CN103281979B - 用于铰接外科装置的控制结构 - Google Patents

用于铰接外科装置的控制结构 Download PDF

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CN103281979B
CN103281979B CN201180046056.5A CN201180046056A CN103281979B CN 103281979 B CN103281979 B CN 103281979B CN 201180046056 A CN201180046056 A CN 201180046056A CN 103281979 B CN103281979 B CN 103281979B
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axle
jaw
electro
end effector
operable
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CN103281979A (zh
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B·C·沃雷尔
黄志凡
J·R·莱斯科
M·C·米勒
G·S·斯特罗布尔
G·A·特里斯
C·S·布莱克
W·E·克莱姆
E·J·亨利
K·M·蒙戈马利
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Ethicon Endo Surgery Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical 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
    • A61B18/14Probes or electrodes therefor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • A61B17/07207Surgical 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B17/295Forceps for use in minimally invasive surgery combined with cutting implements
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00371Multiple actuation, e.g. pushing of two buttons, or two working tips becoming operational
    • A61B2017/0038Simultaneous actuation of two tools by pushing one button or the like
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2901Details of shaft
    • A61B2017/2908Multiple segments connected by articulations
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2927Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2946Locking means

Abstract

本发明公开了一种电外科装置,所述电外科装置包括主体、端部执行器、切割构件和轴。所述端部执行器包括一对钳口和至少一个电极,可操作所述至少一个电极以向夹在所述钳口之间的组织递送RF能量。可操作所述切割构件以切割夹在所述钳口之间的组织。所述轴包括铰接部分,可操作所述铰接部分以将所述端部执行器有选择地定位在相对于所述轴的所述纵向轴线的非平行位置处。所述主体包括控制器,可操作所述控制器以有选择地致动所述铰接部分。所述控制器可以包括旋转旋钮、枢转旋钮或枢转翅片,等等。电联接装置可以沿着至少两条轴线接触导电性运动构件。弹性偏置的杆可帮助触发器从致动位置返回原位置。

Description

用于铰接外科装置的控制结构
Barry C.Worrell
Zhifan F.Huang
Jason R.Lesko
Matthew C.Miller
Geoffrey S.Strobl
Gregory A.Trees
Charles S.Black
William E.Clem
Emron Henry
Kevin M.Montgomery
优先权
本专利申请要求提交于2010年9月24日,名称为“ArticulatingSurgical Device”的美国临时申请No.61/386,094的优先权,该临时申请的公开内容以引用方式并入本文。
背景技术
多种外科器械包括组织切割元件和一个或多个向组织传输RF能量(如,以凝结或密封组织)的元件。此类装置的例子为由Ethicon Endo-Surgery,Inc.(Cincinnati,Ohio)制造的组织密封装置。此类装置的其他例子和相关概念在以下文献中有所公开:2002年12月31日公布的名称为“Electrosurgical Systems and Techniques for Sealing Tissue”的美国专利No.6,500,176,该专利的公开内容以引用方式并入本文;2006年9月26日公布的名称为“Electrosurgical Instrument and Method of Use”的美国专利No.7,112,201,该专利的公开内容以引用方式并入本文;2006年10月24日公布的名称为“Electrosurgical Working End for Controlled Energy Delivery”的美国专利No.7,125,409,该专利的公开内容以引用方式并入本文;2007年1月30日公布的名称为“Electrosurgical Probe and Method of Use”的美国专利No.7,169,146,该专利的公开内容以引用方式并入本文;2007年3月6日公布的名称为“Electrosurgical Jaw Structure for Controlled EnergyDelivery”的美国专利No.7,186,253,该专利的公开内容以引用方式并入本文;2007年3月13日公布的名称为“Electrosurgical Instrument”的美国专利No.7,189,233,该专利的公开内容以引用方式并入本文;2007年5月22日公布的名称为“Surgical Sealing Surfaces and Methods of Use”的美国专利No.7,220,951,该专利的公开内容以引用方式并入本文;2007年12月18日公布的名称为“Polymer Compositions Exhibiting a PTC Property and Methodsof Fabrication”的美国专利No.7,309,849,该专利的公开内容以引用方式并入本文;2007年12月25日公布的名称为“Electrosurgical Instrument andMethod of Use”的美国专利No.7,311,709,该专利的公开内容以引用方式并入本文;2008年4月8日公布的名称为“Electrosurgical Instrument andMethod of Use”的美国专利No.7,354,440,该专利的公开内容以引用方式并入本文;2008年6月3日公布的名称为“Electrosurgical Instrument”的美国专利No.7,381,209,该专利的公开内容以引用方式并入本文;2011年4月14日公布的名称为“Surgical Instrument Comprising First and Second DriveSystems Actuatable by a Common Trigger Mechanism”的美国专利公布No.2011/0087218,该公布的公开内容以引用方式并入本文;以及2011年6月2日提交的名称为“Motor Driven Electrosurgical Device with Mechanical andElectrical Feedback”的美国专利申请No.13/151,181,该专利申请的公开内容以引用方式并入本文。
此外,多种外科器械包括具有铰接部分的轴,其为位于轴的铰接部分远侧的端部执行器提供增强的定位能力。此类装置的例子包括由EthiconEndo-Surgery,Inc.(Cincinnati,Ohio)制造的多种型号的内切割器。此类装置的其他例子和相关概念在以下文献中有所公开:2008年6月3日公布的名称为“Articulating Surgical Stapling Instrument Incorporating aTwo-Piece E-Beam Firing Mechanism”的美国专利No.7,380,696,该专利的公开内容以引用方式并入本文;2008年7月29日公布的名称为“SurgicalStapling and Cutting Device”的美国专利No.7,404,508,该专利的公开内容以引用方式并入本文;2008年11月25日公布的名称为“SurgicalInstrument with Articulating Shaft with Rigid Firing Bar Supports”的美国专利No.7,455,208,该专利的公开内容以引用方式并入本文;2009年3月24日公布的名称为“Surgical Instrument Incorporating an Electrically ActuatedArticulation Mechanism”的美国专利No.7,506,790,该专利的公开内容以引用方式并入本文;2009年6月23日公布的名称为“Surgical StaplingInstrument with an Articulating End Effector”的美国专利No.7,549,564,该专利的公开内容以引用方式并入本文;2009年7月14日公布的名称为“Surgical Instrument Incorporating a Fluid Transfer Controlled ArticulationMechanism”的美国专利No.7,559,450,该专利的公开内容以引用方式并入本文;2010年2月2日公布的名称为“Surgical Instrument with GuidedLaterally Moving Articulation Member”的美国专利No.7,654,431,该专利的公开内容以引用方式并入本文;2010年8月24日公布的名称为“SurgicalInstrument with Laterally Moved Shaft Actuator Coupled to Pivoting ArticulationJoint”的美国专利No.7,780,054,该专利的公开内容以引用方式并入本文;2010年8月31日公布的名称为“Surgical Instrument with ArticulatingShaft with Single Pivot Closure and Double Pivot Frame Ground”的美国专利No.7,784,662,该专利的公开内容以引用方式并入本文;以及2010年9月21日公布的名称为“Surgical Instrument Articulation Joint Cover”的美国专利No.7,798,386,该专利的公开内容以引用方式并入本文。
