CN103429170A - 外科紧固器械 - Google Patents
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Abstract
本发明公开了用于切割和紧固组织和器官诸如血管的外科器械和仓。在各种非限制性形式中，外科器械包括第一钳口，该第一钳口可操作地支撑其中的基本柔性的细长的组织闭合组件。第二钳口相对于第一钳口被活动地支撑，并且能够响应于施加至其的打开动作和闭合动作在打开位置和闭合位置之间选择性地运动。闭合回缩组件能够向基本柔性的细长的组织闭合组件选择性地施加系紧动作。
Description
背景技术
技术领域
本发明涉及外科器械，并且在各种实施例中涉及用于切割和紧固组织及器官诸如血管等的外科切割和紧固器械。
背景技术
外科缝合器已被用于同时在组织中制造纵向切口并在切口的相对侧上施用缝钉线。此类器械常常包括一对协同工作的钳口构件，如果旨在将器械用于内窥镜式或腹腔镜式应用，则所述钳口构件能够穿过插管通道。钳口构件中的一者容纳钉仓，该钉仓具有横向间隔开的至少两排缝钉。另一钳口构件限定具有缝钉成形凹坑的砧座，该缝钉成形凹坑与被支撑在钉仓内的未成形的缝钉排对齐。此类装置的例子在2006年2月21日公布的名称为“Surgical Stapling Instrument Having Separate Distinct Closing and FiringSystems”的美国专利7,000,818中有所公开，该专利的公开内容全文以引用方式并入本文。其它外科切割和缝合器械采用通常被称为“一次性加载单元”或“DLU”的装置。此类装置支撑“单元”形式的钉仓和新刀，该单元能够可操作地附接到外科缝合器械。该单元被设计成当缝钉已被击发后该单元即被丢弃。此类器械的例子在1999年2月2日公布的名称为“Surgical Stapling Apparatus”的美国专利5,865,361中有所公开，该专利的全部公开内容以引用方式并入本文。
在使用中，临床医生能够在组织上闭合缝合器的钳口构件以在击发之前将组织定位。一旦临床医生确定钳口构件正确地抓住组织时，临床医生则可击发手术缝合器，从而切断和缝合组织。同时进行切断及缝合能避免当利用分别仅用于切断或缝合的不同手术工具依次执行这些动作时可能产生的并发症。
血管横断的当前方法采用上述直线切割器装置中的一种来施用缝钉以实现止血目的。然而，缝钉在其成形期间穿通血管，从而增加了渗漏的可能性并且还延长了愈合时间。源于横断部位的此类渗漏有时难以定位。
因此，需要用于解决上述许多挑战的外科钉仓构造。
上述讨论仅仅为了举例说明本技术领域内目前存在的一些不足之处，而不应看作是对权利要求范围的否定。
发明内容
根据至少一种形式的一般方面，提供了包括第一钳口的外科紧固器械。该第一钳口可操作地支撑其中的基本柔性的细长的组织闭合组件。第二钳口相对于第一钳口被活动地支撑，并且能够响应于施加至其上的打开动作和闭合动作在打开位置和闭合位置之间选择性地运动。闭合回缩组件能够向基本柔性的细长的组织闭合组件选择性地施加系紧动作。
根据至少一种形式的其它一般方面，提供了用于切割和封闭血管的紧固件仓。在至少一种形式中，紧固件仓包括具有平台表面的主体部分以及其内的居中设置的狭槽，该狭槽用于容纳穿过其中的外科器械的切割构件。平台表面能够可操作地支撑一对基本柔性的细长的闭合构件，其中一个构件被支撑在居中设置的狭槽的第一侧上，并且另一个构件设置在狭槽的第二侧上。闭合回缩组件至少部分地被可操作地支撑在主体部分中，并且能够向基本柔性的细长的闭合构件中的每一者选择性地施加系紧动作。
根据至少一种形式的其它一般方面，提供了与外科紧固件仓一起使用的闭合组件，该外科紧固件仓内具有闭合回缩组件。在至少一种形式中，闭合组件包括具有第一下部细长部分的第一吸收性闭合构件，该第一下部细长部分可被支撑在紧固件仓的一部分上。第一吸收性闭合构件具有限定第一锁定孔的第一锁定端部。第一吸收性闭合构件还具有与第一下部细长部分整体形成的第一上部细长部分。第一闭合构件还具有第一钩形端部，该第一钩形端部与第一锁定端部以间隔关系被支撑。闭合组件还包括具有第二下部细长部分的第二吸收性闭合构件，该第二下部细长部分可被支撑在紧固件仓的另一部分上，并且具有限定第二锁定孔的第二锁定端部。第二吸收性闭合构件具有第二上部细长部分，该第二上部细长部分与第二下部细长部分整体形成并具有第二钩形端部，该第二钩形端部与第一锁定端部以间隔关系被支撑。桥接构件使第一吸收性闭合构件和第二吸收性闭合构件彼此以间隔关系联接。
附图说明
通过结合附图参考本发明实施例的以下说明，本发明的上述和其它特征及优点及其获取方法将会变得更加明显，并可更好地理解发明本身，其中：
图1为非限制性外科切割和紧固器械实施例的一种形式的侧视图；
图2为非限制性端部执行器实施例的局部分解组件视图；
图3为支撑其中的血管的一部分的非限制性端部执行器实施例的一种形式的透视图；
图4为图3的端部执行器的一部分的剖视图；
图5为非限制性闭合组件实施例的一种形式的透视图；
图5A为处于系紧位置的图5的闭合组件的透视图；
图5B为图4和图5A的闭合组件的另一透视图，该闭合组件的锁定端部以横截面示出，以示出与缝合狭缝锁定接合而将缝合线保持在系紧位置的尖的锁定接片；
