CN103687552A - 机器人控制的机动化外科器械 - Google Patents

机器人控制的机动化外科器械 Download PDF

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CN103687552A
CN103687552A CN201280036394.5A CN201280036394A CN103687552A CN 103687552 A CN103687552 A CN 103687552A CN 201280036394 A CN201280036394 A CN 201280036394A CN 103687552 A CN103687552 A CN 103687552A
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motor
closed
surgical
rotation
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B·E·斯文斯加德
D·C·耶茨
F·E·谢尔顿四世
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Ethicon Endo Surgery Inc
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Ethicon Endo Surgery Inc
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Abstract

本发明提供了一种外科切割和紧固器械，所述外科切割和紧固器械为机动化的并且能够结合机器人系统运行。在一个实施例中，所述器械包括与电池分隔开的充电蓄电池装置，所述充电蓄电池装置在某些条件下为马达提供附加的功率。此外，所述马达可以包括多个线圈。

Description

机器人控制的机动化外科器械
相关专利申请的交叉引用
本非临时性专利申请为授予David C.Yates、Thomas W.Huitema、Frederick E.Shelton,IV和Brett E.Swensgard的2008年9月23日提交的名称为“Motorized Surgical Instrument”的美国专利申请序列号12/235,972、美国专利公布No.US-2010/0076475-A1的部分继续专利申请并且要求其权益，所述专利的全部公开内容以引用方式并入本文。
背景技术
外科缝合器已在现有技术中使用，以同时在组织中切开纵向切口和将成排的钉施加到切口的相对两侧。此类器械通常包括一对协同工作的钳口构件，如果意图将所述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。钳口构件之一容纳钉仓，该钉仓具有横向间隔开的至少两排钉。另一钳口构件限定砧座，所述砧座具有与仓中的钉排对齐的钉成形凹坑。此类器械通常包括多个往复式楔形件，当朝远侧驱动时，所述多个往复式楔形件穿过钉仓中的开口并且接合支撑钉的驱动器，以使钉朝着砧座击发。
适于内窥镜式应用的外科缝合器的例子在已公布的名称为“Surgicalstapling instrument having separate distinct closing and firing systems”的美国专利申请公布No.2004/0232196A1中有所描述，该专利公布的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，以在击发之前定位组织。一旦临床医生已确定钳口构件正在正确地抓持组织，则临床医生可击发外科缝合器，从而切断和缝合组织。同时进行切断和缝合步骤避免了当利用分别仅用于切断或缝合的不同外科工具依次执行此类动作时可能产生的并发症。
其中马达驱动切割器械的马达驱动外科切割和紧固器械也是本领域已知的，例如在名称为“Motor-driven surgical cutting and fastening instrumentwith tactile position feedback”的已公布的美国专利申请公布No.2007/0175962A1中有所描述，该专利申请以引用的方式并入本文。在该参考文献中，柄部中的电池用于对马达提供电能。
发明内容
在一个整体方面，本发明的实施例涉及机动化的外科器械。所述器械可以是内窥镜式器械诸如线切割器或圆形切割器，或腹腔镜式器械。所述器械由钉和/或射频电极构成，用于紧固夹持在端部执行器中的组织。
本文所公开的若干实施例与无线马达驱动器械相关。在一个实施例中，器械包括与电池分隔开的充电蓄电池装置，该充电蓄电池装置在需要时为电动马达提供附加的功率。充电蓄电池装置可由电池首次充电。然后，可将其断开，直至需要充电蓄电池装置提供额外电能时。这时，将充电蓄电池装置与电池串联连接，以为马达提供附加的功率。
在另一个实施例中，马达可以包括至少两个线圈。在一种运行模式下，线圈串联连接，在另一种运行模式下，线圈并联连接。当线圈串联连接时，马达可以具有高速低扭矩输出。当线圈并联连接时，马达可以具有低速高扭矩输出。这样，例如，马达可显示出两种运行模式，而器械不必具有多个马达。
在另一个实施例中，器械利用可替换（可能是可充电）电池组为马达提供电能。电池组可以包括多个电池单元。第一组电池单元可以串联连接于电池组中，并且第二组电池单元可以串联连接于电池组中，但在电池组中，第一组不与第二组串联连接。相反，器械可以包括连接到柄部中的电池单元，例如将电池组安装或置于器械中时将第一组与第二组串联连接的电池单元。
根据本发明的各种实施例的另一个整体方面，提供了机器人控制的外科器械系统。在至少一个实施例中，该系统包括端部执行器，其具有可运动的切割器械。电动马达与端部执行器连通，用于致动切割器械。该系统还包括用于控制马达的马达控制电路。在至少一种形式中，马达控制电路包括机器人系统，该机器人系统与电动马达可操作地连通，用于为其提供电能。马达控制电路还包括充电蓄电池装置和开关电路，该开关电路与机器人系统和充电蓄电池装置连通，用于(i)将充电蓄电池装置临时性连接到机器人系统以为充电蓄电池装置充电，以及(ii)选择性将充电蓄电池装置与机器人系统串联连接以为马达提供附加的功率。
根据本发明的各种实施例的另一个整体方面，提供了包括机器人系统的外科器械系统，所述机器人系统具有可操作地联接到其一部分的端部执行器。端部执行器包括可运动的切割器械。在至少一种形式中，系统包括用于致动切割器械的电动马达，其中马达包括至少两个线圈。马达控制电路连接到马达，该马达将至少两个马达线圈选择性串联或并联连接。
根据本发明的各种实施例的另一个整体方面，提供了包括端部执行器的外科器械系统，所述端部执行器可操作地联接到机器人系统。端部执行器包括可运动的切割器械。系统还包括用于致动切割器械的电动马达。机器人系统中提供了用于为马达提供电能的可移除电池组，其中电池组包括多个电池单元。多个电池单元包括多个第一串联连接的电池单元和多个第二串联连接的电池单元。系统还包括与电池组分隔开的电池单元连接器。当电池组与器械连通时，电池单元连接器将多个第一串联连接的电池单元串联连接到多个第二串联连接的电池单元。
本发明的这些和其他有益效果将从以下描述中显而易见。
附图说明
本文以举例的方式结合以下附图描述了本发明的各种实施例，其中：
图1和2为根据本发明的各种实施例的外科切割和紧固器械的透视图；
图3至5为根据本发明的各种实施例的器械的端部执行器和轴的分解图；
图6为根据本发明的各种实施例的端部执行器的侧视图；
图7为根据本发明的各种实施例的器械的柄部的分解图；
图8和9为根据本发明的各种实施例的柄部的局部透视图；
图10为根据本发明的各种实施例的柄部的侧视图；
图11为用于根据本发明的各种实施例的器械的电路的示意图；
图12至14和17为用于为根据本发明的各种实施例的器械的马达提供电能的电路的示意图；
图15为示出根据本发明的各种实施例的充电管理电路的方框图；
图16为示出根据本发明的各种实施例的充电器座的方框图；
图18示出了电池的典型功率曲线；
图19和20为用于根据本发明的各种实施例的器械的电路的示意图；
图21和23为根据本发明的各种实施例的器械的示意图；
图22和24为根据本发明的各种实施例的电池组的示意图；
图25为一个机器人控制器实施例的透视图；
图26为可操作地支撑本发明的多个外科工具实施例的机器人系统的一个机器人外科臂车/操纵器的透视图；
图27为图26中示出的机器人外科臂车/操纵器的侧视图；
图28为具有用于可操作地支撑机器人操纵器的定位连杆的示例性的臂车结构的透视图，该机器人操纵器可与本发明的各种外科工具实施例一起使用；
图29为本发明的外科工具实施例的透视图；
图30为用于将各种外科工具实施例附接到机器人系统的适配器和工具架布置的分解组件视图；
图31为图30中示出的适配器的侧视图；
图32为图30中示出的适配器的底视图；
图33为图30和31的适配器的顶视图；
图34为图29的外科工具实施例的部分底部透视图；
图35为本发明的可进行关节运动的外科端部执行器实施例的一部分的局部分解图；
图36为移除了工具安装外壳的图34的外科工具实施例的透视图；
图37为移除了工具安装外壳的图34的外科工具实施例的后部透视图；
图38为移除了工具安装外壳的图34的外科工具实施例的前透视图；
图39为图38的外科工具实施例的部分分解透视图；
图40为图34的外科工具实施例的部分横截面侧视图；
图41为图37中示出的外科工具的一部分的放大剖视图；
图42为图34中示出的外科工具实施例的工具安装部分的一部分的分解透视图；
图43为图42的工具安装部分的一部分的放大分解透视图；
图44为图34的外科工具的细长轴组件的一部分的局部剖视图；
图45为本发明的外科工具实施例的闭合螺母实施例的半部分的侧视图；
图46为本发明的另一个外科工具实施例的透视图；
图47为图46的外科工具实施例的外科端部执行器和细长轴组件的一部分的横截面侧视图，其中砧座处于打开位置并且闭合离合器组件处于中间位置；
图48为图47中示出的外科端部执行器和细长轴组件的另一个横截面侧视图，其中离合器组件接合于闭合位置；
图49为图47中示出的外科端部执行器和细长轴组件的另一个横截面侧视图，其中离合器组件接合于击发位置；
图50为本发明的工具安装部分实施例的一部分的顶视图；
图51为本发明的另一个外科工具实施例的透视图；
图52为图51的外科工具实施例的外科端部执行器和细长轴组件的一部分的横截面侧视图，其中砧座处于打开位置；
图53为图51的外科工具实施例的外科端部执行器和细长轴组件的一部分的另一个横截面侧视图，其中砧座处于闭合位置；
图54为本发明的闭合驱动螺母和部分刀杆实施例的透视图；
图55为本发明的另一个工具安装部分实施例的顶视图；
图56为本发明的另一个外科工具实施例的透视图；
图57为图56的外科工具实施例的外科端部执行器和细长轴组件的一部分的横截面侧视图，其中砧座处于打开位置；
图58为图57的外科工具实施例的外科端部执行器和细长轴组件的一部分的另一个横截面侧视图，其中砧座处于闭合位置；
图59为本发明的外科工具实施例的安装衬圈实施例的剖视图，示出了闭合驱动轴的刀杆和远端部分；
图60为图59的安装衬圈实施例的剖视图；
图61为本发明的另一个外科工具实施例的另一个工具安装部分实施例的顶视图；
图61A为本发明的另一个外科工具实施例的齿轮布置的一部分的分解透视图；
图61B为图61A中示出的齿轮布置的横截面透视图；
图62为采用了压力传感器布置的本发明的另一个外科工具实施例的外科端部执行器和细长轴组件的一部分的横截面侧视图，其中砧座处于打开位置；
图63为图62的外科工具实施例的外科端部执行器和细长轴组件的一部分的另一个横截面侧视图，其中砧座处于闭合位置；
图64为与机器人系统的工具架部分相关的本发明的另一个外科工具实施例的一部分的侧视图，其一些部件以横截面示出；
图65为与机器人系统的工具架部分相关的本发明的另一个外科工具实施例的一部分的侧视图，其一些部件以横截面示出；
图66为本发明的另一个外科工具实施例的一部分的侧视图，其一些部件以横截面示出；
图67为本发明的外科工具实施例的一部分的另一个外科端部执行器实施例的一部分的侧视图，其一些部件以横截面示出；
图68为本发明的外科工具实施例的一部分的另一个外科端部执行器实施例的一部分的侧视图，其一些部件以横截面示出；
图69为本发明的外科工具实施例的一部分的另一个外科端部执行器实施例的一部分的侧视图，其一些部件以横截面示出；
图70为图69的端部执行器的一部分的放大剖视图；
图71为图69和70的端部执行器的一部分的另一个剖视图；
图72为本发明的另一个外科工具实施例的外科端部执行器和细长轴组件的一部分的横截面侧视图，其中砧座处于打开位置；
图73为图72的外科工具实施例的外科端部执行器和细长轴组件的一部分的放大横截面侧视图；
图74为图72和73的外科端部执行器和细长轴组件的一部分的另一个横截面侧视图，其中砧座处于闭合位置；
图75为图72至74的外科工具实施例的外科端部执行器和细长轴组件的一部分的放大横截面侧视图；
图76为本发明的外科工具实施例的工具安装部分实施例的顶视图；
图77为本发明的另一个外科工具实施例的透视组件视图；
图78为可与本发明的各种外科工具实施例一起使用的一次性加载单元布置的前透视图；
图79为图78的一次性加载单元的后部透视图；
图80为图78和79的一次性加载单元的底部透视图；
图81为可与本发明的各种外科工具实施例一起使用的另一个一次性加载单元实施例的底部透视图；
图82为图78至80中示出的一次性加载单元的安装部分的分解透视图；
图83为本发明的外科工具实施例的一次性加载单元和细长轴组件实施例的一部分的透视图，其中一次性加载单元处于第一位置；
图84为图83的一次性加载单元和细长轴组件的一部分的另一个透视图，其中一次性加载单元位于第二位置；
图85为图83和84中示出的一次性加载单元和细长轴组件实施例的一部分的剖视图；
图86为图83至85中示出的一次性加载单元和细长轴组件实施例的另一个剖视图；
图87为本发明的外科工具实施例的另一个一次性加载单元实施例和细长轴组件实施例的一部分的局部分解透视图；
图88为本发明的外科工具实施例的另一个一次性加载单元实施例和细长轴组件实施例的一部分的局部分解透视图；
图89为图88的一次性加载单元实施例和细长轴组件实施例的另一个局部分解透视图；
图90为本发明的外科工具实施例的另一个工具安装部分实施例的顶视图；
图91为本发明的另一个外科工具实施例的侧视图，其一些部件以横截面示出并与机器人系统的机器人工具架相关；
图92为可结合本发明的各种外科工具实施例使用的外科端部执行器实施例的分解组件视图；
图93为用于驱动在本发明的各种外科端部执行器实施例中使用的切割器械的缆线驱动系统的一部分的侧视图；
图94为图93的缆线驱动系统和切割器械的顶视图；
图95为处于闭合位置的本发明的缆线驱动传动装置实施例的顶视图；
图96为处于中间位置的图95的缆线驱动传动装置实施例的另一个顶视图；
图97为处于击发位置的图95和96的缆线驱动传动装置实施例的另一个顶视图；
图98为处于图95中示出的位置的缆线驱动传动装置实施例的透视图；
图99为处于图96中示出的位置的缆线驱动传动装置实施例的透视图；
图100为处于图97中示出的位置的缆线驱动传动装置实施例的透视图；
图101为本发明的另一个外科工具实施例的透视图；
图102为用于驱动在本发明的各种外科端部执行器实施例中使用的切割器械的另一个缆线驱动系统实施例的一部分的侧视图；
图103为图102的缆线驱动系统实施例的顶视图；
图104为本发明的另一个外科工具实施例的工具安装部分实施例的顶视图；
图105为本发明的另一个外科工具实施例的俯视剖视图；
图106为本发明的外科工具实施例的外科端部执行器实施例的一部分的剖视图；
图107为图106的外科端部执行器沿着图106中的线107-107截取的横截面端视图；
图108为其部分以横截面示出的图106和107的外科端部执行器的透视图；
图109为图106至108的外科端部执行器的一部分的侧视图；
图110为本发明的各种外科工具实施例的滑动件组件实施例的透视图；
图111为图110的滑动件组件实施例和图109的细长通道的一部分的剖视图；
图112至117以图解法示出了在本发明的外科工具实施例中的钉的顺序击发；
图118为本发明的外科端部执行器实施例的一部分的局部透视图；
图119为本发明的外科工具实施例的外科端部执行器实施例的一部分的局部横截面透视图；
图120为滑动件组件轴向推进穿过其中的图119的外科端部执行器实施例的另一个局部横截面透视图；
图121为本发明的另一个外科工具实施例的另一个滑动件组件实施例的透视图；
图122为滑动件组件轴向推进穿过其中的图119和120中示出的外科端部执行器实施例的一部分的局部顶视图；
图123为图122的外科端部执行器实施例的另一个局部顶视图，为了清楚起见，已省略外科钉仓的顶部表面；
图124为图119和120中示出的外科端部执行器的旋转驱动器实施例和钉推动器实施例的局部横截面侧视图；
图125为本发明的自动重新加载系统实施例的透视图，其中外科端部执行器与其提取系统以提取方式接合；
图126为图125中示出的自动重新加载系统实施例的另一个透视图；
图127为图125和126中示出的自动重新加载系统实施例的横截面正视图；
图128为图125至127中示出的自动重新加载系统实施例的另一个横截面正视图，其中其提取系统从外科端部执行器中移除用过的外科钉仓；
图129为图125至127中示出的自动重新加载系统实施例的另一个横截面正视图，示出了将新的外科钉仓加载到外科端部执行器中；
图130为本发明的另一个自动重新加载系统实施例的透视图，其一些部件以横截面示出；
图131为图130的自动重新加载系统实施例的一部分的分解透视图；
图132为图131中示出的部分自动重新加载系统实施例的另一个分解透视图；
图133为图130至132的自动重新加载系统实施例的横截面正视图；
图134为支撑其中的一次性加载单元的取向管实施例的剖视图；
图135为本发明的另一个外科工具实施例的透视图；
图136为本发明的外科工具实施例的关节运动接头实施例的局部透视图；
图137为本发明的外科工具实施例的闭合管实施例的透视图；
图138为组装在图136的关节运动接头实施例上的图137的闭合管实施例的透视图；
图139为本发明的外科工具实施例的工具安装部分实施例的一部分的顶视图；
图140为图139的工具安装部分实施例中采用的关节运动驱动组件实施例的透视图；
图141为本发明的另一个外科工具实施例的透视图；以及
图142为本发明的另一个外科工具实施例的透视图。
具体实施方式
本专利申请的申请人还拥有与本专利同一日期提交的以下专利申请，这些专利申请各自的全部内容均以引用方式并入本文：
-名称为“Surgical Instrument With Wireless Communication Between aControl Unit of a Robotic System and Remote Sensor”的美国专利申请序列号____，代理人案卷号END5924USCIP2/060339CIP2；
-名称为“Robotically-Controlled Disposable Motor Driven LoadingUnit”的美国专利申请序列号____，代理人案卷号END6213USCIP1/070330CIP1；
-名称为“Robotically-Controlled Endoscopic Accessory Channel”的美国专利申请序列号____，代理人案卷号END5568USCIP2/100809CIP2；
-名称为“Robotically-Controlled Surgical Stapling Devices ThatProduce Formed Staples Having Different Lengths”的美国专利申请序列号____，代理人案卷号END5675USCIP6/050504CIP6；
-名称为“Robotically-Controlled Motorized Cutting and FasteningInstrument”的美国专利申请序列号____，代理人案卷号END6269USCIP1/070391CIP1；
-名称为“Robotically-Controlled Shaft Based Rotary Drive Systems ForSurgical Instruments”的美国专利申请序列号____，代理人案卷号END6089USCIP1/070059CIP1；
-名称为“Robotically-Controlled Surgical Instrument Having RecordingCapabilities”的美国专利申请序列号____，代理人案卷号END5773USCIP4/050698CIP4；
-名称为“Robotically-Controlled Surgical Instrument With ForceFeedback Capabilities”的美国专利申请序列号____，代理人案卷号END5773USCIP5/050698CIP5；
-名称为“Robotically-Driven Surgical Instrument With E-BeamDriver”的美国专利申请序列号____，代理人案卷号END0908USCIP2/100810CIP2；以及
-名称为“Surgical Stapling Instruments With Rotatable StapleDeployment Arrangements”的美国专利申请序列号____，代理人案卷号END7002USNP/110262。
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、制造和用途的原理。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，本文特别描述和在附图中示出的装置和方法为非限制性的示例性实施例，并且本发明各种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，可与其他实施例的特征进行组合。这种修改形式和变化形式旨在包括在本发明的范围之内。
因此，本说明书通篇使用的短语“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”等并不一定都指相同的实施例。此外，在一个或多个其他实施例中，可按照任何合适的方式组合一个或多个实施例的具体特征、结构或特性。这种修改形式和变化形式旨在包括在本发明的范围之内。
图1和2示出了根据本发明的各种实施例的外科切割和紧固器械10。图示实施例为内窥镜式器械，一般来讲，本文所述的器械10的实施例为内窥镜式外科切割和紧固器械。然而，应该指出的是，根据本发明的其他实施例，器械可以是非内窥镜式外科切割和紧固器械，例如腹腔镜式器械。
图1和2中示出的外科器械10包括柄部6、轴8以及在关节运动枢轴14处可枢转地连接到轴8的进行关节运动的端部执行器12。关节运动控制件16可邻近柄部6提供，以实现端部执行器12围绕关节运动枢轴14的旋转。在图示实施例中，端部执行器12能够充当用于夹持、切断和缝合组织的线切割器，但在其他实施例中，可以使用不同类型的端部执行器，例如用于其他类型的外科装置的端部执行器，例如抓紧器、切割器、缝合器、施夹钳、进入装置、药物/基因治疗装置、超声波、射频或激光装置等。有关射频装置的更多细节可见于'312专利。
器械10的柄部6可以包括用于致动端部执行器12的闭合触发器18和击发触发器20。应当理解，具有涉及不同手术任务的端部执行器的器械可具有不同数量或类型的触发器或用于操作端部执行器12的其他合适的控制件。端部执行器12示出为优选地通过伸长轴8与柄部6分离。在一个实施例中，器械10的临床医生或操作者可以通过利用关节运动控制16使端部执行器12相对于轴8进行关节运动，如Geoffrey C.Hueil等人的名称为“Surgical Instrument Having An Articulating End Effector”的已公布的美国专利申请公布No.2007/0158385A1中更详细地描述，该专利申请公布以引用的方式并入本文。
在该实例中，端部执行器12此外包括钉通道22和可枢转平移的夹紧构件，例如砧座24，所述钉通道和可枢转平移的夹紧构件保持在确保有效地缝合和切断被夹持在端部执行器12中的组织的间距处。柄部6包括手枪式握把26，临床医生朝向该手枪式握把26可枢转地牵拉闭合触发器18，以将砧座24朝向端部执行器12的钉槽22夹持或闭合，从而夹持定位在砧座24和钉槽22之间的组织。击发触发器20在闭合触发器18的外侧较远处。如下面进一步描述，一旦闭合触发器18锁定于闭合位置，击发触发器20便可朝向手枪式握把26略微旋转，使得其可被操作者使用一只手触及。然后，操作者可朝向手枪式握把12可枢转地拉动击发触发器20，以引起对端部执行器12中的被夹持组织的缝合和切断。在其他实施例中，可以使用除砧座24之外的不同类型的夹紧构件，例如相对的钳口等。
应当理解，本文使用的术语“近侧”和“远侧”是以握持器械10的柄部6的临床医生为参照的。因此，端部执行器12相对于更近侧的柄部6为远侧。还应当理解，为方便和清楚起见，本文可结合附图使用空间术语例如“竖直”和“水平”。然而，外科器械在多个取向和位置中使用，并且这些术语并非意图进行限制，也并非绝对。
可以首先致动闭合触发器18。一旦临床医生对于端部执行器12的定位感到满意，临床医生即可将闭合触发器18拉动至其紧邻手枪式握把26的完全闭合的锁定位置。然后可致动击发触发器20。当临床医生移除压力时，击发触发器20返回打开位置（在图1和2中示出），如下面更完整地描述。当按下柄部6上的释放按钮时，可释放锁定的闭合触发器18。释放按钮可以各种形式实施，例如图7示出的滑动释放按钮160或已公布的美国专利申请公布No.2007/0175955A1中描述的任何机构，该专利申请公布以引用的方式并入本文。
图3为根据各种实施例的端部执行器12的分解图。如图示实施例中所示，端部执行器12可包括除了前述钉槽22和砧座24之外的切割器械32、滑动件33、可移除地位于钉槽22中的钉仓34以及螺旋状螺杆轴36。切割器械32可以为例如刀。砧座24可在连接到钉槽22的近端的枢轴点25处可枢转地打开和闭合。砧座24还可包括位于其近端的突出部27，所述突出部插入机械闭合系统（以下进一步描述）的部件以打开和闭合砧座24。当闭合触发器18被致动时，即被器械10的使用者牵拉时，砧座24可围绕枢轴点25枢转进入夹紧或闭合位置。如果端部执行器12的夹紧符合要求，操作者即可致动击发触发器20（如下面更详细地解释），使得刀32和滑动件33沿着槽22在纵向上行进，从而切割被夹持在端部执行器12内的组织。滑动件33沿着槽22的运动使得钉仓34的钉被驱动穿过切断的组织并且抵靠闭合的砧座24，使钉转动以紧固被切断的组织。在各种实施例中，滑动件33可以是仓34的一体式部件。名称为“Surgical stapling instrumentincorporating an E-beam firing mechanism”的美国专利No.6,978,921提供了关于此类两行程切割和紧固器械的更多细节，该专利以引用的方式并入本文。滑动件33可以是仓34的一部分，使得当刀32在切割操作后回缩时，滑动件33不会回缩。
应该指出的是，虽然本文描述的器械10的实施例使用对切断的组织进行缝合的端部执行器12，但是在其他实施例中，可以使用用于对切断的组织进行紧固或密封的不同技术。例如，也可使用利用射频能量或粘合剂来紧固被切断的组织的端部执行器。授予Yates等人的名称为“ElectrosurgicalHemostatic Device”的美国专利No.5,709,680以及授予Yates等人的名称为“Electrosurgical Hemostatic Device with Recessed and/or Offset Electrodes”的美国专利No.5,688,270公开了使用射频能量来密封被切断的组织的内窥镜式切割器械，所述专利以引用的方式并入本文。授予Jerome R.Morgan等人的已公布的美国专利申请公布No.2007/0102453A1和授予Frederick E.Shelton,IV等人的已公布的美国专利申请公布No.2007/0102452A1公开了使用粘合剂来紧固被切断的组织的内窥镜式切割器械，所述专利也以引用的方式并入本文。因此，虽然本文的描述涉及如下切割/缝合操作等，但是应当认识到，这仅是示例性实施例，并不旨在进行限制。也可以使用其他组织紧固技术。
图4和5为根据各种实施例的端部执行器12和轴8的分解图，并且图6为它们的侧视图。如图示实施例所示出，轴8可包括通过枢转连接件44枢转地连接的近侧闭合管40和远侧闭合管42。远侧闭合管42包括开口45，砧座24上的突出部27插入该开口以便打开和闭合砧座24，如下文进一步所述。设置于闭合管40、42内部的可以是近侧脊管46。设置于近侧脊管46内部的可以是通过锥齿轮组件52与次（或远侧）驱动轴50连通的主旋转（或近侧）驱动轴48。次驱动轴50连接到接合螺旋状螺杆轴36的近侧传动齿轮56的传动齿轮54。竖直锥齿轮52b可位于近侧脊管46远端中的开口57内并进行枢转。远侧脊管58可用于包封次驱动轴50和传动齿轮54、56。总体来说，主驱动轴48、次驱动轴50和关节运动组件（如，锥齿轮组件52a-c）有时在本文中称为“主驱动轴组件”。
设置在钉槽22远端处的轴承38接纳螺旋状传动螺杆36，从而允许螺旋状传动螺杆36相对于槽22自由旋转。螺旋状螺杆轴36可交接刀32的螺纹开口（未示出），使得轴36的旋转引起刀32通过钉槽22向远侧或向近侧（取决于旋转的方向）平移。因此，当主驱动轴48通过致动击发触发器20而旋转时（如下面更详细地解释），锥齿轮组件52a-c引起次驱动轴50旋转，继而由于接合传动齿轮54、56而引起螺旋状螺杆轴36旋转，其引起刀驱动构件32沿着槽22在纵向上行进，以切割夹持在端部执行器内的任何组织。滑动件33可由例如塑料制成，并且可具有倾斜的远侧表面。当滑动件33横贯槽22时，前倾表面可向上推动或驱动钉仓中的钉穿过被夹持的组织并抵靠砧座24。砧座24使钉弯曲，从而缝合切断的组织。当刀32回缩时，刀32和滑动件33可脱离，从而使滑动件33保留在槽22的远端处。