尽管已研制和使用了若干医疗装置,但据信在本发明人之前还无人研制出或使用所附权利要求中描述的发明。
附图说明
虽然在说明书之后提供了特别指出和清楚地要求保护本技术的权利要求书,但是据信通过对下面某些实施例的描述并结合附图可以更好地理解本技术,附图中类似的参考标号表示相同元件,其中:
图1示出了示例性电外科医疗装置的侧正视图;
图2示出了图1装置的开口构型的端部执行器的透视图;
图3示出了图1装置的开口构型的端部执行器的另一个透视图;
图4示出了图2闭合构型端部执行器的横截面端视图,并且刀片位于远侧位置;
图5示出了具有铰接控制旋钮的另一个示例性电外科医疗装置的透视图;
图6示出了沿图5的线6-6截取的图5装置的轴组件的横截面端视图;
图7示出了图5装置的轴组件元件和端部执行器元件的透视图;
图8示出了图5装置的轴组件支撑构件的透视图;
图9示出了图5装置沿着支撑构件一侧的铰接控制元件的局部透视图;
图10示出了图5装置沿着支撑构件另一侧的铰接控制元件的局部透视图;
图11示出了图9-10的铰接控制元件的俯视平面图;
图12示出了被护套包围的图9的铰接控制元件的局部透视图;
图13示出了图5装置的柄部组件的侧正视图,其中移除了一半外壳;
图14示出了图13柄部组件的铰接控制元件的侧正视图,其中移除了铰接控制旋钮主体的一半;
图15示出了与图9-10铰接控制元件联接的图13柄部组件的铰接控制元件的透视图;
图16示出了沿图15的线16-16截取的图15铰接控制元件的侧剖视图;
图17A示出了图5装置的轴的铰接控制元件和铰接部分的局部剖视图,其中铰接部分为基本上直的构型;
图17B示出了图17A元件的局部剖视图,其中铰接部分处于铰接的第一阶段;
图17C示出了图17A元件的局部剖视图,其中铰接部分处于铰接的第二阶段;
图18示出了具有成角度铰接控制旋钮的另一个示例性电外科医疗装置的侧正视图;
图19示出了图18装置的柄部组件中的铰接控制元件的剖视图;
图20示出了图19铰接控制元件的其中一些的分解透视图;
图21示出了示例性可供选择铰接控制元件的透视图;
图22示出了具有枢转的半球形铰接控制旋钮的另一个示例性电外科医疗装置的透视图;
图23示出了沿图22的线23-23截取的图22装置的铰接控制元件的剖视图;
图24示出了图23铰接控制元件的透视图;
图25示出了图22装置的外壳元件的分解透视图;
图26示出了具有枢转的铰接控制翅片的另一个示例性电外科医疗装置的透视图;
图27示出了图26装置的铰接控制元件的透视图;
图28示出了图26装置的铰接控制元件的另一个透视图;
图29示出了图27-28铰接控制元件的其中一些的俯视平面图;
图30示出了图5装置的柄部组件的远侧部分的透视图,其中移除了柄部组件的一半外壳;
图31示出了图30远侧部分的示例性电联接装置;
图32示出了示例性可供选择的电联接装置;
图33示出了安装在图30远侧部分中的图32电联接装置的局部剖面透视图;
图34示出了另一个示例性可供选择的电联接装置;
图35示出了图5装置的柄部组件的近侧部分的侧正视图,其中移除了柄部组件的一半外壳;
图36示出了图35近侧部分的示例性电联接装置的透视图;
图37A示出了在第一位置包括示例性返回协助枢转凸轮结构的柄部组件的一部分的侧正视图;
图37B示出了图37A元件的侧正视图,其中返回协助枢转凸轮结构处于第二位置;并且
图37C示出了图37A元件的侧正视图,其中返回协助枢转凸轮结构处于第三位置。
附图并非意在以任何方式进行限制,并且可以预期本技术的各种实施例能够以多种其他方式来执行,包括那些未必在附图中示出的方式。附图并入本说明书中并构成其一部分,示出了本技术的若干方面,并与具体实施方式一起用于说明本技术的原理;然而,应当理解,本技术不限于所示出的明确布置方式。
具体实施方式
本技术的某些例子的下述描述不应用于限制其范围。通过以下举例说明设想用于实施本技术的最佳方式之一的描述,本技术的其他例子、特征、方面、实施例和优点对于本领域技术人员将变得显而易见。应当认识到,本文所述的技术包括不脱离本技术的所有其他的不同和明显方面。因此,附图和具体实施方式应被视为实质上是示例性的,而非限制性的。
另外应当理解,本文所述的教导内容、表达方式、实施例、例子等中的任何一个或多个可与本文所述的其他教导内容、表达方式、实施例、例子等中的任何一个或多个相结合。因此下述教导内容、表达方式、实施例、例子等不应视为彼此隔离。根据本文的教导内容,其中本文的教导内容可结合的各种合适方式对于本领域普通技术人员将是显而易见的。这种改变和变型旨在包括在权利要求书的范围之内。
I.具有铰接结构的示例性电外科装置
图1-4示出了根据以下专利的教导内容中的至少一些构建和操作的示例性电外科器械10:美国专利No.6,500,176;美国专利No.7,112,201;美国专利No.7,125,409;美国专利No.7,169,146;美国专利No.7,186,253;美国专利No.7,189,233;美国专利No.7,220,951;美国专利No.7,309,849;美国专利No.7,311,709;美国专利No.7,354,440;美国专利No.7,381,209;美国公布No.2011/0087218;和/或美国专利申请No.13/151,181。如其中所述和将在下文进行更详细描述的那样,可操作电外科器械10以基本上同时切割组织和密封或焊缝组织(如血管等)。换句话讲,电外科器械10的操作与内切割器型缝合器类似,不同的是电外科器械10通过施加双极性RF能量提供组织焊接,而不是通过提供缝合线连接组织。还应当理解的是,与Ethicon Endo-Surgery,Inc.(Cincinnati,Ohio)制造的组织密封装置相比,电外科器械10可以具有多种结构和功能相似性。此外,与本文引用和以引用方式并入本文的任何其他参考文献中提出的装置相比,电外科器械10可以具有多种结构和功能相似性。本文引用的参考文献、EthiconEndo-Surgery,Inc.(Cincinnati,Ohio)制造的组织密封装置的教导内容以及与电外科器械10相关的以下教导内容之间具有一定程度的重叠,在这个意义上,对于本文的任何描述而言,并不旨在推定为承认现有技术。以下若干教导内容事实上将超出本文引用的参考文献的教导内容和Ethicon Endo-Surgery,Inc.(Cincinnati,Ohio)制造的组织密封装置的范围。
A.示例性手持件和轴
本例子的电外科器械10包括手持件20、从手持件20向远侧延伸的轴30,以及设置在轴30远端处的端部执行器40。本例子的手持件20包括手枪式握把22、枢转触发器24、激活按钮26和铰接控制器28。如将在下文进行更详细描述的那样,触发器24可朝向并远离手枪式握把22枢转,以便有选择地致动端部执行器40。如也将在下文进行更详细描述的那样,可操作激活按钮26以有选择地激活与端部执行器40连通的RF电路。在一些版本中,激活按钮26还用作对触发器24的机械锁定装置,使得如果不同时按下按钮26,就无法完全致动触发器24。本文引用的参考文献中的一者或多者公开了如何提供此类锁定装置的例子。应当理解,可以任何合适的方法对手枪式握把22、触发器24和按钮26进行修改、取代、补充等,并且本文中对此类元件的描述仅是示例性的。如将在下文进行更详细描述的那样,可操作本例子的铰接控制器28以有选择地控制轴30的铰接部分36。可采用的铰接控制器28的形式的多个例子也将在下文进行更详细的描述,然而根据本文中的教导内容,其他例子对于本领域的普通技术人员而言将是显而易见的。
本例子的轴30包括外护套32和铰接部分36。可操作铰接部分36以有选择地定位端部执行器40,使其相对于护套32所限定的纵向轴线成多个角度。轴30的铰接部分36和其他元件可采用的形式的多个例子将在下文进行更详细的描述,然而根据本文中的教导内容,其他例子对于本领域的普通技术人员而言将是显而易见的。例如,应当理解,可操作致动铰接部分36的多个元件可以延伸穿过护套32的内部。在一些版本中,还可通过旋钮34使轴30相对于手持件20围绕由护套32限定的纵向轴线旋转。此类旋转可以提供端部执行器40和轴30的整体旋转。在一些其他版本中,可操作旋钮34以使端部执行器40旋转,但不使邻近铰接部分36的轴30的任何部分旋转。作为另一个仅为示例性的例子,电外科器械10可以包括一个旋转控制器,其提供作为单个单元的轴30和端部执行器40的可旋转性;和另一个旋转控制器,其提供端部执行器40的可旋转性,但不使邻近铰接部分36的轴30的任何部分旋转。根据本文的教导内容,其他合适的旋转方案对于本领域的普通技术人员而言将是显而易见的。当然,如果需要,可以简单地省略可旋转的结构。
B.示例性端部执行器
本例子的端部执行器40包括第一钳口42和第二钳口44。在本例子中,第二钳口44相对于轴30基本上固定;而第一钳口42相对于轴30朝向并远离第二钳口42枢转。在一些版本中,致动器,如杆或缆线等,可以延伸穿过护套32并与第一钳口42在枢轴联接装置43处接合,使得致动杆/缆线/等穿过轴30的纵向运动提供第一钳口42相对于轴30和相对于第二钳口44的枢转。当然,钳口42,44可以具有任何其他合适种类的运动,并可以任何其他合适的方式进行致动。仅以举例的方式,并且如将在下文进行更详细描述的那样,可以致动钳口42,44,从而通过击发梁60的纵向平移使其闭合,使得在一些版本中可以简单地省略致动杆/缆线/等。
如图2-4所示,第一钳口42限定纵向延伸的细长狭槽46;而第二钳口44也限定纵向延伸的细长狭槽48。此外,第一钳口42的顶侧存在第一电极表面50;而第二钳口44的下侧存在第二电极表面52。电极表面50,52通过一个或多个沿着轴30的长度延伸的导体(未示出)与电源80连通。可操作电源80以向具有第一极性的第一电极表面50和具有第二(相反的)极性的第二电极表面52递送RF能量,使得RF电流在电极表面50,52之间流动,从而穿过捕集在钳口42,44之间的组织。在一些版本中,击发梁60用作电导体,它与电极表面50,52(如,作为地回路)合作,用于递送捕集在钳口42,44之间的双极性RF能量。电源80可以在电外科器械10的外部或可以与电外科器械10成为一体(如,在手持件20中等),如本文或以其他方式引用的一个或多个参考文献中所述。控制器82控制从电源80向电极表面50,52的功率递送。控制器82也可以在电外科器械10的外部或可以与电外科器械10成为一体(如,在手持件20中等),如本文或以其他方式引用的一个或多个参考文献中所述。还应当理解,可在多个可供选择的位置、以多种构型和多种关系提供电极表面50,52。
如图4所示,第一钳口42的下侧包括与狭槽46相邻的纵向延伸的凹槽58;而第二钳口44的上侧包括与狭槽48相邻的纵向延伸的凹槽58。图2示出了包括多个牙锯齿46的第一钳口42的上侧。应当理解,第二钳口44的下侧可以包括与锯齿46配套的互补锯齿,以加强对捕集在钳口42,44之间的组织的夹持,而不必撕裂组织。图3示出了第一钳口42中作为主要凹槽的锯齿46的例子;以及第二钳口44中作为主要突起的锯齿48。当然,锯齿46,48可以采用任何其他合适的形式或者可以简单地完全省略。还应当理解,锯齿46,48可由非导电性材料或绝缘材料形成,如塑料、玻璃和/或陶瓷,并且可以包括处理剂,如聚四氟乙烯、润滑剂或一些其他处理剂,以基本上防止组织粘在钳口42,44上。