图6为处于部分地闭合取向的图3的端部执行器实施例的另一透视图；
图7为图6的端部执行器的一部分的剖视图；
图8为处于夹紧取向的、并且在缝合线已围绕其中被夹持的血管的部分而被系紧之后的图3和6的端部执行器的另一透视图；
图9为图8示出的端部执行器的剖视透视图；
图10为图8示出的端部执行器的另一剖视图；
图11为图10示出的端部执行器的另一剖视图，其中第一钳口已运动到打开位置；
图12为另一个非限制性闭合组件实施例的一种形式的透视图；
图13为可操作地支撑伤口闭合组件实施例和其中的血管的一部分的非限制性端部执行器实施例的一种形式的透视图；
图14为处于夹紧取向的图13的端部执行器的透视图；
图15为图14的端部执行器的剖视透视图；
图16为图14和15的端部执行器的另一剖视图；
图17为在伤口闭合装置已回缩并且击发杆已穿透血管之后的图14-16的端部执行器的另一剖视图；
图18为图17示出的端部执行器的另一剖视图，其中第一钳口已运动到打开位置；并且
图19为另一个非限制性端部执行器实施例的一种形式的透视图。
具体实施方式
本专利申请的申请人还拥有名称为“Surgical Staple Cartridges WithTissue Tethers For Manipulating Divided Tissues and Methods of UsingSame”、代理人案卷号为END6867USNP/100553的美国专利申请，其与本专利申请提交于同一天，并且全文以引用方式并入本文。
现在将描述某些示例性实施例以从整体上理解本文所公开的装置和方法的结构、功能、制造和用途。这些实施例的一个或多个实例在附图中示出。本领域的普通技术人员将会理解，本文特别描述的以及在附图中示出的装置和方法为非限制性的示例性实施例，并且本发明的多个实施例的范围仅由权利要求书限定。就一个示例性实施例进行图解说明或描述的特征，可与其它实施例的特征进行组合。这种变型和变化形式旨在被包括在本发明的范围之内。
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、结构或特性被包括在至少一个实施例中。因此，本说明书通篇出现的短语“在多个实施例中”、“在一些实施例中”、“在一个实施例中”或“在实施例中”等并不一定都指相同的实施例。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组合。因此，在无限制的情况下，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。这种变型和变化形式旨在被包括在本发明的范围之内。
本文所用术语“近侧”和“远侧”是相对于操纵外科器械柄部的临床医生而言的。术语“近侧”是指最靠近临床医生的部分，并且术语“远侧”是指远离临床医生的部分。还应当理解，为简洁和清楚起见，本文可以结合附图使用诸如“竖直”、“水平”、“上”和“下”之类的空间术语。然而，外科器械在许多方向和位置中使用，并且这些术语并不旨在为限制性的和/或绝对的。
提供了各种示例性装置和方法以执行腹腔镜式和微创外科手术操作。然而，本领域的普通技术人员将容易认识到，本文所公开的多种方法和装置可用于许多外科手术和应用中，包括例如与“开放式”外科手术相关的外科手术和应用。继续参阅本具体实施方式，本领域的普通技术人员将进一步认识到，本文所公开的各种器械可以任何方式插入体内，例如通过自然腔道、通过形成于组织中的切口或穿刺孔等。器械的工作部分或端部执行器部分可被直接插入患者体内、或可通过具有工作通道的进入装置例如套管针插入，外科器械的端部执行器及细长轴可通过所述工作通道被推进。
参见附图，其中在多个视图中类似的数字代表类似的部件。图1示出了能够实践本发明的至少一种形式的多种独特的有益效果的外科器械10的一个实施例。如图1所示，在一种非限制性形式中，外科器械10一般包括连接至工具部分12的柄部部分30，该工具部分12还包括在远侧终止于端部执行器100的轴组件14。轴组件14包括可在脊50上轴向运动的活动闭合管组件40。脊50从将要联接到端部执行器100的柄部部分30延伸。如图1所示，轴组件14不包括用于辅助端部执行器相对于由轴组件14限定的纵向轴线A-A进行关节运动的关节运动接头。在其它非限制性实施例中，轴组件14可包括至少一个关节运动接头，该关节运动接头用于辅助端部执行器相对于纵向轴线进行关节运动。在该非限制性实施例和其它非限制性实施例中，轴组件14可与柄部部分30操作地交接，使得端部执行器100可围绕纵向轴线A-A选择性地旋转。继续参阅本具体实施方式，将变得明显的是，本发明的各种非限制性实施例的独特和新型结构可与采用不同的柄部和轴构造的多种不同外科器械一起被有效利用。例如，器械10的各部分可与公开于名称为“Surgical Stapling Instrument Having Separate DistinctClosing and Firing Systems”的美国专利7,000,818中的外科器械的多个部分相同，该专利的公开内容全文以引用方式并入本文。因此，对于理解本发明的各种实施例和形式而言所不需要的器械10的部件的构造和操作将不在本文具体论述。