图7-10示出了马达驱动线切割器的示例性实施例。图示实施例提供了有关端部执行器中切割器械的部署和加载力的使用者反馈。此外，该实施例可利用由使用者回缩击发触发器20所提供的功率对装置供以功率（所谓的“功率辅助”模式）。如图示实施例中所示出，柄部6包括通常组装在一起形成柄部6的外部的外部下侧件59、60和外部上侧件61、62。可在柄部6的手枪式握把部26中提供电池64，例如锂离子电池。电池64为设置在柄部6的手枪式握把部26的上部中的电动马达65供电。根据各种实施例，可以使用许多串联连接的电池单元为马达65供电。
马达65可以是在没有负载的情况下最大转速为大约25,000RPM的刷式驱动马达。在其他实施例中，马达65可以包括无刷马达、无线马达、同步马达、步进马达或任何其他合适的电动马达。马达64可以驱动包括第一锥齿轮68和第二锥齿轮70的900锥齿轮组件66。锥齿轮组件66可驱动行星齿轮组件72。行星齿轮组件72可包括连接到驱动轴76的小齿轮74。小齿轮74可驱动配合的环形齿轮78，所述配合的环形齿轮78通过驱动轴82驱动螺旋齿轮鼓80。环84可以螺纹方式接合在螺旋齿轮鼓80上。因此，当马达65旋转时，借助于插入的锥齿轮组件66、行星齿轮组件72和环形齿轮78引起环84沿着螺旋齿轮鼓80行进。
柄部6还可以包括与击发触发器20连通的马达运转传感器110，用于检测击发触发器20何时被操作者朝向柄部6的手枪式握把部26拉近（或“闭合”）从而致动端部执行器12进行切割/缝合操作。传感器110可以为比例传感器，例如变阻器或可变电阻器。当击发触发器20被拉近时，传感器110检测此运动，并发送电信号，所述电信号指示提供给马达65的电压（或功率）。当传感器110为可变电阻器等时，马达65的转速可与击发触发器20的运动量大致成比例。即，如果操作者仅少量拉近或者闭合击发触发器20，则马达65的转速相对较低。当完全拉近击发触发器20（或者处于完全闭合位置）时，马达65的转速为其最大值。换句话讲，使用者越用力牵拉击发触发器20，则施加到马达65上的电压就越大，从而转速就越大。
柄部6可以包括邻近击发触发器20上部的中间柄部件104。柄部6还可包括连接在中间柄部件104上的柱子与击发触发器20之间的偏置弹簧112。偏置弹簧112可将击发触发器20偏置到其完全打开位置。这样，当操作者释放击发触发器20时，偏置弹簧112将击发触发器20牵拉其打开位置，从而移除对传感器110的致动，并从而停止马达65的旋转。此外，凭借偏置弹簧112，无论使用者在何时闭合击发触发器20，使用者都将受到针对闭合操作的阻力，从而为使用者提供有关马达65所施加的旋转量的反馈。另外，操作者可停止回缩击发触发器20，从而移除来自传感器100的力，并从而停止马达65。由此，使用者可停止对端部执行器12的部署，从而为操作者提供对切割/紧固操作进行控制的量度。
螺旋齿轮鼓80的远端包括驱动环形齿轮122的远侧驱动轴120，该环形齿轮与小齿轮124配合。小齿轮124连接到主驱动轴组件的主驱动轴48。这样，马达65的旋转引起主驱动轴组件旋转，这引起端部执行器12的致动，如上所述。
以螺纹方式接合在螺旋齿轮鼓80上的环84可包括设置在开槽臂90的狭槽88内的柱子86。开槽臂90具有开口92，所述开口92的相对端94接纳连接在柄部外侧件59、60之间的枢轴销96。枢轴销96还被设置为通过击发触发器20中的开口100和中间柄部件104中的开口102。
此外，柄部6可以包括反向马达（或行程结束传感器）130和止动马达（或行程开始）传感器142。在各种实施例中，反向马达传感器130可以是位于螺旋齿轮鼓80远端处的限位开关，使得当环84到达螺旋齿轮鼓80的远端时，以螺纹方式接合在螺旋齿轮鼓80上的环84接触并触发反向马达传感器130。当反向马达传感器130被启动时，其向马达65发送信号以倒转其旋转方向，从而在切割操作之后撤出端部执行器12的刀32。止动马达传感器142可以是（例如）常闭限位开关。在各种实施例中，其可以位于螺旋齿轮鼓80的近端处，使得当环84到达螺旋齿轮鼓80的近端时，环84将开关142触发。
在操作过程中，当器械10的操作者拉回击发触发器20时，传感器110检测击发触发器20的部署，并且向马达65发送信号以使马达65例如以与操作者拉回击发触发器20的用力程度成比例的速率正向旋转。马达65的正向旋转继而使行星齿轮组件72远端处的环形齿轮78旋转，从而引起螺旋齿轮鼓80旋转，并引起以螺纹方式接合在螺旋齿轮鼓80上的环84沿着螺旋齿轮鼓80向远侧行进。如上所述，螺旋齿轮鼓80的旋转还驱动主驱动轴组件，这继而使得刀32部署在端部执行器12中。即，使得刀32和滑动件33在纵向上横贯槽22，从而切割被夹持在端部执行器12中的组织。另外，在使用缝合型端部执行器的实施例中，使得端部执行器12的缝合操作发生。
待端部执行器12的切割/缝合操作完成时，螺旋齿轮鼓80上的环84将到达螺旋齿轮鼓80的远端，从而导致反向马达传感器130被触发，其向马达65发送信号以使马达65倒转其旋转。这继而导致刀32回缩，并且还使螺旋齿轮鼓80上的环84移动回到螺旋齿轮鼓80的近端。
中间柄部件104包括接合开槽臂90的后侧肩部106，如图8和9中最佳地示出。中间柄部件104还具有接合击发触发器20的前移止挡件107。开槽臂90的运动受到如上所述马达65的旋转的控制。当开槽臂90随着环84从螺旋齿轮鼓80的近端行进至远端而沿逆时针方向旋转时，中间柄部件104将自由地沿逆时针方向旋转。因此，随着使用者拉近击发触发器20，击发触发器20将接合中间柄部件104的前移止挡件107，从而使中间柄部件104沿逆时针方向旋转。然而，由于后侧肩部106接合开槽臂90，所以中间柄部件104将仅能够沿逆时针方向旋转直到开槽臂90允许的距离。这样，如果马达65应当出于某些原因停止旋转，则开槽臂90也将停止旋转，并且使用者将不能够进一步拉近击发触发器20，因为由于开槽臂90的缘故，中间柄部件104将不会自由地沿逆时针方向旋转。
用于通过回缩闭合触发器18而闭合（或夹紧）端部执行器12的砧座24的示例性闭合系统的部件也在图7-10中示出。在图示实施例中，闭合系统包括通过销251连接到闭合触发器18的轭250，所述销251通过闭合触发器18和轭250二者中的对齐开口插入。闭合触发器18围绕其枢转的枢轴销252通过闭合触发器18中的另一个开口插入，该开口与销251插入通过闭合触发器18的位置错开。因此，闭合触发器18的回缩使得闭合触发器18的上部逆时针旋转，轭250经由销251附接到该闭合触发器。轭250的远端通过销254连接到第一闭合托架256。第一闭合托架256连接到第二闭合托架258。总体来说，闭合托架256、258限定近侧闭合管40的近端（参见图4）坐落并保持在其中的开口，使得闭合托架256、258的纵向移动引起近侧闭合管40的纵向运动。器械10还包括设置在近侧闭合管40内部的闭合杆260。闭合杆260可包括窗口261，柄部外部件之一（例如图示实施例中的外部下侧件59）上的柱子263设置进该窗口中，以将闭合杆260固定地连接到柄部6。这样，近侧闭合管40能够相对于闭合杆260在纵向上移动。闭合杆260也可包括远侧衬圈267，其装配到近侧脊管46中的腔体269中并通过顶盖271保持在其中（参见图4）。
在操作过程中，当轭250由于闭合触发器18的回缩而旋转时，闭合托架256、258引起近侧闭合管40朝远侧移动（即，远离器械10的柄部末端），这导致远侧闭合管42向远侧移动，从而导致砧座24围绕枢轴点25旋转进夹紧或闭合位置。当闭合触发器18从锁定位置解锁时，引起近侧闭合管40向近侧滑动，导致远侧闭合管42向近侧滑动，这凭借突出部27插入远侧闭合管42的窗口45中，从而引起砧座24围绕枢轴点25枢转进打开或未夹紧位置。这样，通过回缩和锁定闭合触发器18，操作者便可以夹紧在砧座24和槽22之间的组织，并且可在切割/缝合操作之后将闭合触发器20从锁定位置解锁而松开组织。
机动化外科器械的其他构型公开于名称为“Motor-driven surgicalcutting and fastening instrument with tactile position feedback”的已公布的美国专利申请公布No.2007/0175962A1中，该专利申请公布全文以引用的方式并入本文。
图11为根据本发明的各种实施例的马达控制电路的示意图。在各种实施例中，马达控制电路可以包括一个或多个集成电路(IC)，例如处理器、存储器、微控制器、时限电路等。在其他实施例中，马达控制电路可以不包括任何IC。此类非IC马达控制电路可为有利的，因为对包括IC的外科器械消毒通常比较困难、复杂并且昂贵。
当操作者在锁定闭合触发器18后首先牵拉击发触发器20，传感器110被启动（或闭合，其中传感器110为开关），从而允许电流流过其中。如果常开反向马达传感器开关130打开（意指尚未到达端部执行器行程的尽头），则电流将流到单刀双掷继电器132。当反向马达传感器开关130未闭合时，继电器132的线圈134将不会通电，因此继电器132将处于其断电状态。
如图11中所示，电路还可以包括并联连接的电阻元件144和开关146，其中并联元件与继电器132串联连接。电阻元件144和开关146还连接到功率源64。可以通过响应于切割器械位置传感器150的控制电路148控制开关146。根据各种实施例，当切割器械32(i)非常接近于其行程起点以及(ii)非常接近于其行程终点时，控制电路148可以打开开关146。例如，如通过切割器械位置传感器150测得，当切割器械32(i)距离其行程起点0.001英寸以及(ii)距离其行程终点0.001英寸时，控制电路可以打开开关。随着开关146打开，电流流过电阻元件144，然后流过继电器132、继电器138、马达运转传感器开关110，到达马达65。流过电阻元件144的电流降低了递送至马达65的电流强度，从而降低了马达65递送的功率。因此，当切割器械32(i)非常接近于其行程的起点或(ii)非常接近于其行程的终点时，马达65递送的功率降低。相反地，一旦切割器械32运动到与其行程起点或终点足够远时，控制电路148可以闭合开关146，从而使电阻元件144短路，从而增加到达马达65的电流，从而增加马达递送的功率。
根据各种实施例，电路还包括闭锁传感器开关136a-d，所述开关共同限定联锁电路137，来自断电时的继电器132的电流通过该联锁电路，用于引发马达65的电操作。每个闭锁传感器开关136a-d可能够分别响应于相应条件的存在或不存在，保持打开（即非导电）开关状态或闭合（即导电）开关状态。当器械10被击发时，任何相应条件（如果存在）均可以导致不符合要求的切割和缝合操作和/或对器械10的损坏。闭锁传感器开关136a-d可以响应的条件包括例如(a)槽22中不存在钉仓34，(b)槽22中存在用过的（例如先前击发的）钉仓34，以及(c)砧座24相对于槽22的打开（或以其他方式不完全闭合的）位置。闭锁传感器开关136a-d可以响应的其他条件，例如部件磨损，可以根据由器械10产生的击发操作的累计数量推断。因此，在各种实施例中，如果这些条件中的任何一者存在，相应的闭锁传感器开关136a-d保持打开开关状态，从而防止引发马达65运行所需的电流通过。在各种实施例中，仅在所有条件改善后，允许电流通过闭锁传感器136a-d。应当理解，上述条件仅以举例的方式提供，并且可以提供其他闭锁传感器开关，以响应于不利于器械10的操作的其他条件。类似地应当理解，对于上述条件中的一者或多者可以不存在或无关紧要的实施例，闭锁传感器开关的数量可以少于描述的数量。
如图11中所示，可以使用常开开关构型实施闭锁传感器开关136a，使得当钉仓34位于对应于其被槽22恰当容纳的位置时，保持闭合开关状态。当钉仓34未安装到槽22中时，或不恰当地安装（例如未对齐）时，闭锁传感器开关136a保持打开开关状态。可以使用常开开关构型实施闭锁传感器开关136b，使得仅当未用过的钉仓34（即具有处于未击发位置的滑动件33的钉仓34）存在于槽22中时，保持闭合开关状态。槽22中存在用过的钉仓34使得闭锁传感器开关136b保持打开开关状态。可以使用常开开关构型实施闭锁传感器开关136c，使得当砧座24相对于槽22位于闭合位置时，保持闭合开关状态。可以根据延时特征控制闭锁传感器开关136c，其中仅在砧座24位于闭合位置一段预定时间后，保持闭合开关状态。
可以使用常闭开关构型实施闭锁传感器开关136d，使得仅当器械10产生的击发的累计数量小于预定数量时，保持闭合开关状态。闭锁传感器开关136d可与计数器139连通，该计数器能够保持代表由器械10进行的击发操作的累计数量的计数，将计数与预定数量相比，以及根据比较结果控制闭锁传感器开关136d的开关状态。虽然图11中单独地显示，但应当理解，计数器139可与闭锁传感器开关136d集成，以便形成共同装置。优选地，计数器139实施为电子装置，其具有用于根据为其提供的离散电信号的转变增大保持的计数的输入。应当理解，可以替代使用机械计数器，其能够根据机械输入（例如击发触发器20的回缩）保持计数。当实施为电子装置时，存在于电路中的任何离散信号可用于计数器139输入，所述离散信号对于每次击发操作转变一次。如图11所示，可以使用例如通过行程结束传感器130的致动得到的离散电信号。计数器139可以控制闭锁传感器开关136d的开关状态，使得当保持的计数小于计数器139中存储的预定数量时，保持闭合开关状态。当保持的计数等于预定数量时，计数器139使得闭锁传感器开关136d保持打开开关状态，从而防止电流通过其中。应当理解，可以根据需要选择性地调节计数器139存储的预定数量。根据各种实施例，计数器304可与集成到器械10的外部显示器（未示出）例如LCD显示器连通，用于向使用者指示保持的计数或预定数量与保持的计数之间的差值。
根据各种实施例，联锁电路137可以包括器械10的使用者可见的一个或多个指示器，用于显示闭锁传感器开关136a-d中的至少一者的状态。有关此类指示器的更多细节可见于名称为“Electronic lockouts and surgicalinstrument including same”的已公布的美国专利申请公布No.2007/0175956，该专利申请公布全文以引用的方式并入本文。本专利申请还包括闭锁传感器开关136a-d的示例性安装布置和构型。
在图示实施例中，当闭锁传感器开关136a-d共同保持闭合开关状态时，单刀单掷继电器138将通电。当继电器138通电时，电流流过继电器138，流过马达运转开关传感器110并经由双刀双掷继电器140到达马达65，从而为马达65供电并允许其正向旋转。根据各种实施例，因为继电器138一旦通电，其输出将继电器138保持在通电状态，直至继电器132通电，联锁电路137将不能在引发马达165后防止其运行，即使联锁传感器开关136a-d中的一者或多者随后保持打开开关状态。然而在其他实施例中，可能需要或换句话讲期望连接联锁电路137和继电器138，使得一个或多个闭锁传感器开关136a-d必须保持闭合开关状态，以便在引发马达165后维持其运行。
在各种实施例中，马达的正向旋转使得环84朝远侧运动，从而停用止动马达传感器开关142。因为开关142为常闭的，连接到开关142的螺线管141可通电。螺线管141可以是常规的推式螺线管，该推式螺线管通电时，使得柱塞（未示出）轴向延伸。柱塞的延伸可用于将闭合触发器18保持在回缩位置，从而防止砧座24在击发操作的进行过程中（即，在开关142未被致动时）打开。在螺线管141断电后，回缩柱塞，使得闭合触发器18的手动释放成为可能。
当端部执行器12到达其行程的尽头时，反向马达传感器130将被启动，从而闭合开关130并且为继电器132供电。这使继电器132呈现其通电状态（图11中未示出），从而使电流绕过联锁电路137和马达运转传感器开关110，并且作为使电流流到常闭双刀双掷继电器140并返回马达65的代替，使电流以通过继电器140的方式引起马达65倒转其旋转方向。因为止动马达传感器开关142是常闭的，所以电流将流回到继电器132以保持其通电状态，直到开关142打开为止。当刀32完全回缩时，止动马达传感器开关142被启动，使得开关142打开，从而将电能从马达65移除，并使螺线管141断电。
在其他实施例中，可以使用其他替代方案限制在切割行程循环中特定时间段内供给马达65的电流。其他实施例在美国专利申请序列号12/235,782中有所描述，该专利申请全文以引用的方式并入本文。
在一些情况下，可以有利地为马达65提供电流瞬时增加，以增大输出扭矩。图19示出了为根据各种实施例的马达65提供瞬时增加的电路的实施例。该电路类似于图11中示出的电路，不同的是图19的电路还包括连接到功率源64的充电蓄电池装置1000。充电蓄电池装置1000可以是可存储电荷的任何装置，例如电容器。例如，充电蓄电池装置1000可以包括超级电容器（有时称为超级电容）。当首先打开马达65时，例如当开关110由于击发触发器20的回缩而闭合时，开关S1可以闭合，以使得电池64可对马达65提供电能，如上所述。此外，开关S3还可以仅闭合较短时间段（“充电时段”），以通过电阻器R1对充电蓄电池装置1000充电。例如，根据各种实施例，开关S3可以闭合1至10RC时间常数，其中R为电阻器R1的电阻，C为充电蓄电池装置1000的电容。
充电蓄电池装置1000中的电荷在正常运行条件下可以保持未使用，但如果手术中出现临床医生需要来自马达65的额外输出扭矩的时候，可将充电蓄电池装置1000与电池64串联。这可例如通过打开开关S1和闭合开关S2（S3在充电时间后仍然打开）来实现。随着开关S2闭合，充电蓄电池装置1000将与电池64串联连接，从而为马达65提供额外的电流。
可以通过多种方式检测需要充电蓄电池装置1000的条件。例如，可以存在连接到击发触发器20的可变电阻器或弹簧。当击发触发器回缩超过特定点或以大于阈值水平的力回缩时，充电蓄电池装置1000可以串联连接到电池64。除此之外或作为另外一种选择，柄部6可以包括外部开关（未示出），临床医生可启动该外部开关，以使充电蓄电池装置1000与电池64串联连接。
可以在具有或不具有如上结合图11所述的限流装置的情况下使用充电蓄电池装置1000。
在器械10的使用过程中的某些时间，可以有利地使马达65以高速但相对较低的扭矩输出运行。在其他时间，可以有利地使马达65具有高扭矩输出但速度较低。根据各种实施例，该功能可用具有多个（例如两个或更多个）线圈的马达65完成，如图20中所示。在图示实施例中，马达具有两个线圈。第一线圈1200可以具有线圈半部（或部分）1201和1202。第二线圈1204可以具有线圈半部（或部分）1206和1208。该例子中的马达65可以是具有双极驱动电路1210的6或8引线马达（参见例如图11和12）。需要高速低扭矩模式时，两组线圈可以串联连接。在该模式下，如图20中所示，开关S1和S4闭合，并且开关S2、S3、S5和S6打开。需要低速高扭矩模式时，两组线圈可以并联连接。在该模式下，开关S1和S4打开，并且开关S2、S3、S5和S6闭合。在两种模式间转变的能力有效地形成双速转变，而无需另外的活动部件。它还允许相同马达即使不在同一时间，也能产生高速和高扭矩输出。这种构型的优点在于，其避免了使用多个马达。此外，可以消除一些传动装置，因为马达65在处于并联模式时可产生额外的扭矩，并且在处于串联模式时可产生额外的速度。此外，可采用其他线圈，使得更多数量的运行模式可以实现。例如，可存在用于串联和并联线圈连接的多个组合的线圈。另外，一些线圈可用于感测马达条件等。
根据各种实施例，柄部6可以包括外部马达模式选择开关1220，如图21中所示。通过使用开关1220，器械10的操作者可选择马达65是处于高速低扭矩模式还是处于低速高扭矩模式。其他开关电路也可用于马达65在运行模式之间切换，例如根据传感器输入自动切换马达模式的开关电路。
在机动化外科器械例如上述机动化内窥镜式器械的一者中或在机动化圆形切割器器械中，马达可以通过多个串联连接的电池单元提供电能。另外，在某些情况下可以有利地用电池单元总数的小部分为马达提供电能。例如，如图12中所示，可以通过包括六(6)个串联连接的电池单元310的功率源组299为马达65提供电能。电池单元310可以是例如3伏锂电池单元，例如CR123A电池单元，但在其他实施例中，可使用不同类型的电池单元（包括具有不同电压水平和/或不同化学品的电池单元）。如果将6个3伏电池单元310串联连接以便为马达65提供电能，可用于为马达65提供电能的总电压将为18伏。电池单元310可以包括可充电或不可充电电池单元。
在此类实施例中，在最大负载下，马达65的输入电压可以下降至约9至10伏。在此运行条件下，功率源组299向马达65输送最大功率。因此，如图12中所示，电路可以包括开关312，该开关选择性地允许通过(1)所有电池单元310或(2)一部分电池单元310为马达65提供电能。如图12中所示，通过适当选择，开关312可以允许马达65通过所有6个电池单元或4个电池单元提供电能。这样，开关312可用于通过18伏（使用所有6个电池单元310时）或12伏（如此使用第二电池单元中的4个）为马达65提供电能。在各种实施例中，用于为马达65提供电能的小部分电池单元的数量的设计选择可以基于马达65在最大负载的最大输出下运行时所需的电压。
开关312可以是例如电动机械开关，例如微动开关。在其他实施例中，开关312可以用固态开关例如晶体管实施。诸如按钮开关的第二开关314可用于控制是否对马达65施加电能。另外，正向/反向开关316可用于控制马达65以正向或反向旋转。正向/反向开关316可以用双刀双掷开关实施，例如图11中示出的继电器140。
在操作中，器械10的使用者可通过使用某种开关控制（例如控制开关312的位置的位置相关开关（未示出），例如切换开关、机械杠杆开关或凸轮）选择需要的功率电平。然后使用者可以启动第二开关314，以将选择的电池单元310连接到马达65。此外，图12中示出的电路可用于为其他类型的机动化外科器械（例如圆形切割器和/或腹腔镜式器械）的马达提供电能。有关圆形切割器的更多细节可见于已公布的美国专利申请公布No.2006/0047307A1和公布No.2007/0262116A1，所述专利申请公布以引用的方式并入本文。
在其他实施例中，如图13中所示，主功率源340，例如电池单元，例如CR2或CR123A电池单元可用于为多个次级充电蓄电池装置342充电。主功率源340可以包括一个或多个串联连接的电池单元，在图示实施例中，所述电池单元优选地为可替换的。次级充电蓄电池装置342可以包括例如可充电电池单元和/或超级电容器（也称为“超级电容”或“电化学双层电容”(EDLC)）。超级电容器为电化学电容器，该电化学电容器与普通电解质电容器相比具有异常高的能量密度，通常大于高容量电解质电容器的大约数千倍。
主功率源340可以为次级充电蓄电池装置342充电。一旦充分充电，可以移除主功率源340并且在手术或操作过程中可以使用次级充电蓄电池装置342为马达65提供电能。在各种情况下，充电蓄电池装置342可花费约15至30分钟进行充电。超级电容器具有这样的特征，相比于常规电池，它们可极快地充电和放电。此外，电池仅对有限数量的充电/放电循环有效，而超级电容器通常可反复充电/放电，有时可达到数千万次循环。对于使用超级电容器作为次级充电蓄电池装置342的实施例，超级电容器可以包括碳纳米管、导电聚合物（例如聚并苯）或碳气凝胶。
如图14中所示，充电管理电路344可用于判定次级充电蓄电池装置342何时充分充电。充电管理电路344可以包括指示器，例如一个或多个LED、LCD显示器等，所述指示器被启动以在次级充电蓄电池装置342充分充电时警示器械10的使用者。
主功率源340、次级充电蓄电池装置342和充电管理电路344可以是器械10的柄部6的手枪式握把部26中的功率源组的一部分，或位于器械10的另一个部分中。功率源组可以从手枪式握把部26移除，在这种情况下，当器械10将用于外科手术时，可以通过例如辅助进行外科手术的巡回护士将功率源组无菌地插入手枪式握把部26（或根据其他实施例的器械中的其他位置）。插入功率源组后，护士可将可替换主功率源340置于功率源组中，以在使用器械10之前为次级充电蓄电池装置342充电特定时间段，例如30分钟。当次级充电蓄电池装置342充电完成时，充电管理电路344可以指示功率源组已准备好使用。这时，可以移除可替换的主功率源340。在操作过程中，然后器械10的使用者可以例如通过启动开关314来启动马达65，由此次级充电蓄电池装置342为马达65提供电能。因此，在此类实施例中可使用一个一次性电池（作为主功率源340），而不是让多个一次性电池为马达65提供电能，并且次级充电蓄电池装置342可为可重复使用的。然而，在可供选择的实施例中，应该指出的是次级充电蓄电池装置342可为不可充电的和/或不可重复使用的。次级蓄电器342可以与上文结合图12描述的单元选择开关312一起使用。
充电管理电路344还可以包括指示次级充电蓄电池装置342中保持了多少电荷的指示器（例如LED或LCD显示器）。这样，外科医生（或器械10的其他使用者）可以在涉及器械10的手术过程中知晓保持了多少电荷。
如图15中示出的充电管理电路344可以包括用于测量整个次级蓄电器342中的电荷的电荷仪345。充电管理电路344还可以包括诸如闪存或ROM存储器的非易失性存储器346以及一个或多个处理器348。处理器348可以连接到存储器346以控制存储器。此外，处理器348可以连接到电荷仪345以读取电荷仪345的读数以及以其他方式控制电荷仪345。另外，处理器348可以控制LED或充电管理电路344的其他输出装置。处理器348可将器械10的参数存储在存储器346中。参数可以包括通过可安装在器械10中或在其中使用的各种传感器感测的器械的运行参数，例如击发次数、所涉及的力的水平、端部执行器12的相对钳口之间的压缩间隙的距离、关节运动量等。另外，存储器346中存储的参数可以包括器械10的各种部件的ID值，充电管理电路344可以读取和存储这些值。具有此类ID的部件可以是可替换的部件，例如钉仓34。ID可以是例如充电管理电路344通过RFID转发器350读取的RFID。RFID转发器350可以从器械的部件读取RFID，例如包括RFID标签的钉仓34。可以读取ID值，将其存储在存储器346中，通过处理器348将其与存储器346或另一个与充电管理电路相关联的存储器中存储的可接受ID值的列表进行比较，以判定例如与读取的ID值相关联的可移除/可替换的部件是否可靠和/或合适。根据各种实施例，如果处理器348判定与读取的ID值相关联的可移除/可替换的部件不可靠，则充电管理电路344可以例如通过打开开关（未示出）防止器械10使用功率源组，所述打开开关可防止来自功率源组的功率被输送到马达65。根据各种实施例，处理器348可以评价以判定部件是否可靠和/或合适的各种参数包括：日期代码、部件型号/类型、制造商、区域信息以及以前的错误代码。
充电管理电路344还可以包括输入输出接口352，以与如下文所述的另一个装置连通。这样，可以将存储器346中存储的参数下载到另一个装置。输入输出接口352可以是例如有线或无线接口。
如前所述，功率源组可以包括次级蓄电器342、充电管理电路344和/或正/反开关316。根据各种实施例，如图16中所示，功率源组299可连接到充电器座362，其此外可以为功率源组中的次级蓄电器342充电。可通过在功率源组安装在器械10中时将充电器座362无菌连接到功率源组299，来将充电器座362连接到功率源组299。在功率源组为可移除的其他实施例中，可通过将功率源组299从器械10移除并将其连接到充电器座362，来将充电器座362连接到功率源组299。对于此类实施例，在充电器座362对次级蓄电器342充分充电后，可以将功率源组299无菌地安装在器械10中。
如图16所示，充电器座362可以包括为次级蓄电器342充电的功率源364。充电器座362的功率源364可以是例如电池（或多个串联连接的电池）或将例如来自输电干线的交流电转换为直流电的AC/DC换流器，或为次级蓄电器342充电的任何其他合适的功率源。充电器座362还可以包括指示器装置，例如LED、LCD显示器等，以显示次级蓄电器342的充电状态。
此外，如图16中所示，充电器座362可以包括一个或多个处理器366、一个或多个存储器单元368以及输入输出接口370、372。通过第一输入输出接口370，充电器座362可与功率源组299连通（经由功率源组的输入输出接口352）。这样，例如可以将存储在功率源组299的存储器346中的数据下载到充电器座362的存储器368。这样，处理器366可评价从充电管理电路344下载的可移除/可替换的部件的ID值，以判定部件的可靠性和适用性。还可以将从充电管理电路344下载的运行参数存储在存储器368中，然后经由第二输入输出接口372将其下载到另一个计算机装置，用于例如通过其中进行涉及器械10的操作的医院系统、通过外科医生办公室、通过器械经销商、通过器械制造商等进行评价和分析。
充电器座362还可以包括用于测量整个次级蓄电器342中的电荷的电荷仪374。电荷仪374可与一个或多个处理器366连通，以使得一个或多个处理器366可实时判定功率源组299的适用性，以用于确保高性能。
在另一个实施例中，如图17中所示，电池电路可以包括功率调节器320以控制省电器310供给马达65的电能。功率调节器320还可以是功率源组299的一部分，或者其可以是单独的部件。如上所述，马达65可以是刷式马达。刷式马达的速度通常与施加的输入电压成比例。功率调节器320可以为马达65提供高度调控的输出电压，以使得马达65将在恒定（或基本上恒定的）速度下运行。根据各种实施例，功率调节器320可以包括开关模式功率源转换器，例如如图17的实例中示出的降压升压转换器。此类降压升压转换器320可以包括功率源开关322，例如FET、整流器32、感应器326和电容器328。当功率源开关322打开时，输入电压源（例如功率源310）直接连接到在该状态下存储能量的感应器326。在该状态下，电容器328为输出负载（例如马达65）提供能量。当功率源开关320处于关闭状态时，感应器326连接到输出负载（例如马达65）和电容器328，因此能量从感应器326转移到电容器328和负载65。控制电路330可以控制功率源开关322。控制电路330可以采用数字和/或模拟控制回路。此外，在其他实施例中，控制电路330可以经由诸如串行或并行数字数据总线的通信链路接收来自主控制器（未示出）的控制信息。可以将功率调节器320的输出的电压设定点设定为例如开路电压的一半，在该设定点可从功率源得到的最大功率可供使用。
在其他实施例中，可以采用不同的功率源转换器拓扑，包括线型或开关模式功率源转换器。其他可用的开关模式拓扑包括反激式、正激式、降压式、升压式和SEPIC。可以根椐用于为马达65提供电能的电池单元的数量，来改变功率调节器320的设定点电压。另外，功率调节器320可与图13中示出的次级充电蓄电池装置342一起使用。另外，正向-反向开关316可结合到功率调节器320，虽然在图17中为单独显示的。
