及切割构件的远侧部分的各种构型的侧视图，其示出了上文所列的组件之间的相互作用以及操作。
图22为根据非限制性实施例的外科器械的远侧部分的透视图；其中以透视剖面形式示出了各个内部组件并且为清楚起见省去了一些组件。
图23为图22的外科器械的细长轴的一部分、闭合梁、切割构件和凸块的透视剖面图。
图24为图22的外科器械的钳口沿横向于钳口的纵向轴线的方向截取的剖面图。
图25为图22的外科器械的钳口和细长轴的一部分沿图24中的线25-25截取的剖面图。
图26为图22的外科器械的端部执行器的远侧部分的透视图；该端部执行器示出为夹持、密封、和/或切割组织。
图27为图22的外科器械的远侧部分的透视图，其中钳口处于打开位置并且闭合梁和切割部件处于回缩位置；其中为清楚起见以透视剖面形式示出了各个内部组件。
图28为图22的外科器械的远侧部分的透视图，其中钳口处于闭合位置并且闭合梁和/或切割部件至少部分地推进穿过钳口；其中为清楚起见以透视剖面形式示出了各个内部组件。
图29为根据非限制性实施例的外科器械的侧视图；其中该器械的各个部分为剖视图并且/或者为清楚起见以剖面形式示出。
图30为示出根据非限制性实施例的外科器械的操作的各个阶段或状态的流程图。
对应的参考符号指示贯穿多个视图的对应部分。本文示出的范例以一种或多种形式示出了各种实施例，不应将这种范例理解为是以任何方式限制权利要求的范围。
具体实施方式
各种实施例涉及用于处理组织的设备、系统和方法。示出了许多特定的细节，从而得到对说明书中所述和附图中所示的实施例的整体结构、功能、制造和用途的彻底理解。然而，本领域技术人员将会理解，可在没有这样的特定细节的情况下实施该实施例。在其它实例中，没有详细描述熟知的操作、组件和元件，以免使说明书中描述的实施例模糊不清。本领域普通技术人员将会理解，本文所述和所示的实施例是非限制性的实例，从而可认识到，本文所公开的特定结构和功能细节可能是代表性的，并且不必限制实施例的范围，实施例的范围仅由所附的权利要求限定。
本说明书通篇引用的“各种实施例”、“一些实施例”、“一个实施例”或“实施例”等，是指结合所述实施例描述的具体特征、结构或特性包括在至少一个实施例中。因此，本说明书通篇出现的短语“在各种实施例中”、“在一些实施例中”、“在一个实施例中”或“在实施例中”等并不一定均指相同的实施例。此外，在一个或多个实施例中，具体特征、结构或特性可按任何合适的方式结合。因此，在没有限制的情况下，结合一个实施例示出或描述的具体特征、结构或特性可全部或部分地与一个或多个其它实施例的特征、结构或特性结合。
应当理解，可结合临床医生操纵用来治疗患者的器械的一端在说明书中通篇使用术语“近侧”和“远侧”。术语“近侧”是指器械的最靠近临床医生的部分，术语“远侧”是指距临床医生最远的部分。还应当理解，为简明和清楚起见，本文可参考所示实施例使用例如“竖直”、“水平”、“上”和“下”之类的空间术语。然而，外科手术器械可在多种取向和位置中使用，并且这些术语并不意味着是限制性的和绝对的。
以下非临时性美国专利的全部公开内容据此以引用方式并入本文：
美国专利No.7.381.209，名称为ELECTROSURGICALINSTRUMENT；
美国专利No.7.354.440，名称为ELECTROSURGICAL INSTRUMENTAND METHOD OF USE；
美国专利No.7.311.709，名称为ELECTROSURGICAL INSTRUMENTAND METHOD OF USE；
美国专利No.7.309.849，名称为POLYMER COMPOSITIONSEXHIBITING A PTC PROPERTY AND METHODS OF FABRICATION；
美国专利No.7.220.951，名称为SURGICAL SEALING SURFACESAND METHODS OF USE；
美国专利No.7.189.233，名称为ELECTROSURGICALINSTRUMENT；
美国专利No.7.186.253，名称为ELECTROSURGICAL JAWSTRUCTURE FOR CONTROLLED ENERGY DELIVERY；
美国专利No.7.169.146，名称为ELECTROSURGICAL PROBE ANDMETHOD OF USE；
美国专利No.7.125.409，名称为ELECTROSURGICAL WORKINGEND FOR CONTROLLED ENERGY DELIVERY；以及
美国专利No.7.112.201，名称为ELECTROSURGICAL INSTRUMENTAND METHOD OF USE。
这些系统和方法的各种实施例涉及在自然组织块内形成热“焊缝”或“熔合”。组织“焊接”和组织“熔合”的替代术语在本文中可互换使用，以描述对目标组织块进行热处理，从而产生基本上均匀的熔合在一起的组织块，在例如焊接的血管内后处理立即表现出较强的破裂强度。这种焊缝的强度尤其可用于(i)在血管离断手术中永久性密封血管；(ii)在切除手术中焊接器官边缘；(iii)焊接其中需要永久性闭合的其它解剖管道；并且另外(iv)可用于进行血管吻合术、血管闭合术或将解剖结构或其部分接合在一起的其它手术。本文所公开的组织焊接或熔合区别于“凝结”、“止血”和通常涉及减少和阻塞小血管或血管化组织内的血流的其它类似的描述性术语。例如，向任何表面施加热能均可能导致凝结或止血，但却不属于本文所用术语“焊接”的范畴。此类表面凝结不产生提供处理的组织任何显著强度的焊缝。
在分子水平，如本文所公开的真正“焊接”组织的现象可能源自于由热引起的目标组织块中胶原和其它蛋白分子的变性，以形成瞬态液态或凝胶状蛋白质性混合物。在目标组织内提供所选能量密度，可使得胶原和其它蛋白质内的分子内和分子间氢键交联的水热分解。在可为非常短的所选时间间隔内将变性的蛋白质混合物保持在所选的水合程度(不脱水)。保持目标组织块处于所选极高程度的机械压缩状态，以确保解链的变性蛋白质彼此接近，以便进行交织和缠结。热驰豫之后，随再交联和复性的发生，混杂的蛋白质混合物使得蛋白质缠结，从而产生均匀熔合在一起的块体。