钳口42,44处于闭合位置时,轴30和端部执行器40的尺寸和构型设定成适合穿过具有多种内径的套管针,使得电外科器械10可用于微创手术,然而,如果需要,当然电外科器械10也可以用于开放式手术。仅以举例的方式,钳口42,44处于闭合位置时,轴30和端部执行器40可以具有大约5mm的外径。作为另外一种选择,轴30和端部执行器40可以具有任何其他合适的外径(如,介于大约2mm与大约20mm之间等)。
作为另一个仅为示例性的变型,任一钳口42,44或两个钳口42,44可包括至少一个可通过操作从手术部位抽取蒸汽、烟和/或其他气体/蒸汽/等的口、通道、导管和/或其他结构。此类结构可与抽吸源连通,如外部抽吸源或手持件20内的抽吸源等。此外,端部执行器40可以包括一个或多个组织冷却结构(未示出),当激活电极表面50,52时,该组织冷却结构降低由端部执行器40在相邻组织上导致的热扩散的温度或程度。根据本文的教导内容,此类冷却结构可采用的多种合适形式对于本领域的普通技术人员而言将是显而易见的。
在一些版本中,端部执行器40包括一个或多个能够感测端部执行器40处的多个参数的传感器(未示出),包括但不限于邻近组织的温度、邻近组织的电阻或阻抗、邻近组织上的电压、邻近组织施加到钳口42,44上的力等。仅以举例的方式,端部执行器40可以包括一个或多个位置与电极50,52和/或其他地方相邻的正温度系数(PTC)热敏电阻器主体54,56(如,PTC聚合物等)。可将来自传感器的数据传送至控制器82。控制器82可以多种方式处理此类数据。仅以举例的方式,控制器82可以至少部分地根据从端部执行器40处的一个或多个传感器获得的数据调节或以其他方式更改递送至电极表面50,52的RF能量。除此之外或作为另外一种选择,控制器82可至少部分地根据从端部执行器40处的一个或多个传感器获得的数据通过听觉和/或视觉反馈装置(如,扬声器、灯、显示屏等)使使用者警觉一种或多种状况。还应当理解,一些类型的传感器不一定需要与控制器82连通,并且可以只提供端部执行器40处的纯粹局部效应。例如,当组织和/或端部执行器40的温度升高时,端部执行器40处的PTC热敏电阻器主体54,56可以自动减少电极表面50,52处的能量递送,从而减小过热的可能性。在一些此类版本中,PTC热敏电阻器元件与电源80和电极表面50,52串联;并且PTC热敏电阻器响应于超过阀值的温度而提供增大的阻抗(降低电流流动)。此外,应当理解,电极表面50,52可用作传感器(如,感测组织阻抗等)。根据本文的教导内容,可结合到电外科器械10中的多种类型的传感器对于本领域的普通技术人员而言将是显而易见的。相似地,根据本文的教导内容,能够通过控制器82或以其他方式用来自传感器的数据做的多种事情对于本领域的普通技术人员而言将是显而易见的。根据本文的教导内容,端部执行器40的其他合适的变型对于本领域的普通技术人员而言也将是显而易见的。
C.示例性击发梁
也如图2-4所示,本例子的电外科器械10包括击发梁60,该击发梁可沿着端部执行器40的长度的一部分纵向运动。击发梁60同轴地设置在轴30内,沿着轴30的长度延伸,并在轴30(包括本例子中的铰接部分36)内纵向移动,但应当理解,击发梁60和轴30可以具有任何其他合适的关系。击发梁60包括锋利的远侧刀片64、上凸缘62和下凸缘66。如图4所示,远侧刀片64延伸穿过钳口42,44的狭槽46,48,其中上凸缘62位于凹槽59中的钳口44上面,下凸缘66位于凹槽58中的钳口42下面。远侧刀片64和凸缘62,66的构型在击发梁60的远端处提供“工字梁”型横截面。虽然在本例子中凸缘62,66只沿着击发梁60长度的一小部分纵向延伸,但应当理解,凸缘62,66可以沿着击发梁60的任何合适的长度纵向延伸。此外,当凸缘62,66沿着钳口42,44外部定位时,作为另外一种选择,凸缘62,66可以设置在钳口42,44内形成的相应狭槽中。例如,每个钳口42,44可以限定“T”形狭槽,其中远侧刀片64的一部分设置在每个“T”形狭槽的一个垂直部分中,凸缘62,66设置在“T”形狭槽的水平部分中。根据本发明的教导内容,多种其他合适的构型和关系对于本领域的普通技术人员而言将是显而易见的。
远侧刀片64非常锋利,使得远侧刀片容易切断捕集在钳口42,44之间的组织。在本例子中,远侧刀片64还电接地,从而为RF能量提供回路,如本文其他地方所述。在一些其他版本中,远侧刀片64用作有源电极。除此之外或作为另外一种选择,可以有选择地用超声能量(如,大约55.5kHz的谐波振动等)对远侧刀片64进行供能。
击发梁60向远侧行进时,击发梁60的“工字梁”型构型提供钳口42,44的闭合。具体地讲,当击发梁60从近侧位置(图1-3)向远侧位置(图4)行进时,凸缘62通过紧靠在钳口44中形成的凹槽59促使钳口44可枢转地朝向钳口42。可以在远侧刀片64到达捕集在钳口42,44之间的组织之前用击发梁60使钳口42,44发生该闭合效应。击发梁60进行的此类交会构架可以减小挤压夹持件24以通过全击发冲程致动击发梁60所需的力。换句话讲,在一些此类版本中,在遭遇来自捕集在钳口42,44之间的组织的阻力之前,击发梁60可以已经克服在组织上基本上闭合钳口42,44所需的初始阻力。当然,可以提供任何其他合适的构架。
在本例子中,凸缘62能够紧靠钳口44近端处的滑道结构的凸轮,以便在击发梁60缩回至近侧位置时打开钳口42,并在击发梁60保持在近侧位置时使钳口42保持打开状态。该凸轮系统性能可以有利于使用端部执行器40分离组织层,以便通过迫使钳口42,44离开闭合位置进行钝器解剖等。在一些其他版本中,用弹簧或其他类型的弹性部件使钳口42,44弹性地偏置在打开位置。虽然在本例子中钳口42,44随击发梁60的移动而闭合或打开,但应当理解,其他版本可以提供钳口42,44和击发梁60的独立运动。仅以举例的方式,一个或多个缆线、杆、横梁或其他结构可以延伸穿过轴30,以便独立于击发梁60有选择地致动钳口42,44。可以用手持件20的专用结构单独控制此类钳口42,44致动结构。作为另外一种选择,除了用触发器24控制击发梁60以外,还可以用触发器24控制此类钳口致动结构。还应当理解,可以使击发梁60弹性偏置在近侧位置,使得当使用者松开触发器24上的夹持件时,击发梁60朝近侧缩回。
D.示例性操作
在示例性应用中,将端部执行器40经由套管针插入患者体内。当端部执行器40和轴30的一部分穿过套管针插入时,铰接部分36基本上是直的。然后可以通过操纵铰接控制器28使轴30的铰接部分36枢转或挠曲,以便相对于患者体内的解剖结构将端部执行器40设置在所需位置和取向。然后通过朝手枪式握把22挤压触发器24将两层解剖结构组织捕集在钳口42,44之间。此类组织层可以是患者体内限定解剖结构的同一天然内腔的一部分(如,血管、胃肠道的一部分、生殖系统的一部分等)。例如,沿着血管长度的同一区域,一个组织层可以包括血管的顶部,而另一个组织层可以包括血管的底部(如,使得在使用电外科器械10之前穿过血管的流体路径垂直于端部执行器40所限定的纵向轴线等)。换句话讲,钳口42,44的长度可被取向为垂直于(或至少大致横向于)血管的长度。如上所述,当通过朝手枪式握把22挤压触发器24使击发梁60向远侧驱动时,凸缘62,66通过凸轮系统使钳口44朝钳口44枢转。
将组织层捕集在钳口42,44之间后,使用者通过朝手枪式握把22挤压触发器24使击发梁60继续向远侧行进。当击发梁60向远侧行进时,远侧刀片64同时切断夹住的组织层,导致分离的上层部分与相应的分离的下层部分并置。在一些版本中,这导致以大致横向于血管长度的方向切割血管。应当理解,凸缘62,66分别紧邻钳口42,44上方和下方可以有助于将钳口42,44保持在闭合和夹紧位置。具体地讲,凸缘62,66可以帮助保持钳口42,44之间的显著压缩力。当切断的组织层部分在钳口42,44之间被压缩时,使用者通过按下激活按钮26用双极性RF能量激活电极表面50,52。在一些版本中,(如,通过使用者按下按钮26等)电极50,52有选择地与电源80联接,使得以共同的第一极性激活钳口42,44的电极表面50,52,而以与第一极性相反的第二极性激活击发梁60。因此,双极性RF电流穿过切断的组织层部分的压缩区域在击发梁60和钳口42,44的电极表面50,52之间流动。在一些其他版本中,电极表面50具有一种极性,而电极表面52和击发梁60均具有其他极性。在任一版本中(在至少一些其他版本中),电源80递送的双极性RF能量最终将击发梁60一侧的组织层部分热焊接在一起,并将击发梁60另一侧的组织层部分热焊接在一起。
在某些情况下,激活的电极表面50,52所产生的热与钳口42,44提供的夹紧压力合作可以使组织层部分内的胶原变性,变性的胶原可以在组织层部分内形成密封。因此,限定解剖结构的天然内腔的切断端被止血封口,使得切断端不会泄漏体液。在一些版本中,可以在击发梁60恰好开始向远侧平移并因此在恰好切断组织之前用双极性RF能量激活电极表面50,52。例如,在按钮26除了用作电源80和电极表面50,52之间的开关以外,还用作相对于触发器24的机械锁定装置的版本中可以提供此类时间安排。
尽管以下多项教导内容被描述为电外科器械10的变型形式,但应当理解,以下多项教导内容也可以结合到多种其他类型的装置中。仅以举例的方式,以下多项教导内容除了容易结合到电外科器械10中以外,还容易结合到本文引用的任何参考文献中所提出的装置、其他类型的电外科装置、外科缝合器、外科施夹器和组织抓紧器(除了多种其他装置以外)中。根据本文的教导内容,可结合下述教导内容的其他合适装置对于本领域的普通技术人员而言将是显而易见的。
II.示例性铰接接头构型
轴30的铰接部分36可以采用多种形式。仅以举例的方式,可以根据与本文同一天提交,名称为“Articulation Joint Features for ArticulatingSurgical Device”的美国专利申请No.[代理人案卷号END6889USNP]中的一项或多项教导内容构造铰接部分36,其公开内容以引用方式并入本文。作为另一个仅为示例性的例子,可以根据与本文同一天提交,名称为“Articulation Joint Features for Articulating Surgical Device”的美国专利申请No.[代理人案卷号END6889USNP1]中的一项或多项教导内容构造铰接部分36,其公开内容以引用方式并入本文。此外,可以根据本文引用的至少一个其他参考文献中的教导内容构造铰接部分。根据本文的教导内容,铰接部分36可以采用的多种其他合适形式对于本领域的普通技术人员而言将是显而易见的。
III.示例性铰接控制器构型
如上所述,一些版本的手持件20包括铰接控制器28,可操作铰接控制器28以控制轴30的铰接部分36,从而有选择地定位端部执行器40,使其相对于护套32所限定的纵向轴线成多个角度。手持件20的铰接控制器28和其他元件可以采用的形式的多个例子将在下文进行更详细的描述,但是,根据本文的教导内容,其他例子对于本领域的普通技术人员而言将是显而易见的。仅以举例的方式,铰接控制器28的一些仅为示例性的可供选择的例子在与本文同一天提交,名称为“Control Features for ArticulatingSurgical Device”的美国专利申请No.[代理人案卷号END6888USNP1]中有所公开,其公开内容以引用方式并入本文。
A.具有垂直旋钮的示例性铰接控制器