电池通常被建模为理想的电压源和源电阻。对于理想模型，当源电阻和负载电阻匹配时，最大功率转移到负载。图18示出了电池的典型功率曲线。当电池电路打开时，电池两端的电压较高（为其开路值）并且从电池引出的电流为零。从电池递送的功率也为零。随着从电池引出更多电流，电池两端的电压降低。电池递送的功率为电流和电压的乘积。功率在小于开路电压的电压电平附近达到其峰值。如图18所示，对于大多数电池化学品，由于化学品或正温度系数(PTC)，或者由于电池保护装置，电压/功率在较高的电流下急剧下降。
尤其是对于在手术过程中使用电池（或多个电池）为马达65提供电能的实施例而言，控制电路330可监测输出电压并控制调节器320的设定点，以使得电池在功率曲线的“左侧”或功率递增侧运行。如果电池达到峰值功率电平，控制电路330可改变（例如降低）调节器的设定点，以使得对电池要求更低的总功率。然后马达65将减速。这样，对功率源组的要求几乎从不超过可用功率峰值，以使得手术过程中可避免功率不足的情形。
此外，根据其他实施例，可以这样的方式优化从电池引出的功率：电池单元内的化学反应将有时间恢复，从而优化可从电池得到的电流和功率。在脉冲负载下，电池通常在脉冲开始比脉冲结束提供更多电能。这归因于若干因素，包括：(1)PTC可以在脉冲过程中改变其电阻；(2)电池的温度可以改变；以及(3)电化学反应速率由于阴极处的电解液减少而改变，以及新鲜电解液的扩散速率限制了反应速率。根据各种实施例，控制电路330可以控制转换器320，以使其从电池引出减小的电流，以允许电池在再次脉冲前恢复。
如上所述，根据各种实施例，电池组299可以包括多个电池单元310。图22示出了具有六(6)个电池单元310的实施例。电池单元310可以是例如锂原电池。根据各种实施例，电池组299可以仅具有一小部分内部连接的电池单元。例如，如图22中所示，单元310a连接到单元310b，单元310c连接到单元310d，并且单元310e连接到单元310f。然而，在电池组中单元310b不与单元310c内部连接，并且在电池组中单元310d不与单元310e内部连接。在此类实施例中，器械10的柄部6可以包括电池单元连接器1300，该连接器仅在电池组299物理插入器械10中时串联连接单元310。例如，连接器1300可以包括正输出端1302，将单元310b串联连接到单元310c的连接器1304，将单元310d连接到单元310e的连接器1306，以及负输出端1308。
图23示出了器械10的实施例，其中可替换的、可移除的电池组299安装在器械10的柄部6中。如图23所示，电池单元连接器1300可以集成到柄部6中，使得当电池组299插入柄部6中时，电池单元连接器1300形成必要的电池单元连接。
当然在其他实施例中，可以使用具有不同数量的内部单元和不同数量的内部连接单元的电池组。例如，图24示出了具有6个单元310a-f的实施例，其中3个单元的两组（单元310a-c和单元310d-f）连接在一起。
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，所述装置均可进行修复，以在至少一次使用后再次使用。重新修复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分以及随后组装。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/或置换特定部分后，该装置可以在修复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，装置的修复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修复装置均在本发明的范围内。
优选地，在外科手术之前将对本文所述的发明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。在一种消毒技术中，将器械置于密闭和密封的容器中，例如用TYVEK片覆盖的热成型塑料壳体。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。辐射将装置上和容器中的细菌杀死。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。
装置优选地经过消毒。这可以通过任意数目的本领域技术人员已知的方式来进行，包括β辐射、γ辐射、环氧乙烷、蒸汽和其他方法。
虽然已经通过描述几个实施例举例说明了本发明并且已经相当详细地描述了示例性实施例，但是申请人不旨在将权利要求的范围约束或以任何方式限制到这些细节中。本领域的技术人员可容易看出其他优点和修改形式。本发明的各种实施例表示了相对于现有缝合方法的巨大改进，所述现有缝合方法需要使用单个仓中的不同尺寸的钉以实现具有不同成形（最终）高度的钉。
因此，本发明对内窥镜式手术和设备进行了讨论。但是，本文使用的术语，例如“内窥镜式”不应被理解为将本发明限于仅结合内窥镜式管（即，套管针）使用的外科缝合切断器械。与此相反，本发明据认为可用于进入受限的任何手术中，包括但不限于腹腔镜式手术以及开腹手术。此外，在不脱离本发明的实质和范围的情况下，本发明的各种钉仓的实施例的独特和新颖的方面当与其他形式的缝合设备结合使用时具有效用。
多年以来，已经开发出多种微创机器人（或“远距离外科手术”）系统以增加外科手术的灵活性，并允许外科医生以直观的方式对患者进行手术。多个此类系统在以下美国专利中有所公开，所述各个美国专利全文以引用的方式并入本文：名称为“Articulated Surgical Instrument ForPerforming Minimally Invasive Surgery With Enhanced Dexterity andSensitivity”的美国专利No.5,792,135、名称为“Robotic Arm DLUS ForPerforming Surgical Tasks”的美国专利No.6,231,565、名称为“RoboticSurgical Tool With Ultrasound Cauterizing and Cutting Instrument”的美国专利No.6,783,524、名称为“Alignment of Master and Slave In a MinimallyInvasive Surgical Apparatus”的美国专利No.6,364,888、名称为“Mechanical Actuator Interface System For Robotic Surgical Tools”的美国专利No.7,524,320、名称为“Platform Link Wrist Mechanism”的美国专利No.7,691,098、名称为“Repositioning and Reorientation of Master/SlaveRelationship in Minimally Invasive Telesurgery”的美国专利No.7,806,891以及名称为“Surgical tool With Writed Monopolar Electrosurgical EndEffectors”的美国专利No.7,824,401。然而，过去的多个此类系统已不能生成有效切割和紧固组织所需量级的力。
图25示出了可结合图26中示出的从属机械臂车1100类型使用的主控制器1001的一个型式。主控制器1001和从属机械臂车1100以及它们各自的部件和控制系统在本文中统称为机器人系统1000。此类系统和装置的实例公开于美国专利No.7,524,320中，所述专利以引用的方式并入本文。因而，除了可能必要的理解本发明的多种实施例和形式以外，本文将不详细地描述此类装置的各个细节。众所周知，主控制器1001通常包括如下主控制器（在图25中一般表示为1003）：在外科医生通过立体显示器1002观察手术的同时，所述主控制器由外科医生抓持并在空中操控。主控制器1001通常包括手动输入装置，所述手动输入装置优选地以多个自由度移动并通常还具有用于致动工具（例如，用于闭合抓持锯、施加电势到电极等）的致动手柄。
如图26所示，在一种形式中，机械臂车1100能够致动多个外科工具，一般称为1200。使用主控制器和机械臂车布置的各种机器人外科系统和方法公开于名称为“Multi-Component Telepresence System and Method”的美国专利No.6,132,368中，该专利的全部公开内容以引用的方式并入本文。在各种形式中，机械臂车1100包括基座1002，在图示实施例中，所述基座支撑有三个外科工具1200。在各种形式中，外科工具1200均由一系列手动关节运动的连杆（一般称为装置接头1104）和机器人操纵器1106支撑。本文示出的这些结构具有在机器人连杆的大部分之上延伸的护盖。这些护盖可以是任选的，并且可在尺寸上有所限制或在一些实施例中完全消除，以使用于操纵此类装置的伺服机构遇到的惯性最小化、限制移动部件的体积以避免碰撞并且限制车1100的总重量。车1100将通常具有适于在手术室之间搬运车1100的尺寸。车1100可能够为通常适于穿过标准的手术室门并放置到标准的医院电梯上。在各种形式中，车1100可优选地具有重量并包括轮（或其他运输）系统，所述轮系统允许由单个维护人员将车1100设置在邻近手术台。
现在参见图27，在至少一种形式中，机器人操纵器1106可以包括限制外科工具1200的运动的连杆1108。在各种实施例中，连杆1108包括由旋转接头以平行四边形布置方式联接在一起的刚性连接件，使得外科工具1200围绕空间1110中的某一点旋转，如在公布的美国专利No.5,817,084中更完整地描述，所述专利的全部公开内容以引用的方式并入本文。平行四边形布置方式将旋转限制为围绕轴1112a（有时称为俯仰轴）枢转。支撑平行四边形连杆的连接件可枢转地安装到装置接头1104（图26）上，使得外科工具1200进一步围绕轴1112b（有时称为偏航轴）旋转。俯仰轴1112a和偏航轴1112b在远程中心1114处相交，所述远程中心沿着外科工具1200的轴1208对齐。当由操纵器1106支撑时，外科工具1200可以具有另外的驱动自由度，包括外科工具1200沿着纵向工具轴线“LT-LT”的滑动运动。当外科工具1200沿着工具轴线LT-LT相对于操纵器1106滑动（箭头1112c）时，远程中心1114相对于操纵器1106的基座1116保持固定。从而，使整个操纵器总体上发生移动以重新定位远程中心1114。操纵器1106的连杆1108由一系列的马达1120驱动。这些马达响应于控制系统处理器的命令而主动移动连杆1108。如将在下文中进一步详细描述，马达1120还用于操纵外科工具1200。
图28中示出了可供选择的装置接头结构。在该实施例中，外科工具1200由两个组织操纵工具之间的可供选择的操纵器结构1106'支撑。本领域的普通技术人员将会知道本发明的各种实施例可以包括多种可供选择的机器人结构，包括描述于名称为“Automated Endoscope System For OptimalPositioning”的美国专利No.5,878,193中的那些，该专利的全部内容以引用的方式并入本文。另外，虽然结合外科工具1200和主控制器1001之间的连通在本文中初步描述了机器人部件和机器人外科系统的处理器之间的数据连通，应当理解，类似的连通可发生在操纵器、装置接头、内窥镜或其他图像捕获装置等的电路和机器人外科系统的处理器之间，所述机器人外科系统的处理器用于部件兼容性确认、部件类型识别、部件校正（例如偏移等）通信、部件与机器人外科系统的联接确认等。
图29中示出了非常适于与机器人系统1000一起使用的示例性的非限制性外科工具1200，所述机器人系统具有可操作地联接到主控制器1001的工具驱动组件1010（图30），所述主控制器可通过操作者（即，外科医生）的输入来运行。如图所示，外科工具1200包括外科端部执行器2012，所述端部执行器包括线切割器。在至少一种形式中，外科工具1200通常包括细长轴组件2008，所述细长轴组件具有通过关节运动接头2011联接在一起的近侧闭合管2040和远侧闭合管2042。外科工具1200通过工具安装部分（一般称为1300）可操作地联接到操纵器。外科工具1200还包括将工具安装部分1300机械地且电力地联接到操纵器的接口1230。接口1230的一种形式在图27-31中示出。在各种实施例中，工具安装部分1300包括工具安装板1302，所述工具安装板可操作地支撑多个（图34中示出了四个）可旋转主体部分、从动盘或从动元件1304，所述每个从动盘或从动元件均包括从从动元件1304的表面延伸的一对销1306。一个销1306比相同从动元件1304上的其他销1306更靠近每个从动元件1304的旋转轴，这有助于确保从动元件1304的正向角对齐。接口1230包括能够与安装板1302以安装方式接合的适配器部分1240，如将在下文中进一步描述。适配器部分1240可包括一系列电连接销1242（图32），所述电连接销可通过工具安装部分1300中的电路板联接到存储器结构。虽然结合机械耦合元件、电耦合元件和磁力耦合元件在本文描述了接口1230，应当理解，可使用多种遥测形式，包括红外、电感耦合等。
如图30-33所示，适配器部分1240通常包括工具侧1244和夹持器侧1246。在各种形式中，将多个可旋转主体1250安装到浮动板1248，所述浮动板相对于垂直于适配器1240主表面的周围适配器结构具有限定的运动范围。当沿着工具安装部分外壳1301的侧面致动杠杆1303时（参见图29），浮动板1248的轴向运动有助于使可旋转主体1250从工具安装部分1300脱离。可采用其他机构/布置以可释放的方式将工具安装部分1300联接到适配器1240。在至少一种形式中，通过弹性径向构件将可旋转主体1250弹性地安装到浮动板1248，所述弹性径向构件围绕可旋转主体1250延伸到周边凹痕中。可旋转主体1250可通过偏转这些弹性结构相对于板1248轴向运动。当设置在第一轴向位置（朝工具侧1244）时，可旋转主体1250自由旋转而没有角度限制。然而，当可旋转主体1250朝工具侧1244轴向运动时，突出部1252（从可旋转主体1250径向延伸）横向接合浮动板上的闭锁装置以便限制可旋转主体1250围绕其轴线的角旋转。当驱动销1272将可旋转主体1250推动到受限的旋转位置直到销1234与开口1256’对齐（并滑动到其中）时，可使用该受限的旋转以有助于可旋转主体1250与机器人系统1000的对应工具架部分1270的驱动销1272驱动接合。可旋转主体1250的工具侧1244上的开口1256和夹持器侧1246上的开口1256’能够使工具安装部分1300的从动元件1304（图34）与工具架1270的驱动元件1271准确对齐。有关从动元件1304的内侧和外侧销1306如上所述，开口1256,1256’位于相距其各自的旋转主体1250的旋转轴线不同的距离处，以确保与之要达到的位置不呈180度对齐。另外，每个开口1256略微径向伸长，以适当地容纳周边方向上的销1306。这使得销1306在开口1256、1256’内径向滑动并适应工具1200和工具架1270之间的一些轴偏差，同时使驱动元件和从动元件之间的任何角偏差和角侧隙最小化。工具侧1244上的开口1256与夹持器侧1246上的开口1256’（以虚线示出）成约90度的偏移，如图33中明显地示出。
各种实施例还可包括位于适配器1240夹持器侧1246上的一系列电连接器销1242，并且适配器1240的工具侧1244可包括狭槽1258（图33）以用于容纳工具安装部分1300的销阵列（未示出）。除了在外科工具1200和工具架1270之间传输电信号之外，可通过适配器1240的电路板将这些电连接器中的至少一些联接到适配器存储器装置1260（图32）。
可使用可拆卸的闩锁布置1239以可释放的方式将适配器1240附连到工具架1270。如本文所用，术语“工具驱动组件”在用于机器人系统1000的上下文中时至少涵盖适配器1240和工具架1270的各种实施例，并且其在图30中一般称为1010。例如，如图30所示，工具架1270可包括第一闩锁销布置1274，所述第一闩锁销装置的尺寸设定成容纳在设置于适配器1240中相应的连接叉狭槽1241中。另外，工具架1270还可包括第二闩锁销1276，所述第二闩锁销的尺寸被设定为保持在适配器1240中相应的闩锁连接叉1243中。参见图32。在至少一种形式中，闩锁组件1245可活动地支撑在适配器1240上，并且能够在第一闩锁位置和未闩锁位置之间偏置，在第一闩锁位置中，闩锁销1276保持在各自的闩锁连接叉1243中，在未闩锁位置中，第二闩锁销1276可进入闩锁连接叉1243或从中移除。使用弹簧（未示出）以将闩锁组件偏置到闩锁位置。适配器1240工具侧1244上的凸缘可滑动地容纳工具安装外壳1301的横向延伸的突出部。
然后转到图34-41，在至少一个实施例中，外科工具1200包括外科端部执行器2012，在该实例中，所述外科端部执行器此外包括至少一个部件2024，所述部件相对于至少一个其他部件2022在第一位置和第二位置之间响应于施加至其上的各种控制运动而选择性地运动，如将在下文中进一步详细地描述。在各种实施例中，部件2022包括能够可操作地支撑其中的外科钉仓2034的细长通道2022，并且部件2024包括可枢转地平移的夹紧构件，例如砧座2024。外科端部执行器2012的各种实施例能够使砧座2024和细长通道2022保持在确保有效缝合和切断夹持在外科端部执行器2012中的组织的间距处。如图40所示，外科端部执行器2012还包括切割器械2032和滑动件2033。例如，切割器械2032可以为刀。外科钉仓2034可操作地容纳其中支撑在可移动的钉驱动器（未示出）上的多个外科钉（未示出）。当切割器械2032朝远侧驱动穿过外科钉仓2034中居中设置的狭槽（未示出）时，其也向远侧推动滑动件2033。当滑动件2033朝远侧驱动时，其“楔形”构型接触可移动的钉驱动器并朝闭合砧座2024竖直驱动钉驱动器。当外科钉被驱动到位于砧座2024下侧的成形表面时，形成外科钉。滑动件2033可以是外科钉仓2034的一部分，使得当切割器械2032在切割操作后回缩时，滑动件2033不会回缩。砧座2024可在位于细长通道2022的近端的枢轴点2025处枢转地打开和闭合。砧座2024还可包括位于其近端的突出部2027，所述突出部与机械闭合系统（下文中进一步描述）的部件相互作用以利于砧座2024的打开。细长通道2022和砧座2024可以由导电材料（例如金属）制成，使得它们可作为与端部执行器中的一个或多个传感器连通的天线的一部分，如上所述。外科钉仓2034可以由非导电材料（例如塑料）制成，并且传感器可连接到或设置在外科钉仓2034中，也如上所述。
如图34-41所示，根据各种实施例，通过细长轴组件2008将外科端部执行器2012附接到工具安装部分1300。如图示实施例所示，轴组件2008包括关节运动接头（通常表示为2011），所述关节运动接头使外科端部执行器2012能够选择性地围绕关节运动轴线AA-AA进行关节运动，所述关节运动轴线AA-AA基本上横向于纵向工具轴线LT-LT。参见图35。在其他实施例中，省略了关节运动接头。在各种实施例中，轴组件2008可包括闭合管组件2009，所述闭合管组件包括通过枢转连接件2044枢转地连接和可操作地支撑在脊组件（一般描述为2049）上的近侧闭合管2040和远侧闭合管2042。在图示实施例中，脊组件2049包括远侧脊部分2050，所述远侧脊部分附接到细长通道2022并且可枢转地联接到近侧脊部分2052。闭合管组件2009能够响应于施加至其上的致动运动在脊组件2049上轴向滑动。远侧闭合管2042包括开口2045，砧座2024上的突出部2027插入到所述开口中以当远侧闭合管2042在近侧方向“PD”上轴向运动时有利于砧座2024的打开。闭合管2040、2042可以由导电材料（例如金属）制成，使得其可以用作天线的一部分，如上所述。主驱动轴组件（如，驱动轴2048、2050）的部件可以由非导电材料（例如塑料）制成。
在使用中，围绕纵向工具轴线LT-LT旋转外科端部执行器2012可能是有利的。在至少一个实施例中，工具安装部分1300包括旋转的传输组件2069，所述旋转的传输组件能够接收来自机器人系统1000的工具驱动组件1010的对应的旋转输出运动，并将此旋转输出运动转化成旋转控制运动以使细长轴组件2008（和外科端部执行器2012）围绕纵向工具轴线LT-LT旋转。在各种实施例中，例如，近侧闭合管2040的近端2060通过向前的支撑支架1309和同样可活动地支撑在工具安装板1302上的闭合滑动件2100被旋转地支撑在工具安装部分1300的工具安装板1302上。在至少一种形式中，旋转的传输组件2069包括管齿轮段2062，所述管齿轮段形成于（或附接到）近侧闭合管2040的近端2060上，以通过可操作地支撑在工具安装板1302上的旋转齿轮组件2070可操作地接合。如图37示，在至少一个实施例中，旋转齿轮组件2070包括旋转传动齿轮2072，当工具安装部分1300联接到工具驱动组件1010时，所述旋转传动齿轮联接到工具安装板1302的适配器侧1307上相应的从动盘或从动元件1304中的第一个。参见图34。旋转齿轮组件2070还包括旋转从动齿轮2074，所述旋转从动齿轮与管齿轮段2062和旋转传动齿轮2072以啮合的方式旋转地支撑在工具安装板1302上。将来自机器人系统1000的工具驱动组件1010的第一旋转输出运动施加到相应的从动元件1304，从而将引起旋转传动齿轮2072的旋转。旋转传动齿轮2072的旋转最终导致细长轴组件2008（和外科端部执行器2012）围绕纵向工具轴线LT-LT（图37中由箭头“R”表示）旋转。应当理解，在一个方向上施加来自工具驱动组件1010的旋转输出运动将引起细长轴组件2008和外科端部执行器2012围绕纵向工具轴线LT-LT在第一方向上旋转，并且在相对的方向上施加旋转输出运动将引起细长轴组件2008和外科端部执行器2012在相对于第一方向的第二方向上旋转。
在至少一个实施例中，通过在脊组件2049上沿着远侧方向“DD”使闭合管组件2009轴向运动来实现砧座2024相对于钉仓2034的闭合。如上所述，在各种实施例中，近侧闭合管2040的近端2060由闭合滑动件2100支撑，所述闭合滑动件包括闭合传动装置（一般描述为2099）的一部分。在至少一种形式中，闭合滑动件2100能够将闭合管2009支撑在工具安装板1320上，使得近侧闭合管2040能够相对于闭合滑动件2100旋转并且随闭合滑动件2100轴向行进。具体地讲，如图41所示，闭合滑动件2100具有直立的突出部2101，所述直立的突出部延伸到近侧闭合管2040的近端部分中的径向沟槽2063中。另外，如图39和42所示，闭合滑动件2100具有延伸穿过工具安装板1302中的狭槽1305的突出部部分2102。突出部部分2102能够保持闭合滑动件2100与工具安装板1302滑动接合。在各种实施例中，闭合滑动件2100具有直立部分2104，所述直立部分具有在其上形成的闭合齿条齿轮2106。闭合齿条齿轮2106能够与闭合齿轮组件2110驱动接合。参见图39。
在各种形式中，闭合齿轮组件2110包括闭合正齿轮2112，所述闭合正齿轮联接到工具安装板1302的适配器侧1307上相应的从动盘或从动元件1304中的第二个。参见图34。因此，当工具安装部分1300联接到工具驱动组件1010时，将来自机器人系统1000的工具驱动组件1010的第二旋转输出运动施加到相应的第二从动元件1304上将引起闭合正齿轮2112的旋转。闭合齿轮组件2110还包括与闭合正齿轮2112以啮合的方式而被支撑的闭合减速齿轮组2114。如图38和39所示，闭合减速齿轮组2114包括与闭合正齿轮2112以啮合的方式而被旋转地支撑的从动齿轮2116。闭合减速齿轮组2114还包括与第二闭合传动齿轮2120啮合的第一闭合传动齿轮2118，所述第二闭合传动齿轮与闭合齿条齿轮2106以啮合的方式而被旋转地支撑在工具安装板1302上。因此，将来自机器人系统1000的工具驱动组件1010的第二旋转输出运动施加到相应的第二从动元件1304将引起闭合正齿轮2112和闭合传动装置2110的旋转，并且最终轴向驱动闭合滑动件2100和闭合管组件2009。闭合管组件2009运动的轴向最终取决于第二从动元件1304旋转的方向。例如，响应于从机器人系统1000的工具驱动组件1010接收的一个旋转输出运动，将在远侧方向“DD”上驱动闭合滑动件2100并且最终在远侧方向上驱动闭合管组件1009。当朝远侧驱动远侧闭合管2042时，闭合管段2042的末端将接合砧座2024的一部分并使砧座2024枢转到闭合位置。当施加来自机器人系统1000的工具驱动组件1010的“开口”输出运动时，将沿着近侧方向“PD”驱动闭合滑动件2100和轴组件2008。当在近侧方向上驱动远侧闭合管2042时，其中的开口2045与砧座2024上的突出部2027相互作用以利于其打开。在各种实施例中，当将远侧闭合管2042运动至其起始位置时，可使用弹簧（未示出）以将砧座偏置至打开位置。在各种实施例中，闭合齿轮组件2110的各种齿轮的尺寸设定成能够产生所需的必要的闭合力，所述闭合力满意地在待由外科端部执行器2012切割和缝合的组织上闭合砧座2024。例如，闭合传动装置2110的齿轮的尺寸可设定成能够产生大约70-120磅的力。
在各种实施例中，通过刀杆2200驱动切割器械2032穿过外科端部执行器2012。参见图40和42。在至少一种形式中，刀杆2200可由（例如）不锈钢或其他类似材料制成并且具有大致矩形的横截面形状。此刀杆构型足够刚性以推动切割器械2032穿过夹持在外科端部执行器2012中的组织，同时足够柔性以使外科端部执行器2012相对于近侧闭合管2040和近侧脊部分2052围绕关节运动轴线AA-AA进行关节运动，如将在下文中进一步详细地描述。如图43和44所示，近侧脊部分2052具有延伸穿过其中的矩形通路2054，以在其被轴向推动穿过其中时为刀杆2200提供支撑。近侧脊部分2052具有近端2056，所述近端可旋转地安装到附接到工具安装板1032的脊安装托架2057上。参见图42。此布置允许近侧脊部分2052在近侧闭合管2040内旋转但不轴向运动。
如图40所示，将刀杆2200的远端2202附接到切割器械2032。刀杆2200的近端2204可旋转地附连到刀齿条齿轮2206上，使得刀杆2200相对于刀齿条齿轮2206自由旋转。参见图39。如图36-41所示，刀齿条齿轮2206可滑动地支撑在附接到工具安装板1302的齿条外壳2210内，使得刀齿条齿轮2206保持与刀齿轮组件2220啮合。更具体地讲并结合图39，在至少一个实施例中，刀齿轮组件2220包括刀正齿轮2222，所述刀正齿轮联接到工具安装板1302的适配器侧1307上相应的从动盘或从动元件1304中的第三个。参见图34。因此，将来自机器人系统1000的另一旋转输出运动通过工具驱动组件1010施加到相应的第三从动元件1304，从而将引起刀正齿轮2222的旋转。刀齿轮组件2220还包括刀减速齿轮组2224，所述刀减速齿轮组包括第一刀从动齿轮2226和第二刀传动齿轮2228。刀减速齿轮组2224可旋转地安装到工具安装板1302上，使得第一刀从动齿轮2226与刀正齿轮2222啮合。同样，第二刀传动齿轮2228与第三刀传动齿轮2230啮合，所述第三刀传动齿轮与刀齿条齿轮2206以啮合的方式而被旋转地支撑在工具安装板1302上。在各种实施例中，刀齿轮组件2220的齿轮的尺寸设定成能够产生如下力：需要所述力以驱动切割元件2032穿过夹持在外科端部执行器2012中的组织并致动其中的钉。例如，刀驱动组件2230的齿轮的尺寸可设定成能够产生大约40至100磅的力。应当理解，在一个方向上施加来自工具驱动组件1010的旋转输出运动将引起切割器械2032在远侧方向上轴向运动，并且在相对的方向上施加旋转输出运动将引起切割器械2032在近侧方向上轴向运动。
在各种实施例中，外科工具1200采用包括关节运动接头2011的关节运动系统2007，所述关节运动接头使外科端部执行器2012能够围绕关节运动轴线AA-AA进行关节运动，所述关节运动轴线AA-AA基本上横向于纵向工具轴线LT-LT。在至少一个实施例中，外科工具1200包括第一关节运动杆2250a和第二关节运动杆2250b，所述第一关节运动杆和第二关节运动杆可滑动地支撑在穿过近侧脊部分2052的相应通路2053中。参见图42和44。在至少一种形式中，通过关节运动传动装置（一般称为2249）致动第一关节运动杆2250a和第二关节运动杆2250b，所述关节运动传动装置可操作地支撑在工具安装板1032上。关节运动杆2250a、2250b中的每一个均具有从中伸出导向杆的近端2252，所述导向杆横向延伸穿过近侧脊部分2052的近端部分中的对应狭槽并且进入关节运动螺母2260中的对应弓形狭槽，所述关节运动螺母包括关节运动传动装置的一部分。图43示出了关节运动杆2250a。应当理解，关节运动杆2250b被相似地构造。如图40所示，例如，关节运动杆2250a具有导向杆2254，所述导向杆横向延伸穿过远侧脊部分2050的近端部分2056中的对应狭槽2058并且进入关节运动螺母2260中的对应弓形狭槽2262。另外，关节运动杆2250a具有通过例如销2253a可枢转地联接到远侧脊部分2050的远端2251a，并且关节运动杆2250b具有通过例如销2253b可枢转地联接到远侧脊部分2050的远端2251b。具体地讲，关节运动杆2250a在第一横向上与纵向工具轴线LT-LT横向偏移，并且关节运动杆2250b在第二横向上与纵向工具轴线LT-LT横向偏移。因此，关节运动杆2250a和2250b在相对方向上的轴向运动将使远侧脊部分2050以及附接到其上的外科端部执行器2012能够围绕关节运动轴线AA-AA进行关节运动，如将在下文中进一步详细地描述。