外科器械能够例如向患者的组织提供能量，例如电能、超声能、和/或热能。例如，本文所公开的各种实施例提供下述电外科钳口结构，所述电外科钳口结构适于离断钳口之间的所捕获的组织，并且适于通过可控地施加RF能量而同时焊接或密封所捕获的组织的边缘。更详细地，在各种实施例中，现在参见图1，其示出了电外科器械100。外科器械或电外科器械100可包括近侧柄部105、远侧工作端或端部执行器110、以及设置在这两者间且将柄部105至少部分可操作地耦接到端部执行器110的导入器或细长轴108。端部执行器110可包括一组可打开/可闭合的钳口，具有直的或弯曲的钳口—上部第一钳口120A和下部第二钳口120B。钳口120A和120B可以被可操作地耦接在一起，使得第一钳口120A可相对于第二钳口120B在打开位置(参见图3)和闭合位置(参见图4)之间运动。第一钳口120A和第二钳口120B可各自包括沿它们相应的中间部分分别向外设置的细长狭槽或通道142A和142B(参见图3)。第一钳口120A和第二钳口120B可通过缆线152中的电引线耦接到电源145和控制器150。控制器150可用来启动电源145。在各种实施例中，电源145可包括例如RF源、超声波源、直流电源、和/或任何其它合适类型的电能源。
现在转到图2，其示出了柄部105的侧视图，其中第一柄部主体106A(参见图1)的一半被移除以示出第二柄部主体106B内的一些组件。柄部105可包括从柄部主体106A和/或106B延伸的杠杆臂或触发器128。可沿路径129拉动触发器128，使得触发器128相对于主体106A和/或106B运动。触发器128还可通过往复运动件146耦接到设置在细长轴108内的活动的切割构件140，所述往复运动件146可操作地接合到触发器128的延伸部127。因此，触发器128相对柄部主体106A和/或106B的运动可使得切割构件140相对于钳口120A和120B(参见图1)中的一者或两者进行平移。另外，如下文更详细所述，切割构件140可与闭合梁170(参见图3-4)可释放地接合，闭合梁170还与钳口120A、120B可运动地相联。往复运动件146还可连接到偏置装置，例如弹簧141，偏置装置也可连接到第二柄部主体106B以偏置往复运动件146并因此偏置切割构件140和/或闭合梁170(图3)，从而将钳口120A和120B推压到打开位置，如图1所示。另外，参见图1和2，锁定构件131(参见图2)可通过锁定开关130(参见图1)在锁定位置和解锁位置之间运动，在锁定位置，基本上防止往复运动件146朝远侧运动，如图所示，在解锁位置，可允许往复运动件146自由地沿远侧方向朝细长轴108运动。柄部105可为任何类型的手枪式夹持件或本领域中已知的其它类型的柄部，其能够承载致动器杠杆、触发器或滑动件，以用于致动第一钳口120A和第二钳口120B。细长轴108可具有圆柱形或矩形横截面，并且可包括从柄部105延伸的薄壁管状套筒。细长轴108可包括贯穿其延伸的孔，以用于承载用于致动钳口的致动器机构(例如切割构件140和/或闭合梁170)，并且用于承载将电能递送到端部执行器110的电外科组件的电引线。
端部执行器110可适于捕获、焊接或密封和离断组织。第一钳口120A和第二钳口120B可闭合以由此围绕由切割构件140限定的纵向轴线125来捕获或接合组织。第一钳口120A和第二钳口120B还可向组织施加压缩。细长轴108连同第一钳口120A和第二钳口120B可通过例如旋转三重触头而相对于柄部105旋转完整的360度，如由箭头117所示。第一钳口120A和第二钳口120B可在旋转的同时保持为可打开和/或可闭合。
图3和4示出了端部执行器110的透视图。图3示出了处于开口构型的端部执行器110，图4示出了处于闭合构型的端部执行器110。如上所述，端部执行器110可包括上部第一钳口120A和下部第二钳口120B。另外，第一钳口120A和第二钳口120B可各自具有设置在第一钳口120A和第二钳口120B的内部部分上的组织夹持元件，例如齿状物143。第一钳口120A可包括例如上部第一钳口主体161A，上部第一钳口主体161A具有上部第一向外表面162A和第一电极的上部第一能量递送表面175A。第二钳口120B可包括例如下部第二钳口主体161B，下部第二钳口主体161B具有下部第二向外表面162B和第二电极的下部第二能量递送表面175B。第一能量递送表面175A和第二能量递送表面175B均可围绕端部执行器110的远端以“U”形延伸。能量递送表面175A、175B可提供用于接触、夹持、和/或操纵两者间的组织的组织接触表面。
参见图3-5，在至少一个实施例中，闭合梁170和切割构件140的尺寸和构造可设定成至少部分地装配在第一钳口120A的通道142A内。如图5所示，切割构件140的尺寸和构造也可设定成至少部分地装配在第二钳口120B的通道142B内。在任何情况下，闭合梁170和切割构件140可沿通道142A在第一、回缩位置(与处于打开位置的第一钳口(图3)相关)和第二、推进位置(与处于闭合位置的第二钳口(参见例如图4)相关)之间平移。柄部105的触发器128(参见图2)可适于致动切割构件140并随后致动闭合梁170，闭合梁170也用作钳口闭合机构。例如，当沿路径129朝近侧拉动触发器128时，可经由往复运动件146朝远侧推压切割构件140和/或闭合梁170，如图2所示且如上所述。切割构件140和闭合梁170可各自包括一个或多个部件，但在任何情况下，可各自相对于细长轴108和/或钳口120A、120B运动或平移。另外，在至少一个实施例中，切割构件140可由17-4沉淀硬化不锈钢制成。切割构件140的远侧部分可包括带凸缘的“I”形梁，其能够在钳口120A和120B中的通道142A和142B内滑动。在至少一个实施例中，闭合梁170的远侧部分可包括“C”形梁，其能够在通道142A和142B中的一者内滑动。如图3-5所示，闭合梁示出为位于第一钳口120A的通道142A之内和/或之上。闭合梁170可例如在通道142A内滑动，以相对于第二钳口120B打开和闭合第一钳口120A。闭合梁170的远侧部分还可限定凸轮表面174，以用于例如接合第一钳口120A的向外表面162A。因此，当将闭合梁170通过通道142A从例如第一位置(图3)推进到第二位置(图4)时，可将第一钳口120A推压成闭合的(图4)。也可通过第一钳口120A的上壁165引导闭合梁，如图5所示，上壁165可至少部分地包封闭合梁170。为清楚起见，已从图3-4中省去了上壁165。