图5示出了示例性电外科器械100,其包括手持件120、从手持件120向远侧延伸的轴130和设置在轴130远端处的端部执行器140。本例子的手持件120包括手枪式握把122、枢转触发器124、激活按钮126和旋转铰接旋钮128。触发器124可朝向并远离手枪式握把122枢转,以便有选择地致动端部执行器140,如上所述并如本文引用的一个或多个参考文献中所述。可操作激活按钮126以有选择地激活与端部执行器140连通的RF电路,也如上文所述并如本文引用的一个或多个参考文献中所述。在一些版本中,激活按钮126还用作对触发器124的机械锁定装置,使得如果不同时按下按钮126,就无法完全致动触发器124。本文引用的参考文献中的一者或多者公开了如何提供此类锁定装置的例子。应当理解,可以任何合适的方法对手枪式握把122、触发器124和按钮126进行修改、取代、补充等,并且本文中对此类元件的描述仅是示例性的。如将在下文进行更详细描述的那样,可操作本例子的铰接旋钮128以有选择地控制轴130的铰接部分136。
本例子的轴130包括外护套132、护套132远端处的铰接部分136以及可滑动地和同轴地设置在护套132内的切割构件驱动管138。切割构件驱动管138固定到驱动块139上,驱动块139还固定到端部执行器140的切割构件146上。切割构件驱动管138可纵向运动,以便在纵向上驱动驱动块139,从而使切割构件146纵向运动。切割构件146基本上等同于上文所述的击发梁60。端部执行器140的近侧部分148包括插入件(未示出),该插入件限定容纳延伸穿过近侧部分148的切割构件146一部分的通道。该通道能够允许切割构件146易于相对于插入件平移,同时在切割构件146向远侧行进过程中切割构件146遇到负载时还防止切割构件146在插入件内变形。
在本例子中,通过朝向手枪式握把122挤压触发器124使驱动管138向远侧行进;而通过释放触发器124和/或通过使触发器124远离手枪式握把122主动运动使驱动管138朝近侧缩回。如图13所示,轭125将触发器124与驱动管138联接在一起。当然,可以任何其他合适的方式运动切割构件146。可操作本例子的铰接部分136以有选择地定位端部执行器140,使其相对于护套132所限定的纵向轴线成多个角度。轴130的铰接部分136和其他元件可以采用的形式的多个例子在本文引用的多个参考文献中有所描述,然而根据本文的教导内容,其他例子对于本领域的普通技术人员而言将是显而易见的。相似地,可以根据上文所述的端部执行器40、根据本文引用的多个参考文献的教导内容和/或以根据本文的教导内容对本领域的普通技术人员将显而易见的任何其他合适的方法来构造端部执行器140。
在一些版本中,还可通过旋钮134使轴130围绕护套132限定的纵向轴线相对于手持件120旋转。此类旋转可以提供端部执行器140和轴130的整体旋转。在一些其他版本中,可操作旋钮134以使端部执行器140旋转,但不使邻近铰接部分136的轴130的任何部分旋转。作为另一个仅为示例性的例子,电外科器械100可以包括一个旋转控制器,其提供作为单个单元的轴130和端部执行器140的可旋转性;和另一个旋转控制器,其提供端部执行器140的可旋转性,但不使邻近部分136的轴130的任何部分旋转。根据本文的教导内容,其他合适的旋转方案对于本领域的普通技术人员而言将是显而易见的。当然,如果需要,可以简单地省略可旋转的结构。在提供轴130和/或端部执行器140的旋转的装置的任何版本中,旋转旋钮134和/或轴130和/或端部执行器140可以包括一个或多个有利于视觉识别旋转位置的标记。例如,使用者可以将旋转旋钮134上的标记与轴130和/或端部执行器140上的对应标记相关联,以便更好地理解此类元件相对于患者和器械100的方向。
图6-12示出了为铰接部分136的铰接提供控制的轴130的多个元件。具体地讲,这些元件包括分隔体150、具有相关联的驱动构件162的第一铰接带160,以及具有相关联的驱动构件172的第二铰接带170。如图6所示,分隔体150包括上腔151、中腔152和下腔153。分隔体150还包括侧凹槽154、远侧突出156和间隙158。分隔体150设置在切割构件驱动管138内并在器械100的操作过程中保持固定的纵向位置。因此,分隔体150和外护套132相对于彼此和相对于手持件120保持固定;而切割构件驱动管138相对于分隔体150、外护套132和手持件120往复运动。远侧突出156能够允许驱动块139在基本上不受远侧突出156或分隔体150的任何其他部分的干涉作用的情况下平移。
在本例子中,分隔体150形成为被布置成端对端构型的两件,其中近侧件上的远侧突出有助于限定间隙158。当然,作为另外一种选择,分隔体150可形成为单件或任何其他合适数量的件。仅以举例的方式,间隙158可形成为单件材料上的切口。
如将在下文进行更详细描述的那样,线900延伸穿过分隔体150,以提供与端部执行器140的电连通。具体地讲,线900从分隔体150的近端延伸穿过中腔152,直到线900到达间隙158。在间隙158处,线900向下过渡至下腔153,并延伸穿过下腔153,直到到达分隔体150的远端。然后线900横跨铰接部分136延伸至端部执行器140。因此根据本文的教导内容并根据本文引用的多个参考文献的教导内容,可操作线900以将功率从电源传输至端部执行器140。远侧突出156保护线900使其免受驱动块139的损害,使得不管驱动块139沿着远侧突出156的纵向位置如何,驱动块139都不能接触线900。
第一铰接带160可滑动地设置在分隔体150的一个侧凹槽154中,而第二铰接带170可滑动地设置在分隔体150的另一个侧凹槽154中。重新参考图6,侧凹槽154包括纵向延伸的凹槽155,该纵向延伸的凹槽能够减小与铰接带160,170的接触表面积,从而减小分隔体150与铰接带160,170之间的摩擦。分隔体150也可以由低摩擦力材料形成和/或包括表面处理以降低摩擦力。铰接带160,170均沿着轴130的整个长度纵向延伸,包括穿过铰接部分136。如图7所示,第一铰接带160的远端166固定到端部执行器140的近侧部分148的一侧的锚定点处。第二铰接带170的远端176固定到端部执行器140的近侧部分148的另一侧的锚定点处。如将在下文进行更详细描述的那样,可操作旋转铰接旋钮128以有选择地使一个铰接带160,170向远侧行进,同时使另一个铰接带160,170朝近侧缩回,反之亦然。应当理解,这种相对平移会导致铰接部分136弯曲,从而铰接端部执行器140。具体地讲,端部执行器140将朝向朝近侧缩回的任意铰接带160,170挠曲;并远离朝远侧行进的任意铰接带160,170。
如图9所示,驱动构件162整体固定到铰接带160上并包括横向向内延伸的凹口164。如图10所示,驱动构件172整体固定到铰接带170上并包括横向向内延伸的凹口174。如图11所示,驱动构件162,164是间隔开的,并被构造为使得凹口164,174沿着分隔体150的长度位于不同的纵向位置处。如图12所示,切割构件驱动管138的近侧部分包括纵向延伸的狭槽137。驱动构件162,172可滑动地设置在狭槽137中,凹口164,174径向地布置在切割构件驱动管138外周的外面。狭槽137能够使切割构件驱动管138相对于驱动构件162,172自由平移,从而能够自由致动切割构件164,而不管铰接部分136的铰接状态如何。换句话讲,狭槽137能够使驱动构件162,172相对于切割构件驱动管138自由平移,从而能够自由铰接铰接部分136,而不管切割构件164的纵向位置如何。
如图13-14所示,旋转铰接旋钮128同轴地布置在驱动管138的近侧部分周围并包围驱动构件162,172。铰接旋钮128垂直于轴130限定的纵向轴线取向并可围绕轴130限定的纵向轴线旋转。如将在下文进行更详细描述的那样,铰接旋钮128的此类旋转会导致驱动构件162,172的相对平移,此类相对平移的方向取决于铰接旋钮128的旋转方向,使得铰接旋钮128的旋转会铰接端部执行器140。如图14所示,铰接旋钮128包括第一内螺纹180和第二内螺纹182。在该例子中,螺纹181,182具有相反的螺旋角或方向。
如图14-15所示,第一导螺杆183和第二导螺杆184可滑动地沿着一对销轴123设置,所述销轴固定到外壳121上。因此,可操作导螺杆183,184以在外壳121内平移,但防止其在外壳121内旋转。第一导螺杆183包括与铰接旋钮128的螺纹181接合的外螺纹185;而第二导螺杆184包括与铰接旋钮128的螺纹182接合的外螺纹186。螺纹185的螺旋角与螺纹181的螺旋角互补;而螺纹186的螺旋角与螺纹182的螺旋角互补。因此,应当理解,由于螺旋角相反,旋钮128在第一方向上的旋转会朝远侧推动导螺杆183,同时朝近侧推动导螺杆184;旋钮在第二方向上的旋转会朝近侧推动导螺杆183,同时朝远侧推动导螺杆184。
螺纹181,182,185,186的角度还被构造为使得铰接部分136将被有效地锁定在任何给定的铰接位置,使得由于螺纹181,182,185,186之间的摩擦力,端部执行器140上的横向负载一般不会使铰接部分136弯曲。换句话讲,当旋钮128旋转时,铰接部分136只会更改其构型。虽然螺纹的角度可以基本上防止铰接部分136响应于端部执行器140上的横向负载而弯曲,但该角度仍可以使铰接旋钮128准备旋转,以平移导螺杆183,184。仅以举例的方式,螺纹181,182,185,186的角度可为大约±2度或大约±3度。根据本文的教导内容,其他合适角度对于本领域的普通技术人员而言将是显而易见的。还应当理解,螺纹181,182,185,186可以具有正方形或矩形横截面或任何其他合适的构型。
如图15-16所示,第一张紧轮191通过螺纹与第一导螺杆183接合;而第二张紧轮192通过螺纹与第二导螺杆184接合。因此,可以通过使第一张紧轮191相对于第一导螺杆183旋转来调节第一张紧轮191相对于第一导螺杆183的纵向位置;同时可以通过使第二张紧轮192相对于第二导螺杆184旋转来调节第二张紧轮192相对于第二导螺杆184的纵向位置。否则,第一张紧轮191将与第一导螺杆183整体地平移;而第二张紧轮192将与第二导螺杆184整体地平移。
第一张紧轮191还与垫圈193接合,垫圈进一步与驱动构件172的凹口174接合。垫圈193与驱动构件172之间的接合使得垫圈193和驱动构件172将一起平移。在一些版本中,以张紧轮191既朝远侧拉动垫圈193又朝近侧推动垫圈193的方式将垫圈193固定到张紧轮191上。因此,在一些此类版本中,可操作第一导螺杆183以既朝远侧推动铰接带170又朝近侧拉动铰接带170,这取决于旋钮128的旋转方向。然而,在本例子中,张紧轮191仅邻接垫圈193,使得可操作张紧轮191以朝近侧推动垫圈193,但不能朝远侧拉动垫圈193。因此,在本例子中,可操作第一导螺杆183以朝近侧拉动铰接带170,但不能朝远侧主动推动铰接带170。相反,第一导螺杆183可以只朝远侧拉动张紧轮191,以便在通过铰接部分136连通时,能够响应于铰接带160向近侧的回缩朝远侧驱动铰接带170、驱动构件172和垫圈193。根据本文的教导内容,其他合适的关系对于本领域的普通技术人员而言将是显而易见的。还应当理解,驱动构件172和/或垫圈193可相对于张紧轮191旋转,这可以允许通过旋钮134使轴130旋转。如下文所详述,张紧轮191可用于去除驱动构件172与导螺杆183之间的任何公差间隙。