通过围绕纵向工具轴线LT-LT旋转关节运动螺母2260来控制外科端部执行器2012的关节运动。关节运动螺母2260可旋转地接合在远侧脊部分2050的近端部分2056，并且通过关节运动齿轮组件2270可旋转地在远侧脊部分的近端部分上驱动。更具体地讲并结合图37，在至少一个实施例中，关节运动齿轮组件2270包括关节运动正齿轮2272，所述关节运动正齿轮联接到工具安装板1302的适配器侧1307上相应的从动盘或从动元件1304中的第四个。参见图34。因此，当接口1230联接到工具架1270时，穿过工具驱动组件1010将来自机器人系统1000的另一旋转输入运动施加到相应的第四从动元件1304上，从而将引起关节运动正齿轮2272的旋转。关节运动传动齿轮2274与关节运动正齿轮2272和如图所示的关节运动螺母2260的齿轮部分2264以啮合的方式旋转地支撑在工具安装板1302上。如图42和43所示，关节运动螺母2260具有在其上形成的肩部2266，所述肩部限定环形沟槽2267以容纳其中的保持杆2268。将保持杆2268附接到工具安装板1302上，并用于防止关节运动螺母2260在近侧脊部分2052上轴向运动，同时保持相对于其的旋转能力。因此，由于导向杆2254与关节运动齿轮2260中螺旋狭槽2262的相互作用，在第一方向上旋转关节运动螺母2260将导致关节运动杆2250a在远侧方向“DD”上轴向运动以及关节运动杆2250b在近侧方向“PD”上轴向运动。相似地，在与第一方向相对的第二方向上旋转关节运动螺母2260将导致关节运动杆2250a在近侧方向“PD”上轴向运动并引起关节运动杆2250b在远侧方向“DD”上轴向运动。因此，可以通过同时在远侧方向“DD”上移动关节运动杆2250a和在近侧方向“PD”上移动关节运动杆2250b而使外科端部执行器2012选择性地在第一方向“FD”上围绕关节运动轴线“AA-AA”进行关节运动。同样，可以通过同时在近侧方向“PD”上移动关节运动杆2250a和在远侧方向“DD”上移动关节运动杆2250b而使外科端部执行器2012选择性地在第二方向“SD”上围绕关节运动轴线“AA-AA”进行关节运动。参见图35。
上述工具实施例采用了交接布置，所述交接装置尤其适于将机器人控制的医疗工具安装到至少一种形式的机械臂装置上，所述机械臂布置产生至少四种不同的旋转控制运动。本领域的普通技术人员将会知道可通过机器人系统/控制器经由可编程控制系统来选择性地控制此类旋转输出运动。例如，上述工具布置可很好地适于与由美国加利福尼亚州森尼韦尔的直觉外科手术公司(Intuitive Surgical,Inc.(Sunnyvale,California,U.S.A.))制造的那些机器人系统一起使用，其中许多可以在以引用的方式并入本文的各种专利中详细描述。本发明的各种实施例的独特的和新型的方面用来利用由机器人系统提供的旋转输出运动以生成特定的控制运动，所述控制运动具有使端部执行器切割和缝合组织的足够量级。因此，本发明的各种实施例的独特布置和原则可以使本文所公开和受权利要求保护的多种不同形式的工具系统结合提供程序化的旋转或其他输出运动的其他类型和形式的机器人系统有效地使用。另外，随着继续参阅本具体实施方式将变得更加明显，利用由机器人系统产生的一种或多种控制运动还可以有效地致动需要其他形式的致动运动的本发明的各种端部执行器实施例。
图46-50示出了可结合具有工具驱动组件的机器人系统1000有效使用的另一种外科工具2300，所述工具驱动组件可操作地联接到通过操作者的输入运行的机器人系统的控制器，并且其能够向支撑在工具驱动组件上的至少一个可旋转主体部分提供至少一种旋转输出运动。在各种形式中，外科工具2300包括外科端部执行器2312，所述外科端部执行器包括细长通道2322和可枢转平移的夹紧构件，例如砧2324，所述细长通道和可枢转平移的夹紧构件保持在确保有效地缝合和切断被夹持在外科端部执行器2312中的组织的间距处。如图示实施例中所示，外科端部执行器2312可包括除了前述细长通道2322和砧座2324之外的具有在其上形成的滑动件部分2333的切割器械2332、位于细长通道2322中的外科钉仓2334和具有在其上形成的螺旋形螺纹的旋转端部执行器驱动轴2336。例如，切割器械2332可以为刀。如将在下文中进一步详细地描述，旋转端部执行器驱动轴2336将使切割器械2332和滑动件部分2333轴向行进穿过外科钉仓2334以在起始位置和结束位置之间运动。切割器械2332轴向行进的方向取决于端部执行器驱动轴2336旋转的方向。砧座2324可在连接到细长通道2322的近端的枢轴点2325处可枢转地打开和闭合。砧座2324还可包括位于其近端的突出部2327，所述突出部可操作地与机械闭合系统（以下进一步描述）的部件交接以打开和闭合砧座2324。当旋转端部执行器驱动轴2336时，切割器械2332和滑动件2333将穿过外科钉仓2334从起始位置纵向行进至结束位置，从而切割夹持在外科端部执行器2312中的组织。滑动件2333穿过外科钉仓2334的运动使得其中的钉被驱动穿过被切断的组织并且抵靠闭合的砧座2324，所述砧座使钉弯曲以紧固被切断的组织。在一种形式中，细长通道2322和砧座2324可以由导电材料（例如金属）制成，使得它们可作为与端部执行器中的一个或多个传感器连通的天线的一部分，如上所述。外科钉仓2334可以由非导电材料（例如塑料）制成，并且传感器可以连接到或设置在外科钉仓2334中，如上所述。
应该指出的是，虽然本文描述的外科工具2300的实施例使用对切断的组织进行缝合的外科端部执行器2312，但是在其他实施例中，可使用用于对切断的组织进行紧固或密封的不同技术。例如，也可使用利用射频能量或粘合剂来紧固被切断的组织的端部执行器。授予Yates等人的名称为“Electrosurgical Hemostatic Device”的美国专利No.5,709,680以及授予Yates等人的名称为“Electrosurgical Hemostatic Device With Recessed And/OrOffset Electrodes”的美国专利No.5,688,270公开了使用射频能量来紧固被切断的组织的切割器械，该专利以引用的方式并入本文。授予Morgan等人的美国专利申请序列号11/267,811以及授予Shelton等人的美国专利申请序列号11/267,363公开了使用粘合剂来紧固被切断的组织的切断器械，该专利也以引用的方式并入本文。因此，虽然本文的描述涉及切割/缝合操作等，但是应当认识到，这仅是示例性实施例，并不旨在进行限制。也可以使用其他组织紧固技术。
在图示实施例中，外科端部执行器2312联接到细长轴组件2308，所述细长轴组件联接到工具安装部分2460并限定纵向工具轴线LT-LT。在该实施例中，细长轴组件2308不包括关节运动接头。本领域的普通技术人员将会理解其他实施例中可具有关节运动接头。在至少一个实施例中，细长轴组件2308包括中空的外管2340，所述中空的外管可旋转地支撑在工具安装部分2460的工具安装盘2462上，如将在下文中进一步详细地描述。在各种实施例中，细长轴组件2308还包括远侧脊轴2350。远侧脊轴2350具有远端部分2354，所述远端部分联接到远侧固定基座部分2360或与其一体化形成，该远侧固定基座部分不可移除地联接到通道2322。参见图47-49。
如图47所示，远侧脊轴2350具有滑动地容纳在近侧脊轴2353中的狭槽2355内的近端部分2351，所述近侧脊轴通过至少一个支撑衬圈2357不可活动地支撑在中空的外管2340内。如图47和48进一步所示，外科工具2300包括闭合管2370，所述闭合管被限制为相对于远侧固定基座部分2360仅进行轴向运动。闭合管2370具有近端2372，所述近端具有在其中形成并且与传动装置布置螺纹接合的内螺纹2374，所述传动装置布置（一般描述为2375）可操作地支撑在工具安装板2462上。在各种形式中，传动装置布置2375包括旋转驱动轴组件（一般称为2381）。当旋转时，旋转驱动轴组件2381将促使闭合管2370轴向运动，如将在下文中进一步详细地描述。在至少一种形式中，旋转驱动轴组件2381包括闭合离合器组件（一般称为2380）的闭合驱动螺母2382。更具体地讲，闭合驱动螺母2382具有近端部分2384，所述近端部分相对于外管2340可旋转地支撑并与闭合管2370螺纹接合。出于组装目的，近端部分2384可通过螺纹附接到保持环2386。与闭合驱动螺母2382的末端2387协作的保持环2386限定环状狭槽2388，锁定衬圈2390的肩部2392延伸到所述环状狭槽中。锁定衬圈2390不可移除地附接（例如，焊接、胶粘等）到外管2340的末端。此布置用于将闭合驱动螺母2382附连到外管2340上，同时使闭合驱动螺母2382相对于外管2340旋转。闭合驱动螺母2382还具有远端2383，所述远端具有螺纹部分2385，所述螺纹部分与闭合管2370的内螺纹2374通过螺纹接合。因此，闭合驱动螺母2382的旋转将使闭合管2370轴向运动，如图48中的箭头“D”所示。
通过由中空的驱动套管2400传输的控制运动实现砧座2324的闭合和切割器械2332的致动。如图47和48所示，中空驱动套管2400可旋转地并且可滑动地容纳在远侧脊轴2350上。驱动套管2400具有可旋转地安装到近侧脊轴2353上的近端部分2401，所述近侧脊轴从工具安装部分2460伸出使得驱动套管2400可相对于近侧脊轴旋转。参见图47。另外如图47-49所示，驱动套管2400通过驱动轴2440围绕纵向工具轴线“LT-LT”旋转。驱动轴2440具有附接到其远端2442并与附接到驱动套管2400的从动齿轮2450啮合的传动齿轮2444。
驱动套管2400还具有远端部分2402，所述远端部分联接到闭合离合器组件2380的闭合离合器2410部分，所述闭合离合器组件具有近侧面2412和远侧面2414。近侧面2412具有在其上形成的一系列近侧齿状物2416，所述近侧齿状物适于与形成于闭合驱动螺母2382的近端部分2384中的相应的近侧齿状物腔体2418选择性地接合。因此，当近侧齿状物2416与闭合驱动螺母2382中的近侧齿状物腔体2418啮合时，驱动套管2400的旋转将引起闭合驱动螺母2382的旋转，并且最终引起闭合管2370轴向运动，如将在下文中进一步详细地描述。
尤其如图47和48所示，驱动离合器部分2410的远侧面2414具有在其上形成的一系列远侧齿状物2415，所述远侧齿状物适于与形成于刀驱动轴组件2420的面板部分2424中的相应的远侧齿状物腔体2426选择性地接合。在各种实施例中，刀驱动轴组件2420包括中空的刀轴段2430，所述中空的刀轴段可旋转地容纳在远侧脊轴2350的对应部分上，所述远侧脊轴的对应部分附接到固定基座2360或从固定基座2360突出。当闭合离合器部分2410的远侧齿状物2415与面板部分2424中的远侧齿状物腔体2426啮合时，驱动套管2400的旋转将引起驱动轴段2430围绕固定轴2350旋转。如图47-49所示，将刀传动齿轮2432附接到驱动轴段2430，并与附接到端部执行器驱动轴2336的驱动刀齿轮2434啮合。因此，驱动轴段2430的旋转将引起端部执行器驱动轴2336的旋转，从而朝远侧驱动切割器械2332和滑动件2333穿过外科钉仓2334，以切割和缝合夹持在外科端部执行器2312中的组织。滑动件2333可由例如塑料制成，并且可具有倾斜的远侧表面。当滑动件2333横贯细长通道2322时，滑动件2333的前倾表面可向上推动或“驱动”外科钉仓2334中的钉穿过被夹持的组织并抵靠砧座2324。砧座2324使钉弯曲或“成形”，从而缝合切断的组织。如本文所用，术语“击发”是指引发如下动作：需要所述动作以沿远侧方向驱动切割器械和滑动件部分穿过外科钉仓，以切割夹持在外科端部执行器中的组织并驱动钉穿过切断的组织。
在使用中，围绕纵向工具轴线LT-LT旋转外科端部执行器2312可能是有利的。在至少一个实施例中，传动装置布置2375包括旋转的传输组件2465，所述旋转的传输组件能够接收来自机器人系统1000的工具驱动组件1010的对应的旋转输出运动，并将此旋转输出运动转化成旋转控制运动以使细长轴组件2308（和外科端部执行器2312）围绕纵向工具轴线LT-LT旋转。如图50所示，外管2340的近端2341可旋转地支撑在支架布置2343中，所述支架装置附接到工具安装部分2460的工具安装板2462。旋转齿轮2345形成在细长轴组件2308的外管2340的近端2341上或附接到其上，以与可操作地支撑在工具安装板2462上的旋转齿轮组件2470啮合。在至少一个实施例中，当工具安装部分2460联接到工具驱动组件1010时，旋转传动齿轮2472联接到工具安装板2462的适配器侧上相应的从动盘或从动元件1304中的第一个。参见图34和50。旋转驱动组件2470还包括旋转从动齿轮2474，所述旋转从动齿轮与旋转齿轮2345和旋转传动齿轮2472以啮合的方式而被旋转地支撑在工具安装板2462上。将来自机器人系统1000的第一旋转输出运动通过工具驱动组件1010施加到相应的从动元件1304，从而将通过可操作地联接至其而引起旋转传动齿轮2472的旋转。旋转传动齿轮2472的旋转最终导致细长轴组件2308（和端部执行器2312）围绕纵向工具轴线LT-LT旋转（主旋转运动）。
通过使闭合管2370在远侧方向“DD”上轴向运动，实现砧座2324相对于钉仓2034的闭合。通过向闭合驱动螺母2382施加旋转控制运动，实现闭合管2370在远侧方向“DD”上的轴向运动。为了向闭合驱动螺母2382施加旋转控制运动，闭合离合器2410必须首先与闭合驱动螺母2382的近端部分2384啮合。在各种实施例中，传动装置布置2375还包括可操作地支撑在工具安装板2462上的移位器驱动组件2480。更具体地讲并结合图50，可以看出，近侧脊部分2353的近端部分2359延伸穿过旋转齿轮2345并可旋转地联接到移位器齿轮齿条2481，所述移位器齿条穿过狭槽2482可滑动地附连到工具安装板2462。移位器驱动组件2480还包括移位器传动齿轮2483，当工具安装部分2460联接到工具架1270时，所述移位器传动齿轮联接到工具安装板2462的适配器侧上相应的从动盘或从动元件1304中的第二个。参见图34和50。移位器驱动组件2480还包括移位器从动齿轮2478，所述移位器从动齿轮与移位器传动齿轮2483和移位器齿条齿轮2482以啮合的方式而被旋转地支撑在工具安装板2462上。将来自机器人系统1000的第二旋转输出运动通过工具驱动组件1010施加到相应的从动元件1304，从而将通过可操作地联接至其而引起移位器传动齿轮2483的旋转。移位器传动齿轮2483的旋转最终引起移位器齿轮齿条2482和近侧脊部分2353以及驱动套管2400和附接至其的闭合离合器2410的轴向运动。闭合离合器2410的轴向行进方向取决于移位器传动齿轮2483通过机器人系统1000旋转的方向。因此，移位器传动齿轮2483在第一旋转方向上的旋转将引起闭合离合器2410沿近侧方向“PD”的轴向运动，从而使近侧齿状物2416与闭合驱动螺母2382中的近侧齿状物腔体2418啮合。反之，移位器传动齿轮2483在第二旋转方向（与第一旋转方向相反）上的旋转将引起闭合离合器2410沿远侧方向“DD”的轴向运动，从而使远侧齿状物2415与形成于刀驱动轴组件2420的面板部分2424中的相应的远侧齿状物腔体2426啮合。
一旦使闭合离合器2410与闭合驱动螺母2382啮合，闭合驱动螺母2382通过旋转闭合离合器2410进行旋转。通过向传动装置布置2375的旋转驱动传输部分2490施加旋转输出运动来控制闭合离合器2410的旋转，所述传动装置布置可操作地支撑在工具安装板2462上，如图50所示。在至少一个实施例中，旋转驱动传输部分2490包括旋转驱动组件2490’，所述旋转驱动组件包括齿轮2491，当工具安装部分2460联接到工具架1270时，所述齿轮联接到工具安装板2462的适配器侧上相应的从动盘或从动元件1304中的第三个。参见图34和50。旋转驱动传输部分2490还包括第一旋转从动齿轮2492，所述第一旋转从动齿轮与第二旋转从动齿轮2493和旋转传动齿轮2491以啮合的方式而被旋转地支撑在工具安装板2462上。第二旋转从动齿轮2493联接到驱动轴2440的近端部分2443。
旋转传动齿轮2491在第一旋转方向上的旋转将引起驱动轴2440在第一方向上的旋转。反之，旋转传动齿轮2491在第二旋转方向（与第一旋转方向相反）上的旋转将引起驱动轴2440在第二方向上的旋转。如上所述，驱动轴2440具有传动齿轮2444，所述传动齿轮附接到其远端2442并与附接到驱动套管2400的从动齿轮2450啮合。因此，驱动轴2440的旋转引起驱动套管2400的旋转。
现将描述操作外科工具2300的方法。一旦工具安装部分2462可操作地联接到机器人系统1000的工具架1270，并定向至邻近待切割和缝合的靶组织的位置，如果砧座2334尚未处于打开位置（图47），机器人系统1000可向移位器传动齿轮2483施加第一旋转输出运动，这使闭合离合器2410轴向运动至与闭合驱动螺母2382啮合（如果尚未与其啮合）。参见图48。一旦机器人系统1000的控制器1001确定闭合离合器2410与闭合驱动螺母2382啮合（例如，通过外科端部执行器2312中与机器人控制系统连通的一个或多个传感器），则机器人控制器1001可向旋转传动齿轮2492施加第二旋转输出运动，如上所述，这将最终引起旋转驱动螺母2382在第一方向上的旋转，从而引起闭合管2370在远侧方向“DD”上的轴向运动。当闭合管2370在远侧方向上运动时，其接触砧座2323的一部分并使砧座2324枢转至闭合位置，从而夹持介于砧座2324和外科钉仓2334之间的靶组织。一旦机器人控制器1001确定砧座2334已通过外科端部执行器2312中与之连通的相应的一个或多个传感器枢转至闭合位置，则机器人系统1000停止向旋转传动齿轮2491施加第二旋转输出运动。机器人控制器1001还可以为外科医生提供砧座2334已完全闭合的指示。然后外科医生可引发击发过程。在可供选择的实施例中，击发过程可由机器人控制器1001自动引发。然后，机器人控制器1001向移位器传动齿轮2483施加主旋转控制运动2483，这使闭合离合器2410轴向运动至与刀驱动轴组件2420的面板部分2424啮合。参见图49。一旦机器人系统1000的控制器1001确定闭合离合器2410与面板部分2424啮合（通过端部执行器2312中与机器人控制器1001连通的一个或多个传感器），则机器人控制器1001向旋转传动齿轮2492施加第二旋转输出运动，如上所述，这最终使切割器械2332和滑动件部分2333沿远侧方向“DD”轴向运动穿过外科钉仓2334。当切割器械2332朝远侧运动穿过外科钉仓2334时，切断夹持在其中的组织。当滑动件部分2333朝远侧驱动时，其驱动外科钉仓中的钉穿过切断的组织，从而与砧座2324形成接触。一旦机器人控制器1001确定切割器械2324已到达外科钉仓2334中的结束位置（通过端部执行器2312中与机器人控制器1001连通的一个或多个传感器），则机器人控制器1001停止向旋转传动齿轮2491施加第二旋转输出运动。然后，机器人控制器1001向旋转传动齿轮2491施加次旋转输出运动，这最终使切割器械2332和滑动件部分2333沿近侧方向“PD”轴向行进至起始位置。一旦机器人控制器1001通过外科端部执行器2312中与机器人控制器1001连通的一个或多个传感器确定切割器械2324已到达起始位置，则机器人控制器1001停止向旋转传动齿轮2491施加次旋转输出运动。然后，机器人控制器1001向移位器传动齿轮2483施加主旋转输出运动，从而使闭合离合器2410运动至与旋转驱动螺母2382接合。一旦闭合离合器2410已运动至与旋转驱动螺母2382啮合，则机器人控制器1001向旋转传动齿轮2491施加次输出运动，这最终引起旋转驱动螺母2382在第二方向上旋转，从而使闭合管2370在近侧方向“PD”上运动。如图47-49所示，闭合管2370中具有开口2345，所述开口接合砧座2324上的突出部2327以使砧座2324枢转至打开位置。在可供选择的实施例中，当闭合管2370回到起始位置时（图47），还可使用弹簧以将砧座2324枢转至打开位置。
图51-55示出了可结合机器人系统1000有效使用的另一个外科工具2500。在各种形式中，外科工具2500包括外科端部执行器2512，所述外科端部执行器包括细长通道2522形式的“第一部分”和可枢转地平移的夹紧构件（例如砧座2524）形式的“第二可移动部分”，所述第一部分和第二可移动部分保持在确保有效缝合和切断夹持在外科端部执行器2512中的组织的间距处。如图示实施例中所示，外科端部执行器2512可包括除了前述细长通道2522和砧座2524之外的切割器械2532形式的“第三可移动部分”、滑动件（未示出）和可移除地位于细长通道2522中的外科钉仓2534。例如，切割器械2532可以为刀。砧座2524可在连接到细长通道2522的近端的枢轴点2525处可枢转地打开和闭合。砧座2524还可包括位于其近端的突出部2527，所述突出部能够与机械闭合系统（以下进一步描述）的部件可操作地交接以打开和闭合砧座2524。当致动时，刀2532和滑动件沿着细长通道2522纵向行进，从而切割夹持在外科端部执行器2512中的组织。滑动件沿着细长通道2522的运动使得外科钉仓2534的钉被驱动穿过切断的组织并且抵靠闭合的砧座2524，所述砧座使钉弯曲以紧固被切断的组织。在一种形式中，细长通道2522和砧座2524可以由导电材料（例如金属）制成，使得它们可以作为与外科端部执行器中的一个或多个传感器连通的天线的一部分，如上所述。外科钉仓2534可以由非导电材料（例如塑料）制成，并且传感器可以连接到或设置在外科钉仓2534中，如上所述。
应该指出的是，虽然本文描述的外科工具2500的实施例使用对切断的组织进行缝合的外科端部执行器2512，但是在其他实施例中，可使用用于对切断的组织进行紧固或密封的不同技术。例如，也可使用利用射频能量或粘合剂来紧固被切断的组织的端部执行器。授予Yates等人的名称为“Electrosurgical Hemostatic Device”的美国专利No.5,709,680以及授予Yates等人的名称为“Electrosurgical Hemostatic Device With Recessed And/OrOffset Electrodes”的美国专利No.5,688,270公开了使用射频能量来紧固被切断的组织的切断器械，该专利以引用的方式并入本文。授予Morgan等人的美国专利申请序列号11/267,811以及授予Shelton等人的美国专利申请序列号11/267,363公开了使用粘合剂来紧固被切断的组织的切割器械，该专利也以引用的方式并入本文。因此，虽然本文的描述涉及切割/缝合操作等，但是应当认识到，这仅是示例性实施例，并不旨在进行限制。也可以使用其他组织紧固技术。
在图示实施例中，外科端部执行器2512的细长通道2522联接到细长轴组件2508，所述细长轴组件联接到工具安装部分2600。在至少一个实施例中，细长轴组件2508包括中空的脊管2540，所述中空的脊管不可移除地联接到工具安装部分2600的工具安装板2602。如图52和53所示，细长通道2522的近端2523包括能够附接到脊管2540的远端2541的中空的管状结构。在一个实施例中，例如，将细长通道2522的近端2523焊接或胶粘到脊管2540的远端。
如图52和53进一步所示，在至少一个非限制性实施例中，外科工具2500还包括闭合管2550形式的可轴向运动的致动构件，所述闭合管被限制为相对于细长通道2522和脊管1540进行轴向运动。闭合管2550具有近端2552，所述近端具有形成于其中的内螺纹2554，所述内螺纹与闭合驱动螺母2560形式的可旋转运动的部分进行螺纹接合。更具体地讲，闭合驱动螺母2560具有相对于细长通道2522和脊管2540旋转支撑的近端部分2562。出于组装目的，近端部分2562螺纹附接到保持环2570。保持环2570容纳在沟槽2529中，所述沟槽在细长通道2522的近端2523上的肩部2527和脊管1540的远端2541之间形成。此布置用于将闭合驱动螺母2560可旋转地支撑在细长通道2522内。闭合驱动螺母2560的旋转将引起闭合管2550轴向运动，如图52中的箭头“D”所示。
驱动构件延伸穿过脊管2540和闭合驱动螺母2560，在至少一个实施例中，所述驱动构件包括具有远端部分2582的刀杆2580，所述远端部分可旋转地联接到切割器械2532，使得刀杆2580可相对于切割器械2582旋转。如图52-54所示，闭合驱动螺母2560中具有狭槽2564，刀杆2580可滑动地延伸穿过所述狭槽。此布置允许刀杆2580相对于闭合驱动螺母2560轴向运动。然而，刀杆2580围绕纵向工具轴线LT-LT的旋转还将引起闭合驱动螺母2560的旋转。闭合管2550运动的轴向最终取决于刀杆2580和闭合驱动螺母2560旋转的方向。当朝远侧驱动闭合管2550时，其远端将接触砧座2524并使砧座2524枢转至闭合位置。当施加来自机器人系统1000的开放式旋转输出运动时，闭合管2550将沿近侧方向“PD”被驱动，并且凭借突出部2527与闭合管2550中的开口2555的接合而将砧座2524枢转至打开位置。
在使用中，围绕纵向工具轴线LT-LT旋转外科端部执行器2512可能是有利的。在至少一个实施例中，工具安装部分2600能够接收来自机器人系统1000的相应的第一旋转输出运动，并将此旋转输出运动转化成旋转控制运动以使细长轴组件2508围绕纵向工具轴线LT-LT旋转。如图55所示，中空的脊管2540的近端2542可旋转地支撑在支架布置2603中，所述支架装置附接到工具安装部分2600的工具安装板2602。外科工具2500的各种实施例还包括可操作地支撑在工具安装板2602上的传动装置布置，一般描述为2605。在各种形式中，传动装置布置2605包括旋转齿轮2544，所述旋转齿轮形成于或附接到脊管2540的近端2542，以与可操作地支撑在工具安装板2602上的旋转驱动组件2610啮合。在至少一个实施例中，当工具安装部分2600联接到工具架1270时，旋转传动齿轮2612联接到工具安装板2602的适配器侧上相应的旋转主体、从动盘或从动元件1304中的第一个。参见图34和55。旋转驱动组件2610还包括旋转从动齿轮2614，所述旋转从动齿轮与旋转齿轮2544和旋转传动齿轮2612以啮合的方式而被旋转地支撑在工具安装板2602上。将来自机器人系统1000的第一旋转输出运动通过工具驱动组件1010施加到相应的从动旋转主体1304，从而将通过可操作地联接至其而引起旋转传动齿轮2612的旋转。旋转传动齿轮2612的旋转最终使细长轴组件2508（和端部执行器2512）围绕纵向工具轴线LT-LT旋转。
通过使闭合管2550在远侧方向“DD”上轴向运动，实现砧座2524相对于外科钉仓2534的闭合。通过向闭合驱动螺母2382施加旋转控制运动，实现闭合管2550在远侧方向“DD”上的轴向运动。在各种实施例中，通过向刀杆2580施加旋转输出运动来转动闭合驱动螺母2560。通过向旋转闭合系统2620施加旋转输出运动来控制刀杆2580的旋转，所述旋转闭合系统可操作地支撑在工具安装板2602上，如图55所示。在至少一个实施例中，旋转闭合系统2620包括闭合传动齿轮2622，当工具安装部分2600联接到工具架1270时，所述闭合传动齿轮联接到工具安装板2462的适配器侧上相应的从动可旋转主体部分、盘或元件1304中的第二个。参见图34和55。在至少一个实施例中，闭合传动齿轮2622与闭合齿轮系（一般描述为2623）驱动啮合。闭合齿轮驱动系2623包括可旋转地支撑在工具安装板2602上的第一从动闭合齿轮2624。通过驱动轴2628将第一闭合从动齿轮2624附接到第二闭合从动齿轮2626。第二闭合从动齿轮2626与可旋转地支撑在工具安装板2602上的第三闭合从动齿轮2630啮合。闭合传动齿轮2622在第二旋转方向上的旋转将引起第三闭合从动齿轮2630在第二方向上的旋转。反之，闭合传动齿轮2483在次旋转方向（与第二旋转方向相反）上的旋转将引起第三闭合从动齿轮2630在次旋转方向上的旋转。
如图55所示，将驱动轴组件2640联接到刀杆2580的近端。在各种实施例中，驱动轴组件2640包括具有正方形横截面形状的近侧部分2642。近侧部分2642能够与第三从动齿轮2630中相应的成形孔滑动地接合。当第三从动齿轮2630旋转时，此布置引起驱动轴组件2640（和刀杆2580）的旋转。驱动轴组件2640通过刀驱动组件2650在远侧和近侧方向上被轴向推进。一种形式的刀驱动组件2650包括旋转传动齿轮2652，当工具安装部分2600联接到工具架1270时，所述旋转传动齿轮联接到工具安装板2462的适配器侧上相应的从动可旋转主体部分、盘或元件1304中的第三个。参见图34和55。旋转从动齿轮2652与齿轮系（一般描述为2653）驱动啮合。在至少一种形式中，齿轮系2653还包括可旋转地支撑在工具安装板2602上的第一旋转从动齿轮组件2654。第一旋转从动齿轮组件2654与第三旋转从动齿轮组件2656啮合，所述第三旋转从动齿轮组件可旋转地支撑在工具安装板2602上并且与第四旋转从动齿轮组件2658啮合，所述第四旋转从动齿轮组件与驱动轴组件2640的螺纹部分2644啮合。旋转传动齿轮2652在第三旋转方向上旋转将引起驱动轴组件2640和刀杆2580在远侧方向“DD”上轴向行进。反之，旋转传动齿轮2652在三级旋转方向（与第三旋转方向相反）上旋转将引起驱动轴组件2640和刀杆2580在近侧方向上运动。
现将描述操作外科工具2500的方法。一旦工具安装部分2600可操作地联接到机器人系统1000的工具架1270，则机器人系统1000可将外科端部执行器2512定位在邻近待切割和缝合的靶组织的位置。如果砧座2524尚未处于打开位置（图52），机器人系统1000可向闭合传动齿轮2622施加第二旋转输出运动，这引起刀杆2580在第二方向上的旋转。刀杆2580在第二方向上的旋转引起闭合驱动螺母2560在第二方向上的旋转。当闭合驱动螺母2560在第二方向上旋转时，闭合管2550在近侧方向“PD”上运动。当闭合管2550在近侧方向“PD”上运动时，砧座2524上的突出部2527与闭合管2550中的开口2555交接并使砧座2524枢转至打开位置。除此之外或在可供选择的实施例中，当闭合管2550回到起始位置时（图52），可使用弹簧（未示出）以将砧座2354枢转至打开位置。然后，可通过机器人系统1000操纵打开的外科端部执行器2512以将靶组织定位在打开的砧座2524和外科钉仓2534之间。然后，外科医生可通过致动机器人控制系统1000以向闭合传动齿轮2622施加第二旋转输出运动来引发闭合过程，如上所述，这最终引起闭合驱动螺母2382在第二方向上的旋转，从而引起闭合管2250在远侧方向“DD”上的轴向行进。当闭合管2550在远侧方向上运动时，其接触砧座2524的一部分并使砧座2524枢转至闭合位置，从而夹持砧座2524和钉仓2534之间的靶组织。一旦机器人控制器1001确定砧座2524已通过端部执行器2512中与之连通的相应的一个或多个传感器枢转至闭合位置，则机器人控制器1001停止向闭合传动齿轮2622施加第二旋转输出运动。机器人控制器1001还可以为外科医生提供砧座2524已完全闭合的指示。然后外科医生可引发击发过程。在可供选择的实施例中，击发过程可由机器人控制器1001自动引发。