在至少一个非限制性实施例中，端部执行器100一般来讲包括一对钳口110,120，该一对钳口能够切割和紧固被切断的组织例如血管的端部。然而，尽管本文所公开的各种非限制性实施例特别适于切割和封闭血管，但是可设想到本发明的各种实施例可被有效地采用以切割和紧固其它形式的组织。如将在下文进一步详细地论述，钳口120支撑组织紧固件仓130，该组织紧固件仓可操作地支撑组织闭合组件149。参见图2。器械10包括击发杆16，该击发杆一般具有在其远侧部分上的尖锐的组织切刃或刀构件17。随着击发杆16朝远侧被驱动通过轴组件14并且朝远侧被驱动通过血管紧固件仓，该组织切刃切断夹持在钳口110,120之间的组织。
在图1示出的非限制性实施例中，柄部部分30被形成为具有手枪式握把34。闭合触发器36被枢转地安装到柄部部分30并且与闭合管组件40可操作地交接，以实现其在脊构件50上的轴向运动。当闭合触发器36由临床医生朝手枪式握把部34枢转地拉动时，闭合管组件40沿远侧方向被驱动以与钳口120交接，以促使其朝向组织紧固件仓130夹持或闭合。柄部部分30还支撑位于闭合触发器36外侧的击发触发器38。击发触发器38与击发杆16可操作地交接。当闭合触发器36由临床医生朝手枪式握把34枢转地拉动时，击发杆16朝远侧被驱动。当击发杆16朝远侧被驱动穿过组织紧固件仓130时，被夹持的组织被切断。
如在图4,7,10和11中可见，在各种非限制性实施例中，组织紧固件仓130被支撑在脊50的远端部分52上，或者可被支撑在联接到脊50的细长通道中。组织紧固件仓130包括由例如聚合物材料模塑而成的仓体132，并且仓体具有居中设置的狭槽134。当击发杆16被驱动穿过狭槽时，狭槽能够将击发杆16的远端17可操作地容纳在其中。仓体132可通过U形仓托盘136附连到脊50的远端52。U形仓托盘围绕脊50的远端52延伸，并且与仓体132以保持形式交接。例如，仓体132可与仓托盘136上的按扣闭锁装置138以按扣形式交接。
在各种非限制性实施例中，组织紧固件仓130能够可操作地支撑一般被指配为149的柔性的细长的组织闭合组件。如图5中可见，在至少一种形式中，组织闭合组件149包括一对互连的缝合条150和170。柔性的细长的组织闭合组件149包括第一缝合条150，该第一缝合条具有基本U形的细长的第一主体部分152。第一缝合条150可由可生物吸收的材料加工成形，并且包括终止于第一锁定端部157的第一细长下部153。第一缝合条150还具有终止于第一钩端部162的第一上部160。第一下部153和第一上部160中的每一者内具有多个狭缝154，该多个狭缝有利于缝合条150的弯曲和系紧，如下文将进一步详细地论述。第一锁定端部157限定第一锁定腔158，该第一锁定腔能够容纳穿过其中的第一钩端部162。
组织闭合组件149还包括第二缝合条170，该第二缝合条具有基本U形的第二细长主体部分172。第二缝合条170也可由可生物吸收的材料加工成形，并且包括终止于第二锁定端部175的第二细长下部173。第二缝合条170还具有终止于第二钩端部182的第二上部180。第二下部173和第二上部180中的每一者内具有多个狭缝174，该多个狭缝有利于缝合条170的弯曲和系紧，如下文将进一步详细地论述。第二锁定端部175限定第二锁定腔177，该第二锁定腔能够容纳穿过其中的第二钩端部182。第二缝合条170可利用桥接构件190连接到第一缝合条150，该桥接构件将锁定端部157,175连接在一起。
图5A和5B还示出了组织闭合组件149，其中缝合条150,170中的每一者均处于系紧取向。如上文所述，第一缝合条150内具有多个狭缝154，并且第二缝合条170内形成有多个狭缝174。当工作于薄壁血管诸如非常脆弱的肺静脉上时，条150,170上的任何突出部可意外刺穿血管，或换句话讲造成创伤。如在图5B中尤其可见，例如狭缝174（同样，狭缝154）以一定角度提供，使得当缝合线150,170被系紧时，它们形成相对平滑的内表面以压缩血管。还如在图5B中可见，锁定端部175可被形成为具有至少一个，并且优选地一对偏置的尖的锁定接片178,179，该锁定接片能够在缝合线系紧过程期间接合位于缝合线170的相对侧上的狭缝174，以将缝合线170锁定就位。应当理解，第一锁定端部150被形成为具有类似的尖的锁定接片（未示出）。
仓体132具有平台表面140，该平台表面与钳口110的下侧呈面对关系。平台表面140具有用于支撑第一下部缝合部分153的第一闭合件容纳沟槽142和支撑第二下部缝合部分173的第二闭合件容纳沟槽144。参见图2。此外，在仓体132中提供有用于容纳第一锁定端部157的第一锁定容器146和用于容纳第二锁定端部175的第二锁定容器148，如图所示。
在各种非限制性实施例中，钳口110可相对于钳口120选择性地运动，以夹持血管“V”或其间的其它组织。通过延伸穿过脊50中形成的细长凸耳狭槽54的一对凸耳112，钳口110枢转地联接到脊50，使钳口110能够响应于接收自闭合管组件40的打开动作和闭合动作而相对于钳口120从打开位置枢转到闭合位置。如在图2,3,6和8-11中可见，闭合管组件40的远端41包括用于接合钳口110上的打开接片113的马蹄形孔42和接片43。当闭合管组件40在端部执行器框架50上朝远侧被推进时，马蹄形孔42向接片113施加闭合动作以使钳口110朝钳口120运动。当闭合管组件40沿近侧方向被撤回时，接片43接合接片113以将钳口110远离钳口120运动到打开位置。在各种实施例中，钳口110内还具有一对闭合件保持狭槽114，其用于支撑其中的第一上部缝合部分160和第二上部缝合部分180。