相似地,第二张紧轮192与垫圈194接合,该垫圈进一步与驱动构件162的凹口164接合。垫圈194和驱动构件162之间的接合使得垫圈194和驱动构件162将一起平移。在一些版本中,以张紧轮192既朝远侧拉动垫圈194又朝近侧推动垫圈194的方式将垫圈194固定到张紧轮192上。因此,在一些此类版本中,可操作第二导螺杆184以既朝远侧推动铰接带160又朝近侧拉动铰接带160,这取决于旋钮128的旋转方向。然而,在本例子中,张紧轮192仅邻接垫圈194,使得可操作张紧轮192以朝近侧推动垫圈194,但不能朝远侧拉动垫圈194。因此,在本例子中,可操作第二导螺杆184以朝近侧拉动铰接带160,但不能朝远侧主动推动铰接带160。相反,第二导螺杆184可以只朝远侧拉动张紧轮192,以便在通过铰接部分136连通时,能够响应于铰接带170向近侧的回缩朝远侧驱动铰接带160、驱动构件162和垫圈194。根据本文的教导内容,其他合适的关系对于本领域的普通技术人员而言将是显而易见的。还应当理解,驱动构件162和/或垫圈194可相对于张紧轮192旋转,这可以允许通过旋钮134使轴130旋转。如下文所详述,张紧轮192可用于去除驱动构件162与导螺杆184之间的任何公差间隙。
图17A-17C示出了使铰接部分136弯曲以铰接端部执行器140的多个相互作用的上述元件。在图17A中,铰接部分136为基本上直的构型。然后,旋转旋钮128,这导致导螺杆183朝近侧平移,导螺杆184朝远侧行进。导螺杆183的这种近侧平移朝近侧拉动铰接带170,这导致铰接部分136开始弯曲,如图17B所示。铰接部分136的这种弯曲朝远侧拉动铰接带160。响应于旋钮128旋转的导螺杆184的远侧行进能使铰接带160和驱动构件162朝远侧行进。在一些其他版本中,导螺杆184的远侧行进朝远侧主动驱动驱动构件162和铰接带160。当使用者继续旋转旋钮128时,上述相互作用以相同的方式继续进行,导致铰接部分136的进一步弯曲,如图17C所示。应当理解,以相反的方向旋转旋钮128会使铰接部分136变直,以相反的方向进一步旋转会使铰接部分136以相反的方向弯曲。
在一些版本中,旋钮128包括与基本上直的构型的铰接部分136相关的视觉指示标记。此类视觉指示标记可以与手持件120的外壳121上的对应视觉指示标记对齐。因此,当使用者旋转旋钮128使铰接部分136接近基本上直的构型时,使用者可以观察此类指示标记,以确认铰接部分136是否事实上达到基本上直的构型。仅以举例的方式,可以在刚好从套管针收回器械100之前进行这一步,以减小铰接部分136钩在套管针的远侧边缘上的可能性。当然,此类指示标记只是任选的。
在某些情况下,制造的不一致会导致铰接带160,170具有稍微不同的长度。除此之外或作为另外一种选择,在相对于铰接旋钮128对导螺杆183,184进行初始定位时、在相对于导螺杆183,184对张紧轮191,192进行初始定位时可以具有固有的制造相关的不一致和/或可能导致铰接带160,170的不可取的定位/关系的其他不一致。此类不一致可以在器械100的铰接结构的操作中导致无效运动或不合格。要解决此类问题,可以使张紧轮191,192相对于导螺杆183,184旋转,以调整驱动构件162,172相对于导螺杆183,184的纵向位置。例如,如果铰接带170中的张力不足,可以旋转张紧轮191,以朝近侧驱动垫圈193和驱动构件172,直到铰接带170达到足够的张紧程度。相似地,如果铰接带160中的张力不足,可以旋转张紧轮192,以朝近侧驱动垫圈195和驱动构件162,直到铰接带160达到足够的张紧程度。在此类调整过程中,导螺杆183,184可以保持基本上固定。在此类调整过程中,铰接部分136可以保持基本上直的,并且甚至可以在此类调整过程中使其保持基本上直的。
在一些版本中,手动旋转张紧轮191,192。在一些其他版本中,用齿条或其他齿轮使张紧轮191,192自动旋转。在一些此类自动校正系统中,控制逻辑可以监测用于驱动与张紧轮191,192接合的校正齿条或齿轮的马达上的负载,并且当负载达到与带160,170的适当张紧相关的阈值时可以自动停止驱动此类齿条或齿轮。例如,在制造不一致或公差造成张紧轮191,192与垫圈193,194之间或垫圈193,194与驱动构件162,172之间具有初始间隙的情况下,可以旋转张紧轮191,192,直到此类间隙闭合并且使先前有间隙的元件之间充分接触。作为另一个仅为示例性的变型,当带160,170和/或驱动构件162,172的近端到达某个点时,可以使张紧轮191,192自动停止。根据本文的教导内容,可以调节张紧轮191,192的多种合适方式对于本领域普通技术人员而言将是显而易见的。还应当理解,当驱动构件162,172和其相应的垫圈193,194之间的间隙达到零时,可以将张紧轮191,192热熔、胶合、焊接或以其他方式结合到相应的导螺杆183,184上。此类结合可以防止随后张紧轮191,192相对于其相应的导螺杆183,184运动。
作为另一个仅为示例性的例子,可以在带160,170的远端处解决制造不一致。例如,在将带160,170的远端固定到端部执行器140的近侧部分148上之前,可以使铰接部分136保持直的构型,并可以朝远侧拉动带160,170,以移除带160,170中的任何松弛部分。带160,170均张紧后,可以将带160,170焊接或以其他方式固定到端部执行器140的近侧部分148上。应当理解,这种校正形式并不限于器械100,这使得该校正形式可以容易地应用于本文所述的多种其他器械,等等。根据本文的教导内容,其他合适的结构和校正方法对于本领域普通技术人员而言将是显而易见的。
B.具有成角度的旋钮的示例性铰接控制器
图18示出了示例性电外科器械200,其包括手持件220、从手持件220朝远侧延伸的轴230和设置在轴230远端处的端部执行器240。本例子的手持件220包括手枪式握把222、枢转触发器224、激活按钮226和旋转铰接旋钮228。触发器224可朝向并远离手枪式握把222枢转,以便有选择地致动端部执行器240,如上所述并如本文引用的一个或多个参考文献中所述。可操作激活按钮226以有选择地激活与端部执行器240连通的RF电路,也如上所述并如本文引用的一个或多个参考文献中所述。在一些版本中,激活按钮226还用作对触发器224的机械锁定装置,使得如果不同时按下按钮226,就无法完全致动触发器224。本文引用的参考文献中的一者或多者公开了如何提供此类锁定装置的例子。应当理解,可以任何合适的方式对手枪式握把222、触发器224和按钮226进行修改、取代、补充等,并且本文中对此类元件的描述仅是示例性的。如将在下文进行更详细描述的那样,可操作本例子的铰接旋钮228以有选择地控制轴230的铰接部分236。
本例子的轴230包括外护套232、护套232远端处的铰接部分236以及可滑动地和同轴地设置在护套232内的切割构件驱动管238。切割构件驱动管238固定到击发梁(未示出)上,该击发梁基本上等同于上文所述的击发梁60。切割构件驱动管238可以纵向运动,以纵向驱动击发梁。在本例子中,通过朝向手枪式握把222挤压触发器224使驱动管238向远侧行进;而通过释放触发器224和/或通过使触发器224远离手枪式握把222主动运动使驱动管238朝近侧缩回。如图19所示,轭225将触发器224与驱动管238联接在一起。当然,可以任何其他合适的方式运动击发梁。可操作本例子的铰接部分236以有选择地定位端部执行器240,使其相对于护套232所限定的纵向轴线成多个角度。轴230的铰接部分236和其他元件可以采用的形式的多个例子在本文引用的多个参考文献中有所描述,然而根据本文的教导内容,其他例子对于本领域普通技术人员而言将是显而易见的。相似地,可以根据上文所述的端部执行器40、根据本文引用的多个参考文献的教导内容和/或以根据本文的教导内容对本领域普通技术人员将显而易见的任何其他合适的方法来构造端部执行器240。
在一些版本中,还可通过旋钮234使轴230相对于手持件220围绕由护套232限定的纵向轴线旋转。此类旋转可以提供端部执行器240和轴230的整体旋转。在一些其他版本中,可操作旋钮234以使端部执行器240旋转,但不使邻近铰接部分236的轴230的任何部分旋转。作为另一个仅为示例性的例子,电外科器械200可以包括一个旋转控制器,其提供作为单个单元的轴230和端部执行器240的可旋转性;和另一个旋转控制器,其提供端部执行器240的可旋转性,但不使邻近部分236的轴230的任何部分旋转。根据本文的教导内容,其他合适的旋转方案对于本领域的普通技术人员而言将是显而易见的。当然,如果需要,可以简单地省略可旋转的结构。在提供轴230和/或端部执行器240的旋转的装置的任何版本中,旋钮234和/或轴230和/或端部执行器240可以包括一个或多个有利于视觉识别旋转位置的标记。例如,使用者可以将旋转旋钮234上的标记与轴230和/或端部执行器240上的对应标记相关联,以便更好地理解此类元件相对于患者和器械200的方向。
应当理解,为铰接部分236提供控制的轴230的元件可以与上文器械100的上下文中结合图6-12所述的那些基本上相同。换句话讲,图19-20的结构容易与图6-12的结构结合。在本例子中,铰接带276为上文所述的铰接带160的功能等同物;而铰接带270为上文所述的铰接带170的功能等同物。具体地讲,铰接带270,276可以相反的方向平移,以便有选择地使铰接部分236向任一方向弯曲。
图19-20示出了为铰接部分236的铰接提供控制的手持件220的多个元件。具体地讲,这些元件包括近侧驱动螺母260、远侧驱动螺母261、近侧导螺杆284、远侧导螺杆283、万向节驱动环250和旋钮228。导螺杆283,284沿着销轴223设置,销轴固定到手持件220的外壳221上,使得导螺杆283,284在手持件220内平移,但不在手持件220内旋转。铰接带270固定到远侧导螺杆283上,而铰接带276固定到近侧导螺杆284上。这些关系可以类似于上文结合器械100所述的那些。因此,应当理解,铰接带270可随远侧导螺杆283向任一方向平移;而铰接带276可随近侧导螺杆284向任一方向平移。
远侧导螺杆283与远侧驱动螺母261通过螺纹接合。具体地讲,远侧导螺杆283包括与远侧驱动螺母261的内螺纹281啮合的外螺纹285。相似地,近侧导螺杆284与近侧驱动螺母260通过螺纹接合。具体地讲,近侧导螺杆284包括与远侧驱动螺母260的内螺纹282啮合的外螺纹286。螺纹281,285的取向/角度为一个方向,而螺纹282,286的取向/角度为相反的方向。因此,螺纹281,282,285,286类似于上文所述的螺纹181,182,185,186。在本例子中,驱动螺母260,261固定在一起,使得驱动螺母260,261一起旋转。因此,当旋转驱动螺母260,261时,铰接带270向一个方向平移,而铰接带276向另一个方向平移,这取决于驱动螺母260,261的旋转方向。
驱动螺母261包括上凹槽263和相对的下凹槽(未示出)。相似地,驱动螺母260包括上凹槽262和相对的下凹槽(未示出)。当将驱动螺母260,261接合在一起时,这些凹槽262,263对齐并合作容纳销轴264。这些销轴264用于旋转驱动螺母260,261。具体地讲,销轴264设置在万向节环250的对应开口266中。因此,驱动螺母260,261将响应于万向节环250的旋转而旋转。万向节环250还包括另一对相对的开口252,其也容纳一组销轴254。这些销轴254用于旋转万向节环250。具体地讲,销轴254设置在旋钮228的对应开口256中。因此,万向节环250和驱动螺母260,261将响应于旋钮228的旋转而旋转。与上文所述的旋钮128不同,该例子的旋钮228以某个角度取向,该取向相对于轴230所限定的纵向轴线是倾斜的。然而,旋钮228仍可围绕轴230所限定的纵向轴线旋转。通过万向节环250中的销轴254,264的枢轴联接装置实现该构型和可操作性。换句话讲,万向节环250以类似于万向接头的方式通过同时进行的枢转和旋转提供旋钮228的旋转运动向驱动螺母260,261的转移。