在机器人控制器1001确定砧座2524处于闭合位置之后，然后机器人控制器1001向旋转传动齿轮2652施加第三旋转输出运动，这引起驱动轴组件2640和刀杆2580在远侧方向“DD”上的轴向运动。当切割器械2532朝远侧运动穿过外科钉仓2534时，切断夹持在其中的组织。当滑动件部分（未示出）朝远侧驱动时，其驱动外科钉仓2534中的钉穿过切断的组织，从而与砧座2524形成接触。一旦机器人控制器1001通过外科端部执行器2512中与机器人控制器1001连通的一个或多个传感器确定切割器械2532已到达外科钉仓2534内的结束位置，则机器人控制器1001停止向旋转传动齿轮2652施加第二旋转输出运动。然后，机器人控制器1001向旋转传动齿轮2652施加次旋转控制运动，这最终使切割器械2532和滑动件部分在近侧方向“PD”上轴向行进至起始位置。一旦机器人控制器1001通过端部执行器2512中与机器人控制器1001连通的一个或多个传感器确定切割器械2524已到达起始位置，则机器人控制器1001停止向旋转传动齿轮2652施加次旋转输出运动。然后，机器人控制器1001可向闭合传动齿轮2622施加次旋转输出运动，这引起刀杆2580在次方向上的旋转。刀杆2580在次方向上的旋转引起闭合驱动螺母2560在次方向上的旋转。当闭合驱动螺母2560在次方向上旋转时，闭合管2550在近侧方向“PD”上运动至打开位置。
图56-61B示出了可结合机器人系统1000有效使用的另一个外科工具2700。在各种形式中，外科工具2700包括外科端部执行器2712，所述外科端部执行器包括细长通道2722形式的“第一部分”和包括可枢转地平移的夹紧构件（例如砧座2724）形式的“第二可移动部分”，所述第一部分和第二可移动部分保持在确保有效缝合和切断夹持在外科端部执行器2712中的组织的间距处。如图示实施例中所示，外科端部执行器2712可包括除了前述通道2722和砧座2724之外的切割器械2732形式的“第三可移动部分”、滑动件（未示出）和可移除地位于细长通道2722中的外科钉仓2734。例如，切割器械2732可以为刀。砧座2724可在连接到细长通道2722的近端的枢轴点2725处可枢转地打开和闭合。砧座2724还可包括位于其近端的突出部2727，所述突出部与机械闭合系统（以下进一步描述）的部件交接以打开和闭合砧座2724。当致动时，刀2732和滑动件沿着细长通道2722纵向行进，从而切割夹持在外科端部执行器2712中的组织。滑动件沿着细长通道2722的运动使得外科钉仓2734的钉被驱动穿过切断的组织并且抵靠闭合的砧座2724，所述砧座使钉弯曲以紧固被切断的组织。在一种形式中，细长通道2722和砧座2724可以由导电材料（例如金属）制成，使得它们可以作为与外科端部执行器中的一个或多个传感器连通的天线的一部分，如上所述。外科钉仓2734可以由非导电材料（例如塑料）制成，并且传感器可以连接到或设置在外科钉仓2734中，如上所述。
应该指出的是，虽然本文描述的外科工具2500的实施例使用对切断的组织进行缝合的外科端部执行器2712，但是在其他实施例中，可使用用于对切断的组织进行紧固或密封的不同技术。例如，也可使用利用射频能量或粘合剂来紧固被切断的组织的端部执行器。授予Yates等人的名称为“Electrosurgical Hemostatic Device”的美国专利No.5,709,680以及授予Yates等人的名称为“Electrosurgical Hemostatic Device With Recessed And/OrOffset Electrodes”的美国专利No.5,688,270公开了使用射频能量来紧固被切断的组织的切割器械，该专利以引用的方式并入本文。授予Morgan等人的美国专利申请序列号11/267,811以及授予Shelton等人的美国专利申请序列号11/267,363公开了使用粘合剂来紧固被切断的组织的切断器械，该专利也以引用的方式并入本文。因此，虽然本文的描述涉及切割/缝合操作等，但是应当认识到，这仅是示例性实施例，并不旨在进行限制。也可以使用其他组织紧固技术。
在图示实施例中，外科端部执行器2712的细长通道2722联接到细长轴组件2708，所述细长轴组件联接到工具安装部分2900虽然未示出，细长轴组件2708可包括关节运动接头以允许外科端部执行器2712围绕基本上横向于工具轴线LT-LT的轴线选择性地进行关节运动。在至少一个实施例中，细长轴组件2708包括中空的脊管2740，所述中空的脊管不可移除地联接到工具安装部分2900的工具安装板2902。如图57和58所示，细长通道2722的近端2723包括通过安装衬圈2790附接到脊管2740的中空的管状结构。图59中示出了安装衬圈2790的剖视图。在各种实施例中，安装衬圈2790具有能够附接至脊管2740的远端的近侧凸缘末端2791。在至少一个实施例中，例如，将安装衬圈2790的近侧凸缘末端2791焊接或胶粘到脊管2740的远端。如图57和58进一步所示，安装衬圈2790还具有安装毂部分2792，所述安装毂部分的尺寸设定成能够容纳其上的细长通道2722的近端2723。细长通道2722的近端2723通过例如焊接、粘结等不可移除地附接到安装毂部分2792。
如图57和58进一步所示，外科工具2700还包括闭合管2750形式的可轴向运动的致动构件，所述闭合管被限制为相对于细长通道2722进行轴向运动。闭合管2750具有近端2752，所述近端具有形成于其中的内螺纹2754，所述内螺纹与闭合驱动螺母2760形式的可旋转运动的部分进行螺纹接合。更具体地讲，闭合驱动螺母2760具有相对于细长通道2722和脊管2740旋转支撑的近端部分2762。出于组装目的，近端部分2762螺纹附接到保持环2770。保持环2770容纳在沟槽2729中，所述沟槽在通道2722的近端2723上的肩部2727和安装衬圈2790的安装毂2729之间形成。此布置用于将闭合驱动螺母2760旋转地支撑在通道2722内。闭合驱动螺母2760的旋转将引起闭合管2750轴向运动，如图57中的箭头“D”所示。
驱动构件延伸穿过脊管2740、安装衬圈2790和闭合驱动螺母2760，在至少一个实施例中，所述驱动构件包括具有联接到切割器械2732的远端部分2782的刀杆2780。如图57和58所示，安装衬圈2790具有穿过其中的通路2793以允许刀杆2780滑动地穿过其中。相似地，闭合驱动螺母2760中具有狭槽2764，刀杆2780可滑动地延伸穿过所述狭槽。此布置允许刀杆2780相对于闭合驱动螺母2760轴向运动。
通过旋转从动闭合轴2800来控制砧座2724的致动。如图57和58所示，闭合驱动轴2800的远端部分2802延伸穿过安装衬圈2790中的通路2794，并且闭合齿轮2804附接至其上。闭合齿轮2804能够与闭合驱动螺母2760的内表面2761驱动接合。因此，闭合轴2800的旋转也将引起闭合驱动螺母2760的旋转。闭合管2750运动的轴向最终取决于闭合轴2800和闭合驱动螺母2760旋转的方向。例如，响应于接收自机器人系统1000的一个旋转闭合运动，闭合管2750将在远侧方向“DD”上被驱动。当闭合管2750朝远侧驱动时，开口2745将接合砧座2724上的突出部2727并使砧座2724枢转至闭合位置。当施加来自机器人系统1000的开放式旋转运动时，闭合管2750将在近侧方向“PD”上被驱动并且将砧座2724枢转至打开位置。在各种实施例中，可使用弹簧（未示出）以将砧座2724偏置至打开位置（图57）。
在使用中，围绕纵向工具轴线LT-LT旋转外科端部执行器2712可能是有利的。在至少一个实施例中，工具安装部分2900能够接收来自机器人系统1000的相应的第一旋转输出运动以使细长轴组件2708围绕工具轴线LT-LT旋转。如图61所示，中空的脊管2740的近端2742可旋转地支撑在支架布置2903和轴承组件2904中，所述支架装置和轴承组件附接到工具安装部分2900的工具安装板2902。旋转齿轮2744形成于或附接到脊管2740的近端2742，以与可操作地支撑在工具安装板2902上的旋转驱动组件2910啮合。在至少一个实施例中，当工具安装部分2600联接到工具架1270时，旋转传动齿轮2912联接到工具安装板2602的适配器侧上相应的从动盘或从动元件1304中的第一个。参见图34和61。旋转驱动组件2910还包括旋转从动齿轮2914，所述旋转从动齿轮与旋转齿轮2744和旋转传动齿轮2912以啮合的方式而被旋转地支撑在工具安装板2902上。将来自机器人系统1000的第一旋转控制运动通过工具架1270和适配器1240施加到相应的从动元件1304，从而将通过可操作地联接至其而引起旋转传动齿轮2912的旋转。旋转传动齿轮2912的旋转最终导致细长轴组件2708（和端部执行器2712）围绕纵向工具轴线LT-LT旋转（主旋转运动）。
通过使闭合管2750在远侧方向“DD”上轴向运动，实现砧座2724相对于钉仓2734的闭合。通过向闭合驱动螺母2760施加旋转控制运动，实现闭合管2750在远侧方向“DD”上的轴向运动。在各种实施例中，通过施加旋转输出运动到闭合驱动轴2800来旋转闭合驱动螺母2760。如图61所示，闭合驱动轴2800的近端部分2806上具有与闭合驱动组件2920啮合的从动齿轮2808。在各种实施例中，闭合驱动系统2920包括闭合传动齿轮2922，当工具安装部分2900联接到工具架1270时，所述闭合传动齿轮联接到工具安装板2462的适配器侧上相应的从动旋转主体或从动元件1304中的第二个。参见图34和61。闭合传动齿轮2922以与闭合齿轮系（一般描述为2923）以啮合的方式而被支撑。在至少一种形式中，闭合齿轮系2923包括可旋转地支撑在工具安装板2902上的第一从动闭合齿轮2924。通过驱动轴2928将第一闭合从动齿轮2924附接到第二闭合从动齿轮2926。第二闭合从动齿轮2926与行星齿轮组件2930啮合。在各种实施例中，行星齿轮组件2930包括可旋转地支撑在轴承组件2904中的从动行星闭合齿轮2932，所述轴承组件安装在工具安装板2902上。如图61和61B所示，闭合驱动轴2800的近端部分2806可旋转地支撑在脊管2740的近端部分2742中，使得从动齿轮2808与行星齿轮2932上形成的中心齿轮齿2934啮合。另外如图61A所示，两个另外的支撑齿轮2936附接到脊管2740的近端部分2742或相对于所述脊管的近端部分旋转地支撑以向其提供轴承支撑。此具有行星齿轮组件2930的布置用于通过旋转驱动组件2910适应脊轴2740的旋转，同时允许闭合从动齿轮2808与闭合驱动系统2920保持啮合。另外，闭合传动齿轮2922在第一方向上的旋转将最终引起闭合驱动轴2800和闭合驱动螺母2760的旋转，这将最终导致砧座2724闭合，如上所述。反之，闭合传动齿轮2922在第二相反方向上的旋转将最终引起闭合驱动螺母2760在相反方向上的旋转，这将使砧座2724打开。
如图61所示，刀杆2780的近端2784具有与之附接并与刀驱动组件2940驱动接合的螺纹轴部分2786。在各种实施例中，螺纹轴部分2786通过附接到工具安装板2902的轴承2906旋转地支撑。此布置允许螺纹轴部分2786相对于工具安装板2902旋转和轴向运动。刀杆2780通过刀驱动组件2940在远侧和近侧方向上轴向推进。一种形式的刀驱动组件2940包括旋转传动齿轮2942，当工具安装部分2900联接到工具架1270时，所述旋转传动齿轮联接到工具安装板2902的适配器侧上相应的旋转主体、从动盘或从动元件1304中的第三个。参见图34和61。旋转传动齿轮2942与刀齿轮系（一般描述为2943）啮合。在各种实施例中，刀齿轮系2943包括可旋转地支撑在工具安装板2902上的第一旋转从动齿轮组件2944。第一旋转从动齿轮组件2944与第三旋转从动齿轮组件2946啮合，所述第三旋转从动齿轮组件可旋转地支撑在工具安装板2902上并且与第四旋转从动齿轮组件2948啮合，所述第四旋转从动齿轮组件与刀杆2780的螺纹部分2786啮合。旋转传动齿轮2942在一个方向上的旋转将引起刀杆2780在远侧方向“DD”上轴向行进。反之，旋转传动齿轮2942在相反方向上的旋转将引起刀杆2780在近侧方向上运动。否则，可使用工具2700，如上所述。
图62和63示出了基本上与上文详细描述的工具2700相同的外科工具实施例2700。然而，工具2700’包括压力传感器2950，所述压力传感器能够向机器人控制器1001提供关于砧座2724受到的夹紧压力的量的反馈。在各种实施例中，例如，压力传感器可包括弹簧偏置的接触开关。对于连续信号而言，可使用其上具有应变计的悬臂梁或内部有应变计的圆顶按钮盖。另一种产品形式可包括仅以已知的所需负载接触的断路开关。此布置可包括基座上的圆顶，其中该圆顶为一个电极并且基座为另一个电极。此布置允许机器人控制器1001通过调节施加到砧座2724的闭合压力的量来调节施加到外科端部执行器2712内组织的夹紧压力的量。本领域的普通技术人员将会理解，此压力传感器布置可与本文所述的若干外科工具实施例以及它们的等价结构一起有效地使用。
图64示出了可结合机器人系统1000有效使用的另一个外科工具3000的一部分。外科工具3003采用一个或多个机载马达以为外科端部执行器切割器械的各种部件提供功率。在至少一个非限制性的实施例中，例如，外科工具3000包括线切割器（未示出）形式的外科端部执行器，其具有上述类型和构造的砧座（未示出）和外科钉仓布置（未示出）。外科工具3000还包括上述类型的细长轴（未示出）和砧座闭合布置（未示出）。因而，除了必须理解外科工具3000的各种实施例的独特和新颖属性之外，此部分的具体实施方式将不重复对那些部件的描述。
在所示实施例中，端部执行器包括联接到刀杆3003的切割器械3002。如图64所示，外科工具3000包括工具安装部分3010，所述工具安装部分包括能够与适配器部分1240’以安装方式交接的工具安装板3012，所述适配器部分以上述各种方式联接到机器人系统1000。工具安装部分3010能够可操作地支撑其上的传动布置3013。在至少一个实施例中，适配器部分1240’在适配器1240没有采用功率旋转主体和盘构件的情况下可能与上文中详细描述的适配器部分1240相同。在其他实施例中，适配器部分1240’可能与适配器部分1240相同。被视为在本发明的各种形式的实质和范围内的其他修改形式可以采用一种或多种来自工具架部分1270（如在上文中所述）的机械运动（即，旋转运动）以激活/致动传动装置布置3013，同时还使用一个或多个在工具安装部分3010内的马达以为外科端部执行器的一个或多个其他部件提供功率。另外，虽然所示实施例的端部执行器包括线切割器，但是本领域的普通技术人员将会知道，在不脱离本发明的各种形式的实质和范围的情况下可结合其他类型的外科端部执行器有效地使用所示实施例的独特和新颖属性。
在各种实施例中，工具安装板3012能够至少容纳第一击发马达3011以为刀杆3003提供击发和回缩运动，所述刀杆联接到切割器械3002或与切割器械可操作地交接。工具安装板3012具有一系列电连接销3014，所述电连接销能够与适配器1240’中的狭槽1258（图33）交接。此布置允许机器人系统1000的控制器1001为外科工具3000的电子控制电路3020提供控制信号。虽然结合机械耦合元件、电耦合元件和磁力耦合元件在本文中描述了接口，应当理解，可使用多种遥测形式，包括红外、电感耦合等。
控制电路3020在图64中以图解示意图的形式示出。在一种形式或实施例中，控制电路3020包括电池3022形式的功率源，所述电池联接到通断螺线管功率源开关3024。控制电路3020还包括联接到双极开关3028的通断击发螺线管3026以用于控制马达3011的旋转方向。因而，当机器人系统1000的控制器1001提供适当的控制信号时，开关3024将允许电池3022为双极开关3028提供电能。机器人系统1000的控制器1001还将为双极开关3028提供适当的信号，从而为马达3011提供电能。当期望击发外科端部执行器（即，朝远侧驱动切割器械3002穿过夹持在外科端部执行器中的组织）时，双极开关3028将处于第一位置。当期望将切割器械3002回缩至起始位置时，双极开关3028将通过控制器1001运动至第二位置。
外科工具3000的各种实施例还采用尺寸设定成与击发齿轮系3031结合的齿轮箱3030，在至少一个非限制性实施例中，所述击发齿轮系包括击发传动齿轮3032，所述击发传动齿轮与击发从动齿轮3034啮合以生成所需量的驱动力，从而驱动切割器械3002穿过组织并以本文所述的各种方式驱动和形成钉。在图61中示出的实施例中，从动齿轮3034联接到与螺母布置3038螺纹接合的螺杆轴3036，限制所述螺母布置进行轴向运动（由箭头“D”表示）。将螺母布置3038附接到击发杆3003。因而，通过在第一方向上旋转螺杆轴3036在远侧方向“DD”上驱动切割器械3002，并通过在相反的第二方向上旋转螺杆轴可以在近侧方向“PD”上回缩切割器械3002。
图65示出了另一个基本上与上述工具3000相同的外科工具3000’的一部分，不同的是从动齿轮3034附接到驱动轴3040。将驱动轴3040附接到与第三从动齿轮3044啮合的第二传动齿轮3042，所述第三从动齿轮与联接到击发杆3003的螺钉3046啮合。
图66示出了可结合机器人系统1000有效使用的另一个外科工具3200。在该实施例中，外科工具3200包括非限制性形式的外科端部执行器3212，所述外科端部执行器包括相对于至少一个其他端部执行器部件部分在第一位置和第二位置之间选择性运动的部件部分。如将在下文中进一步详细地描述，外科工具3200采用机载马达以为传动装置布置3305的各种部件提供功率。外科端部执行器3212包括可操作地支撑外科钉仓3234的细长通道3222。细长通道3222具有可滑动地延伸到中空的细长轴组件3208中的近端3223，所述中空的细长轴组件联接到工具安装部分3300。另外，外科端部执行器3212包括通过一对耳轴3225可枢转地联接到细长通道3222的砧座3224，所述耳轴容纳在细长通道3222中相应的开口3229内。轴组件3208的远端部分3209包括开口3245，当细长通道3222相对于轴组件3208的远端部分3209在近侧方向“PD”上轴向运动时，砧座3224上的突出部3227插入到所述开口中以打开砧座3224。在各种实施例中，可以使用弹簧（未示出）以将砧座3224偏置至打开位置。
如上所述，外科工具3200包括工具安装部分3300，所述工具安装部分包括能够操作地支撑传动装置布置3305并与适配器部分1240’安装交接的工具安装板3302，所述适配器部分以上述各种方式联接到机器人系统1000。在至少一个实施例中，适配器部分1240’在没有适配器1240采用的功率盘构件的情况下可能与上文中详细描述的适配器部分1240相同。在其他实施例中，适配器部分1240’可能与适配器部分1240相同。然而，在此实施例中，因为外科端部执行器3212的各种部件全部由工具安装部分3300中的马达提供电能，外科工具3200将不采用或需要来自工具架部分1270的任何机械（即，非电力的）致动运动以为外科端部执行器3200部件提供功率。被视为在本发明的各种形式的实质和范围内的其他修改形式可以采用一种或多种来自工具架部分1270（如在上文中所述）的机械运动以激活/致动一个或多个外科端部执行器部件，同时还使用一个或多个在工具安装部分内的马达以为外科端部执行器的一个或多个其他部件提供功率。
在各种实施例中，工具安装板3302能够支撑第一击发马达3310以用于为传动装置布置3305提供击发和回缩运动，从而驱动联接到上述类型的切割器械3332的刀杆3335。如图66所示，工具安装板3212具有一系列电连接销3014，所述电连接销能够与适配器1240’中的狭槽1258（图33）交接。此装置允许机器人系统1000的控制器1001为外科工具3200的电子控制电路3320、3340提供控制信号。虽然结合机械耦合元件、电耦合元件和磁力耦合元件在本文中描述了接口，应当理解，可使用多种遥测形式，包括红外、电感耦合等。
在一种形式或实施例中，第一控制电路3320包括第一电池3322形式的第一功率源，所述第一电池联接到第一通断螺线管功率源开关3324。第一击发控制电路3320还包括第一通断击发螺线管3326，所述第一通断击发螺线管联接到第一双极开关3328以控制第一击发马达3310的旋转方向。因而，当机器人控制器1001提供适当的控制信号时，第一开关3324将允许第一电池3322为第一双极开关3328提供电能。机器人控制器1001还将为第一双极开关3328提供适当的信号，从而为第一击发马达3310提供电能。当期望击发外科端部执行器（即，朝远侧驱动切割器械3232穿过夹持在外科端部执行器3212中的组织）时，第一开关3328将通过机器人控制器1001设置在第一位置。当期望将切割器械3232回缩至起始位置时，机器人控制器1001将发送适当的控制信号以使第一开关3328运动至第二位置。
外科工具3200的各种实施例还采用尺寸设定成与附接的击发传动齿轮3332结合的第一齿轮箱3330，所述击发传动齿轮可操作地与击发齿轮系3333交接。在至少一个非限制性实施例中，击发齿轮系333包括击发从动齿轮3334，所述击发从动齿轮与传动齿轮3332啮合以生成所需量的驱动力，从而驱动切割器械3232穿过组织并以本文中所述的各种方式驱动和形成钉。在图66示出的实施例中，从动齿轮3334联接到驱动轴3335，所述驱动轴具有与之联接的第二从动齿轮3336。第二从动齿轮3336与第三从动齿轮3337以啮合的方式被支撑，所述第三从动齿轮与第四从动齿轮3338啮合。第四从动齿轮3338与刀杆3235的螺纹近侧部分3339啮合，限制所述刀杆进行轴向运动。因而，通过在第一方向上旋转驱动轴3335，在远侧方向“DD”上驱动切割器械3232并在相反的第二方向上旋转驱动轴3335，切割器械3232可在近侧方向“PD”上回缩。
如上所述，通过相对于细长轴组件3208使细长通道3222轴向运动来控制砧座3224的打开和闭合。细长通道3222的轴向运动由闭合控制系统3339控制。在各种实施例中，闭合控制系统3339包括闭合轴3340，所述闭合轴具有与螺纹闭合杆3342通过螺纹接合的中空的螺纹端部3341。螺纹端部3341可旋转地支撑在脊轴3343中，所述脊轴可操作地与工具安装部分3300交接并延伸穿过轴组件3208的一部分，如图所示。闭合系统3339还包括闭合控制电路3350，所述闭合控制电路包括第二电池3352形式的第二功率源，所述第二电池联接到第二通断螺线管功率源开关3354。闭合控制电路3350还包括第二通断击发螺线管3356，所述第二通断击发螺线管联接到第二双极开关3358以控制第二闭合马达3360的旋转。因而，当机器人控制器1001提供适当的控制信号时，第二开关3354将允许第二电池3352为第二双极开关3354提供电能。机器人控制器1001还将为第二双极开关3358提供适当的信号，从而为第二马达3360提供电能。当期望闭合砧座3224时，第二开关3348将处于第一位置。当期望打开砧座3224时，第二开关3348将运动至第二位置。
工具安装部分3300的各种实施例还采用联接到闭合传动齿轮3364的第二齿轮箱3362。闭合传动齿轮3364与闭合齿轮系3363啮合。在各种非限制性形式中，闭合齿轮系3363包括附接到闭合驱动轴3366的闭合从动齿轮3365。与附接到闭合轴3340的闭合轴齿轮3360啮合的闭合传动齿轮3367也附接到闭合驱动轴3366。图66示出了处于打开位置的端部执行器3212。如上所述，当螺纹闭合杆3342处于图66中示出的位置时，弹簧（未示出）将砧座3224偏置至打开位置。当期望闭合砧座3224时，机器人控制器1001将启动第二马达3360以旋转闭合轴3340，从而在近侧方向‘PD’上牵拉螺纹闭合杆3342和通道3222。当砧座3224与轴3208的远端部分3209接触时，砧座3224枢转至闭合位置。
现将描述操作外科工具3200的方法。一旦工具安装部分3302可操作地联接到机器人系统1000的工具架1270，机器人系统1000可将端部执行器3212定位在邻近待切割和缝合的靶组织的位置。如果砧座3224尚未处于打开位置，则机器人控制器1001可启动第二闭合马达3360以在远侧方向上将通道3222驱动至图66中示出的位置。一旦机器人控制器1001通过在端部执行器和/或工具安装部分3300中的一个或多个传感器确定外科端部执行器3212已处于打开位置，则机器人控制器1001可为外科医生提供信号，从而通知外科医生随后可闭合砧座3224。一旦靶组织定位在打开的砧座3224和外科钉仓3234之间，则外科医生可通过启动机器人控制器1001以向第二闭合马达3360施加闭合控制信号来开始闭合过程。第二闭合马达3360向闭合轴3340施加旋转运动，以在近侧方向“PD”上牵拉通道3222直到砧座3224枢转至闭合位置。一旦机器人控制器1001通过在外科端部执行器3212和/或与机器人控制系统连通的工具安装部分3300中的一个或多个传感器确定砧座3224已运动至闭合位置，则马达3360可被停止。然后，可通过外科医生启动控制器1001上的触发器、按钮等手动开始击发过程，或控制器1001可自动地开始击发过程。
为了开始击发过程，机器人控制器1001启动击发马达3310以在远侧方向“DD”上驱动击发杆3235和切割器械3232。一旦机器人控制器1001通过在外科端部执行器3212和/或马达驱动部分3300中的传感器确定切割器械3232已运动至外科钉仓3234中的结束位置，则机器人控制器1001可为外科医生提供指示信号。然后，外科医生可手动启动第一马达3310以回缩切割器械3232至起始位置，或机器人控制器1001可自动地启动第一马达3310以回缩切割元件3232。
图66中示出的实施例不包括关节运动接头。图67和68示出了分别具有端部执行器3212’、3212”的外科工具3200’和3200”，所述端部执行器可与具有本文所公开的各种类型的关节运动接头的细长轴实施例一起使用。例如，如图64所示，螺纹闭合轴3342通过柔性缆线或其他柔性构件3345联接到细长通道3222的近端3223。关节运动接头（未示出）在细长轴组件3208中的位置将与柔性构件3345一致，从而使柔性构件3345适应此关节运动。另外，在上述的实施例中，柔性构件3345可旋转地附连到细长通道3222的近端部分3223以使柔性构件33345相对于其旋转，从而防止柔性构件3229相对于通道3222“卷绕”。虽然未示出，可通过刀杆以上述方式中的一者来驱动切割元件，所述刀杆也可适应细长轴组件的关节运动。图68示出了基本上与上述外科端部执行器3212相同的外科端部执行器3212”，不同的是螺纹闭合杆3342附接到闭合螺母3347，限制所述闭合螺母仅在细长轴组件3208内进行轴向运动。将柔性构件3345附接到闭合螺母3347。此布置还防止螺纹闭合杆3342卷绕柔性构件3345。可采用柔性刀杆3235’以利于外科端部执行器3212”的关节运动。
上述外科工具3200、3200’和3200”也可采用本文所述的切割器械实施例中的任何一个。如上所述，通过牵拉细长通道至与细长轴组件的远端接触来闭合这些工具的每个端部执行器的砧座。因此，一旦靶组织位于钉仓3234和砧座3224之间，机器人控制器1001可开始向内牵拉通道3222至轴组件3208中。然而，在各种实施例中，为了防止端部执行器3212、3212’、3212”在该闭合过程中使靶组织随着端部执行器运动，控制器1001可同时使工具架运动并最终使工具运动以补偿细长通道3222的运动，从而使靶组织实际上被夹持在砧座和细长通道之间而不被移动。
图69-71示出了除了下文描述的差异之外基本上与上述外科工具3200”相同的另一个外科工具实施例3201。在该实施例中，螺纹闭合杆3342’具有可变节距的沟槽。更具体地讲，如图70所示，闭合杆3342’具有远侧沟槽部分3380和近侧沟槽部分3382。远侧沟槽部分3380和近侧沟槽部分3382能够与支撑在中空的螺纹端部3341’中的凸耳3390相接合。如图70所示，远侧沟槽部分3380具有比沟槽部分3382更细小的节距。因此，此可变节距布置通过凸耳3390和近侧沟槽部分3382之间的接合而允许细长通道3222以第一速度或速率被牵拉到轴3208中。当凸耳3390接合远侧沟槽部分时，通道3222将以第二速度或速率被牵拉到轴3208中。因为近侧沟槽部分3382比远侧沟槽部分3380更粗糙，第一速度将大于第二速度。此布置用于加速端部执行器的初始闭合以用于操纵组织，然后在将组织准确地定位在其中之后，生成适当夹持组织以对组织进行切割和缝合的闭合力的大小。因此，砧座3234最初以较小的力快速闭合，然后随着砧座更慢闭合而施加更大的闭合力。
在将组织完全夹持在所需位置以进行切割和缝合之前，可利用外科端部执行器打开和闭合运动以允许使用者使用端部执行器抓持和操纵组织。例如，使用者可在该过程中多次打开和闭合外科端部执行器以将端部执行器定位在使组织被保持在所需位置的适当的位置。因此，在至少一些实施例中，为了生成用于击发的高负载，细牙螺纹可能需要多达5至10次完全旋转以生成必要的负载。在一些情况下，例如，该动作可能花费长达2至5秒。如果在定位/组织操纵过程中每次也花费等长的时间打开和闭合端部执行器，则定位端部执行器可能花费过长的时间。如果出现这种情况，使用者可能放弃使用端部执行器以使用常规的抓紧器装置。使用抓紧器等可不利地增加与完成外科手术相关的成本。
上述实施例采用一个或多个电池以为用于驱动端部执行器部件的马达提供电能。通过机器人系统1000控制马达的启动。在可供选择的实施例中，功率源可包括由机器人系统1000为马达提供的交流电“AC”。即，交流电可由通过工具架和适配器为机器人系统1000提供电能的系统供给。在其他实施例中，功率源线或绳可附接到工具安装部分3300以提供所需的来自单独的交流功率源或直流功率源的电能。
在使用中，控制器1001可以施加初始旋转运动至闭合轴3340（图66）以向内轴向牵拉细长通道3222至细长轴组件3208中，并以第一速率使砧座从第一位置运动至中间位置，所述中间位置对应于其中远侧沟槽部分3380过渡到近侧沟槽部分3382的点。进一步将旋转运动施加到闭合轴3340将使砧座相对于外科钉仓从中间位置运动至闭合位置。当处于闭合位置时，待切割和缝合的组织被适当地夹持在砧座和外科钉仓之间。
图72-75示出本发明的另一个外科工具实施例3400。该实施例包括从工具安装部分3500延伸的细长轴组件3408。细长轴组件3408包括可旋转的近侧闭合管段3410，所述可旋转的近侧闭合管段可旋转地连接在近侧脊构件3420上，该近侧脊构件刚性地联接到工具安装部分3500的工具安装板3502。近侧脊构件3420具有远端3422，所述远端联接到外科端部执行器3412的细长通道部分3522。例如，在至少一个实施例中，细长通道部分3522具有远端部分3523，所述远端部分“以钩的形式接合”脊构件3420的远端3422。细长通道3522能够支撑其中的外科钉仓3534。该实施例可使用本文所公开的各种切割器械实施例中的一个来切断夹持在外科端部执行器3412中的组织，并将钉仓3534中的钉击发至切断的组织中。