另外，在各种实施例中，切割构件140的尺寸和构造可设定成至少部分地装配或滑动在闭合梁170内，例如闭合梁170的内部通道171内。在至少一个实施例中，如图5所示，尽管切割构件140的部件可定位在闭合梁170内，但切割构件140的一部分可沿横向于由闭合梁170限定的纵向轴线172的方向从闭合梁170突出。切割构件140的凸缘144A和144B可限定内部凸轮表面，以用于接合闭合梁170的内部通道171和第二钳口120B的向外表面162B。如下文更详细所述，钳口120A和120B的打开和闭合可利用凸轮机构和钳口120A、120B的向外表面162A、162B将极高的压缩力施加到组织上，凸轮机构可包括往复式“C形梁”闭合梁170和/或“I形梁”切割构件140。
更具体地讲，仍参见图3-5，切割构件140的远端的凸缘144A和144B可共同地适于分别可滑动地接合闭合梁170的内部通道171和第二钳口120B的第二向外表面162B。第一钳口120A内的通道142A和第二钳口120B内的通道142B的尺寸和构造可设定成适应闭合梁170和/或切割构件140的运动，切割构件140可包括组织切割元件，例如锐利的远侧边缘和/或表面153(参见图6)。例如，图4示出了至少部分地穿过通道142A推进的闭合梁170的远端178。推进闭合梁170可将端部执行器110从图3所示的开口构型闭合成图4所示的闭合构型。闭合梁170可沿通道142A在第一、回缩位置和第二、完全推进位置之间运动或平移。回缩位置可如图3所示，其中钳口120A、120B处于打开位置并且闭合梁170的远端178定位成邻近上部向外表面162A。尽管未示出，但当闭合梁170的远端178推进到通道142A的远端164并且钳口处于闭合位置时，可形成完全推进位置，参见图4。同样，切割构件140(图5)能够相对于第一钳口在回缩位置(其中钳口120A、120B处于打开位置(图3))和完全推进位置(其中切割构件推进到例如通道142A的远端164且钳口处于闭合位置(图4))之间平移。如上所述，当闭合梁170通过钳口120A、120B推进时，切割构件140也可相对于闭合梁170平移。然而，在某个点处，可使切割构件140与闭合梁170分离，如下文更详细所述。因此，闭合梁170的推进可将初始较低水平或数量的压缩压力或外力施加到夹持在钳口120A、120B之间的组织，并且如下文所述，切割构件140相对于闭合梁170的后续推进不仅可切割或切断组织，而且可将较高水平或数量的压缩压力或外力施加到夹持在钳口120A、120B之间的组织。由切割构件140提供给所夹持组织的较高水平或数量的压缩可归因于如下事实：闭合梁170仅可将外力施加到第一钳口120A，而切割构件140可将外力施加到钳口120A和120B。当仅操纵组织时可需要较低水平或数量的压缩，而当用能量密封和/或离断组织时可需要较高水平或数量的压缩。
在至少一个实施例中，闭合梁170和切割构件140的远侧部分可定位在端部执行器110的钳口120A和120B中的一者或两者的内部和/或附近、和/或细长轴108的远端。更具体地讲，参见图5，例如，当闭合梁170处于第二、完全推进位置并且切割构件140也处于其完全推进位置时，垂直于切割构件的纵向轴线125的平面(例如图5中的横切端部执行器110的平面)可横切闭合梁170、切割构件140和第一钳口120A的组织接触表面(例如能量递送表面175A)。同样例如当闭合梁170处于第二、完全推进位置并且切割构件也处于其完全推进位置时，此平面也可横切第二钳口120B的组织接触表面，例如能量递送表面175B。
此外，在图4所示的闭合位置，上部第一钳口120A和下部第二钳口120B分别限定第一钳口120A的第一能量递送表面175A和第二钳口120B的第二能量递送表面175B之间的间隙或尺寸D。尺寸D可等于例如约0,0005″至约0,040″，并且优选地为例如约0,001″至约0,010″。另外，第一能量递送表面175A和第二能量递送表面175B的边缘可设置成圆形以防止切开组织。
现在参见图1和3，端部执行器110可耦接到电源145和控制器150。第一能量递送表面175A和第二能量递送表面175B同样可各自耦接到电源145和控制器150。第一能量递送表面175A和第二能量递送表面175B能够接触组织并且将适于密封或焊接组织的电外科能量递送到所接合的组织。控制器150可调节电源145递送的电能，继而向第一能量递送表面175A和第二能量递送表面175B递送电外科能量。可通过启动按钮124来初始化能量递送，启动按钮124与触发器128可操作地接合并且经由电缆152与控制器150电气连通。如上所述，由电源145递送的电外科能量可包括射频(RF)能量。此外，相对的第一能量递送表面和第二能量递送表面175A和175B可承载耦接到电源145和控制器150的可变电阻正温度系数(PTC)本体。有关电外科端部执行器、钳口闭合机构、以及电外科能量递送表面的另外的细节在以下的美国专利和公开的专利申请中有所描述，所有这些专利和专利申请均全文以引用方式并入本文中并形成本说明书的一部分：美国专利No.7.381.209；No.7.311.709；No.7.220.951；No.7.189.233；No.7.186.253；No.7.125.409；No.7.112.201；No.7.087.054；No.7.083.619；No.7.070.597；No.7.041.102；No.7.011.657；No.6.929.644；No.6.926.716；No.6.913.579；No.6.905.497；No.6.802.843；No.6.770.072；No.6.656.177；No.6.533.784；和No.6.500.176；以及美国专利申请公开No.2010/0036370和No.2009/0076506。