如在图9中可见，外科器械10还包括闭合回缩组件200。在多种非限制性实施例中，闭合回缩组件200包括从中央致动构件206延伸的第一回缩钩202和第二回缩钩204。回缩钩202,204可由合适的金属或其它材料加工成形，并且中央致动构件206可由类似的材料加工成形。中央致动构件206延伸穿过脊50中的纵向通道（未示出），并且与可操作地支撑在柄部部分30上的回缩致动器210交接。回缩致动器210可例如包括附接到或换句话讲与中央致动构件206可操作地连通的枢轴构件，以便通过使回缩致动器210沿“A”方向枢转（图1），而使得闭合回缩组件200沿近侧方向“PD”被牵拉（图9）。如在图5中尤其可见，第一缝合条150的第一钩端部162具有穿过其中的钩容纳孔164，该钩容纳孔适于通过闭合回缩组件200的第一回缩钩202以钩的形式被接合。相似地，第二缝合条170的第二钩端部182具有穿过其中的钩容纳孔184，该钩容纳孔适于通过闭合回缩组件200的第二回缩钩204以钩的形式被接合。
现在将结合图1,3,4和6-11来描述外科器械10的操作。在使用期间，端部执行器100被引入到患者体内邻近将被切割和紧固的血管“V”的位置。端部执行器100可例如通过已安装在患者体内的套管针的插管而被引入到患者体内。端部执行器也可通过患者体内的开放切口来被插入。一旦端部执行器已被置于患者体内邻近血管“V”的位置，则钳口110利用闭合触发器36（图1）被枢转到打开位置。临床医生随后操作开放式端部执行器，使得血管“V”被定位在钳口110,120之间，使得血管“V”位于上部缝合部分160,180以及支撑仓平台表面140上的其对应的下部缝合部分153,173。参见图3和4。
如图3和4所示，一旦血管“V”被容纳在上部缝合部分160和下部缝合部分180之间，则临床医生可开始朝柄部部分30(图1)的手枪式握把部34枢转闭合触发器36，以沿着远侧方向“DD”推进闭合管组件40。当闭合管组件40的远端41朝远侧运动时，其首先接触钳口110上的接片113。闭合管组件40沿远侧方向“DD”的继续运动使钳口110相对于钳口120朝远侧运动，直到凸耳112触及凸耳狭槽54的顶端。闭合管组件40的进一步远侧运动使闭合管组件40的远端41在钳口110上的接片113之上朝远侧滑动，使得接片113被容纳在闭合管组件40中的马蹄形孔42内。参见图6。闭合管组件40的此类运动迫使钳口110朝钳口120枢转。钳口110的此类轴向行进和枢转行进使缝合钩端部162,182运动成与锁定腔158,177分别对齐。然后，临床医生使回缩致动器210沿“A”方向（图1）枢转，以将闭合回缩组件200沿近侧方向“PD”（图9）牵拉。闭合回缩组件200的此类运动使第一回缩钩202以钩的形式接合第一缝合线150的钩容纳孔164，并且第二回缩钩204以钩的形式接合第二缝合线170的钩容纳孔184。回缩致动器210的进一步枢转行进会牵拉缝合钩端部162,182，以在仓体132中的刀狭槽134的相对侧上围绕血管“V”来系紧缝合线150,170。所述锁定端部157,175的每一者中的尖的锁定接片将缝合线150,170锁定就位，如上文所述。
当临床医生在刀狭槽134的每一侧上围绕血管“V”系紧缝合线150,170后，临床医生随后使闭合触发器36枢转到完全闭合位置。在该闭合位置，闭合触发器利用已知的锁定结构被可释放地锁定。闭合触发器36如此运动到完全闭合位置使钳口110将血管“V”夹持在钳口110,120之间。然后，临床医生通过启动击发触发器38或其它致动构造朝远侧推进击发杆16，从而驱动击发杆16的远端17上的组织切刃通过仓体132中的刀狭槽134并最终穿过血管“V”。当击发杆16的远端17通过端部执行器朝远侧被推进时，远端可与第一钳口110交接以在其切穿血管时将其保持在夹紧位置。此类动作切割两根系紧的缝合线150,170之间的血管。击发杆16的远端随后肯定从端部执行器中撤回，以使临床医生能够使钳口110运动到打开位置，从而从其释放被切割的血管“V”。
当血管“V”已被切割以形成第一封闭血管端部“V1”和第二封闭血管端部（未示出）后，击发杆16回缩。在各种实施例中，例如当临床医生移除压力时，击发触发器28以弹簧形式返回。此类动作使击发杆16沿近侧方向回缩。其它击发杆回缩和回缩构造也是已知的并可被采用。在图1示出的实施例中，释放按钮31与闭合触发器交接，使得当释放按钮被压下时，闭合触发器36被解锁。一旦闭合触发器36已被解锁，其可被弹簧偏置以返回到起始位置。闭合触发器36运动到起始位置使闭合管组件40沿近侧方向“PD”回缩。闭合管组件40的此类运动使接片43接触钳口110上的接片113，以使其运动到最初的起始或打开位置。参见图11。