外科端部执行器3412具有通过一对耳轴3525可枢转地联接到细长通道3522的砧座3524，所述耳轴容纳在细长通道3522中相应的开口3529内。砧座3524通过远侧闭合管段3430在打开位置（图72）和闭合位置（图73-75）之间运动。远侧闭合管段3430的远端部分3432包括开口3445，当远侧闭合管段3430相对于其进行轴向运动时，砧座3524上的突出部3527插入到所述开口中以打开和闭合砧座3524。在各种实施例中，将开口3445成形以使得当闭合管段3430在近侧方向上运动时，闭合管段3430使砧座3524枢转至打开位置。除此之外或作为另外一种选择，可使用弹簧（未示出）以将砧座3524偏置至打开位置。
如图72-75所示，远侧闭合管段3430包括凸耳3442，所述凸耳从其远端3440延伸至与可旋转的近侧闭合管段3410的远端3412中形成的可变节距沟槽/螺纹3414进行螺纹接合。可变节距沟槽/螺纹3414具有远侧部分3416和近侧部分3418。远侧沟槽/螺纹部分3416的节距小于近侧沟槽/螺纹部分3418的节距。另外如图72-75所示，通过轴向保持器销3450限制远侧闭合管段3430相对于脊构件3420进行轴向运动，所述轴向保持器销容纳在脊构件3420的远端中的轴向狭槽3424中。
如上所述，通过旋转近侧闭合管段3410打开和闭合砧座2524。可变节距螺纹布置通过凸耳3442和近侧沟槽/螺纹部分3418之间的接合而允许以第一速度或速率在远侧方向“DD”上驱动远侧闭合管段3430。当凸耳3442接合远侧沟槽/螺纹部分3416时，将以第二速度或速率在远侧方向上驱动远侧闭合管段3430。因为近侧沟槽/螺纹部分3418比远侧沟槽/螺纹部分3416更粗糙，第一速度将大于第二速度。
在至少一个实施例中，工具安装部分3500能够接收来自机器人控制器1001的相应的第一旋转运动，并将该第一旋转运动转化成主旋转运动，以使可旋转的近侧闭合管段3410围绕纵向工具轴线LT-LT旋转。如图76所示，近侧闭合管段3410的近端3460可旋转地支撑在附接到工具安装部分3500的工具安装板3502的支架布置3504中。旋转齿轮3462形成于或附接到闭合管段3410的近端3460，以与可操作地支撑在工具安装板3502上的旋转驱动组件3470啮合。在至少一个实施例中，当工具安装部分3500联接到工具架1270时，旋转传动齿轮3472联接到工具安装板3502的适配器侧上相应的从动盘或从动元件1304中的第一个。参见图34和76。旋转驱动组件3470还包括旋转从动齿轮3474，所述旋转从动齿轮与旋转齿轮3462和旋转传动齿轮3472以啮合的方式而被旋转地支撑在工具安装板3502上。将来自机器人控制器1001的第一旋转控制运动通过工具架1270和适配器1240施加到相应的从动元件1304，从而将通过可操作地联接至其而引起旋转传动齿轮3472的旋转。旋转传动齿轮3472的旋转最终引起闭合管段3410的旋转，从而打开和闭合砧座3524，如上所述。
如上所述，外科端部执行器3412采用上述类型和构造的切割器械。图76示出了用于轴向推进刀杆3492的刀驱动组件3480的一种形式，所述刀杆附接到该切割器械。一种形式的刀驱动组件3480包括旋转传动齿轮3482，当工具驱动部分3500联接到工具架1270时，所述旋转传动齿轮联接到工具安装板3502的适配器侧上相应的从动盘或从动元件1304中的第三个。参见图34和76。刀驱动组件3480还包括可旋转地支撑在工具安装板5200上的第一旋转从动齿轮组件3484。第一旋转从动齿轮组件3484与第三旋转从动齿轮组件3486啮合，所述第三旋转从动齿轮组件可旋转地支撑在工具安装板3502上并与第四旋转从动齿轮组件3488啮合，所述第四旋转从动齿轮组件与联接到刀杆3492的驱动轴组件3490的螺纹部分3494啮合。旋转传动齿轮3482在第二旋转方向上旋转将引起驱动轴组件3490和刀杆3492在远侧方向“DD”上轴向行进。反之，旋转传动齿轮3482在次旋转方向（与第二旋转方向相反）上旋转将引起驱动轴组件3490和刀杆3492在近侧方向上运动。
图77-86示出了可结合机器人系统1000使用的本发明的另一个外科工具3600实施例。如图77所示，工具3600包括一次性加载单元3612形式的端部执行器。可结合工具3600使用的一次性加载单元的各种形式在例如名称为“End Effector Arrangements For a Surgical Cutting and StaplingInstrument”的美国专利申请公布No.US2009/0206131A1中公开，该专利的公开内容全文以引用的方式并入本文。
在至少一种形式中，一次性加载单元3612包括砧座组件3620，所述砧座组件被支撑以相对于可操作地支撑其中的钉仓3640的载体3630而枢转行进。安装组件3650可枢转地联接到仓载体3630，以使载体3630围绕关节运动轴线AA-AA相对于纵向工具轴线LT-LT枢转。参见图82，安装组件3650包括上部安装部分3652和下部安装部分3654。每个安装部分包括在其每个侧面上的螺纹镗孔3656，所述螺纹镗孔的尺寸设定成能够容纳螺栓（未示出）以固定载体3630的近端。一对中心定位的枢转构件3658通过一对联接构件3660在上部安装部分和下部安装部分之间延伸，所述联接构件与外壳部分3662的远端接合。每个联接构件3660均包括互锁近侧部分3664，所述互锁近侧部分能够容纳于在外壳部分3662的近端中形成的沟槽3666中，从而使安装组件3650和外壳部分3662保持在相对于其的纵向固定位置。
在各种形式中，一次性加载单元3614的外壳部分3662包括包含在外部壳体3674内的上半部外壳3670和下半部外壳3672。上半部外壳3670的近端包括用于以可释放的方式接合细长轴3700和插入尖端3678的接合块3676。接合块3676与细长轴3700的远端形成卡口式联接，这将在下文中进一步详细地描述。外壳半部3670,3672限定用于可滑动地容纳轴向驱动组件3680的通道3674。第二关节运动连接件3690的尺寸设定成可滑动地定位于在外壳半部3670,3672之间形成的狭槽3679中。将一对防爆板3691设置在邻近与轴向驱动组件3680的远端相邻的外壳部分3662的远端，以防止在载体3630的关节运动过程中驱动组件3680向外凸出。
在各种实施例中，第二关节运动连接件3690包括至少一个细长金属板。优选地，堆叠两个或更多个金属板以形成连接件3690。关节运动连接件3690的近端包括钩部分3692，所述钩部分能够接合延伸穿过细长轴3700的第一关节运动连接件3710。第二关节运动连接件3690的远端包括套环3694，所述套环的尺寸设定成能够接合安装组件3650上形成的突出。突出与枢轴销3658横向错开，使得第二关节运动连接件3690的线性运动促使安装组件3650围绕枢轴销3658枢转，从而使载体3630进行关节运动。
在各种形式中，轴向驱动组件3680包括细长的驱动横梁3682，所述细长的驱动横梁包括远侧工作头3684和近侧接合部分3685。驱动横梁3682可由单个材料片或优选地多个堆叠的片材制成。接合部分3685包括一对接合指状物，所述接合指状物的尺寸设定成并能够以安装方式接合驱动构件3686中形成的一对相应的保持狭槽。驱动构件3686包括近侧通道口3687，当一次性加载单元3614的近端与外科工具3600的细长轴3700接合时，所述近侧通道口能够容纳控制杆2720的远端3722（参见图86）。
参见图77和84-86，为了使用外科工具3600，首先将一次性加载单元3612固定到细长轴3700的远端。应当理解，外科工具3600可包括关节运动或非关节运动的一次性加载单元。为了将一次性加载单元3612固定到细长轴3700，将控制杆3720的远端3722插入到一次性加载单元3612的插入尖端3678中，并且插入尖端3678在图84中箭头“A”示出的方向上纵向滑动到细长轴3700的远端，使得第二关节运动连接件3690的钩部分3692在细长轴3700中的通道3702内滑动。每个接合块3676将在细长轴3700各自的通道（未示出）中对齐。当钩部分3692接合通道3702的近侧壁3704时，一次性加载单元3612在图83和84中箭头“B”示出的方向上旋转以使第二关节运动连接件3690的钩部分3692运动至与第一关节运动连接件3710的指状物3712接合。接合块3676还在细长轴3700中的环形通道3703内形成“卡口式”联接。在加载单元3612的旋转过程中，接合块3676接合挡板3730的凸轮表面3732（图84），以首先在图84中箭头“C”示出的方向上移动板3730以便将接合构件3734锁定在控制杆3720的凹槽3721中，从而防止控制杆3720在一次性加载单元3612的附接过程中纵向运动。在最终程度的旋转过程中，接合块3676从凸轮表面3732脱离以允许挡板3730在图83和86中箭头“D”示出的方向上从接合构件3734的后面运动，从而再次允许控制杆3720纵向运动。虽然上述附接方法反映了相对于细长轴3700操纵一次性加载单元3612，但是本领域的普通技术人员将会知道，一次性加载单元3612可支撑在固定位置，并且机器人系统1000可相对于一次性加载单元3612操纵细长轴部分3700，从而实现上述联接过程。
图87示出了可附接在具有细长轴3700’的卡口式布置中的另一个一次性加载单元3612’，所述细长轴除了下文所述差异之外基本上与轴3700相同。如图87所示，细长轴3700’具有延伸其至少一部分的狭槽3705，并且所述狭槽能够容纳其中的接合块3676。在各种实施例中，一次性加载单元3612’包括从其延伸的臂3677，在一次性加载单元3612’旋转之前，所述臂可与从外壳部分3662延伸的接合块3676对齐或至少基本上对齐。在至少一个实施例中，例如，当一次性加载单元3612’插入到细长轴3700’中时，臂3677和接合块3676可插入到细长轴3700’中的狭槽3705中。当一次性加载单元3612’旋转时，可将臂3677充分地限制在狭槽3705内，使得狭槽3705可将臂保持在适当的位置，然而接合块3676可被定位为使得其不被限制在狭槽3705内并可相对于臂3677旋转。当旋转时，关节运动连接件3690的钩部分3692与延伸穿过细长轴3700’的第一关节运动连接件3710接合。
可使用将一次性加载单元联接到细长轴的末端的其他方法。例如，如图88和89所示，一次性加载单元3612”可包括能够与细长轴3700”的连接器部分3740接合的连接器部分3613。在至少一个实施例中，连接器部分3613可以包括可以与连接器部分3740的至少一个突出和/或沟槽配合的至少一个突出和/或沟槽。在至少一个此类实施例中，连接器部分可包括协作的燕尾部分。在各种实施例中，连接器部分能够彼此互锁，并且防止或至少抑制一次性加载单元3612”沿着轴线3741进行远侧和/或近侧运动。在至少一个实施例中，轴向驱动组件3680’的远端可包括小孔3681，所述小孔能够容纳从控制杆3720’延伸的突出3721。在各种实施例中，此布置可允许一次性加载单元3612”在不与轴线3741共线或平行的方向上组装到细长轴3700。虽然未示出，轴向驱动组件3680’和控制杆3720可包括任何其他合适的突出和小孔布置以可操作地彼此连接。另外在该实施例中，第一关节运动连接件3710可操作地与第二关节运动连接件3690接合。
如图77和90所示，外科工具3600包括工具安装部分3750。工具安装部分3750包括能够附接至工具驱动组件1010的工具安装板3751。工具安装部分可操作地支撑其上的传动装置布置3752。在使用中，围绕由细长轴3700限定的纵向工具轴线旋转一次性加载单元3612可能是有利的。在至少一个实施例中，传动装置布置3752包括旋转的传输组件3753，所述旋转的传输组件能够接收来自机器人系统1000的工具驱动组件1010的对应的旋转输出运动，并将此旋转输出运动转化成旋转控制运动以使细长轴3700（和一次性加载单元3612）围绕纵向工具轴线LT-LT旋转。如图90所示，细长轴3700的近端3701可旋转地支撑在支架布置3754中，所述支架装置附接到工具安装部分3750的工具安装板3751。旋转齿轮3755形成于或附接到细长轴3700的近端3701，以与可操作地支撑在工具安装板3751上的旋转齿轮组件3756啮合。在至少一个实施例中，当工具安装部分3750联接到工具驱动组件1010时，旋转传动齿轮3757驱动地联接到工具安装板3751的适配器侧上相应的从动盘或从动元件1304中的第一个。旋转的传输组件3753还包括旋转从动齿轮3758，所述旋转从动齿轮以与旋转齿轮3755和旋转传动齿轮3757以啮合的方式而被旋转地支撑在工具安装板3751上。将来自机器人系统1000的第一旋转输出运动通过工具驱动组件1010施加到相应的从动元件1304，从而将通过可操作地联接至其而引起旋转传动齿轮3757的旋转。旋转传动齿轮3757的旋转最终致使细长轴3700（和一次性加载单元3612）围绕纵向工具轴线LT-LT旋转（主旋转运动）。
如图90所示，将驱动轴组件3760联接到控制杆2720的近端。在各种实施例中，控制杆2720通过刀/闭合驱动传动装置布置3762在远侧和近侧方向上轴向行进。一种形式的刀/闭合驱动组件3762包括旋转传动齿轮3763，当工具安装部分3750联接到工具架1270时，所述旋转传动齿轮联接到工具安装板3751的适配器侧上相应的从动可旋转主体部分、盘或元件1304中的第二个。旋转从动齿轮3763与齿轮系（一般描述为3764）驱动啮合。在至少一种形式中，齿轮系3764还包括可旋转地支撑在工具安装板3751上的第一旋转从动齿轮组件3765。第一旋转从动齿轮组件3765与第二旋转从动齿轮组件3766啮合，所述第二旋转从动齿轮组件可旋转地支撑在工具安装板3751上并且与第三旋转从动齿轮组件3767啮合，所述第三旋转从动齿轮组件与驱动轴组件3760的螺纹部分3768啮合。旋转传动齿轮3763在第二旋转方向上旋转将引起驱动轴组件3760和控制杆2720在远侧方向“DD”上轴向行进。反之，旋转传动齿轮3763在次旋转方向（与第二旋转方向相反）上旋转将引起驱动轴组件3760和控制杆2720在近侧方向上运动。当控制杆2720在远侧方向上运动时，其朝远侧驱动其驱动横梁3682和工作头3684穿过外科钉仓3640。当工作头3684朝远侧驱动时，其可操作地接合砧座3620以将砧座枢转至闭合位置。
可通过施加轴向关节运动控制运动至第一关节运动连接件3710和第二关节运动连接件3690来使仓载体3630围绕关节运动轴线AA-AA选择性地进行关节运动。在各种实施例中，传动装置布置3752还包括可操作地支撑在工具安装板3751上的关节运动驱动器3770。更具体地讲并结合图90可看出，能够可操作地与第一关节运动连接件3710接合的关节运动驱动轴3771的近端部分3772延伸穿过旋转齿轮3755并可旋转地联接到移位器齿条齿轮3774，所述移位器齿条齿轮穿过狭槽3775可滑动地附连到工具安装板3751。关节运动驱动器3770还包括移位器传动齿轮3776，当工具安装部分3750联接到工具架1270时，所述移位器传动齿轮联接到工具安装板3751的适配器侧上相应的从动盘或从动元件1304中的第三个。关节运动驱动组件3770还包括移位器从动齿轮3778，所述移位器从动齿轮与移位器传动齿轮3776和移位器齿条齿轮3774以啮合的方式而被旋转地支撑在工具安装板3751上。将来自机器人系统1000的第三旋转输出运动通过工具驱动组件1010施加到相应的从动元件1304，从而将通过可操作地联接至其而引起移位器传动齿轮3776的旋转。移位器传动齿轮3776的旋转最终引起移位器齿轮齿条3774和关节运动驱动轴3771的轴向运动。关节运动驱动轴3771的轴向行进的方向取决于移位器传动齿轮3776通过机器人系统1000旋转的方向。因此，移位器传动齿轮3776在第一旋转方向上的旋转将引起关节运动驱动轴3771在近侧方向“PD”上的轴向运动并引起仓载体3630围绕关节运动轴线AA-AA在第一方向上枢转。反之，移位器传动齿轮3776在第二旋转方向（与第一旋转方向相反）上的旋转将引起关节运动驱动轴3771在远侧方向“DD”上的轴向运动，从而引起仓载体3630围绕关节运动轴线AA-AA在相反方向上枢转。
图91示出了可结合机器人系统1000使用的本发明的另一个外科工具3800实施例。如图91所示，外科工具3800包括线切割器3814形式的外科端部执行器3812，所述线切割器采用各种缆线驱动的部件。各种形式的缆线驱动的线切割器在例如名称为“Surgical Stapler With Universal Articulationand Tissue Pre-Clamp”的美国专利No.7,726,537和名称为“Cable DrivenSurgical Stapling and Cutting Instrument With Improved Cable AttachmentArrangements”的美国专利申请公布No.US2008/0308603A1中公开，所述专利的公开内容全文均以引用的方式并入本文。此类线切割器3814可以被称为“一次性加载单元”，因为其被设计为在单次使用后被丢弃。然而，本发明的各种实施例的各种独特和新颖的布置也可结合可重复使用的缆线驱动的端部执行器使用。
如图91所示，在至少一种形式中，线切割器3814包括可操作地支撑其中的外科钉仓3834的细长通道3822。砧座3824被可枢转地支撑以相对于外科钉仓3834运动。砧座3824具有能够与预夹紧衬圈3840相互作用的凸轮表面3825，所述预夹紧衬圈被支撑以相对于凸轮表面进行轴向运动。将端部执行器3814与附接到工具安装部分3900的细长轴组件3808联接。在各种实施例中，可采用闭合缆线3850以将预夹紧衬圈3840朝远侧移动到凸轮表面3825及其上方，以相对于外科钉仓3834闭合砧座3824并压缩其间的组织。优选地，闭合缆线3850在点3841处或靠近点3841附接到预夹紧衬圈3840，并馈通砧座3824（或在砧座3824的近侧部分的下方）中的通道并朝近侧馈通轴3808。闭合缆线3850在近侧方向“PD”上的致动迫使预夹紧衬圈3840朝远侧抵靠凸轮表面3825以相对于钉仓组件3834闭合砧座3824。可采用返回机构，例如，弹簧、缆线系统等以将预夹紧衬圈3840返回至重新打开砧座3824的预夹紧方向。
细长轴组件3808的形状可以是圆柱形的，并且限定通道3811，所述通道的尺寸可被设计为能够容纳管适配器3870。参见图92。在各种实施例中，管适配器3870可与细长轴3808的内部通道以摩擦配合接合的方式而被滑动容纳。管适配器3870的外表面还可包括至少一个机械接口，例如，切口或凹口3871，所述切口或凹口被取向为与设置在内部通道3811的内周边上的相应的机械接口，例如径向向内延伸的突起或棘爪（未示出）配合，以将管适配器3870锁定到细长轴3808。在各种实施例中，管适配器3870的远端可包括一对相对的凸缘3872a和3872b，它们限定了用于在其中枢转地容纳枢轴块3873的腔体。每个凸缘3872a和3872b可包括小孔3874a和3874b，所述小孔被取向为容纳延伸穿过枢轴块3873中的小孔的枢轴销3875，以允许枢轴块3873围绕与纵向工具轴线“LT-LT”垂直的轴线而枢转运动。通道3822可由两个向上延伸的凸缘3823a、3823b构成，所述向上延伸的凸缘中具有尺寸设定成能够容纳枢轴销3827的小孔。继而，枢轴销3875穿过枢轴块3873中的小孔安装，以允许外科端部执行器3814在给定的外科手术过程中当需要时围绕“Y”轴旋转。枢轴块3873沿着“Z”轴围绕销3875的旋转使外科端部执行器3814围绕“Z”轴旋转。参见图92。在不脱离本发明的实质和范围的情况下，可有效采用将细长通道3822紧固到枢轴块3873上的其他方法。
在制备或组装过程中外科钉仓3834可被组装并安装在细长通道3822内，并作为外科端部执行器3812的一部分出售，或在需要时外科钉仓3834可被设计为选择性地安装在细长通道3822内并单独出售，例如作为单次使用的置换件、可替换的或一次性的钉仓组件。例如，外科端部执行器3812可枢转地、操作地或一体地附接到一次性外科缝合器的细长轴组件3808的远端3809上是在本公开范围内的。众所周知，使用的或用过的一次性加载单元3814可从细长轴组件3808中移除并用未使用的一次性单元替换。一旦将未耗费的或未使用的仓3834安装在细长通道3822中，则线切割器3814还可优选地包括致动器、优选地动态夹紧构件3860、滑动件3862以及钉推动器（未示出）和钉（未示出）。参见图92。
在各种实施例中，动态夹紧构件3860与滑动件3862相连，例如，安装和靠在滑动件上、或与其相连或一体结合和/或靠在其后面。据设想，动态夹紧构件3860可具有与其连接的或一体成型的凸轮楔形件或凸轮表面，或由凸轮楔形件或凸轮表面的远侧前表面推动。在各种实施例中，动态夹紧构件3860可包括具有横向小孔3864（销3865可安装或安装在其中）的上部3863、中央支撑件或向上的延伸部分3866和基本上为T形的底部凸缘3867，所述各部分配合以在滑动件3862的纵向远侧运动过程中沿着理想的切割路径滑动地保持动态夹紧构件3860。前切刃3868（这里为刀片3869）的尺寸设定成靠在钉仓组件3834的狭槽3835中，并且一旦缝合就使组织分离。如本文所用，术语“刀组件”可以包括上述动态夹紧构件3860、刀3869和滑动件3862或其他刀/横梁/滑动件驱动布置和切割器械布置。另外，本发明的各种实施例可采用刀组件/切割器械布置，所述刀组件/切割器械装置可完全支撑在钉仓3834中或局部支撑在钉仓3834和细长通道3822中或全部支撑在细长通道3822中。
在各种实施例中，可通过缆线驱动组件3870在近侧和远侧方向上驱动动态夹紧构件3860。在一个非限制性形式中，缆线驱动组件包括一对推进缆线3880、3882和击发缆线3884。图93和94示出了图表形式的缆线3880、3882、3884。如那些图所示，第一推进缆线3880可操作地支撑在第一远侧缆线过渡支撑体3885和第一近侧缆线过渡支撑体3886上，所述第一远侧缆线过渡支撑体可包括附接到细长通道3822的远端的例如皮带轮、杆、绞盘等，所述第一近侧缆线过渡支撑体可包括由细长通道3822可操作地支撑的例如皮带轮、杆、绞盘等。第一推进缆线3880的远端3881附连到动态夹紧组件3860。第二推进缆线3882可操作地支撑在第二远侧缆线过渡支撑体3887和第二近侧缆线过渡支撑体3888上，所述第二远侧缆线过渡支撑体可包括安装到细长通道3822的远端的例如皮带轮、杆、绞盘等，所述第二近侧缆线过渡支撑体可包括安装到细长通道3822的近端的例如皮带轮、杆、绞盘等。第二推进缆线3882的近端3883可附接到动态夹紧组件3860。另外，在这些实施例中，采用环状击发缆线3884并将其连接在支撑体3889上，所述支撑体可包括安装在细长轴3808中的皮带轮、杆、绞盘等。在一个实施例中，回缩缆线3884可在套环中形成并联接到连接器3889’，所述连接器固定地附接到第一推进缆线3880和第二推进缆线3882。
本发明的各种非限制性实施例包括可操作地支撑在工具安装部分3900的工具安装板3902上的缆线驱动传动装置3920。工具安装部分3900具有一系列电连接销3904，所述电连接销能够与适配器1240’中的狭槽1258（图33）交接。此布置允许机器人系统1000为工具3800的控制电路3910提供控制信号。虽然结合机械耦合元件、电耦合元件和磁力耦合元件在本文中描述了接口，应当理解，可使用多种遥测形式，包括红外、电感耦合等。
控制电路3910在图91中以图解示意图的形式示出。在一种形式或实施例中，控制电路3910包括电池3912形式的功率源，所述电池联接到通断螺线管功率源开关3914。然而，在其他实施例中，功率源可包括交流功率源。控制电路3910还包括通断螺线管3916，所述螺线管联接到双极开关3918以控制马达旋转方向。因此，当机器人系统1000提供适当的控制信号时，开关3914将允许电池3912为双极开关3918提供电能。机器人系统1000还为双极开关3918提供适当的信号以为移位器马达3922提供电能。
转到图95-100，缆线驱动传动装置3920的至少一个实施例包括可操作地安装到驱动轴3932的驱动皮带轮3930，所述驱动轴附接到上述类型和构造的从动元件1304，所述从动元件被设计为与适配器1240的相应的驱动元件1250交接。参见图33和98。因此，当工具安装部分3900可操作地联接到工具架1270时，机器人系统1000可在所需方向上施加旋转运动到驱动皮带轮3930。第一驱动构件或皮带3934驱动接合驱动皮带轮3930，并且可旋转地支撑在移位器轭3940上的第二驱动轴3936。移位器轭3940可操作地联接到移位器马达3922，使得移位器马达3922的轴3923在第一方向上的旋转将在第一方向“FD”上偏移移位器轭，并且移位器马达轴3923在第二方向上的旋转将在第二方向“SD”上偏移移位器轭3940。本发明的其他实施例可采用移位器螺线管布置，以在所述的第一方向和第二方向上偏移移位器轭
如图95-98所示，闭合传动齿轮3950安装到第二驱动轴3936，并能够与闭合驱动组件（一般称为3951）选择性地啮合。同样，击发传动齿轮3960也安装到第二驱动轴3936，并能够与击发驱动组件（一般称为3961）选择性地啮合。第二驱动轴3936的旋转引起闭合传动齿轮3950和击发传动齿轮3960旋转。在一个非限制性实施例中，闭合驱动组件3951包括闭合从动齿轮3952，所述闭合从动齿轮联接到可旋转地支撑在第三驱动轴3956上的第一闭合皮带轮3954。闭合缆线3850驱动地容纳在第一闭合皮带轮3954上，使得闭合从动齿轮3952的旋转将驱动闭合缆线3850。同样，击发驱动组件3961包括击发从动齿轮3962，所述击发从动齿轮联接到可旋转地支撑在第三驱动轴3956上的第一击发皮带轮3964。第一驱动皮带轮3954和第二驱动皮带轮3964在第三驱动轴3956上独立地旋转。击发缆线3884驱动地容纳在第一击发皮带轮3964上，使得击发从动齿轮3962的旋转将驱动击发缆线3884。
另外在各种实施例中，缆线驱动传动装置3920还包括制动组件3970。例如，在至少一个实施例中，制动组件3970包括闭合制动器3972，所述闭合制动器包括附接到传动装置外壳3971的一部分的弹簧臂3973。闭合制动器3972具有齿轮凸耳3974，所述齿轮凸耳的尺寸设定成能够接合闭合从动齿轮3952的齿状物，如将在下文中进一步详细地描述。制动组件3970还包括击发制动器3976，所述击发制动器包括附接到传动装置外壳3971的另一部分的弹簧臂3977。击发制动器3976具有齿轮凸耳3978，所述齿轮凸耳的尺寸设定成能够接合击发从动齿轮3962的齿状物。
外科工具3800的至少一个实施例可按如下使用。工具安装部分3900可操作地联接到机器人系统1000的接口1240。操作机器人系统的控制器或控制单元，以将待切割和缝合的组织定位在打开的砧座3824和钉仓3834之间。当位于初始位置时，制动组件3970已锁定了闭合从动齿轮3952和击发从动齿轮3962，使得它们不能旋转。即，如图96所示，齿轮凸耳3974与闭合从动齿轮3952锁定接合，并且齿轮凸耳3978与击发从动齿轮3962锁定接合。一旦外科端部执行器3814已被适当地定位，机器人系统1000的控制器1001将为移位器马达3922（或移位器螺线管）提供控制信号，从而在第一方向上移动移位器轭3940。当移位器轭3940在第一方向上运动时，当闭合传动齿轮3950运动至与闭合从动齿轮3952啮合时，闭合传动齿轮使齿轮凸耳3974运动至与闭合从动齿轮3952脱离。如图95所示，当处于该位置时，齿轮凸耳3978保持与击发从动齿轮3962锁定接合，从而防止击发系统的致动。然后，机器人控制器1001穿过从动元件1304和工具架1240的对应部件之间的接口而为驱动皮带轮3930提供第一旋转致动运动。当驱动皮带轮3930在第一方向上旋转时，闭合缆线3850被旋转以将预夹紧衬圈3840驱动至与砧座3824的凸轮表面3825闭合接合，以便使其运动至闭合位置，从而夹紧砧座3824和钉仓3834之间的靶组织。参见图91。一旦砧座3824已运动至闭合位置，机器人控制器1001停止施加第一旋转运动至驱动皮带轮3930。然后，机器人控制器1001可通过发送另一控制信号至移位器马达3922（或移位器螺线管）来使移位器轭在第二方向“SD”上运动而开始击发过程，如图97所示。当移位器轭3940在第二方向上运动时，当击发传动齿轮3960运动至与击发从动齿轮3962啮合时，击发传动齿轮使齿轮凸耳3978与击发从动齿轮3962脱离。如图97所示，当处于该位置时，齿轮凸耳3974保持与闭合从动齿轮3952锁定接合，从而防止闭合系统的致动。然后，穿过从动元件1304和工具架1240的对应部件之间的接口来启动机器人控制器1001，以为驱动皮带轮3930提供第一旋转致动运动。当驱动皮带轮3930在第一方向上旋转时，击发缆线3884被旋转以在远侧方向“DD”上驱动动态夹紧构件3860，从而击发钉并切割夹持在端部执行器3814中的组织。一旦机器人系统1000通过传感器或通过监测施加到驱动皮带轮3930的旋转输入的量来确定动态夹紧构件3860已到达其最远侧位置，则控制器1001可向驱动皮带轮3930施加第二旋转运动以在相反方向上旋转闭合缆线3850，从而在近侧方向“PD”上回缩动态夹紧构件3860。一旦动态夹紧构件回缩至起始位置，停止向驱动皮带轮3930施加第二旋转运动。然后，移位器马达3922（或移位器螺线管）通电，以将移位器轭3940移动到闭合位置（图95）。一旦闭合传动齿轮3950与闭合从动齿轮3952啮合，则机器人控制器1001可再次向驱动皮带轮3930施加第二旋转运动。驱动皮带轮3930在第二方向上的旋转使闭合缆线3850将预夹紧衬圈3840回缩至与砧座3824的凸轮表面3825脱离，以允许砧座3824运动至打开位置（通过弹簧或其他装置），从而从外科端部执行器3814释放被缝合的组织。
图101示出了采用如图102-104中示出的齿轮从动击发杆4092的外科工具4000。该实施例包括从工具安装部分4100延伸的细长轴组件4008。工具安装部分4100包括可操作地支撑其上的传动装置布置4103的工具安装板4102。细长轴组件4008包括可旋转的近侧闭合管4010，所述可旋转的近侧闭合管可旋转地连接在近侧脊构件4020上，所述近侧脊构件刚性联接到工具安装板4102。近侧脊构件4020具有联接到外科端部执行器4012的细长通道部分4022的远端。外科端部执行器4012可基本上类似于上述外科端部执行器3412。另外，可通过与近侧闭合管4010可操作地交接的远侧闭合管4030打开和闭合外科端部执行器4012的砧座4024。远侧闭合管4030与上述远侧闭合管3430相同。相似地，近侧闭合管4010与上述近侧闭合管段3410相同。