在各种实施例中，可能有利的是在切割构件140推进穿过钳口120A、120B之前来闭合钳口120A、120B。因此，参见图3-5，在切割构件140推进到通道142A内之前，闭合梁170可至少部分地推进穿过通道142A。在此类实施例中，联锁构件可将切割构件140和闭合梁170选择性地保持在一起，使得它们可相对第一钳口沿至少一个方向彼此同步平移直至联锁构件使切割构件140与闭合梁170分离，其后可通过钳口120A、120B中的通道142A、142B和/或通过闭合梁170来推进切割构件140。在至少一个实施例中，参见图6，联锁构件可包括可旋转地安装到闭合梁170或切割构件140的制转杆，例如制转杆180。如图6所示，可在制转杆180中的小孔181处将制转杆可旋转地安装到闭合梁通道171的至少一个内表面。制转杆180可在第一、锁定位置(在图6中以虚线显示)和第二、解锁位置(在图6中以实线显示)之间旋转。偏置构件(未示出)(例如扭转弹簧)可使制转杆沿箭头方向182偏置到解锁位置。如下文更详细所述，制转杆180的近端183能够接合切割构件140的各个部分。例如，在至少一个实施例中，当制转杆180处于锁定位置时，制转杆180的近端183可接合切割构件140的远端148。另外，在至少一个实施例中，当制转杆180处于解锁位置时，制转杆180的近端183可滑动地容纳在形成于切割构件140中的凹槽156内。
制转杆180可使切割构件140和闭合梁170选择性地互连，如下文所述。参见图7和8，当用户朝柄部主体106A或106B拉动触发器128(参见图1-2)时，可将闭合梁170从回缩、初始位置(图7)推进到完全推进位置(图8)。如此拉动触发器128可使得切割构件140朝远侧运动并因此可同样使得闭合梁170朝远侧运动，这是因为切割构件的远端148沿远侧方向推压制转杆的近端183。制转杆的近端183和切割构件的远端148之间的摩擦和/或干涉可在切割构件140静止或朝远侧运动时将制转杆180保持在其锁定位置。在推进闭合梁170以闭合钳口120A、120B(图8)之后，可相对闭合梁170来推进切割构件140。当闭合梁170被第一钳口的通道142A的远端164(参见图4)阻止朝远侧运动时，可例如为用户提供反馈，例如触觉反馈(如下文更详细所述)。为了使制转杆180解锁，用户可运动或松开触发器128(图1-2)以稍远离柄部主体106A和/或106B。参见图9，如此运动触发器128可使得切割构件140朝近侧运动，这样可将制转杆180从其锁定位置(图9中的虚线)释放并且沿箭头182的方向旋转到其解锁位置(实线)(这归因于所存在的偏置构件(未示出))。在制转杆180处于其解锁位置之后，用于可再次向回朝向柄部主体106A和/或106B运动触发器来推进切割构件140。切割构件140现在可独立于闭合梁170运动到钳口120A和120B内和/或运动穿过钳口120A和120B，因为制转杆180可滑动到切割构件的凹槽156内。
也可使用替代制转杆构型。例如，现在参见图10，外科器械200的远侧部分示出为夹持组织T；为清楚起见已省去了所示器械200的多个部分。外科器械200可大致类似于上述外科器械100。例如，外科器械200可包括通过细长轴108可操作地连接到端部执行器210的柄部105(图1)。端部执行器210可包括通过由切割构件240驱动的闭合梁270的相对推进来闭合的可打开和可闭合的钳口220A和220B。当用户相对柄部主体(可类似于柄部主体106A和/或106B(参见图1-2))运动触发器(可类似于触发器128(参见图1-2))时，切割构件240可相对钳口220A、220B运动。可通过例如旋转地或枢转地安装到闭合梁270的内部部分的联锁构件(例如制转杆280)将切割构件240和闭合梁270选择性地保持在一起或进行联锁。另外，参见图11，可通过容纳在闭合梁270的弓形狭槽284中的制转杆销轴285将制转杆280可旋转以及可平移地安装到闭合梁270。偏置构件(未示出)可朝向中性位置来偏置弹簧，如图11所示。制转杆280可沿由箭头286指示的远离闭合梁270的方向旋转，或制转杆280可沿由箭头287指示的朝向闭合梁270的方向旋转；然而，在不对制转杆280施加外力的情况下，制转杆280可偏置到中性位置，如图11所示。当将制转杆280定位成邻近第一钳口220A中的凹口221时，凹口221可有利于制转杆285沿狭槽284平移。
制转杆280可将闭合梁270和切割梁选择性地保持在一起，这至少部分地归因于制转杆280和切割构件240之间的摩擦。因此，当制转杆处于图11所示的中性位置时，可在制转杆280和闭合梁的远端248之间存在足够的摩擦和/或干涉，使得可通过切割构件240将闭合梁270至少部分地推进穿过第一钳口220A(图10)，使得钳口220A至少部分地闭合。在闭合钳口220A、220B之后或期间，闭合梁270可经受例如来自夹持组织的足够阻力，阻力可使得制转杆旋转成缩进位置，例如图12所示的位置。切割构件240沿远侧方向(例如由图12中的箭头“D”指示的方向)的继续推进例如仍可沿远侧方向D推进闭合梁270，这是因为偏置制转杆280和切割构件240之间存在足够的摩擦力。然而，当闭合梁270到达钳口的通道的远端(未示出，参见例如图4中的通道的远端164)时，切割构件240随后可相对于闭合梁270和钳口220A、220B(图10)进一步地推进。在这种情况下，可克服制转杆280和切割构件240之间的摩擦阻力，使得切割构件240紧靠制转杆280相对地滑动。参见图13，切割构件240可沿近侧方向(例如由箭头“P”所示的方向)回缩直至将制转杆280在切割构件240的凹槽256中推压成伸展位置，从而将闭合梁280互连到切割构件240，以用于将切割构件240和闭合梁280从钳口220A、220B(图10)回缩。在闭合梁270已充分地回缩之后，钳口可打开。