一旦钳口110已返回到打开位置，在第一缝合线150和第二缝合线170之间延伸的桥接件190将第一封闭血管端部和第二封闭血管端部保持在一起以使它们能够被检查。一旦临床医生已检查封闭血管端部，第一缝合线150和第二缝合线170被切割以使其分别与其各自的闭合回缩钩202,204脱离。如果需要，临床医生还可切割桥接件190以分离封闭的血管端部。然后，端部执行器100可从患者体内撤回。如果临床医生希望再利用装置10，则临床医生必须首先从先前使用过的闭合组件149从其各自的回缩钩202,204移除钩端部156和176，并且使回缩钩202,204返回到其在仓体132中的各自起始位置（图4）。闭合组件149然后被安装到仓体132中（图3）。之后，器械10可再次被利用。
图12-18示出了装置10与另一种形式的柔性的细长的组织闭合组件149’一起使用。如在图12中尤其可见，闭合组件149’包括具有主体部分312的第一吸收性闭合构件310，所述主体部分具有形成于其上的多个单向倒钩314。闭合组件149’还包括具有主体部分332的第二吸收性闭合构件330，所述主体部分具有多个形成于其上的单向倒钩334。第一闭合构件310和第二闭合构件330可由那些由Covidien of Mansfield（Massachusetts）制造的商标为V-LocTM的伤口闭合装置加工成形。又如在图12中可见，第一闭合构件310的主体部分312具有终止于第一锁定端部318的第一细长下部316，其中端部315被卷绕并焊接以形成第一锁定套环320。第一闭合构件310还具有第一细长上部322，该第一细长上部与第一细长下部316整体形成并且具有第一钩形端部324。第一钩形端部324终止于延伸穿过第一锁定套环320的被焊接的第一远侧套环326。类似地，第二闭合构件330的主体部分332具有终止于第二锁定端部338的第二细长下部336，其中端部335被卷绕并焊接以形成第二锁定套环340。第二闭合构件330还具有第二细长上部342，该第二细长上部与第二细长下部336整体形成并且具有第二钩形端部344。第二钩形端部344终止于延伸穿过第二锁定套环340的被焊接的第二远侧套环346。在各种实施例中。锁定套环320,340附接到吸收性桥接件350。
柔性的细长的组织闭合组件149’可以上述有关于闭合组件149的方式被安装到仓体132中。然而，在该实施例中，换句话讲基本上与上述钳口110相同的钳口110′具有两个向下突出的侧向翅片115以便为第一闭合构件310和第二闭合构件330提供进一步支撑。参见图13和14。
可结合图13-18来理解具有柔性的细长的组织闭合组件149′的器械10的操作。图13示出了在端部执行器100被引入患者体内并且血管“V”已被捕获在钳口110’和120之间后的端部执行器100。临床医生随后开始朝柄部30（图1）的手枪式握把部34枢转闭合触发器36，以沿着远侧方向“DD”推进闭合管组件40。当闭合管组件40的远端41朝远侧运动时，其首先接触钳口110’上的接片113。闭合管组件40沿远侧方向“DD”的持续运动使钳口110’相对于钳口120朝远侧运动，直到凸耳112触及凸耳狭槽54的顶端。闭合管组件40的进一步远侧运动使闭合管组件40的远端41在钳口110′的接片113之上朝远侧滑动，使得接片113被容纳在闭合管组件40中的马蹄形孔42内。参见图14。闭合管组件40的此类运动迫使钳口110′朝钳口120枢转。钳口110′的此类轴向行进和枢转行进使钩部分320,340并且具体地远侧套环322,342运动到与相应的锁定套环318,328对齐。然后，临床医生沿“A”方向（图1）枢转所述回缩致动器210，沿近侧方向“PD”（图15）牵拉所述闭合回缩组件200。闭合回缩组件200的此类运动使第一回缩钩202以钩的形式接合第一闭合构件310的远侧套环322，并且第二回缩钩204以钩的形式接合第二闭合构件330的第二远侧套环342。回缩致动器210的进一步枢转行进对钩端部202,204进行牵拉，以围绕仓体132中的刀狭槽134的相对侧上的血管“V”系紧闭合构件310,330。
在临床医生已围绕刀狭槽134的每一侧上的血管“V”系紧伤口闭合构件310,330之后，临床医生随后将闭合触发器36枢转到完全闭合位置，其中该闭合触发器利用已知的锁定结构被可释放地锁定。闭合触发器36如此运动到完全闭合位置使钳口110′夹紧钳口110’,120之间的血管“V”。参见图16。然后，临床医生通过启动击发触发器38或其它致动构造朝远侧推进击发杆16，从而驱动击发杆16的远端上的组织切刃穿过仓体132中的刀狭槽134并最终穿过血管“V”。
在血管“V”已被切割以形成第一封闭血管端部“V1”和第二封闭血管端部（未示出）后，击发杆16回缩。临床医生随后可使钳口110’运动到图18所示的打开位置。在第一闭合构件310和第二闭合构件330之间延伸的桥接件150将第一封闭血管端部和第二封闭血管端部保持在一起以用于检查。一旦临床医生已检查封闭端部，第一闭合构件310和第二闭合构件330被切割以使其与各自的回缩钩202,204分别脱离。如果需要，临床医生还可切割桥接件350以分离封闭的血管端部。然后，端部执行器100可从患者体内撤回。如果临床医生希望再利用装置10，则临床医生必须首先从其各自的回缩钩202,204移除环状的端部322,342，并且使回缩钩202,204返回到其在仓体132（图15）中的各自起始位置。新的闭合组件149’随后被安装到仓体132中。然后，器械10可被再次利用。