在一些版本中,驱动螺母260,261沿着边缘彼此接触,所述边缘包括锯齿或其他配合结构,在将驱动螺母260,261固定到一起之前它们能够调节驱动螺母260,261相对于彼此的旋转位置。仅以举例的方式,这可以调节驱动螺母260,261的旋转位置,以收紧铰接带270,276中的松弛部分和/或补偿其他制造不一致。
还如图19所示,手持件220包括具有球292的制动杆290。球292与围绕旋钮228的近侧边缘排列的一系列凹槽294之一接合。杆290弹性偏置,迫使球292进入凹槽294,使得球292和凹槽294形成制动结构。此类结构可以防止旋钮228的意外旋转,从而基本上防止铰接部分236意外地变直或弯曲。当然,器械100也可以包括此类制动结构。此外,可以简单地完全省略此类制动结构。
图21示出了可用于驱动导螺杆283,284的示例性可供选择的元件。具体地讲,图21示出了围绕球驱动器296设置的示例性可供选择的旋钮229。球驱动器296包括外脊297和内孔298。旋钮229可滑动地与脊297接合,使得尽管旋钮229沿着平面的取向倾斜于孔298的纵向轴线,也可以用旋钮229使球驱动器296围绕孔298的纵向轴线自由旋转。孔298可以包括两组相对的螺纹(未示出),它们与螺纹281,282基本上相同。因此,具有导螺杆283,284时,旋钮229的旋转将以相反的方向同时平移导螺杆283,284。根据本文的教导内容,用于器械200的元件的其他合适的变型对于本领域普通技术人员而言将是显而易见的。
C.具有枢转半球旋钮的示例性铰接控制器
图22示出了示例性电外科器械300,其包括手持件320、从手持件320向远侧延伸的轴330和设置在轴330远端处的端部执行器340。本例子的手持件320包括手枪式握把322、枢转触发器324、激活按钮326和枢转铰接旋钮328。触发器324可朝向并远离手枪式握把322枢转,以便有选择地致动端部执行器340,如上文所述并如本文引用的一个或多个参考文献中所述。可操作激活按钮326以有选择地激活与端部执行器340连通的RF电路,也如上文所述并如本文引用的一个或多个参考文献中所述。在一些版本中,激活按钮326还用作对触发器324的机械锁定装置,使得如果不同时按下按钮326,就无法完全致动触发器324。本文引用的参考文献中的一者或多者公开了如何提供此类锁定装置的例子。应当理解,可以任何合适的方式对手枪式握把322、触发器324和按钮326进行修改、取代、补充等,并且本文中对此类元件的描述仅是示例性的。如将在下文进行更详细描述的那样,可操作本例子的铰接旋钮328以有选择地控制轴330的铰接部分336。
本例子的轴330包括外护套332、护套332远端处的铰接部分336以及可滑动地和同轴地设置在护套332内的切割构件驱动管338。切割构件驱动管338固定到击发梁(未示出)上,该击发梁基本上等同于上文所述的击发梁60。切割构件驱动管338可纵向运动,以纵向驱动击发梁。在本例子中,通过朝向手枪式握把322挤压触发器324使驱动管338朝远侧行进;而通过释放触发器324和/或通过使触发器324远离手枪式握把322主动运动使驱动管338朝近侧缩回。如图24所示,轭395将触发器324与驱动管338联接在一起。当然,可以任何其他合适的方式运动击发梁。可操作本例子的铰接部分336以有选择地定位端部执行器340,使其相对于护套332所限定的纵向轴线成多个角度。轴330的铰接部分336和其他元件可采用的形式的多个例子在本文引用的多个参考文献中有所描述,然而根据本文的教导内容,其他例子对于本领域的普通技术人员而言将是显而易见的。相似地,可以根据上文所述的端部执行器40、根据本文引用的多个参考文献的教导内容和/或以根据本文的教导内容对本领域的普通技术人员将显而易见的任何其他合适的方法来构造端部执行器340。
在一些版本中,还可通过旋钮334使轴330相对于手持件320围绕由护套332限定的纵向轴线旋转。此类旋转可以提供端部执行器340和轴330的整体旋转。在一些其他版本中,可操作旋钮334以使端部执行器340旋转,但不使邻近铰接部分336的轴330的任何部分旋转。作为另一个仅为示例性的例子,电外科器械300可以包括一个旋转控制器,其提供作为单个单元的轴330和端部执行器340的可旋转性;和另一个旋转控制器,其提供端部执行器340的可旋转性,但不使邻近部分336的轴330的任何部分旋转。根据本文的教导内容,其他合适的旋转方案对于本领域的普通技术人员而言将是显而易见的。当然,如果需要,可以简单地省略可旋转的结构。在提供轴330和/或端部执行器340的旋转的装置的任何版本中,旋转旋钮334和/或轴330和/或端部执行器340可以包括一个或多个有利于视觉识别旋转位置的标记。例如,使用者可以将旋转旋钮334上的标记与轴330和/或端部执行器340上的对应标记相关联,以便更好地理解此类元件相对于患者和器械300的方向。
应当理解,为铰接部分336提供控制的轴330的元件可以与上文器械100的上下文中结合图6-12所述的那些基本上相同。换句话讲,图22-24的结构容易与图6-12的结构结合。在本例子中,铰接带376为上文所述的铰接带160的功能等同物;而铰接带370为上文所述的铰接带170的功能等同物。具体地讲,铰接带370,376可以相反的方向平移,以便有选择地使铰接部分336向任一方向弯曲。
图22-24示出了为铰接部分336的铰接提供控制的手持件320的多个元件。具体地讲,这些元件包括枢转旋钮328,该枢转旋钮与远端处具有小齿轮374的杆371联接。销轴372固定在一对外壳部分323,325之间并穿过杆371,使得杆371围绕销轴372枢转。如图25所示,外壳部分323,325包括互补的凹槽327,329,当将外壳部分323,325固定到一起时,互补的凹槽提供杆371穿过的通道。
小齿轮374与一对相对的齿条350,356啮合,使得杆371围绕销轴372枢转时,齿条350,356以相反的方向同时平移。齿条350整体固定到铰接带370上;而齿条356整体固定到铰接带376上。因此,杆371和小齿轮374以一个方向枢转时,铰接带370将朝远侧平移,而铰接带376同时朝近侧平移;并且杆371和小齿轮374以相反的方向枢转时,铰接带370将朝近侧平移,而铰接带376同时朝远侧平移。应当理解,可以通过接合旋钮328使杆371和小齿轮374枢转。还应当理解,此类枢转会使铰接部分336向一个方向弯曲,该方向取决于旋钮328、杆371和小齿轮374的枢转方向。在一些版本中,使用者可以将旋钮328与握住手枪式握把322的手的拇指接合,使得完全可以用单手操作器械300的所有结构。
如上所述,本例子的轴330可相对于手持件320的主外壳321旋转。在一些版本中,铰接带370,376、齿条350,356、销轴372、杆371、旋钮328和外壳部分323,325全部与轴330一起相对于手持件320的主外壳321旋转。因此,使用者可以用旋钮334或旋钮328和/或外壳部分323,325中的任一者旋转该整个组件。在此类版本中,旋钮328沿着平面旋转,该平面也将与轴330一起旋转,从而使使用者更直观地感测端部执行器340和铰接部分336的铰接平面的角取向。在一些其他版本中,铰接带370,376、齿条350,356、销轴372、杆371、旋钮328和外壳部分323,325相对于手持件320的主外壳321保持旋转地固定,而轴330相对于手持件320的主外壳321旋转。根据本文的教导内容,器械300可被构造和操作的其他合适方式对于本领域普通技术人员而言将是显而易见的。
D.具有枢转翅片的示例性铰接控制器
图26示出了示例性电外科器械400,其包括手持件420、从手持件420向远侧延伸的轴430和设置在轴430远端处的端部执行器440。本例子的手持件420包括手枪式握把422、枢转触发器424、激活按钮426和枢转铰接翅片428。触发器424可朝向并远离手枪式握把422枢转,以便有选择地致动端部执行器440,如上文所详述并如本文引用的一个或多个参考文献中所述。可操作激活按钮426以有选择地激活与端部执行器440连通的RF电路,也如上文所详述并如本文引用的一个或多个参考文献中所述。在一些版本中,激活按钮426还用作对触发器424的机械锁定装置,使得如果不同时按下按钮426,就无法完全致动触发器424。本文引用的参考文献中的一者或多者公开了如何提供此类锁定装置的例子。应当理解,可以任何合适的方法对手枪式握把422、触发器424和按钮426进行修改、取代、补充等,并且本文中对此类元件的描述仅是示例性的。如将在下文进行更详细描述的那样,可操作本例子的铰接翅片428以有选择地控制轴430的铰接部分436。
本例子的轴430包括外护套432、护套432远端处的铰接部分436以及可滑动地和同轴地设置在护套432内的切割构件驱动管438。切割构件驱动管438固定到击发梁(未示出)上,该击发梁基本上等同于上文所述的击发梁60。切割构件驱动管438可纵向运动,以纵向驱动击发梁。在本例子中,通过朝向手枪式握把422挤压触发器424使驱动管438向远侧行进;而通过释放触发器424和/或通过使触发器424远离手枪式握把422主动运动使驱动管438朝近侧缩回。如图24所示,轭495将触发器424与驱动管438联接在一起。当然,可以任何其他合适的方式运动击发梁。可操作本例子的铰接部分436以有选择地设置端部执行器440,使其相对于护套432所限定的纵向轴线成多个角度。轴430的铰接部分436和其他元件可以采用的形式的多个例子在本文引用的多个参考文献中有所描述,然而根据本文的教导内容,其他例子对于本领域普通技术人员而言将是显而易见的。相似地,可以根据上文所述的端部执行器40、根据本文引用的多个参考文献的教导内容和/或以根据本文的教导内容对本领域普通技术人员将显而易见的任何其他合适的方法来构造端部执行器440。
在一些版本中,还可通过旋钮434使轴430相对于手持件420围绕护套432限定的纵向轴线旋转。此类旋转可以提供端部执行器440和轴430的整体旋转。在一些其他版本中,可操作旋钮434以使端部执行器440旋转,但不使邻近铰接部分436的轴430的任何部分旋转。作为另一个仅为示例性的例子,电外科器械400可以包括一个旋转控制器,其提供作为单个单元的轴430和端部执行器440的可旋转性;和另一个旋转控制器,其提供端部执行器440的可旋转性,但不使邻近部分436的轴430的任何部分旋转。根据本文的教导内容,其他合适的旋转方案对于本领域的普通技术人员而言将是显而易见的。当然,如果需要,可以简单地省略可旋转的结构。在提供轴430和/或端部执行器440的旋转的装置的任何版本中,旋转旋钮434和/或轴430和/或端部执行器440可以包括一个或多个有利于视觉识别旋转位置的标记。例如,使用者可以将旋转旋钮434上的标记与轴430和/或端部执行器440上的对应标记相关联,以便更好地理解此类元件相对于患者和器械400的方向。
应当理解,为铰接部分436提供控制的轴430的元件可以与上文器械100的上下文中结合图6-12所述的那些基本上相同。换句话讲,图26-29的结构容易与图6-12的结构结合。在本例子中,铰接带476为上文所述的铰接带160的功能等同物;而铰接带470为上文所述的铰接带170的功能等同物。具体地讲,铰接带470,476可以相反的方向平移,以便有选择地使铰接部分436向任一方向弯曲。