图14-21提供了一组示意图，其进一步示出了制转杆280、切割构件240的远侧部分、闭合梁270和钳口220A的操作；为清楚起见已省去了其它组件。如图14所示，闭合梁处于回缩、静止位置。当切割构件240朝向钳口220A朝远侧推进时，同样由于制转杆280和切割构件240之间的摩擦和/或干涉而使得闭合梁270推进。当闭合梁270推进到钳口220A内部、之中和/或附近时，可将钳口220A推压到闭合位置，如图15所示。如图15所示，通过相对钳口220A和/或闭合梁270推进切割构件240而使得制转杆已旋转到缩进位置。然而，可在偏置制转杆280和切割构件240之间存在足够的摩擦，使得闭合梁270和切割构件240可仍为以平移方式互连或联锁的。因此，如图16所示，可通过下述方式重新打开钳口220A：沿远离钳口220A的近侧方向回缩切割构件240，使得闭合梁270也朝近侧回缩。如此回缩切割构件240可同样使得闭合梁270在远侧回缩，直至闭合梁270到达例如定位在细长轴108内的阻挡件209(图11)。仍参见图16，在闭合梁270到达阻挡件209之后，切割构件240可接着沿制转杆280滑动，直至制转杆280至少部分地透出切割构件240，使得制转杆280由偏置构件(未示出)进行推压以旋转到其中性位置。参见图17，其后可重新推进切割构件240，因此也重新推进闭合梁270并且重新闭合钳口220A。
在钳口220A已例如通过闭合梁270进行闭合之后，如图17所示，可继续推进切割构件240，因此也由于制转杆280和切割构件240之间的摩擦而推进闭合梁270。参见图18，一旦闭合梁270到达钳口的通道的远端264(另外参见图4中的通道142A的远端164)，切割构件240即可开始沿制转杆280滑动并且推进穿过钳口220A和/或220B和夹持在这两者间的任何组织T(参见图10)直至切割构件240到达完全推进位置或另一个所需位置。
在将切割构件240推进到钳口220A内之后，可将闭合梁从钳口220A回缩并且可重新打开钳口220A，如下文所述。参见图19，可沿远离通道远端264的近侧方向回缩切割构件240。然而，由于得自被切割构件240新近切割并且/或者可能仍接触切割构件240的侧面的组织的摩擦阻力，制转杆280和切割构件240之间的摩擦可不再足以将闭合梁270和切割构件可平移地联锁在一起。因此，当切割构件回缩时，可将制转杆280偏置到切割构件240的凹槽256内，从而充当扣件并且通过制转杆280和凹槽256之间的干涉来将切割构件240和闭合梁270保持在一起。因此，切割构件240沿近侧方向(即，远离通道远端264)的进一步回缩可开始也沿近侧方向运动闭合梁270。如图10-21所示，凹槽256可定位成紧邻或靠近切割构件240的远端。然而，作为另外一种选择，凹槽可定位成相距切割构件240的远端的位置比图示位置更远。例如，在一个实施例中，可相对钳口220A来定位凹槽256，使得当切割构件240到达完全推进位置(参见图18)时可将制转杆280容纳在凹槽256中。因此，在此类实施例中，在切割构件240得到完全推进即刻之后并且/或者在切割构件回缩期间，制转杆280可有助于将切割构件240和闭合梁270保持在一起。在任何情况下，参见图20并且在至少一个实施例中，在闭合梁270已至少部分地回缩之后，制转杆280可由于图11-13所示的弓形狭槽284而旋转和平移到另一个缩进位置内。参见图21，制转杆280的这种运动可允许切割构件240完全回缩到图21所示的位置，其后可通过偏置构件(未示出)将制转杆280复位并且偏置到其中性位置。作为另外一种选择，在至少一个实施例中，可通过下述方式来将制转杆280从图13所示的伸展位置返回到图11所示的中性位置：用户运动或拉动触发器128(图1-2)以稍靠近柄部主体106A和/或106B使得切割构件240和凹槽256朝远侧运动，从而允许制转杆280在闭合梁270内旋转到缩进位置(参见图12)。随后，用户可运动或返回触发器128(图1-2)以较充分地远离柄部主体106A和/或106B，使得制转杆280可返回到其中性位置，从而使制转杆280复位。在任何情况下，此后可重复图14-21中的一者或多者所示的上述步骤和/或相对运动以例如再次夹持、操纵和/或切割组织。
根据各种实施例的可充当联锁构件的制转杆构型的另外的细节可存在于名称为MRI BIOPSY DEVICE的美国专利申请序列号11/076.612中，该专利申请的全文以引用方式并入本文中。
在至少一个实施例中，联锁构件可包括从切割构件突出的凸块。例如，参见图22-23，大致类似于上述外科器械100的外科器械300可包括通过细长轴308可操作地耦接在一起的端部执行器310和柄部(未示出，参见图1中的柄部105)。端部执行器310可包括通过由切割构件340驱动的闭合梁370(在图22中为清楚起见未示出，参见图23)的相对推进来闭合的可打开和可闭合的钳口320A和320B。当用户相对柄部主体(可类似于柄部主体106A和/或106B(参见图1-2))运动触发器(可类似于触发器128(参见图1-2))时，切割构件340可相对钳口320A、320B运动。可通过例如从切割构件340的顶部或外部突出的联锁构件(例如凸块380)来将切割构件340和闭合梁370选择性地保持在一起或进行联锁。凸块380可与切割构件340一体或整体地形成。作为另外一种选择，可例如通过粘合剂、焊接件、扣紧构件、和/或任何其它合适类型的附接机构将凸块380附接到切割构件。
如图23所示，当切割构件340相对于闭合梁380处于凸起位置时，凸块380能够接合闭合梁380。在此类实施例中，凸块380可接合形成于闭合梁370的内部通道371中的凹口或棘爪382、嵌套在凹口或棘爪382内、和/或由凹口或棘爪382以其它方式可释放地容纳。棘爪382可包括近侧壁和远侧壁(未示出)，当切割构件340以及凸块380处于凸起位置时，所述近侧壁和远侧壁允许闭合梁370可平移地耦接到切割构件340。作为另外一种选择，尽管未示出，但在至少一个实施例中，凸块380可附接到和/或形成于闭合梁370中并且棘爪382可形成于切割构件340中。