图19示出了可与器械10结合使用的另一个端部执行器实施例100″。该非限制性实施例采用紧固件仓400。该紧固件仓能够在血管切割线的每一侧上也部署单排外科缝钉。已知有多种外科钉仓构造。例如，以引用方式并入本文的美国专利7,000,818公开了多种形式的外科钉仓。除了下文指出的差别外，本发明的各种实施例的仓400可基本上类似于那些仓或其它已知钉仓。例如，除了位于细长刀狭槽408的第一侧403上的仓体402中的第一排404缝钉开口406和细长刀狭槽408的第二侧414上的第二排410缝钉开口412外，仓体402如上所述还能够以上述方式可操作地支撑闭合组件149,149’中的一者。
端部执行器100”的钳口110”基本上类似于如上所述的钳口110,110’，不同的是，钳口110”还能够充当砧座，用于使被支撑在仓400内的缝钉成形。例如，钳口110”的下表面设有两排缝钉成形凹坑；当钳口110”枢转并被锁定到夹紧位置时，缝钉成形凹坑与仓体402中的对应的缝钉开口对齐。此类缝钉成形凹坑用于当其以已知方式被驱动穿过血管“V”时来使缝钉成形。
如上关于端部执行器100,100’所述，端部执行器100”还可以类似方式被使用/启动。例如，临床医生以上述方式操作钳口110”以如图19所示捕获血管“V”。钳口110”随后被锁定到夹紧位置，并且临床医生随后可致动回缩致动器210以系紧缝合线或闭合构件，无论哪种情况。当临床医生随后致动击发杆16以使其朝远侧运动时，击发杆16将不仅切穿血管，而且还使可操作地支撑在缝钉凹坑中的缝钉被驱动出缝钉凹坑进入钳口110”的下侧中所提供的对应的缝钉成形凹坑。例如，如在美国专利7,000,818中所描述，缝钉可被可操作地支撑在缝钉驱动构件上，该缝钉驱动构件被活动地支撑在仓体中的缝钉凹坑中的每一者内。当击发杆16的远端部分朝远侧被驱动进入仓体402中，其与活动地支撑在其中的楔形滑动件相互作用。当楔形滑动件被击发杆16朝远侧推进穿过仓体402时，缝钉驱动器在其各自的凹坑内被向上推动，从而将被支撑在其上的缝钉驱动出凹坑且与钳口110”的下侧成形接触，并且最终穿过被切割的血管端部。因此，封闭的血管端部不仅用缝合线或伤口闭合装置来密封，而且其也用缝钉线来密封。
已在外科器械的构造为手持式且手动操作或致动的情况下描述了本文所述的非限制性实施例。本领域的普通技术人员将容易理解，所公开的本发明的各种非限制性实施例的独特且新型的结构还可在下面的应用中有效地获得，其中用来打开和闭合钳口的闭合装置以及那些用于启动击发杆和缝合致动构件的控制构造可由一个或多个机械手或其它自动化系统构造来控制。因此，本文所公开的各种非限制性实施例的要求保护的范围不应被局限于手持式和/或手动操作的器械。另外，本文所公开的各种非限制性实施例可与如下外科器械构造一起被采用，该外科器械构造可为动力式的（例如，通过电力、气动、流体等），以及可为或不为手持式的，以及可为或不为手动致动的、或由机械手或其它自动化控制系统构造来致动。本文所公开的本发明的各种实施例旨在涵盖此类修正形式。
可将本发明所公开的装置设计为单次使用后即进行处理，或者可将它们设计为可多次使用。然而，在任一种情况下，所述装置均可进行调理，以在至少一次使用后再次使用。调理可包括如下步骤的任意组合：拆卸该装置。然后清洗或置换某些部件，以及随后组装。特别是，所述装置可以拆卸，而且可以任意组合选择性地置换或移除该装置任意数目的特定零件或部分。清洗和/或置换特定部件后，该装置可以在调理设施处重新组装以便随后使用，或者在即将进行外科手术前由外科手术队重新组装。本领域的技术人员将会知道，装置的调理可利用多种用于拆卸、清洗/置换和重新组装的技术。这些技术的使用以及所得的调理装置均在本发明的范围内。
优选的是，在手术前处理本文所述的装置。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。然后将容器和装置置于能够穿透该容器的辐射区，例如γ辐射、x射线或高能电子。辐射杀死装置上和容器中的细菌。然后将灭菌后的装置保存在消毒容器中。该密封容器将器械保持无菌，直到在医疗设备中打开该容器。
以引用方式全文或部分地并入本文的任何专利、公布或其它公开材料均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的材料。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。
尽管已经将本发明作为示例性设计进行了描述，但还可以在本公开的实质和范围内对本发明进行修改。因此本专利申请旨在涵盖采用本发明一般原理的任何变型、用途或改型。此外，本专利申请旨在涵盖本发明所属领域中出自已知或惯用实践范围内的背离本公开的型式。
Claims (18)
1.一种外科紧固器械，包括：
第一钳口，所述第一钳口可操作地支撑其内的基本柔性的细长的组织闭合组件；
第二钳口，所述第二钳口相对于所述第一钳口被活动地支撑，并且能够响应于施加至其上的打开动作和闭合动作在打开位置和闭合位置之间选择性地运动；和
闭合回缩组件，所述闭合回缩组件能够向所述基本柔性的细长的组织闭合组件选择性地施加系紧动作。