通过以上述方式相对于远侧闭合管3410旋转近侧闭合管4010来打开和闭合砧座4024。在至少一个实施例中，传动装置布置包括闭合传动装置布置（一般称为4011）。如将在下文中进一步描述，闭合传动装置4011能够接收来自机器人系统1000的相应的第一旋转运动，并将此第一旋转运动转化成主旋转运动，以使可旋转的近侧闭合管4010围绕纵向工具轴线LT-LT旋转。如图104所示，近侧闭合管4010的近端4060可旋转地支撑在支架布置4104中，所述支架装置附接到工具安装部分4100的工具安装板4102。旋转齿轮4062形成于或附接到闭合管段4010的近端4060，以与可操作地支撑在工具安装板4102上的旋转驱动组件4070啮合。在至少一个实施例中，当工具安装部分4100联接到工具架1270时，旋转传动齿轮4072联接到工具安装板4102的适配器侧上相应的从动盘或从动元件1304中的第一个。参见图34和104。旋转驱动组件4070还包括旋转从动齿轮4074，所述旋转从动齿轮与旋转齿轮4062和旋转传动齿轮4072以啮合的方式而被旋转地支撑在工具安装板4102上。将来自机器人系统1000的第一旋转控制运动通过工具架1270和适配器1240施加到相应的从动元件1304，从而将通过可操作地联接至其而引起旋转传动齿轮4072的旋转。旋转传动齿轮4072的旋转最终引起闭合管段4010的旋转，从而打开和闭合砧座4024，如上所述。
如上所述，端部执行器4012采用如图102和103中示出的切割元件3860。在至少一个非限制性实施例中，传动装置布置4103还包括刀驱动传动装置，所述刀驱动传动装置包括刀驱动组件4080。图104示出了用于轴向推进刀杆4092的刀驱动组件4080的一种形式，所述刀杆使用上述缆线相对于外科工具3800附接到此切割元件。具体地讲，刀杆4092替代外科工具3800的实施例中采用的击发缆线3884。一种形式的刀驱动组件4080包括旋转传动齿轮4082，当工具安装部分4100联接到工具架1270时，所述旋转传动齿轮联接到工具安装板4102的适配器侧上相应的从动盘或从动元件1304中的第二个。参见图34和104。刀驱动组件4080还包括可旋转地支撑在工具安装板4102上的第一旋转从动齿轮组件4084。第一旋转从动齿轮组件4084与第三旋转从动齿轮组件4086啮合，所述第三旋转从动齿轮组件可旋转地支撑在工具安装板4102上并与第四旋转从动齿轮组件4088啮合，所述第四旋转从动齿轮组件与联接到刀杆4092的驱动轴组件4090的螺纹部分4094啮合。旋转传动齿轮4082在第二旋转方向上旋转将引起驱动轴组件4090和刀杆4092在远侧方向“DD”上轴向行进。反之，旋转传动齿轮4082在次旋转方向（与第二旋转方向相反）上旋转将引起驱动轴组件4090和刀杆4092在近侧方向上运动。击发杆4092在近侧方向“PD”上的运动将在远侧方向“DD”上驱动切割元件3860。反之，击发杆4092在远侧方向“DD”上的运动将引起切割元件3860在近侧方向“PD”上运动。
图105-111示出了可结合机器人系统1000有效使用的另一个外科工具5000。在各种形式中，外科工具5000包括外科缝合器械形式的外科端部执行器5012，所述外科缝合器械包括细长通道5020和可枢转平移的夹紧构件（例如砧座5070），所述细长通道和可枢转平移的夹紧构件保持在确保有效缝合和切断夹持在外科端部执行器5012中的组织的间距处。如图107所示，细长通道5020的横截面可以是基本U形的，并且由例如钛、203不锈钢、304不锈钢、416不锈钢、17-4不锈钢、17-7不锈钢、6061或7075铝、铬钢、陶瓷等制成。基本U形的金属通道盘5022可支撑在细长通道5020的底部，如图所示。
各种实施例包括滑动件组件5030形式的致动构件，所述滑动件组件可操作地支撑在外科端部执行器5012中，并响应于施加至其上的控制运动在起始位置和结束位置之间轴向运动。在一些形式中，金属通道盘5022具有居中设置的狭槽5024以可运动地容纳滑动件组件5030的基座部分5032。基座部分5032包括支脚部分5034，所述支脚部分的尺寸设定成可滑动地容纳在细长通道5020中的狭槽5021中。参见图107。如图107、110和111所示，滑动件组件5030的基座部分5032包括能够通过螺纹容纳在螺纹驱动轴5130上的轴向延伸的螺纹镗孔5036，如将在下文中进一步详细地描述。另外，滑动件组件5030包括支撑组织切割刀片或组织切割器械5040的直立支撑部分5038。直立支撑部分5038终止于顶部5042，所述顶部具有从其中突起的横向延伸的一对保持翅片5044。如图107所示，翅片5044被定位成容纳在砧座5070中相应的狭槽5072内。当滑动件组件5030朝远侧驱动穿过夹持在外科端部执行器5014中的组织时，翅片5044和支脚5034用于将砧座5070保持在所需的间隔开的闭合位置处。另外如图109和111所示，滑动件组件5030还包括往复或顺序致动的驱动组件5050，以朝闭合砧座5070驱动钉推动器。
更具体地讲并结合图107和108，细长通道5020能够可操作地支撑其中的外科钉仓5080。在至少一种形式中，外科钉仓5080包括主体部分5082，所述主体部分可由例如维克特拉(Vectra)、尼龙（6/6或6/12）制成并包括居中设置的狭槽5084，以容纳滑动件组件5030的直立支撑部分5038。参见图107。这些材料还可用10%-40%的玻璃、碳或矿物质填充。外科钉仓5080还包括多个腔体5086以用于可运动地支撑其中成行的或成排的钉支撑推动器5088。腔体5086可排列在间隔开的纵向延伸的行或排5090、5092、5094、5096中。例如，排5090在本文中可被称为第一外侧排。排5092在本文中可被称为第一内侧排。排5094可被称为第二内侧排以及排5096可被称为第二外侧排。第一内侧排5090和第一外侧排5092位于纵向狭槽5084的第一横向侧上，第二内侧排5094和第二外侧排5096位于纵向狭槽5084的第二横向侧上。第一内侧排5092中的第一钉推动器5088相对于第一外侧排5090中的第一钉推动器5088交错排列。相似地，第二外侧排5096中的第二钉推动器5088相对于第二内侧排5094中的第二推动器5088交错排列。每个推动器5088可操作地支撑其上的外科钉5098。
在各种实施例中，顺序致动或往复致动的驱动组件5050包括各自附接到公共轴5056的一对外侧驱动器5052和一对内侧驱动器5054，所述公共轴可旋转地安装在滑动件组件5030的基座5032中。外侧驱动器5052被取向为与设置在通道盘5022中的相应的多个外侧激活腔体5026顺序或往复地接合。同样，内侧驱动器5054被取向为与设置在通道盘5022中的相应的多个内侧激活腔体5028顺序或往复地接合。内侧激活腔体5028相对于邻近的外侧激活腔体5026交错排列。参见图108。另外如图108和110所示，在至少一个实施例中，滑动件组件5030还包括位于镗孔5036的每个侧面上的远侧楔形件段5060和中间楔形件段5062，以当滑动件组件5030在远侧方向“DD”上朝远侧驱动时与推动器5088接合。如上所述，滑动件组件5030通过螺纹容纳在驱动轴5130的螺纹部分5132上，所述驱动轴可旋转地支撑在端部执行器5012中。例如，在各种实施例中，驱动轴5130具有支撑在远侧轴承5136中的远端5134，所述远侧轴承安装在外科端部执行器5012中。参见图107和108。
在各种实施例中，外科端部执行器5012通过细长轴组件5108联接到工具安装部分5200。在至少一个实施例中，工具安装部分5200可操作地支撑传动装置布置（一般称为5204），所述传动装置布置能够接收来自机器人系统的旋转输出运动。细长轴组件5108包括可在脊构件5120上旋转和轴向运动的外部闭合管5110，所述脊构件刚性联接到工具安装部分5200的工具安装板5201。脊构件5120还具有联接到外科端部执行器5012的细长通道部分5020的远端5122。
在使用中，围绕由细长轴组件5008限定的纵向工具轴线LT-LT来旋转外科端部执行器5012可能是有利的。在各种实施例中，外部闭合管5110具有近端5112，所述近端通过向前的支撑支架5203可旋转地支撑在工具驱动部分5200的工具安装板5201上。外部闭合管5110的近端5112能够可操作地与传动装置布置5204的旋转传动部分5206交接。在各种实施例中，外部闭合管5110的近端5112也支撑在闭合滑动件5140上，所述闭合滑动件也可活动地支撑在工具安装板5201上。闭合管齿轮段5114形成在外部闭合管5110的近端5112上，以与旋转传动装置5206的旋转驱动组件5150啮合。如图105所示，在至少一个实施例中，旋转驱动组件5150包括旋转传动齿轮5152，当工具驱动部分5200联接到工具架1270时，所述旋转传动齿轮联接到工具安装板5201的适配器侧1307上相应的从动盘或从动元件1304中的第一个。旋转驱动组件5150还包括旋转从动齿轮5154，所述旋转从动齿轮与闭合管齿轮段5114和旋转传动齿轮5152以啮合的方式而被旋转地支撑在工具安装板5201上。将来自机器人系统1000的第一旋转控制运动通过工具架1270和适配器1240施加到相应的从动元件1304以引起旋转传动齿轮5152的旋转。旋转传动齿轮5152的旋转最终引起细长轴组件5108（和端部执行器5012）围绕纵向工具轴线LT-LT（图105中由箭头“R”表示）旋转。
通过使外部闭合管5110在远侧方向“DD”上轴向运动，实现砧座5070相对于外科钉仓5080的闭合。外部闭合管5110的此类轴向运动可以通过传动装置布置5204的闭合传动部分5144实现。如上所述，在各种实施例中，外部闭合管5110的近端5112由闭合滑动件5140支撑，所述闭合滑动件使近端5112相对于其进行旋转，但是随着闭合滑动件5140轴向行进。具体地讲，如图105所示，闭合滑动件5140具有直立的突出部5141，所述直立的突出部延伸到外部闭合管5110的近端部分5112中的径向沟槽5115中。另外，如上所述，闭合滑动件5140可滑动地安装到工具安装板5201。在各种实施例中，闭合滑动件5140具有直立部分5142，所述直立部分具有在其上形成的闭合齿条齿轮5143。闭合齿条齿轮5143能够与闭合传动装置5144驱动接合。
在各种形式中，闭合传动装置5144包括闭合正齿轮5145，所述闭合正齿轮联接到工具安装板5201的适配器侧1307上相应的从动盘或从动元件1304中的第二个。因此，当接口1230联接到工具安装部分5200时，将来自机器人系统1000的第二旋转控制运动通过工具架1270和适配器1240施加到相应的第二从动元件1304上将引起闭合正齿轮5145的旋转。闭合传动装置5144还包括以与闭合正齿轮5145和闭合齿条齿轮5143啮合的方式而被支撑的从动闭合齿轮组5146。因此，将来自机器人系统1000的第二旋转控制运动通过工具架1270和适配器1240施加到相应的第二从动元件1304将引起闭合正齿轮5145的旋转，并最终轴向驱动闭合滑动件5140和外部闭合管5110。闭合管5110运动的轴向最终取决于第二从动元件1304旋转的方向。例如，响应于接收自机器人系统1000的一个旋转闭合运动，闭合滑动件5140将在远侧方向“DD”上被驱动，并且外部闭合管5110最终也将在远侧方向上被驱动。外部闭合管5110具有远端5116中的开口5117，所述远端能够以上述方式与砧座5070上的突出部5071接合。当朝远侧驱动外部闭合管5110时，闭合管5110的近端5116将接触砧座5070并将其枢转闭合。当施加来自机器人系统1000的“开口”旋转运动时，将在近侧方向“PD”上驱动闭合滑动件5140和外部闭合管5110，并且以上述方式将砧座5070枢转至打开位置。
在至少一个实施例中，驱动轴5130具有近端5137，所述近端具有与之附接的近侧轴齿轮5138。近侧轴齿轮5138以与附接到旋转驱动杆5160的远侧传动齿轮5162啮合的方式而被支撑，使用脊构件5120可旋转地支撑所述旋转驱动杆。通过旋转刀传动装置5207来控制旋转驱动杆5160和最终旋转驱动轴5130的旋转，所述旋转刀传动装置包括支撑在工具安装板5210上的传动装置布置5204的一部分。在各种实施例中，旋转刀传动装置5207包括可操作地支撑在工具安装板5201上的旋转刀驱动系统5170。在各种实施例中，刀驱动系统5170包括旋转传动齿轮5172，当工具驱动部分5200联接到工具架1270时，所述旋转传动齿轮联接到工具安装板5201的适配器侧上相应的从动盘或从动元件1304中的第三个。刀驱动系统5170还包括第一旋转从动齿轮5174，所述第一旋转从动齿轮与第二旋转从动齿轮5176和旋转传动齿轮5172以啮合的方式而被旋转地支撑在工具安装板5201上。将第二旋转从动齿轮5176联接到旋转驱动杆5160的近端部分5164。
旋转传动齿轮5172在第一旋转方向上的旋转将引起旋转驱动杆5160和旋转驱动轴5130在第一方向上的旋转。反之，旋转传动齿轮5172在第二旋转方向（与第一旋转方向相反）上的旋转将引起旋转驱动杆5160和旋转驱动轴5130在第二方向上的旋转。2400因此，驱动轴2440的旋转引起驱动套管2400的旋转。
现将描述操作外科工具5000的一种方法。工具驱动器5200可操作地联接到机器人系统1000的接口1240。操作机器人系统1000的控制器1001以将待切割和缝合的组织定位在打开的砧座5070和外科钉仓5080之间。一旦通过机器人系统1000定位外科端部执行器5012而使得靶组织位于砧座5070和外科钉仓5080之间，则可启动机器人系统1000的控制器1001以向与闭合正齿轮5145联接的第二从动元件1304施加第二旋转输出运动，以在远侧方向上轴向驱动闭合滑动件5140和外部闭合管5110，从而以上述方式枢转闭合砧座5070。一旦机器人控制器1001通过例如外科端部执行器5012和/或工具驱动部分5200中的传感器确定砧座5070已闭合，则机器人控制器1001系统可为外科医生提供表明砧座闭合的指示。此类指示可以是例如光和/或可听见的声音、控制构件上的触觉反馈等形式。然后外科医生可引发击发过程。然而，在可供选择的实施例中，机器人控制器1001可自动开始击发过程。
为了开始击发过程，机器人控制器将第三旋转输出运动施加到与旋转传动齿轮5172联接的第三从动盘或从动元件1304。旋转传动齿轮5172的旋转使旋转驱动杆5160和旋转驱动轴5130以上述方式旋转。可以结合图106、108和109最好地理解外科钉5098的击发和成形。当滑动件组件5030在远侧方向“DD”上驱动穿过外科钉仓5080时，远侧楔形件段5060首先接触钉推动器5088并开始使其朝闭合砧座5070运动。当滑动件组件5030继续朝远侧移动时，外侧驱动器5052将落入通道盘5022中的相应的激活腔体5026中。然后，每个外侧驱动器5052的相对端将接触相应的外侧推动器5088，所述外侧推动器将远侧楔形件段5060和中间楔形件段5062向上移动。滑动件组件5030的进一步远侧运动使外侧驱动器5052旋转并朝砧座5070驱动相应的推动器5088，从而当推动器驱动至砧座5070中时使支撑在其上的钉5098成形。应当理解，当滑动件组件5030朝远侧运动时，刀片5040切断夹持在砧座和钉仓之间的组织。因为内侧驱动器5054和外侧驱动器5052附接到相同的轴5056并且内侧驱动器5054与外侧驱动器5052在轴5056上径向错开，当外侧驱动器5052朝砧座5070驱动其相应的推动器5088时，内侧驱动器5054落入其下一个相应的激活腔体5028中，从而使它们以相同的方式朝闭合砧座5070可旋转地或往复地驱动相应的内侧推动器5088。因此，当滑动件组件5030朝远侧被驱动时，在居中设置的狭槽5084的每一侧上的横向对应的外侧钉5098同时一起成形，并且在狭槽5084的每一侧上的横向对应的内侧钉5098同时一起成形。一旦机器人控制器1001通过传感器或通过监测施加到驱动轴5130和/或旋转驱动杆5160的旋转输出量来确定滑动件组件5030已到达其最远侧位置，则控制器1001可将第三旋转输出运动施加到驱动轴5130以在相反方向上旋转驱动轴5130，从而将滑动件组件5030回缩至其起始位置。一旦滑动件组件5030回缩至起始位置（如通过端部执行器5012和/或工具驱动部分5200中的传感器发送信号），则停止向驱动轴5130施加第二旋转运动。然后，外科医生可手动启动砧座打开过程或可通过机器人控制器1001自动开始。为了打开砧座5070，将第二旋转输出运动施加到闭合正齿轮5145，以在近侧方向上轴向驱动闭合滑动件5140和外部闭合管5110。当闭合管5110朝近侧运动时，在闭合管5110远端5116中的开口5117接触砧座5070上的突出部5071，以将砧座5070枢转至打开位置。当闭合管5116返回至起始位置时，也可使用弹簧将砧座5070偏置至打开位置。此外，外科端部执行器5012和/或工具安装部分5200中的传感器可为机器人控制器1001提供表明砧座5070现已打开的信号。然后，外科端部执行器5012可从外科手术部位撤回。
图112-117以图解法示出了外科工具组件5000’中钉的顺序击发，所述外科工具组件基本上类似于上述外科工具组件5000。在该实施例中，内侧驱动器5052’和外侧驱动器5054’具有凸轮形状，其具有如图112-118中示出的凸轮表面5053和致动器突起5055。驱动器5052’、5054’连接在由滑动件组件5030’可旋转地支撑的相同的轴5056’上。在该实施例中，滑动件组件5030’具有用于接合推动器5088的远侧楔形件段5060’。图112示出了当滑动件组件5030’在远侧方向“DD”上被驱动时两个内侧或外侧驱动器5052’、5054’的初始位置。如图所示，推动器5088a向上推进楔形件段5060’并接触驱动器5052’、5054’。滑动件组件5030’在远侧方向上的进一步行进促使驱动器5052’、5054’在“P”方向（图113）上枢转，直到致动器部分5055接触激活腔体5026、5028的端壁5029a，如图114所示。滑动件组件5030’在远侧方向“DD”上的继续推进促使驱动器5052’、5054’在“D”方向上旋转，如图115所示。当驱动器5052’、5054’旋转时，推动器5088a向上推动凸轮表面5053至图116中示出的最终竖直位置。当推动器5088a到达图116和117中示出的最终竖直位置时，将支撑在其上的钉（未示出）驱动至砧座的钉成形表面以形成钉。
图119-124示出了例如可结合上文详细描述的工具安装部分1300和轴2008使用的外科端部执行器5312。在各种形式中，外科端部执行器5312包括细长通道5322，所述细长通道如上所述被构造为支撑其中的外科钉仓5330。外科钉仓5330包括主体部分5332，所述主体部分包括用于容纳滑动件组件5380的竖直支撑部分5386的居中设置的狭槽5334。参见图119-121。外科钉仓体部分5332还包括多个腔体5336以用于可运动地支撑其中的钉支撑推动器5350。腔体5336可排列在间隔开的纵向延伸的排5340、5342、5344、5346中。排5340、5342位于纵向狭槽5334的一个横向侧上，并且排5344、5346位于纵向狭槽5334的另一个横向侧上。在至少一个实施例中，推动器5350能够支撑其上的两个外科钉5352。具体地讲，位于细长狭槽5334的一侧上的每个推动器5350支撑处于交错取向的排5340中的一个钉5352和排5342中的一个钉5352。同样，位于细长狭槽5334的另一侧上的每个推动器5350支撑处于交错取向的排5344中的一个外科钉5352和排5346中的另一个外科钉5352。因此，每个推动器5350支撑两个外科钉5352。
如图119、120进一步所示，外科钉仓5330包括多个旋转驱动器5360。更具体地讲，在细长狭槽5334的一侧上的旋转驱动器5360排列在单行5370中并且与行5340、5342中的推动器5350相对应。另外，在细长狭槽5334的另一侧上的旋转驱动器5360排列在单行5372中并且与行5344、5346中的推动器5350相对应。如图119所示，每个旋转驱动器5360可旋转地支撑在钉仓体5332内。更具体地讲，每个旋转驱动器5360可旋转地容纳在相应的驱动器轴5362上。每个驱动器5360具有在其上形成的弓形斜坡部分5364，所述弓形斜坡部分能够接合在每个推动器5350上形成的弓形下表面5354上。参见图124。另外，每个驱动器5360具有底部支撑部分5366，所述底部支撑部分从驱动器延伸以滑动地支撑通道5322上的推动器5360。每个驱动器5360具有能够与滑动件组件5380接合的向下延伸的致动杆5368。
如图121所示，在至少一个实施例中，滑动件组件5380包括基座部分5382，所述基座部分具有支脚部分5384，所述支脚部分的尺寸设定成可滑动地容纳在通道5322的狭槽5333中。参见图119。滑动件组件5380包括支撑组织切割刀片或组织切割器械5388的直立支撑部分5386。直立支撑部分5386终止于顶部5390，所述顶部具有从其中突起的横向延伸的一对保持翅片5392。将翅片5392定位成容纳于砧座（未示出）中相应的狭槽（未示出）内。正如上述实施例，当滑动件组件5380朝远侧被驱动穿过夹持在外科端部执行器5312中的组织时，翅片5392和支脚部分5384用于将砧座（未示出）保持在所需的间隔开的闭合位置。直立支撑部分5386能够附接到刀杆2200（图40）。滑动件组件5380还具有水平延伸的致动器板5394，将所述水平延伸的致动器板成形为用于与推动器5360上的每个致动杆5368致动接合。
现将结合图119和120描述外科端部执行器5312的操作。当在远侧方向“DD”上驱动滑动件组件5380穿过钉仓5330时，致动器板5394顺序接触推动器5360上的致动杆5368。当滑动件组件5380继续朝远侧运动时，致动器板5394顺序接触细长狭槽5334的每一侧上的驱动器5360的致动器杆5368。此动作使驱动器5360从第一未致动位置旋转至致动部分，在该致动部分中，推动器5350朝闭合砧座被驱动。当推动器5350朝砧座被驱动时，其上的外科钉5352被驱动至与砧座的下侧形成接触。一旦机器人系统1000通过传感器或其他装置确定滑动件组件5080已到达其最远侧位置时，则机器人系统1000的控制系统可将刀杆和滑动件组件5380回缩至起始位置。然后，机器人控制系统可启动用于将砧座返回至打开位置以释放被缝合的组织的过程。
图125-129示出了本发明的自动重新加载系统实施例的一种形式，一般称为5500。在一种形式中，自动重新加载系统5500能够用“新的”外科端部执行器部件替换机器人外科系统的可操纵的外科工具部分中“用过的”外科端部执行器部件。如本文所用，术语“外科端部执行器部件”可包括例如外科钉仓、一次性加载单元、或使用时被用过并且必须用新的部件替换的其他端部执行器部件。此外，术语“用过的”是指端部执行器部件已被启动并且在当前状态下不再可用于所需目的。例如，在外科钉仓或一次性加载单元的上下文中，术语“用过的”是指之前支撑在其中的至少一些未成形的钉已从其“击发”。如本文所用，术语“新的”外科端部执行器部件是指在预期用途条件下的端部执行器部件。在外科钉仓或一次性加载单元的上下文中，例如，术语“新的”是指其中具有未成形的钉并且准备好使用的此类部件。
在各种实施例中，自动重新加载系统5500包括基座部分5502，所述基座部分可策略性地位于机器人系统1000的机械臂车1100（图26）的工作区域1109内。如本文所用，术语“可操纵的外科工具部分”总体上是指本文所公开的各种类型的外科工具和可操作地附接到例如机械臂车1100或类似装置的其他形式的外科机器人致动的工具，所述机械臂车1100或类似装置能够自动地操纵和致动外科工具。本文所用的术语“工作区域”是指机器人系统的可操纵的外科工具部分的运动的范围。图26总体上示出了可包括机械臂车1100的工作区域的区域。本领域的普通技术人员将会知道在此示出的工作区域的形状和尺寸仅为示例性的。工作区域的最后尺寸、形状和位置将最终取决于可操纵的外科工具部分的构造、行进限制的范围和位置。因此，本文所用的术语“工作区域”旨在涵盖多种不同尺寸和形状的工作区域，并且不应限制于图26中示出的样品工作区域的具体尺寸和形状。
如图125所示，基座部分5502包括新的部件支撑部分或布置5510，所述新的部件支撑部分或装置能够在“加载取向”上可操作地支撑至少一个新的外科端部执行器部件。如本文所用，术语“加载取向”是指以此方式支撑新的端部执行器部件，以允许可操纵的外科工具部分的相应的部件支撑部分在除了必须的致动机器人系统之外没有人为干预的情况下，与新的端部执行器部件（或使新的端部执行器部件与可操纵的外科工具部分的相应的部件支撑部分加载接合）加载接合（即，可操作地位于或可操作地附接到新的端部执行器部件）。继续参阅本具体实施方式将进一步理解，在至少一个实施例中，准备护士将在外科手术之前用完成外科手术所需的适当长度和颜色的钉仓（一些外科钉仓可支撑某些尺寸的钉，其尺寸可由仓体的颜色指示）来加载新的部件支撑部分。然而，在外科手术过程中，不需要直接的人机互动来重新加载机器人线切割器。在一种形式中，外科端部执行器部件包括钉仓2034，所述钉仓能够可操作地设置于上述各种其他端部执行器装置布置的任何部件支撑部分（细长通道）中。出于解释的目的，将新的（未使用的）仓指定为“2034a”并且将用过的仓指定为“2034b”。该图示出了被设计为与包括通道2022和砧座2024的外科端部执行器2012一起使用的仓2034a、2034b，所述通道和砧座的构造和操作在上文中已详细地描述。仓2034a、2034b与上述仓2034相同。在各种实施例中，仓2034a、2034b能够扣合保持（即，加载接合）在外科端部执行器2012的通道2022中。然而，继续参阅本具体实施方式，本领域的普通技术人员将会知道在不脱离本发明的实质和范围的情况下，可结合其他仓布置的自动移除和安装而有效地利用自动的仓重新加载系统5500的独特且新颖的特性。
在示出的实施例中，术语“加载取向”是指将新的外科钉仓2034a的远侧末端部分2035a插入到新的仓支撑部分5510的相应的支撑腔体5512中，使得新的外科钉仓2034a的近端部分2037a处于方便的取向，以使臂车1100操纵外科端部执行器2012至如下位置：在该位置，新的仓2034a可自动地加载到外科端部执行器2012的通道2022中。在各种实施例中，基座5502包括至少一个传感器5504，所述传感器与机器人控制器1001的控制系统1003连通，以为控制系统1003提供基座5502的位置和/或每个分段的或新的仓2034a的重新加载长度和颜色。
另外如图所示，基座5502还包括能够收集用过的仓2034b的收集容器5520，所述用过的仓已从可操作地附接到机器人系统1000的外科端部执行器2012中移除或脱离。另外，在一种形式中，自动重新加载系统5500包括提取系统5530，在除了必须的启动机器人系统之外无需特定的人为干预的情况下，所述提取系统用于将用过的端部执行器部件从端部执行器或可操纵的外科工具部分的相应的支撑部分中自动地移除。在各种实施例中，提取系统5530包括提取钩构件5532。在一种形式中，例如，提取钩构件5532刚性地支撑在基座部分5502上。在一个实施例中，提取钩构件具有在其上形成的至少一个钩5534，当其支撑在外科端部执行器2012的细长通道2022中时，所述钩能够与用过的仓2034b的远端2035以钩的形式接合。在各种形式中，提取钩构件5532便利地位于收集容器5520的一部分中，使得当用过的端部执行器部件（仓2034b）与提取钩构件5532以提取方式接合时，用过的端部执行器部件（仓2034b）从相应的部件支撑部分（细长通道2022）移除并落入收集容器5020中。因此，为了使用该实施例，可操纵的外科工具部分对附接至其的端部执行器进行操纵，以使其中用过的仓2034b的远端2035与钩5534以钩的形式接合，然后以此方式移动端部执行器，以将用过的仓2034b从细长通道2022中分离。
在其他布置中，提取钩构件5532包括旋转的轮构型，所述旋转的轮构型具有从其突起的一对沿直径相对的钩5334。参见图125和128。提取钩构件5532可旋转地支撑在收集容器5520中，并联接到由机器人系统的控制器1001所控制的提取马达5540。该形式的自动重新加载系统5500可按如下使用。图127示出了可操作地附接到可操纵的外科工具部分1200的外科端部执行器2012的引入。如图所示，机器人系统1000的臂车1100将外科端部执行器2012置于所示的位置，其中提取构件5532的钩端部5534与外科端部执行器2012中用过的仓2034b的远端2035以钩的形式接合。外科端部执行器2012的砧座2024处于打开位置。用过的仓2034b的远端2035与钩端部5532接合后，提取马达5540被致动以旋转提取轮5532，从而使用过的仓2034b从通道2022中脱离。为了有助于用过的仓2034b从通道2022中脱离（或如果提取构件5530是固定的），机器人系统1000可在向上的方向上（图128中的箭头“U”）移动外科端部执行器2012。随着用过的仓2034b从通道2022中分离，用过的仓2034b落入收集容器5520中。一旦用过的仓2034b从外科端部执行器2012中移除，则机器人系统1000将外科端部执行器2012移动至图126中示出的位置。
在各种实施例中，传感器布置5533邻近提取构件5532定位，所述提取构件与机器人系统1000的控制器1001连通。传感器布置5533可包括传感器，当远侧末端部分2035b与提取构件5532接合时，所述传感器能够感测外科端部执行器2012的存在，更具体地讲感测用过的外科钉仓2034b的顶端2035b的存在。在一些实施例中，传感器布置5533可包括例如光幕布置。然而，可采用其他形式的接近传感器。在此布置中，当具有用过的外科钉仓2034b的外科端部执行器2012与提取构件5532以提取方式接合时，传感器感测外科钉仓2034b的远侧末端2035b（如光幕被损坏）。当提取构件5532旋转并且松散地弹出外科钉仓2034b并落入收集容器5520中时，光幕又一次未被损坏。因为在此过程中未移动外科端部执行器2012，所以机器人控制器1001确定用过的外科钉仓2034b已从中移除。也可成功地采用其他传感器布置以为机器人控制器1001提供用过的外科钉仓2034b已从外科端部执行器2012中移除的指示。