图26-29示出了为铰接部分436的铰接提供控制的手持件420的多个元件。具体地讲,这些元件包括枢转翅片428,该枢转翅片与远端处具有一对轭474,478的杆471联接。销轴472固定到手持件420的外壳421上并穿过杆471,使得杆471围绕销轴472枢转。应该指出的是,为清楚起见,图29省略了杆471和枢转翅片428。第一致动臂480包括远端482,该远端通过销轴484与轭474可枢转地联接。第二致动臂490包括远端492,该远端通过销轴494与轭478可枢转地联接。第一致动臂480的近端486包括联接装置488,该联接装置牢固地固定到致动横梁476的近端。第二致动臂490的近端496包括联接装置498,该联接装置牢固地固定到致动横梁470的近端。如图29所示,致动横梁476穿过联接装置498。然而,致动横梁476未固定到联接装置498上,使得致动横梁476和联接装置498可以相对于彼此自由运动。
致动臂480,490用作将翅片428和杆471的枢转运动转变成致动横梁470,476的平移运动的联动装置。具体地讲,翅片428向一个方向的枢转运动通过臂480,490传递,以使铰接横梁470朝远侧平移,同时使铰接横梁476朝近侧平移。翅片428向相反的方向的枢转运动通过臂480,490传递,以使铰接横梁470朝近侧平移,同时使铰接横梁476朝远侧平移。还应当理解,此类枢转将使铰接部分436向一个方向弯曲,该方向取决于翅片428和杆471的枢转方向。在一些版本中,使用者可以将翅片428与握住手枪式握把422的手的拇指接合,使得完全可以用单手操作器械400的所有结构。
在一些版本中,可以有选择地将翅片428的枢转位置锁定在合适的位置。例如,器械400能够需要使翅片428垂直运动(向上或向下)以解锁和/或枢转翅片428。仅以举例的方式,外壳421可以包括多个凹槽,该多个凹槽能够根椐杆471围绕销轴472的枢转位置有选择地容纳杆471。弹力构件可以使杆471偏置成与凹槽接合,使得使用者必须逆着该弹性偏置使杆471远离凹槽挠曲,以便可枢转地调整翅片428的位置。作为另一个仅为示例性的变型,器械400可以需要将翅片428朝远侧推动或朝近侧拉动以解锁翅片428,以进行枢转运动。而且,此类结构可以使翅片428弹性偏置成锁定构型。根据本文的教导内容,可以有选择地锁定翅片428的枢转位置的其他合适方法对于本领域普通技术人员而言将是显而易见的。作为另外一种选择,器械400可以简单地完全省略此类锁定装置。
根据本文的教导内容,器械400可被构造和操作的其他合适方法对于本领域普通技术人员而言将是显而易见的。
IV.其他示例性结构
应当理解,除了上文所述的那些或作为替代,本文所述的电外科器械10的任何一种版本还可以包括多个其他结构。此类其他结构的多个例子如下文所述,然而根据本文的教导内容,其他结构对于本领域普通技术人员而言将是显而易见的。
A.示例性电联接装置
如上所述,端部执行器40,140,240,340,440的一个或多个元件可被设置为与电源电连通。此类电源可以在器械10,100,200,300,400的内部或者可以在器械的外部。图30-36示出了若干示例性元件,该若干示例性元件可用于提供电源与端部执行器40,140,240,340,440的一个或多个元件之间的电联接。虽然图30-36的例子是在器械100的上下文中示出的,但应当理解,这些例子可以容易地应用于本文所述的器械10,200,300,400的任何其他版本。相似地,除了根据本文的教导内容对本领域普通技术人员将显而易见的其他类型的器械以外,这些例子可以容易地应用于本文引用的参考文献中所述的多种器械。
如图30所示,联接装置500固定到切割构件驱动管138上。联接装置500由导电材料形成,例如钢或一些其他金属。联接装置500包括一对臂510,512,该一对臂包括向外扩张的自由端。臂510,512能够容纳驱动管138并被弹性偏置,以便在驱动管138相对于联接装置500平移和旋转时保持臂与驱动管138接触。驱动管138也由导电材料形成,例如钢或一些其他金属。驱动管138除了与切割构件146机械连通之外,还与切割构件146电连通。因此驱动管138提供联接装置500与切割构件146之间的导电管。臂510,512从基座520伸出,该基座固定到手持件120的外壳121上。线(未示出)与基座520联接。此类线可以进一步与电源联接。在本例子中,线是接地的。具体地讲,端部执行器140的一个或多个电极用作有源电极,而切割构件146用作接地回路。驱动管138和联接装置500还提供从切割构件146至地线的接地回路。当然,在一些其他版本中,这些元件反而可以用作有源电子元件,而不是用作接地元件。
图32示出了可用于替代联接装置500的示例性可供选择的联接装置600。该例子的联接装置包括三个臂610,612,630。臂610,612基本上类似于上文所述的臂510,512,并且包括接触驱动管138的相应的接触点614,616。臂610,612沿着共用平面布置并沿着共用轴线(如,沿着点614,616之间限定的线)与驱动管138接触。臂630沿着与臂610,612的平面垂直的平面布置。臂630弹性偏置(如,类似片簧等),以迫使接触点632与驱动管138接触。因此,如图33所示,联接装置600能够在三个单独的接触点614,616,632处并沿着两个垂直平面/轴线接合驱动管138。这可以提供联接装置600与驱动管138之间更可靠的电连续性,包括驱动管138相对于联接装置600平移和/或旋转时。臂610,612,630全部从基座620伸出,该基座可以固定到手持件120的外壳121上。与基座520一样,线(未示出)可以与基座620联接,以提供接地回路或将有源电力传输至联接装置600,从而传输至切割构件146。
图34示出了可用于替代联接装置700的又一个示例性可供选择的联接装置700。该例子的联接装置包括一对臂710,712。臂710,712基本上类似于上文所述的臂510,512,并且包括接触驱动管138的相应的接触点714,716。臂710,712沿着共用平面布置并沿着共用轴线(如,沿着点714,716之间限定的线)与驱动管138接触。联接装置700还包括沿着与臂710,712的平面垂直的平面布置的导电性销轴732和导电性罐730。罐730内的弹簧(未示出)使销轴732远离罐730弹性偏置,以迫使销轴732与驱动管138接触。因此,联接装置700能够在三个单独的接触点714,716,732处并沿着两个垂直平面/轴线接合驱动管138。这可以提供联接装置700与驱动管138之间更可靠的电连续性,包括驱动管138相对于联接装置700平移和/或旋转时。臂710,712和罐730全部从基座720伸出,该基座可以固定到手持件120的外壳121上。与基座520一样,线(未示出)可以与基座720联接,以提供接地回路或将有源电力传输至联接装置700,从而传输至切割构件146。根据本文的教导内容,电联接驱动管138的其他合适的结构和方法对于本领域普通技术人员而言将是显而易见的。
如上所述,线900延伸穿过分隔体150,以提供与端部执行器140的电连通。例如,线900可以与端部执行器140的一个或多个电极电连通。因此,线900可以用作端部执行器140的接地回路或可以将有源电力传输至端部执行器140。在一些版本中,线900将有源电力传输至端部执行器140的一个或多个电极,而驱动管138用作接地回路。图35-36示出了示例性传导联接件800,其可用于将线900与电源或与电接地电联接。联接装置800包括从基座840伸出的三个臂810,820,830。臂810,830的自由端812,832被取向为一个方向,而臂820的自由端822被取向为相反的方向,使得臂810,820,830具有交替的取向。如图36所示,每个臂810,820,830包括对应的凹槽814,824,834。凹槽814,824,834能够容纳线900。臂810,820,830弹性偏置,以呈现图36所示的构型,使得当线900设置在凹槽814,824,834中时,臂810,820,830弹性顶住线900。因此,即使线900相对于联接装置800旋转,臂810,820,830也保持与线900的电连续性。线900还具有足够的抗扭强度,以避免在线900相对于联接装置800旋转时缠绕或卷绕,使得线900将在凹槽814,824,834内旋转。
如图35所示,联接装置800被布置成刚好邻近驱动管138和分隔体150的近端。因此线900离开分隔体150的中腔152,并沿着大致直线进入凹槽814,824,834。在一些版本中,线900继续穿过联接装置800并进入与外壳121联接的线护套920。然而,在本例子中,线900在臂834处或刚好邻近臂834处终止。基座840固定到外壳121上,并且进一步与经由基座840向联接装置800传输电力的另一条线(未示出)联接。该另一条线可以与按钮126联接,可以与控制模块(未示出)联接,可以延伸穿过线护套920,或可以其他形式提供。根据本文的教导内容,电联接线900和/或端部执行器140的其他合适结构和方法对于本领域普通技术人员而言将是显而易见的。
B.示例性返回行程辅助
如上所述,可以朝向手枪式握把22,124,224,324,424挤压触发器24,124,224,324,424,以致动端部执行器40,140,240,340,440。在前述例子中,弹簧(未示出)使触发器24,124,224,324,424远离手枪式握把22,124,224,324,424弹性偏置。因此,使用者通过朝向手枪式握把22,124,224,324,424充分挤压触发器24,124,224,324,424致动端部执行器40,140,240,340,440之后,使用者可以简单地释放触发器24,124,224,324,424,然后弹簧可以使触发器24,124,224,324,424返回“原”位置,其在该位置远离手枪式握把22,124,224,324,424枢转。在一些版本中,通过铰接部分36,136,236,336,436的摩擦可以提供阻止触发器24,124,224,324,424返回原位置的很大阻力,尤其是在铰接部分36,136,236,336,436处于弯曲构型时。当触发器24,124,224,324,424接近其返回行程的末端时,该阻力最明显。因此,在某些情况下,期望在触发器24,124,224,324,424接近其返回行程末端时为其提供附加的机械辅助。
图37A-37C示出了示例性元件,该示例性元件可用于辅助触发器24,124,224,324,424从致动位置(如,触发器24,124,224,324,424向手枪式握把22,124,224,324,424枢转的位置)至原位置(如,触发器24,124,224,324,424远离手枪式握把22,124,224,324,424枢转的位置)的返回行程。在该例子中,通过枢转臂1100将触发器1024可枢转地固定到手持件的外壳1021上。卷簧1102设置在枢转臂1100和外壳1021之间,并能够使触发器1024向图37A中所示的原位置弹性偏置。如将在下文进行更详细描述的那样,触发器1024还包括与凸轮杆1200接合的朝近侧延伸的凸轮臂1110。凸轮臂1110包括下侧1112和凹口1114。
凸轮杆1200通过销轴1202可枢转地固定到外壳1021上。扭力弹簧1210同轴地设置在销轴1202周围并使凸轮杆1200向图37A中所示的旋转位置弹性偏置。凸轮杆1200包括自由端1220,该自由端与凸轮臂1110的下侧1112或凸轮臂1110的凹口1114接合,这取决于触发器1024的旋转位置。具体地讲,当触发器1024从原位置(图37A)以大约15°的角度范围向部分致动位置(图37B)运动时,自由端1220保持大致设置在凹口1114中。然后,当触发器1024继续运动至完全致动位置(图37C)(在本例子中,距原位置为大约33°)时,自由端1220向凸轮臂1110的下侧1112平移。