2.根据权利要求1所述的外科紧固器械，其中所述基本柔性的细长的组织闭合组件包括：
第一吸收性缝合线；和
第二吸收性缝合线。
3.根据权利要求2所述的外科紧固器械，其中所述第一吸收性缝合线和第二吸收性缝合线通过吸收性桥接构件连接在一起。
4.根据权利要求2所述的外科紧固器械，其中所述第一吸收性缝合线包括第一基本U形的柔性的第一主体部分，所述第一基本U形的柔性的第一主体部分终止于限定第一锁定孔的第一锁定端部以及与所述第一锁定孔间隔开并且与其基本上对齐的第一钩形端部，并且其中所述第二吸收性缝合线包括第二基本U形的柔性的第二主体部分，所述第二基本U形的柔性的第二主体部分终止于限定第二锁定孔的第二锁定端部以及与所述第二锁定孔间隔开并且与其基本上对齐的第二钩形端部。
5.根据权利要求4所述的外科紧固器械，其中所述闭合回缩组件包括：
第一回缩钩，所述第一回缩钩被活动地支撑，用于当所述第一钩形端部已被推进穿过所述第一锁定孔后与所述第一钩形端部选择性地以钩的形式接合；和
第二回缩钩，所述第二回缩钩被活动地支撑，用于当所述第二钩形端部已被推进穿过所述第二锁定孔后与所述第二钩形端部选择性地以钩的形式接合。
6.根据权利要求1所述的外科器械，其中所述基本柔性的细长的组织闭合组件包括：
第一吸收性闭合构件，所述第一吸收性闭合构件上具有多个单向倒钩；和
第二吸收性闭合构件，所述第二吸收性闭合构件上具有多个单向倒钩。
7.根据权利要求6所述的外科紧固器械，其中所述第一吸收性闭合构件和第二吸收性闭合构件通过吸收性桥接构件连接在一起。
8.根据权利要求6所述的外科紧固器械，其中所述第一吸收性闭合构件包括第一基本U形的柔性的第一主体部分，所述第一基本U形的柔性的第一主体部分终止于限定第一锁定孔的第一锁定端部以及与所述第一锁定孔间隔开并且与其基本上对齐的第一钩形端部，并且其中所述第二吸收性闭合构件包括第二基本U形的柔性的第二主体部分，所述第二基本U形的柔性的第二主体部分终止于限定第二锁定孔的第二锁定端部以及与所述第二锁定孔间隔开并且与其基本上对齐的第二钩形端部。
9.根据权利要求8所述的外科紧固器械，其中所述第一锁定端部和所述第二锁定端部通过桥接构件连接在一起。
10.根据权利要求1所述的外科紧固器械，还包括：
多个第一缝钉，所述多个第一缝钉被可操作地支撑在所述第一钳口中，位于内部能够容纳所述切割构件的狭槽的第一侧上，和
多个第二缝钉，所述多个第二缝钉被可操作地支撑在所述第一钳口中，位于所述狭槽的第二侧上。
11.一种用于切割和封闭血管的紧固件仓，包括：
主体部分，所述主体部分具有平台表面和在其内居中设置的狭槽，所述狭槽用于容纳穿过其中的外科器械的切割构件，所述平台表面能够可操作地支撑一对基本柔性的细长的闭合构件，其中一个构件被支撑在所述居中设置的狭槽的第一侧上，并且另一个构件被设置在所述狭槽的第二侧上；和
闭合回缩组件，所述闭合回缩组件至少部分地被可操作地支撑在所述主体部分中，并且能够向所述基本柔性的细长的闭合构件中的每一者选择性地施加系紧动作。
12.根据权利要求11所述的紧固件仓，还包括：
多个第一未成形缝钉，所述多个第一未成形缝钉被可操作地支撑在所述主体部分中，位于所述狭槽的第一侧上；和
多个第二未成形缝钉，所述多个第二未成形缝钉被可操作地支撑在所述主体部分中，位于所述狭槽的第二侧上。
13.根据权利要求11所述的紧固件仓，其中所述闭合回缩组件包括：
第一回缩钩，所述第一回缩钩能够可操作地以钩的形式接合所述基本柔性的细长的闭合构件中的第一者的一部分；和
第二回缩钩，所述第二回缩钩能够可操作地以钩的形式接合所述基本柔性的细长的闭合构件中的第二者的一部分。
14.一种与外科紧固件仓一起使用的闭合组件，所述外科紧固件仓内具有闭合回缩组件，所述闭合组件包括：
第一吸收性闭合构件，所述第一吸收性闭合构件具有第一下部细长部分，所述第一下部细长部分能够被支撑在所述紧固件仓的一部分上并且具有限定第一锁定孔的第一锁定端部，所述第一吸收性闭合构件具有第一上部细长部分，所述第一上部细长部分与所述第一下部细长部分整体形成并且具有与所述第一锁定端部以间隔关系被支撑的第一钩形端部；
第二吸收性闭合构件，所述第二吸收性闭合构件具有第二下部细长部分，所述第二下部细长部分能够被支撑在所述紧固件仓的另一部分上并且具有限定第二锁定孔的第二锁定端部，所述第二吸收性闭合构件具有第二上部细长部分，所述第二上部细长部分与所述第二下部细长部分整体形成并且具有与所述第一锁定端部以间隔关系被支撑的第二钩形端部；和
桥接构件，所述桥接构件联接彼此呈间隔关系的所述第一吸收性闭合构件和所述第二吸收性闭合构件。
15.根据权利要求14所述的闭合组件，其中所述第一吸收性闭合构件包括第一缝合线，并且其中所述第二吸收性闭合构件包括第二缝合线。
16.根据权利要求14所述的闭合组件，其中所述第一吸收性构件具有形成于其上的第一多个第一单向倒钩，并且其中所述第二吸收性构件具有形成于其上的第二多个第二单向倒钩。