当闭合梁370相对钳口320A处于所需位置，例如完全推进位置时，可使凸块380从棘爪382脱离。现在参见图24-26，第二钳口320B可包括向外表面362B。向外表面362B可导向切割构件340的下部凸缘344B(图23)，使得切割构件可横向于闭合梁的纵向轴线372(图23)运动。如图25所示，向外表面362B还可包括至少一个斜面363。斜面363可接触例如切割构件的至少一部分(例如下部凸缘344B)，并且因此例如当切割构件340沿远侧方向推进时使得切割构件340以及凸块380从图23所示的凸起位置运动到图26所示的降低位置。换句话讲，当切割构件340的下部凸缘344B沿斜面363朝远侧推进时，切割构件340和凸块380可横向于闭合梁的纵向轴线(图23)运动。在此降低位置(图26)，凸块380可从闭合梁370的棘爪382脱离。切割构件340可因此相对钳口320A、320B和闭合梁370运动。换句话讲，当凸块380处于处于降低位置时，切割构件340可独立于闭合梁370运动，且不会影响后者相对钳口320A、320B的位置。同样，当切割构件340沿近侧方向回缩时，斜面363可使得切割构件340和凸块380移回凸起位置，从而通过凸块380和棘爪382之间的接合来将闭合梁370和切割构件340联锁在一起。此外，当切割构件340在凸起和降低位置之间平移时上部切割构件凸缘344A可在闭合梁370内运动，使得当切割构件处于降低位置时凸缘344A接触和/或压贴在闭合梁370的内表面。
参见图27-28，可按如下方式来操作外科器械300。当切割构件340和闭合梁370同步推进(原因在于定位在棘爪382内的凸块380使得切割构件340和闭合梁370联锁在一起)时，第一钳口320A可从打开位置(图27)旋转到闭合位置(图28)。闭合梁370可沿第一钳口的向外表面362A并且在切割构件340前面推进穿过端部执行器310，直至闭合梁370到达第一钳口的通道342A(图24)的远端364A(参见图25)或另一个预定位置。同时或几乎同时，切割构件340的下部凸缘344B可遇到斜面363(图25)，这可使得切割构件340和凸块380相对于闭合梁370从凸起位置(图27)运动到降低位置(图28)。其后，由于凸块380可不再被定位在棘爪382内，则切割构件340可独立于闭合梁370朝远侧推进，从而在该过程中切断组织“T”。
在上文所述的各种实施例中，触发器(例如示于图1-2中的触发器128)能够致动切割构件(例如切割构件140、240和/或340)和闭合梁(例如闭合梁170、270和/或370)，使得例如闭合梁和切割构件相对于例如第一钳口(例如钳口120A、220A和/或320A)平移。闭合梁和切割构件的这种致动可为用户提供控制下述操作的能力，所述操作为仅利用一个触发器来闭合钳口和将切割构件击发穿过钳口的操作。在此类实施例中，柄部触发器能够为用户提供触觉反馈，从而为用户提供有关外科器械处于闭合、密封和/或切割阶段的反馈。
现在参见图29，示出了外科器械400的简化图。柄部主体406B的一部分被移除以示出定位在柄部的柄部主体406A内的一些内部组件。外科器械400可大致类似于上述外科器械100。例如，如图29所示，外科器械400可包括通过细长轴408可操作地耦接到端部执行器410的柄部。端部执行器410可包括通过由切割构件440驱动的闭合梁470的相对推进来闭合的可打开和可闭合的钳口420A和420B。当用户例如相对形成于柄部主体106A和/或106B中的拇指座432来运动触发器(例如触发器428)时，切割构件440可相对钳口420A、420B运动。切割构件440可通过上文所述的联锁构件中的一者或多者与闭合梁470选择性地联锁在一起。另外，在至少一个实施例中，联锁构件可至少在初始时、在闭合钳口420A、420B和/或从中击发切割构件440之前定位成在柄部内和/或邻近细长轴408。
更详细地讲，可将触发器428耦接到可与齿条446可操作地接合的小齿轮或齿轮427。齿轮427的齿可与齿条446的齿适当地啮合，使得当用户朝向或背向拇指座432旋转触发器428时，齿轮426旋转，从而使得齿条446沿分别由标定为“D”和“P”的箭头指示的远侧或近侧方向平移。齿条446可耦接到切割构件440。因此，触发器相对拇指座432的运动可使得齿轮427旋转，这可使得齿条446平移，从而可使得切割构件440和/或闭合梁470也相对于钳口420A、420B平移，如上文的各种实施例中所述。
齿轮427和/或齿条446还可包括一个或多个增大的或换句话讲异常的齿，这可使得用户在例如相对拇指座432来旋转触发器428期间感到干涉、听到咔嗒声、和/或接收到任何其它合适的触觉反馈。当触发器428处于某个或某些预定位置(例如位置491、492和/或493)时可提供这种触觉反馈。第一位置491可与处于如图所示的初始、打开位置的端部执行器410相关。将触发器428拉动到第二位置492可提供与处于闭合位置的钳口420A、420B相关的触觉反馈。第三位置493可与处于完全推进位置(未示出；参见例如图18中的切割构件240的相对位置)的切割构件440相关。因此，当端部执行器410处于各个阶段时可为用户提供触觉反馈，这在其中例如当在外科手术期间使用外科器械400并且端部执行器410位于患者体内时而不能看到端部执行器410的情况下可为有益的。