对扭力弹簧1210的弹簧常数加以选择,使得当使用者将其从原位置移动至致动位置时,该弹簧常数不会显著增加对触发器1024致动的阻力。然而,在使触发器1024从致动位置返回至原位置时,扭力弹簧1210为卷簧1102提供明显的辅助,尤其是触发器1024到达图37B中所示的位置时。当触发器1024在返回行程中从图37C所示的完全致动位置向图37B所示的部分致动位置平移时,自由端1220只是紧靠凸轮臂1110的下侧1112行进,不为使触发器1024朝着原位置返回的卷簧1102提供明显的帮助。然而,在触发器1024的返回行程中,一旦自由端1220到达凹口1114,凸轮杆1200就位于机械驱动凸轮臂1100的更佳位置,从而扭力弹簧1210为使触发器1024从图37B所示位置返回图37A所示的原位置的卷簧1102提供明显的帮助。当然,可以使用任何其他合适的元件、结构和构型帮助触发器1024返回原位置。作为另外一种选择,如果需要,可以简单地省略此类元件。
应当理解,本文中的任何装置也可以包括以下文献中所公开的多种结构中的一种或多种:与本文同一天提交,名称为“Control Features forArticulating Surgical Device”的美国专利申请No.[代理人案卷号END6888USNP1],其公开内容以引用方式并入本文;与本文同一天提交,名称为“Articulation Joint Features for Articulating Surgical Device”的美国专利申请No.[代理人案卷号END6889USNP],其公开内容以引用方式并入本文;和/或与本文同一天提交,名称为“Articulation Joint Features forArticulating Surgical Device”的美国专利申请No.[代理人案卷号END6889USNP1],其公开内容以引用方式并入本文。
还应当理解,可以对本文所述装置中的任何一种进行修改,以包括用于驱动本来以手动方式运动的元件的马达或其他电动装置。此类修改的多个例子在1011年6月2日提交的名称为“Motor Driven ElectrosurgicalDevice with Mechanical and Electrical Feedback”的美国专利申请No.13/151,481中有所描述,该专利申请的公开内容以引用方式并入本文。根据本文的教导内容,可将马达或其他电动装置结合到本文任何装置中的多种其他合适的方法对于本领域普通技术人员而言将是显而易见的。
还应当理解,可以对本文所述装置中的任何一种进行修改,以包括医疗装置本身所需元件的大部分,如果不是全部的话。更具体地讲,本文所述的装置能够使用内部或可附连的电源,而不是需要用缆线将装置的插头插入外部电源内。如何使医疗装置能够包括便携式电源的多个例子在2010年11月5日提交的名称为“Energy-Based Surgical Instruments”的美国临时专利申请序列No.61/410,603中有所公开,该临时专利申请的公开内容以引用方式并入本文。根据本文的教导内容,可将电源结合到本文任何装置中的多种其他合适的方法对于本领域普通技术人员而言将是显而易见的。
VI.其他方面
虽然本文中的例子主要在电外科器械的上下文中描述,但应当理解,本文的教导内容可以容易地应用于多种其他类型的医疗器械。仅以举例的方式,本文的教导内容可以容易地应用于组织抓紧器、组织取出袋部署器械、外科缝合器、超声外科器械等。还应当理解,本文的教导内容可以容易地应用于本文引用的任何参考文献中所述的任何器械,使得可以容易地以多种方式将本文的教导内容与本文引用的任何参考文献的教导内容相结合。可结合本文的教导内容的其他类型的器械对于本领域普通技术人员而言将是显而易见的。
应当理解,所述以引用方式并入本文中的任何专利、出版物或其他公开材料,无论是全文或部分,仅在并入的材料与本公开中给出的定义、陈述或其他公开材料不冲突的范围内并入本文。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。据述以引用方式并入本文但与本文所述的现有定义、陈述或其他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。
本发明的一些实施例可在传统的内窥镜检查和开放性手术器械以及机器人辅助手术中得到应用。例如,本领域的普通技术人员将认识到,本文的各种教导内容可易于与2004年8月31日公布的名称为“Robotic SurgicalTool with Ultrasound Cauterizing and Cutting Instrument”的美国专利No.6,783,524的各种教导内容相结合,该专利的公开内容以引用方式并入本文。
本文所公开的实施例装置可设计为使用一次后丢弃,也可设计为供多次使用。在上述任一或两种情况下,都可对这些实施例进行修复,以便在使用至少一次后再使用。修复可包括以下步骤的任意组合:拆卸装置、然后清洗或更换特定部件和随后进行重新组装。具体地讲,可以拆卸装置的实施例,并且可有选择地以任何组合形式来更换或拆除装置的任意数量的特定部件或零件。在清洗和/或更换特定零件时,装置的实施例可在修复设施中重新组装或者在即将进行外科前由外科团队重新组装,以供随后使用。本领域的技术人员将会知道,修复装置时可利用多种技术进行拆卸、清洗/更换和重新组装。这些技术的使用以及所得的修复装置均在本发明的范围内。
可对本文所述的实施例在外科前进行处理,以下仅通过举例的方式说明。首先,可获取新的或用过的器械,并根据需要进行清洗。然后可对器械进行消毒。在一种消毒技术中,将该装置置于闭合并密封的容器中,例如塑料或TYVEK袋中。然后可将容器和器械置于可穿透该容器的辐射场,例如γ辐射、X射线或高能电子。辐射可将器械上和容器中的细菌杀死。然后可将消毒后的器械保存在消毒容器中。该密封容器可将器械保持在无菌状态,直到在医疗设施中打开该容器。还可使用本领域已知的任何其他技术对装置消毒,所述技术包括但不限于β辐射或γ辐射、环氧乙烷或蒸汽消毒。
已经示出和描述了本发明的多个实施例,可由本领域普通技术人员进行适当修改来实现本文描述的方法和系统的进一步改进而不偏离本发明的范围。已经提及了若干此类潜在的修改形式,并且其他修改形式对于本领域的技术人员而言将显而易见。例如,上面讨论的例子、实施例、几何形状、材料、尺寸、比率、步骤等均是示例性的而非必需的。因此,本发明的范围应以下面的权利要求书考虑,并且应理解为不限于说明书和附图中示出和描述的结构和操作细节。

Claims (17)

1.一种电外科装置,包括:
(a)主体,所述主体包括近端和远端;
(b)端部执行器,所述端部执行器包括:
(i)第一钳口,和
(ii)第二钳口,
其中所述第一钳口能够朝着所述第二钳口运动,以夹住所述第一钳口和第二钳口之间的组织,
其中所述第一钳口和所述第二钳口中的至少一者包括至少一个电极,
其中所述至少一个电极能够操作以将RF能量递送至夹在所述第一钳口和第二钳口之间的组织;
(c)切割构件,所述切割构件能够操作以切割夹在所述第一钳口和所述第二钳口之间的组织;
(d)轴,所述轴在所述主体和所述端部执行器之间延伸,其中所述轴限定纵向轴线,其中所述轴包括铰接部分,其中所述铰接部分能够操作以将所述端部执行器有选择地定位在相对于所述轴的所述纵向轴线的非平行位置,其中所述主体包括能够操作以有选择地致动所述铰接部分的控制器,其中控制器定位在主体的近端和远端之间;
(e)第一铰接带,所述第一铰接带穿过所述轴纵向延伸;和
(f)第二铰接带,所述第二铰接带穿过所述轴纵向延伸,其中第一铰接带和第二铰接带还与所述铰接部分联接,以有选择地使所述铰接部分弯曲或枢转,其中所述控制器能够操作以使所述铰接带以相反的方向平移。
2.根据权利要求1所述的电外科装置,其中所述控制器包括旋钮。
3.根据权利要求2所述的电外科装置,其中所述旋钮能够沿着垂直于所述轴的所述纵向轴线的平面旋转。
4.根据权利要求2所述的电外科装置,其中所述旋钮能够围绕所述轴的所述纵向轴线沿着倾斜于所述轴的所述纵向轴线的平面旋转。
5.根据权利要求4所述的电外科装置,其中所述控制器还包括球驱动器,其中所述旋钮围绕所述球驱动器设置。
6.根据权利要求1所述的电外科装置,其中所述控制器包括第一螺纹区域和第二螺纹区域,其中所述第一螺纹区域包括具有第一取向的螺纹,其中所述第二螺纹区域包括具有第二取向的螺纹,其中所述第二取向与所述第一取向相反,其中所述控制器能够操作以使所述第一螺纹区域和第二螺纹区域同时以共同的方向旋转。
7.根据权利要求6所述的电外科装置,其中所述控制器还包括与所述第一螺纹区域接合的第一导螺杆和与所述第二螺纹区域接合的第二导螺杆,其中所述第一导螺杆和所述第二导螺杆能够响应于所述第一螺纹区域和第二螺纹区域以所述共同的方向旋转而以相反的方向平移。
8.根据权利要求7所述的电外科装置,还包括与所述第一导螺杆联接的第一铰接构件和与所述第二导螺杆联接的第二铰接构件,其中所述第一铰接构件和第二铰接构件响应于所述第一导螺杆和所述第二导螺杆的平移而穿过所述轴纵向平移,从而致动所述铰接部分。
9.根据权利要求8所述的电外科装置,还包括第一旋转构件,所述第一旋转构件能够有选择地定位在所述第一导螺杆和所述第一铰接构件之间,以调节性地将所述第一导螺杆与所述第一铰接构件联接。
10.根据权利要求1所述的电外科装置,其中所述控制器包括枢转构件,其中所述枢转构件能够操作以使所述铰接部分基于所述枢转构件相对于所述主体的枢转角度弯曲或枢转。
11.根据权利要求10所述的电外科装置,其中所述控制器还包括一对相对的齿条,其中所述枢转构件包括杆和与所述齿条接合的小齿轮,其中所述小齿轮能够操作以使所述齿条响应于所述枢转构件的枢转而以相反的方向同时平移,其中所述齿条能够操作以使所述铰接部分基于所述齿条的相对纵向运动弯曲或枢转。
12.根据权利要求10所述的电外科装置,其中所述枢转构件能够沿着枢转平面枢转,其中所述铰接部分能够沿着对应于所述枢转平面的铰接平面弯曲或枢转,其中所述轴和所述控制器能够相对于所述主体并围绕所述轴的所述纵向轴线旋转,使得所述枢转平面和所述铰接平面能够围绕所述轴的所述纵向轴线旋转。
13.根据权利要求10所述的电外科装置,其中所述枢转构件包括能够用使用者的拇指接合的翅片。
14.根据权利要求10所述的电外科装置,其中所述控制器还包括一对连接臂,所述连接臂能够操作以将所述枢转构件的枢转运动转变成两个平移构件的相对的平移运动,其中所述平移构件能够操作以使所述铰接部分响应于所述平移构件的相对平移弯曲或枢转。
15.根据权利要求1所述的电外科装置,还包括延伸穿过所述轴的细长构件,其中所述细长构件能够通过所述轴传导电力,或通过所述轴提供电接地回路,其中所述细长构件能够相对于所述主体运动,其中所述主体包括传导联接件,其中所述传导联接件能够接触所述细长构件并在所述细长构件相对于所述主体运动时保持与所述细长构件的电连续性。
16.根据权利要求15所述的电外科装置,其中所述传导联接件能够沿着至少两条轴线接触所述细长构件。
17.根据权利要求1所述的电外科装置,还包括:
(a)能够操作以致动所述切割构件的触发器,其中所述触发器包括凸轮臂;和
(b)与所述凸轮臂接合的触发器回位杆,其中所述触发器回位杆能够使所述触发器向原位置偏置。
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