17.根据权利要求14所述的闭合组件，其中所述第一锁定端部包括第一锁定套环，所述第一锁定套环形成于所述第一吸收性闭合构件的所述第一下部端部中并且在其中限定所述第一锁定孔，并且其中所述第一吸收性闭合构件的所述第一上部具有延伸穿过所述第一锁定孔并终止于第一回缩套环的第一钩部分，并且其中所述第二锁定端部包括第二锁定套环，所述第二锁定套环形成于所述第二吸收性闭合构件的所述第二下部端部中并且在其中限定所述第二锁定孔，并且其中所述第一吸收性闭合构件的所述第二上部具有延伸穿过所述第二锁定孔并终止于第二回缩套环的第二钩部分。
18.根据权利要求17所述的闭合组件，其中所述第一锁定套环和所述第二锁定套环通过所述桥接构件连接在一起。
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| US13/048,559 | 2011-03-15 | ||
| US13/048,559 US9044229B2 (en) | 2011-03-15 | 2011-03-15 | Surgical fastener instruments |
| PCT/US2012/028899 WO2012125621A1 (en) | 2011-03-15 | 2012-03-13 | Surgical fastener instruments |
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| CN103429170A true CN103429170A (zh) | 2013-12-04 |
| CN103429170B CN103429170B (zh) | 2016-08-10 |
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| CN201280012608.5A Active CN103429170B (zh) | 2011-03-15 | 2012-03-13 | 外科紧固器械 |
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| US (1) | US9044229B2 (zh) |
| EP (1) | EP2685906B1 (zh) |
| JP (1) | JP6017465B2 (zh) |
| CN (1) | CN103429170B (zh) |
| AU (1) | AU2012230045B2 (zh) |
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| CN106061404B (zh) * | 2013-12-23 | 2018-12-04 | 伊西康内外科有限责任公司 | 具有独立钳口控制特征结构的外科切割和缝合器械 |
| CN106456164A (zh) * | 2014-06-25 | 2017-02-22 | 伊西康内外科有限责任公司 | 用于外科缝合器的闭锁接合特征结构 |
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| CN106456164B (zh) * | 2014-06-25 | 2020-04-10 | 伊西康内外科有限责任公司 | 用于外科缝合器的闭锁接合特征结构 |
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| CN105125247A (zh) * | 2015-08-28 | 2015-12-09 | 常州华森医疗器械有限公司 | 一种带翘头的腔镜直线切割闭合器的抵钉槽 |
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Also Published As
| Publication number | Publication date |
|---|---|
| CN103429170B (zh) | 2016-08-10 |
| RU2013145871A (ru) | 2015-04-20 |
| EP2685906A1 (en) | 2014-01-22 |
| AU2012230045A1 (en) | 2013-09-12 |
| CA2829818A1 (en) | 2012-09-20 |
| EP2685906B1 (en) | 2019-05-29 |
| WO2012125621A1 (en) | 2012-09-20 |
| US9044229B2 (en) | 2015-06-02 |
| JP6017465B2 (ja) | 2016-11-02 |
| RU2597141C2 (ru) | 2016-09-10 |
| AU2012230045B2 (en) | 2016-09-01 |
| JP2014515637A (ja) | 2014-07-03 |
| BR112013023604A2 (pt) | 2016-12-06 |
| BR112013023604B1 (pt) | 2020-12-15 |
| US20120234899A1 (en) | 2012-09-20 |
| CA2829818C (en) | 2019-05-21 |
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