在至少一个实施例中，外科器械400可通过缆线152电耦接到如上文所述的控制器150和电源145。在此类实施例中，端部执行器410可包括能量递送表面475A、475B，能量递送表面475A、475B类似于也描述于上文中的能量递送表面175A、175B。能量递送表面475A、475B可与缆线152电耦接，使得可将电能提供到表面475A和/或475B。在此类实施例中，当触发器428处于某个或某些预定位置时，该触发器可使得控制器150允许电源将电流提供到能量递送表面475A和/或475B。例如，触发器428可电耦接到控制器145，使得触发器可运动到顺序地位于第二位置492和第三位置493之间的中间位置，并且当触发器处于此中间位置时可对能量递送表面475A和/或475B供能。因此，用户可将触发器428按压到第二位置492(同样与处于闭合构型的钳口420A、420B相关)并且随后用户可知道在朝第三位置493持续按压触发器428不久之后即可启动能量递送表面475A和/或475B以焊接组织。与能量启动相关的中间位置能够使得电流在切割构件440开始进入钳口420A、420B之间的空间或间隙之前就开始流到能量递送表面475A和/或475B。这种构型可允许外部组织层(例如血管的外膜层)在被施用能量之前例如进行压缩。因此，在切割构件开始切断靶组织之前即可对靶组织进行焊接、消融、密封、或换句话讲能量改性。
图30示出了流程图500，其示出了根据本文的一个或多个实施例的外科器械的各个阶段或状态。当通过将闭合梁(例如闭合梁170、270、370和/或470)例如向前滑动、朝钳口(钳口120A、220A、320A和/或420A)滑动、和/或滑动到钳口内例如以使得钳口闭合由此来夹持组织时，则达到状态“G”501。从状态G 501起，可对组织进行处理。可通过回缩闭合梁来释放组织以达到状态“R”506，其后可分别重新访问状态G 501和M502。当在状态M 502处充分地处理组织之后，用户可例如通过继续按压触发器(例如触发器128和/或428)来启用能量递送表面(例如能量递送表面175A、175B、475A和/或475B)例如以产生第一密封组织区域。在状态“M′”505处可通过将钳口保持为闭合状态来进一步地处理组织。其后，可在状态R 506处释放组织并且在状态G 501处再次重新夹持该组织的不同位置，例如与第一密封组织区域邻接的位置。可在状态M 502处再次处理组织并且随后可在状态E 503再次密封组织，以产生第二密封区域。可重复此过程直至产生足够的密封区域。其后，可在状态“K”504处通过下述方式来切割或切断密封组织：进一步地按压触发器，使得切割构件(例如切割构件140、240、340和/或440)例如朝远侧滑动并且接下来在切割组织之后朝近侧滑动。然后，可在状态M′505处再次处理切割和密封的组织并且最终可在状态R 506处释放切割和密封的组织。然后可重复此过程以夹持(状态G 501)、处理(状态M 502)、用能量密封(状态E 503)、切割(状态K 504)、再处理(状态M′505)和/或释放(状态R 506)另一个靶组织区域。
本文所述的装置的实施例可利用微创或开放外科手术技术而引入到患者体内。在某些情况下，可能有利的是使用微创和开放外科手术技术的组合来将装置引入患者体内。微创技术可更加精确和有效地触及用于诊断和治疗过程的治疗区域。为了到达患者体内的内部治疗区域，可例如在多部位腹腔镜手术、单部位腹腔镜手术、或单切口腹腔镜手术中以腹腔镜方式插入本文所述的装置。此外，本文所述的装置可用于例如单孔触及手术中。除此之外或作为另外一种选择，本文所述的装置可插入穿过身体的自然开口，例如嘴、肛门和/或阴道。借助将各种医疗装置通过患者的自然开口而引导至患者体内来实施的微创手术在本领域中已知为NOTESTM手术。装置的某些部分可经由皮肤或通过小键孔切口而引导至组织处理区域。
内窥镜式微创外科手术和诊断医疗过程用来通过将小管插入体内来评估和治疗内部器官。内窥镜可具有刚性或柔性管。柔性内窥镜可通过自然身体开口(例如，嘴、肛门和/或阴道)或经由套管针通过相对较小的键孔切口(通常为0,5-1.5cm)而引入。内窥镜可用来观察内部器官的表面状况，包括异常或患病的组织，例如病变和其它表面状况，并且捕获图像，以用于视觉检测和摄影。内窥镜可适于和构造为具有工作通路，以用于将医疗器械引导至治疗区域，进行活组织检查、检查异物和/或进行外科手术。
本文所公开的装置可设计成单次使用后处理掉，也可设计成多次使用。然而在任一种情况下，该器械均可重新恢复，以便在至少一次使用后再次使用。重新恢复可包括以下步骤的组合：拆卸装置、然后清洗或更换特定部件以及后续重新组装。具体来讲，该装置可拆卸，并且可任意组合对装置的任意数目的重新特定部件或零件进行选择性地更换或移除。清洗和/或置换特定部分后，该装置可在重新恢复设施处重新组装以随后使用，或在即将进行外科手术前由外科团队重新组装。本领域普通技术人员将会知道，重新恢复装置时可采用多种不同技术来拆卸、清洗/更换和重新组装。这种技术的使用以及所得重新恢复器械均在本专利申请的范围内。
优选地，在外科手术之前将对本文所述的装置的各种实施例进行处理。首先，获取新的或用过的装置，并在必要时对装置进行清洁。然后对装置进行消毒。在一种灭菌技术中，将器械置于封闭并密封的容器中，例如塑料或TYVEK
Figure BPA00001673463500221
口袋中。然后将容器和装置放置在能够穿透该容器的辐射区，例如γ辐射、x-射线或高能电子。辐射将装置上和容器中的细菌杀死。然后可将灭菌后的装置保存在消毒容器中。该密封容器使器械保持无菌，直到在医疗设备中打开该容器。其它消毒技术可通过本领域技术人员已知的任何多种方式进行，包括β辐射、γ辐射、环氧乙烷和/或蒸汽。
虽然文中结合某些公开的实施例对装置的多种实施例作了描述，但这些实施例的许多修改和变化形式也可被实施。例如，可采用不同类型的端部执行器。另外，凡是公开了用于某些组件的材料的，均可使用其它材料。上述描述和以下权利要求旨在涵盖所有这类修改形式和变型。
据述以引用方式全部或部分地并入本申请的任何专利、公布、或其它公开材料仅在所并入的材料不与本发明所述的现有定义、陈述、或其它公开材料相冲突的程度下并入本申请。由此，在必要的程度下，本文所明确阐述的公开内容将取代以引用方式并入本文的任何相冲突材料。如果据述以引用方式并入本文但与本文所述的现有定义、陈述或其它公开材料相冲突的任何材料或其部分，仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。

Claims (20)

1.一种外科器械，包括：
端部执行器，所述端部执行器包括：
限定通道的第一钳口；
第二钳口，其中所述第一钳口和所述第二钳口能够操作地耦接在一起，使得所述第一钳口能够相对于所述第二钳口在打开位置和闭合位置之间运动；
闭合梁，所述闭合梁的尺寸和构造被设定成至少部分地装配在所述通道内，其中所述闭合梁能够沿所述通道在第一位置和第二位置之间平移，其中当所述闭合梁处于所述第二位置时所述第一钳口处于所述闭合位置；和
切割构件，所述切割构件的尺寸和构造被设定成至少部分地装配在所述通道内，其中所述切割构件能够沿所述通道并相对于所述闭合梁平移。
2.根据权利要求1所述的外科器械，还包括联锁构件，所述联锁构件能够将所述切割构件和所述闭合梁选择性地保持在一起，使得所述切割构件和所述闭合梁相对于所述第一钳口沿至少一个方向彼此同步平移。
3.根据权利要求2所述的外科器械，其中，所述联锁构件包括制转杆，所述制转杆能够旋转地安装到所述闭合梁和所述切割构件中的一者。
4.根据权利要求2所述的外科器械，其中，所述联锁构件包括从所述切割构件突出的凸块，其中所述凸块能够接合所述闭合梁，并且其中所述第二钳口还包括斜面，所述斜面能够使所述切割构件远离所述闭合梁运动并且使所述凸块从所述闭合梁脱离。
5.根据权利要求1所述的外科器械，其中，所述切割构件的尺寸和构造被设定成至少部分地装配在所述闭合梁内。
6.根据权利要求1所述的外科器械，其中，所述切割构件限定纵向轴线，其中所述切割构件从所述闭合梁沿横向于所述纵向轴线的方向突出。
7.根据权利要求1所述的外科器械，还包括能够操作地耦接到所述端部执行器的柄部，其中所述柄部包括主体和从所述主体延伸的触发器，其中所述触发器能够相对于所述主体运动，并且其中所述触发器能够操作地耦接到所述切割构件，使得当所述触发器相对于所述主体运动时所述切割构件相对于所述第一钳口平移。
8.根据权利要求7所述的外科器械，其中，所述触发器能够致动所述闭合梁和所述切割构件，使得所述闭合梁和所述切割构件相对于所述第一钳口平移。
9.根据权利要求7所述的外科器械，其中，所述柄部触发器能够在所述触发器相对于所述柄部主体的预定位置提供触觉反馈。
10.一种外科器械，包括：
端部执行器，所述端部执行器包括：
包括组织接触表面的第一钳口；
第二钳口，其中所述第一钳口和所述第二钳口能够操作地耦接在一起，使得所述第一钳口能够相对于所述第二钳口在打开位置和闭合位置之间运动；
能够操作地接触所述第一钳口的闭合梁，其中所述闭合梁能够相对于所述第一钳口在第一位置和第二位置之间平移，并且其中当所述闭合梁处于所述第二位置时通过所述闭合梁将所述第一钳口推压到所述闭合位置；和
限定纵向轴线的切割构件，其中所述切割构件能够相对于所述第一钳口在回缩位置和完全推进位置之间平移，并且其中所述切割构件能够相对于所述闭合梁平移；
其中，当所述闭合梁处于所述第二位置并且所述切割构件处于所述完全推进位置时，垂直于所述纵向轴线的平面横切所述组织接触表面、所述闭合梁以及所述切割构件。
11.根据权利要求10所述的外科器械，还包括联锁构件，所述联锁构件能够将所述切割构件和所述闭合梁选择性地保持在一起，使得所述切割构件和所述闭合梁相对于所述第一钳口沿至少一个方向彼此同步平移。
12.根据权利要求11所述的外科器械，其中，所述联锁构件包括制转杆，所述制转杆能够旋转地安装到所述闭合梁和所述切割构件中的一者。
13.根据权利要求11所述的外科器械，其中，所述联锁构件包括从所述切割构件突出的凸块，其中所述凸块能够接合所述闭合梁，并且其中所述第二钳口还包括接触所述切割构件的至少一部分的斜面。
14.一种外科器械，包括：
端部执行器，所述端部执行器包括：
第一钳口；
第二钳口，其中所述第一钳口和所述第二钳口能够操作地耦接在一起，使得所述第一钳口能够相对于所述第二钳口在打开位置和闭合位置之间运动；
闭合梁，其中所述闭合梁能够相对于所述第一钳口在第一位置和第二位置之间平移，并且其中当所述闭合梁处于所述第二位置时通过所述闭合梁将所述第一钳口推压到所述闭合位置；
能够相对于所述第一钳口平移的切割构件，其中所述切割构件能够相对于所述闭合梁平移；和
联锁构件，所述联锁构件能够将所述切割构件和所述闭合梁选择性地保持在一起，使得所述切割构件和所述闭合梁相对于所述第一钳口沿至少一个方向彼此同步平移。
15.根据权利要求14所述的外科器械，还包括能够操作地耦接到所述端部执行器的柄部，其中所述柄部包括主体和从所述主体延伸的触发器，其中所述触发器能够相对于所述主体运动，其中所述触发器能够操作地耦接到所述切割构件，使得当所述触发器相对于所述主体运动时所述切割构件相对于所述第一钳口平移。
16.根据权利要求15所述的外科器械，其中，所述切割构件能够相对于所述第一钳口在回缩位置和完全推进位置之间平移，其中所述触发器能够在第一位置、第二位置和第三位置之间顺序地运动；
其中当所述触发器处于所述第一位置时，所述第一钳口处于所述打开位置；
其中当所述触发器处于所述第二位置时，所述第一钳口处于所述闭合位置；
其中当所述触发器处于所述第三位置时，所述切割构件处于所述完全推进位置。
17.根据权利要求16所述的外科器械，其中，所述端部执行器还包括至少一个能量递送表面，其中触发器能够运动到顺序地位于所述第二位置和第三位置之间的中间位置，其中当所述触发器处于所述中间位置时对所述能量递送表面供能。
18.根据权利要求14所述的外科器械，其中，所述联锁构件包括能够旋转地安装到所述闭合梁或所述切割构件的制转杆。
19.根据权利要求14所述的外科器械，其中，所述联锁构件包括从所述切割构件突出的凸块，其中所述凸块能够接合所述闭合梁，并且其中所述第二钳口还包括接触所述切割构件的至少一部分的斜面。
20.根据权利要求19所述的外科器械，其中，所述闭合梁包括能够可释放地容纳所述凸块的棘爪。
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