如图129所示，外科端部执行器2012被定位成抓持通道2022和砧座2024之间新的外科钉仓2034a。更具体地讲，如图126和129所示，每个腔体5512具有与之相关的相应的直立的压垫5514。定位外科端部执行器2012使得压垫5514位于新的仓2034a和砧座2024之间。一旦处于该位置，机器人系统1000将砧座2024闭合到压垫5514上，所述压垫用于推动新的仓2034a至与外科端部执行器2012的通道2022扣合。一旦新的仓2034a已在细长通道2022中扣合到位，则机器人系统1000从自动的仓重新加载系统5500中撤出外科端部执行器2012，以与进行另一个外科手术结合使用。
图130-134示出了另一个自动重新加载系统5600，其可用于从可操纵的外科工具布置3600（图77-90）中移除用过的一次性加载单元3612并在其中重新加载新的一次性加载单元3612，所述可操纵的外科工具装置可操作地附接到臂车1100或机器人系统1000的其他部分。如图130和131所示，一种形式的自动重新加载系统5600包括外壳5610，所述外壳具有支撑在其上的旋转转盘顶板5620形式的可移动的支撑组件，所述旋转转盘顶板与外壳5610配合形成中空的封闭区5612。自动重新加载系统5600能够可操作地支撑在机器人系统的可操纵的外科工具部分的工作区域中，如上所述。在各种实施例中，旋转转盘板5620具有用于支撑其中的多个取向管5660的多个孔5622。如图131和132所示，旋转转盘板5620附连到芯轴5624上。芯轴5624居中设置在封闭区5612内并具有附接至其的芯轴齿轮5626。芯轴齿轮5626与联接到转盘驱动马达5630的转盘传动齿轮5628啮合，所述转盘驱动马达与机器人系统1000的机器人控制器1001可操作地连通。
自动重新加载系统5600的各种实施例还可包括转盘锁定组件，一般称为5640。在各种形式中，转盘锁定组件5640包括附连到芯轴5624上的凸轮盘5642。芯轴齿轮5626可附接到凸轮盘5642的下侧，并且凸轮盘5642可键锁到芯轴5624。在可供选择的布置中，芯轴齿轮5626和凸轮盘5642可独立地非旋转地附连到芯轴5624。如图131和132所示，多个凹口5644围绕凸轮盘5642的周边间隔开。锁定臂5648可枢转地安装到外壳5610中，并通过锁定弹簧5649被偏置到与凸轮盘5642的周边接合。如图130所示，凸轮盘5642的外周边是圆形的以有利于相对于锁定臂5648旋转凸轮盘5642。每个凹口5644的边缘也是圆形的，使得当凸轮盘5642旋转时，通过凸轮盘5642的周边使锁定臂5648与凹口5644脱离。
各种形式的自动重新加载系统5600能够支撑便携式/可替换的托盘组件5650，所述托盘组件能够在各个取向管5660中支撑多个一次性加载单元3612。更具体地讲并结合图131和132，可替换的托盘组件5650包括具有从其底侧突起的居中设置的定位芯轴5654的托盘5652。定位芯轴5654的尺寸设定成能够容纳在芯轴5624的中空端部5625中。托盘5652中具有能够支撑其中的取向管5660的多个孔5656。每个取向管5660在期望方向上通过取向管5660上的定位翅片5666被定位在可替换的托盘组件5650中的对应孔5656中，所述取向管被设计为容纳在托盘组件5650中相应的定位狭槽5658中。在至少一个实施例中，定位翅片5666具有大致V形的横截面形状，所述横截面形状的尺寸设定成适合在V形定位狭槽5658中。此布置用于在所需的起始位置处定位取向管5660，同时当向其施加旋转运动时，使其在孔5656中旋转。即，当向取向管5660施加旋转运动时，V形定位翅片5666将从其相应的定位狭槽中弹出，从而使管5660相对于托盘5652旋转，如将在下文中进一步详细地描述。另外如图130-132所示，可替换的托盘5652可设有一个或多个柄部部分5653，以当加载有取向管5660时有利于托盘组件5652的传输。
如图134所示，每个取向管5660包括具有凸缘式开口端5664的主体部分5662。主体部分5662限定腔体5668，所述腔体的尺寸设定成能够在其中容纳一次性加载单元3612的一部分。为了对一次性加载单元3612在取向管5660中进行正确取向，腔体5668具有在其中形成的平坦的定位表面5670。如图134所示，平坦的定位表面5670能够有利于在所需的或预定的非旋转方向上将一次性加载单元插入到腔体5668中。另外，腔体5668的端部5669可包括泡沫或缓冲材料5672，所述泡沫或缓冲材料被设计为缓冲腔体5668内的一次性加载单元3612的远端。另外，定位表面的长度可与一次性加载单元3612的轴向驱动组件3680的滑动支撑构件3689配合，以进一步将一次性加载单元3612定位在取向管5660中的所需位置。
取向管5660可由尼龙、聚碳酸酯、聚乙烯、液晶聚合物、6061或7075铝、钛、300或400系列不锈钢、涂布的或涂漆钢、电镀钢等制成，并且当加载到可替换的托盘5662并且定位芯轴5654插入到芯轴5624的中空端部5625中时，取向管5660延伸穿过转盘顶板5620中相应的孔5662。每个可替换的托盘5662配备有与机器人系统1000的控制器1001的控制系统1003连通的位置传感器5663。传感器5663用于确定重新加载系统的位置，以及容纳在托盘中的每个重新加载件的数量、长度、颜色和击发状态。另外，与机器人控制器1001连通的一个或多个光学传感器5665可用于感测加载到位于托盘5662中的一次性加载单元的类型/尺寸/长度。
自动重新加载系统5600的各种实施例还包括用于将旋转运动施加到取向管5660的驱动组件5680，从而将一次性加载单元3612保持附接到外科工具3600（总体上为“可操纵的外科工具部分”）的轴3700，所述外科工具可操作地联接到机器人系统。驱动组件5680包括附接到锁定臂5648的支撑轭5682。因此，支撑轭5682随着锁定臂5648枢转。支撑轭5682可旋转地支撑管惰轮5684和管驱动轮5686，所述管驱动轮由附接至其的管马达5688驱动。管马达5688与控制系统1003连通并受其控制。管惰轮5684和管驱动轮5686由例如天然橡胶、三都平(sanoprene)、热塑性聚氨酯树脂(isoplast)等制成，使得其外表面生成足够量的摩擦力，以在管马达5688致动时使与之接触的取向管5660旋转。惰轮5684和管驱动轮5686相对于彼此取向，以在两者间形成支架区域5687以用于容纳其中驱动接合的取向管5060。
在使用中，加载到自动重新加载系统5600中的一个或多个取向管5660是空的，同时其他取向管5660可操作地支撑其中相应的新的一次性加载单元3612。如将在下文中进一步详细地描述，使用空的取向管5660容纳其中用过的一次性加载单元3612。
在系统5600定位在机器人系统的可操纵的外科工具部分的工作区域内之后，可按如下使用自动重新加载系统5600。如果可操纵的外科工具部分具有可操作地与之联接的用过的一次性加载单元3612，则支撑在可替换的托盘5662上的取向管5660中的一个是空的，以容纳其中用过的一次性加载单元3612。然而，如果可操纵的外科工具部分不具有可操作地与之联接的一次性加载单元3612，则每个取向管5660可设有适当取向的新的一次性加载单元3612。
如上所述，一次性加载单元3612采用旋转的“卡口式”联接布置，以将一次性加载单元3612可操作地联接到可操纵的外科工具部分的对应部分。即，为了将一次性加载单元3612附接到可操纵的外科工具部分（3700-参见图83、84）的对应部分，当那些部件已运动至彼此加载接合时，必须将旋转安装运动施加到一次性加载单元3612和/或可操纵的外科工具部分的对应部分。此类安装运动在本文统称为“加载运动”。同样，为了将用过的一次性加载单元3612从可操纵的外科工具的相应部分中分离，必须施加旋转分离运动到用过的一次性加载单元3612和/或可操纵的外科工具部分的相应部分，同时移动用过的一次性加载单元和可操纵的外科工具的相应部分使之彼此远离。此类分离运动在本文中统称为“提取运动”。
为了开始加载过程，启动机器人系统1000以操纵可操纵的外科工具部分和/或自动重新加载系统5600以使可操纵的外科工具部分与新的一次性加载单元3612加载接合，所述新的一次性加载单元支撑在与驱动组件5680驱动接合的取向管5660中。一旦机器人控制系统1000的机器人控制器1001（图25）将可操纵的外科工具部分定位成与新的一次性加载单元3612加载接合，机器人控制器1001启动驱动组件5680以施加旋转加载运动到其中支撑有新的一次性加载单元3612的取向管5660，和/或施加另一个旋转加载运动到可操纵的外科工具部分的相应部分。在施加此类旋转加载运动时，机器人控制器1001还使可操纵的外科工具部分的相应部分朝新的一次性加载单元3612移动至与之加载接合。一旦一次性加载单元3612与可操纵的工具部分的相应部分加载接合，加载运动中止并且可使可操纵的外科工具部分移动远离自动重新加载系统5600，所述自动重新加载系统附带有与之可操作地联接的新的一次性加载单元3612。
为了将用过的一次性加载单元3612从相应的可操纵的外科工具部分中分离，机器人系统的机器人控制器1001操纵可操纵的外科工具部分，以将用过的一次性加载单元3612的远端插入到空的取向管5660中，所述取向管与驱动组件5680保持驱动接合。然后，机器人控制器1001启动驱动组件5680，以施加旋转提取运动到其中支撑有用过的一次性加载单元3612的取向管5660和/或施加旋转提取运动到可操纵的外科工具部分的相应部分。机器人控制器1001还使可操纵的外科工具部分从用过的旋转的一次性加载单元3612中撤离。然后，停止旋转提取运动。
用过的一次性加载单元3612从可操纵的外科工具部分中移除之后，机器人控制器1001可启动转盘驱动马达5630，以导引转盘顶板5620使另一个取向管5660与驱动组件5680驱动接合，所述另一个取向管支撑其中的新的一次性加载单元3612。然后，可重复加载过程，以将其中新的一次性加载单元3612附接到可操纵的外科工具部分的相应部分。机器人控制器1001可记录已从特定的可替换托盘5652中使用的一次性加载单元的数量。一旦控制器1001确定从此托盘中使用了所有新的一次性加载单元3612，则控制器1001可为外科医生提供如下信号（可视的和/或可听的），所述信号表明支撑所有用过的一次性加载单元3612的托盘5652必须被容纳新的一次性加载单元3612的新的托盘5652所替换。
图135-140示出了非常适于与具有工具驱动组件1010（图27）的机器人系统1000一起使用的本发明的外科工具6000的另一个非限制性实施例，所述工具驱动组件可操作地联接到通过操作者（即，外科医生）的输入而运行的主控制器1001。如图135所示，外科工具6000包括外科端部执行器6012，所述端部执行器包括线切割器。在至少一种形式中，外科工具6000通常包括细长轴组件6008，所述细长轴组件具有通过关节运动接头6100联接在一起的近侧闭合管6040和远侧闭合管6042。外科工具6000通过工具安装部分（一般称为6200）可操作地联接到操纵器。外科工具6000还包括接口6030，所述接口可以上述详细描述的各种方式将工具安装部分6200机械地和电力地联接到操纵器。
在至少一个实施例中，外科工具6000包括外科端部执行器6012，所述外科端部执行器此外包括至少一个部件6024，所述部件相对于至少一个其他部件6022在第一位置和第二位置之间响应于施加到部件6024的各种控制运动而选择性地运动，如将在下文中进一步详细地描述，从而进行外科手术。在各种实施例中，部件6022包括能够可操作地支撑其中的外科钉仓6034的细长通道6022，并且部件6024包括可枢转地平移的夹紧构件，例如砧座6024。外科端部执行器6012的各种实施例能够使砧座6024和细长通道6022保持在确保有效缝合和切断夹持在外科端部执行器6012中的组织的间距处。除非另外说明，端部执行器6012类似于上述外科端部执行器2012并包括切割器械（未示出）和滑动件（未示出）。砧座6024可包括位于其近端的突出部6027，所述突出部与机械闭合系统（下文中进一步描述）的部件相互作用以利于砧座6024的打开。细长通道6022和砧座6024可以由导电材料（例如金属）制成，使得它们可作为与端部执行器中的一个或多个传感器连通的天线的一部分，如上所述。外科钉仓6034可以由非导电材料（例如塑料）制成，并且传感器可连接到或设置在外科钉仓6034中，也如上所述。
如图135所示，根据各种实施例，通过细长轴组件6008将外科端部执行器6012附接到工具安装部分6200。如图示实施例中所示，细长轴组件6008包括关节运动接头（一般称为6100），所述关节运动接头使外科端部执行器6012围绕基本上横向于纵向工具轴线LT-LT的第一工具关节运动轴线AA1-AA1和基本上横向于纵向工具轴线LT-LT以及第一关节运动轴线AA1-AA1的第二工具关节运动轴线AA2-AA2选择性地进行关节运动。参见图136。在各种实施例中，细长轴组件6008包括闭合管组件6009，所述闭合管组件包括通过枢转连接件6044和6046枢转地连接的近侧闭合管6040和远侧闭合管6042。闭合管组件6009可活动地支撑在脊组件上（一般称为6102）。
如图137所示，近侧闭合管6040通过上部枢转连接件6044U和下部枢转连接件6044L可枢转地连接到中间闭合管接头6043，使得中间闭合管接头6043围绕第一闭合轴线CA1-CA1和第二闭合轴线CA2-CA2相对于近侧闭合管6040枢转。在各种实施例中，第一闭合轴线CA1-CA1基本上平行于第二闭合轴线CA2-CA2，并且两根闭合轴线CA1-CA1,CA2-CA2基本上横向于纵向工具轴线LT-LT。如图134进一步所示，中间闭合管接头6043通过左侧枢转连接件6046L和右侧枢转连接件6046R可枢转地连接到远侧闭合管6042，使得中间闭合管接头6043围绕第三闭合轴线CA3-CA3和第四闭合轴线CA4-CA4相对于远侧闭合管6042枢转。在各种实施例中，第三闭合轴线CA3-CA3基本上平行于第四闭合轴线CA4-CA4，并且两根闭合轴线CA3-CA3,CA4-CA4基本上横向于第一闭合轴线CA1-CA1和第二闭合轴线CA2-CA2以及纵向工具轴线LT-LT。
闭合管组件6009能够响应于施加至其上的致动运动而在脊组件6102上轴向滑动。远侧闭合管6042包括开口6045，所述开口与砧座6024上的突出部6027交接以当远侧闭合管6042在近侧方向“PD”上轴向运动时有利于砧座6024的打开。闭合管6040,6042可以由导电材料（例如金属）制成，使得其可以用作天线的一部分，如上所述。脊组件6102的部件可以由非导电材料（例如塑料）制成。
如上所述，外科工具6000包括工具安装部分6200，所述工具安装部分能够以上文详细描述的各种方式可操作地附接到机器人系统1000的工具安装组件1010。如图139所示，工具安装部分6200包括可操作地支撑其上的传动装置布置6204的工具安装板6202。在各种实施例中，传动装置布置6204包括关节运动传动装置6142，所述关节运动传动装置包括关节运动系统6140的一部分，以围绕第一工具关节运动轴线TA1-TA1和第二工具关节运动轴线TA2-TA2使外科端部执行器6012进行关节运动。第一工具关节运动轴线TA1-TA1基本上横向于第二工具关节运动轴线TA2-TA2，第一工具关节运动轴线和第二工具关节运动轴线均基本上横向于纵向工具轴线LT-LT。参见图136。
为了有利于使外科端部执行器6012围绕第一工具关节运动轴线TA1-TA1和第二工具关节运动轴线TA2-TA2选择性地进行关节运动，脊组件6102包括近侧脊部分6110，所述近侧脊部分通过枢轴销6122可枢转地联接到远侧脊部分6120以围绕TA1-TA1选择性地枢转行进。相似地，远侧脊部分6120通过枢轴销6124可枢转地附接到外科端部执行器6012的细长通道6022，以使外科端部执行器6012围绕第二工具轴线TA2-TA2相对于远侧脊部分6120选择性地枢转。
在各种实施例中，关节运动系统6140还包括可操作地与外科端部执行器6012交接的多个关节运动元件，以及可操作地支撑在工具安装构件6200中的关节运动控制装置布置6160，如将在下文中进一步详细地描述。在至少一个实施例中，关节运动元件包括第一对第一关节运动缆线6144和6146。第一关节运动缆线位于纵向工具轴线的第一或右侧上。因此，第一关节运动缆线在本文中称为右上部缆线6144和右下部缆线6146。右上部缆线6144和右下部缆线6146沿着近侧脊部分6110的右侧分别延伸穿过相应的通路6147、6148。参见图140。关节运动系统6140还包括第二对第二关节运动缆线6150、6152。第二关节运动缆线位于纵向工具轴线的第二或左侧上。因此，第二关节运动缆线在本文中称为左上部关节运动缆线6150和左下部关节运动缆线6152。左上部关节运动缆线6150和左下部关节运动缆线6152在近侧脊部分6110中分别延伸穿过通路6153、6154。
如图136所示，右上部缆线6144围绕上部枢转接头6123延伸并且在左侧枢转接头6125处附接到细长通道6022的左上侧。右下部缆线6146围绕下部枢转接头6126延伸并且在左侧枢转接头6125处附接到细长通道6022的左下侧。左上部缆线6150围绕上部枢转接头6123延伸并且在右侧枢转接头6127处附接到细长通道6022的右上侧。左下部缆线6152围绕下部枢转接头6126延伸并且在右侧枢转接头6127处附接到细长通道6022的右下侧。因此，为了围绕第一工具关节运动轴线TA1-TA1使外科端部执行器6012向左（箭头“L”）枢转，必须在近侧方向“PD”上牵拉右上部缆线6144和右下部缆线6146。为了围绕第一工具关节运动轴线TA1-TA1使外科端部执行器6012向右（箭头“R”）进行关节运动，必须在近侧方向“PD”上牵拉左上部缆线6150和左下部缆线6152。为了在向上的方向（箭头“U”）上围绕第二工具关节运动轴线TA2-TA2使外科端部执行器6012进行关节运动，必须在近侧方向“PD”上牵拉右上部缆线6144和左上部缆线6150。为了在向下的方向（箭头“DW”）上围绕第二工具关节运动轴线TA2-TA2使外科端部执行器6012进行关节运动，必须在近侧方向“PD”上牵拉右下部缆线6146和左下部缆线6152。
关节运动缆线6144、6146、6150、6152的近端联接到包括球形接头组件的关节运动控制布置6160，所述球形接头组件是关节运动传动装置6142的一部分。更具体地讲并结合图140，球形接头组件6160包括在近侧脊6110的近侧部分上形成的球形构件6162。关节运动控制环6164可活动地支撑在球形构件6162上。如图140进一步所示，关节运动缆线6144、6146、6150、6152的近端通过相应的球形接头布置6166联接到关节运动控制环6164。关节运动控制环6164由关节运动驱动组件6170控制。尤其如图140所示，将第一关节运动缆线6144、6146的近端在位于平面6159上的相应间隔开的第一点6149、6151处附接到关节运动控制环6164。同样，将第二关节运动缆线6150、6152的近端在也沿着平面6159设置的相应间隔开的第二点6153、6155处附接到关节运动控制环6164。继续参阅本具体实施方式，本领域的普通技术人员将会知道，当关节运动控制环6164由关节运动驱动组件6170操纵时，关节运动控制环6164上的此类缆线附接构型有利于所需范围内的关节运动动作。
在各种形式中，关节运动驱动组件6170包括水平关节运动组件（一般称为6171）。在至少一种形式中，水平关节运动组件6171包括附接到水平齿轮布置6180的水平推动缆线6172。关节运动驱动组件6170还包括竖直关节运动组件（一般称为6173）。在至少一种形式中，竖直关节运动组件6173包括附接到竖直齿轮布置6190的竖直推动缆线6174。如图139和140所示，水平推动缆线6172延伸穿过附接到近侧脊部分6110的支撑板6167。水平推动缆线6174的远端通过相应的球形/枢转接头6168附接到关节运动控制环6164。竖直推动缆线6174延伸穿过支撑板6167，并且其远端通过相应的球形/枢转接头6169附接到关节运动控制环6164。
水平齿轮布置6180包括枢转地安装到水平轴6181上的水平从动齿轮6182，所述水平轴附接到近侧脊部分6110的近侧部分。水平推动缆线6172的近端可枢转地附接到水平从动齿轮6182，使得当水平从动齿轮6172围绕水平枢转轴线HA旋转时，水平推动缆线6172施加第一枢转运动到关节运动控制环6164。同样，竖直齿轮布置6190包括竖直从动齿轮6192，所述竖直从动齿轮可枢转地支撑在与近侧脊部分6110的近侧部分附接的竖直轴6191上，以便围绕竖直枢转轴线VA枢转行进。竖直推动缆线6174的近端可枢转地附接到竖直从动齿轮6192，使得当竖直从动齿轮6192围绕竖直枢转轴线VA旋转时，竖直推动缆线6174施加第二枢转运动到关节运动控制环6164。
水平从动齿轮6182和竖直从动齿轮6192通过可操作地与关节运动移位器组件6320交接的关节运动齿轮系6300驱动。在至少一种形式中，关节运动移位器组件包括关节运动传动齿轮6322，所述关节运动传动齿轮联接到工具安装板6202的适配器侧1307上相应的从动盘或从动元件1304中的一个。参见图34。因此，当接口1230联接到工具架1270时，将来自机器人系统1000的旋转输入运动通过工具驱动组件1010施加到相应的从动元件1304上，从而将引起关节运动传动齿轮6322的旋转。将关节运动从动齿轮6324附接到可旋转地支撑在工具安装板6202上的花键式移位器轴6330。关节运动从动齿轮6324与关节运动传动齿轮6322啮合，如图所示。因此，关节运动传动齿轮6322的旋转将引起轴6330的旋转。在各种形式中，移位器从动齿轮组件6340可活动地支撑在移位器轴6330的花键部分6332上。
在各种实施例中，移位器从动齿轮组件6340包括附接到移位器板6344的从动移位器齿轮6342。移位器板6344与移位器螺线管组件6350可操作地交接。移位器螺线管组件6350通过导体6352联接至相应的销6352。参见图139。将销6352取向为与适配器1240的工具侧1244上的狭槽1258（图33）电连通。此布置用于将移位器螺线管组件6350电联接到机器人控制器1001。因此，移位器螺线管6350的致动将如图139和140中的箭头“S”所示使移位器轴6330的花键部分6332上的移位器从动齿轮组件6340发生偏移。关节运动齿轮系6300的各种实施例还包括水平齿轮组件6360，所述水平齿轮组件包括安装在可旋转地附接到工具安装板6202的轴6361上的第一水平传动齿轮6362。第一水平传动齿轮6362以与第二水平传动齿轮6364啮合的方式而支撑。如图140所示，水平从动齿轮6182与第二水平从动齿轮6364的远侧面部分6365啮合。
关节运动齿轮系6300的各种实施例还包括竖直齿轮组件6370，所述竖直齿轮组件包括安装在可旋转地支撑在工具安装板6202上的轴6371上的第一竖直传动齿轮6372。第一竖直传动齿轮6372以与第二竖直传动齿轮6374啮合的方式而被支撑，第二水平传动齿轮6364与所述第二竖直传动齿轮被同心地支撑。第二竖直传动齿轮6374可旋转地支撑在近侧脊部分6110上以绕其行进。第二水平传动齿轮6364可旋转地支撑在所述第二竖直传动齿轮6374的一部分上以独立地在其上旋转行进。如图140所示，竖直从动齿轮6192与第二竖直从动齿轮6374的远侧面部分6375啮合。
在各种形式中，第一水平传动齿轮6362具有第一直径并且第一竖直传动齿轮6372具有第二直径。如图139和140所示，轴6361与轴6371不在公共轴线上。即，第一水平从动齿轮6362和第一竖直从动齿轮6372不围绕公共轴线旋转。因此，当移位器齿轮6342设置在中心“锁定”位置使得移位器齿轮6342与第一水平从动齿轮6362和第一竖直传动齿轮6372啮合时，关节运动系统6140的部件被锁定就位。因此，可移动的移位器齿轮6342和第一水平和竖直传动齿轮6362,6372的布置及关节运动移位器组件6320可统称为关节运动锁定系统（一般称为6380）。
在使用中，机器人系统1000的机器人控制器1001可按如下控制关节运动系统6140。为了围绕第一工具关节运动轴线TA1-TA1使端部执行器6012向左进行关节运动，机器人控制器1001启动移位器螺线管组件6350，以使移位器齿轮6342与第一水平传动齿轮6362啮合。然后，控制器1001施加第一旋转输出运动到关节运动传动齿轮6322，以在第一方向上驱动移位器齿轮，从而最终在另一个第一方向上驱动水平从动齿轮6182。驱动水平从动齿轮6182以枢转球形部分6162上的关节运动环6164，从而在近侧方向“PD”上牵拉右上部缆线6144和右下部缆线6146。为了围绕第一工具关节运动轴线TA1-TA1使端部执行器6012向右进行关节运动，机器人控制器1001启动移位器螺线管组件6350，以使移位器齿轮6342与第一水平传动齿轮6362啮合。然后，控制器1001在相反方向上施加第一旋转输出运动到关节运动传动齿轮6322，以在第二方向上驱动移位器齿轮6342，从而最终在另一个第二方向上驱动水平从动齿轮6182。此动作使关节运动控制环6164以此方式运动以在近侧方向“PD”上牵拉左上部缆线6150和左下部缆线6152。在各种实施例中，当致动水平齿轮组件6360时，在竖直齿轮组件6370的齿轮之间产生的齿轮比和摩擦力用于防止竖直从动齿轮6192的旋转。
为了围绕第二工具关节运动轴线TA2-TA2在向上的方向上使端部执行器6012进行关节运动，机器人控制器1001启动移位器螺线管组件6350，以使移位器齿轮6342与第一竖直传动齿轮6372啮合。然后，控制器1001施加第一旋转输出运动到关节运动传动齿轮6322，以在第一方向上驱动移位器齿轮6342，从而最终在另一个第一方向上驱动竖直从动齿轮6192。驱动竖直从动齿轮6192以枢转近侧脊部分6110的球形部分6162上的关节运动环6164，从而在近侧方向“PD”上牵拉右上部缆线6144和左上部缆线6150。为了围绕第二工具关节运动轴线TA2-TA2在向下的方向上使端部执行器6012进行关节运动，机器人控制器1001启动移位器螺线管组件6350，以使移位器齿轮6342与第一竖直驱动齿轮6372啮合。然后，控制器1001在相反方向上施加第一旋转输出运动到关节运动传动齿轮6322，以在第二方向上驱动移位器齿轮6342，从而最终在另一个第二方向上驱动竖直从动齿轮6192。从而此动作使关节运动控制环6164在近侧方向“PD”上牵拉右下部缆线6146和左下部缆线6152。在各种实施例中，当致动竖直齿轮组件6370时，在水平齿轮组件6360的齿轮之间产生的齿轮比和摩擦力用于防止水平从动齿轮6182的旋转。
在各种实施例中，多个传感器可以与机器人控制器1001连通，以确定端部执行器6012的关节运动位置。例如，此类传感器可与关节运动接头6100交接或位于工具安装部分6200中。例如，可以使用传感器以检测近侧脊部分6110的球形部分6162上的关节运动控制环6164的位置。来自传感器至控制器1001的此类反馈允许控制器1001调节关节运动传动齿轮6322的旋转量和旋转输出的方向。另外，如上所述，当移位器传动齿轮6342居中设置成与第一水平传动齿轮6362和第一竖直传动齿轮6372啮合时，端部执行器6012被锁定在关节运动位置。因此，获得所需的关节运动量之后，控制器1001可启动移位器螺线管组件6350，以使移位器齿轮6342与第一水平传动齿轮6362和第一竖直传动齿轮6372啮合。在可供选择的实施例中，可将移位器螺线管组件6350弹簧启动至中心锁定位置。
在使用中，围绕纵向工具轴线LT-LT旋转外科端部执行器6012可能是有利的。在至少一个实施例中，工具安装部分上的传动装置布置6204包括旋转的传输组件6400，所述旋转的传输组件能够接收来自机器人系统1000的工具驱动组件1010的相应的旋转输出运动，并将此旋转输出运动转化成旋转控制运动，以使细长轴组件6008（和外科端部执行器6012）围绕纵向工具轴线LT-LT旋转。在各种实施例中，例如，近侧闭合管6040的近端部分6041通过向前的支撑支架6205以及也可活动地支撑在工具安装板6202上的闭合滑动件6510而旋转地支撑在工具安装部分6200的工具安装板6202上。在至少一种形式中，旋转的传输组件6400包括管齿轮段6402，所述管齿轮段形成于（或附接到）近侧闭合管6040的近端6041上，以通过可操作地支撑在工具安装板6202上的旋转齿轮组件6410可操作地接合。如图139所示，在至少一个实施例中，旋转齿轮组件6410包括旋转传动齿轮6412，当工具安装部分6200联接到工具驱动组件1010时，所述旋转传动齿轮联接到工具安装板6202的适配器侧1307上相应的从动盘或从动元件1304中的第二个。参见图34。旋转齿轮组件6410还包括第一旋转从动齿轮6414，所述第一旋转从动齿轮与旋转传动齿轮6412以啮合的方式而被旋转地支撑在工具安装板6202上。第一旋转从动齿轮6414附接到可旋转地支撑在工具安装板6202上的驱动轴6416。第二旋转从动齿轮6418附接到驱动轴6416，并与在近侧闭合管6040上的管齿轮段6402啮合。将来自机器人系统1000的工具驱动组件1010的第二旋转输出运动施加到相应的从动元件1304，从而将引起旋转传动齿轮6412的旋转。旋转传动齿轮6412的旋转最终导致细长轴组件6008（和外科端部执行器6012）围绕纵向工具轴线LT-LT旋转。应当理解，在一个方向上施加来自工具驱动组件1010的旋转输出运动将引起细长轴组件6008和外科端部执行器6012围绕纵向工具轴线LT-LT在第一方向上旋转，并且在相对的方向上施加旋转输出运动将引起细长轴组件6008和外科端部执行器6012在相对于第一方向的第二方向上旋转。
在至少一个实施例中，通过在脊组件2049上沿着远侧方向“DD”使细长轴组件2008的闭合部分轴向运动来实现砧座2024相对于钉仓2034的闭合。如上所述，在各种实施例中，近侧闭合管6040的近端部分6041由闭合滑动件6510支撑，所述闭合滑动件包括闭合传动装置（一般描述为6512）的一部分。如图139所示，近侧闭合管部分6040的近端部分6041具有在其上形成的衬圈6048。闭合滑动件6510通过与衬圈6048中的环形沟槽6049接合的轭6514与衬圈6048联接。此布置用于使衬圈6048在保持与闭合传动装置6512联接的同时围绕纵向工具轴线LT-LT旋转。在各种实施例中，闭合滑动件6510具有直立部分6516，所述直立部分具有在其上形成的闭合齿条齿轮6518。闭合齿条齿轮6518能够与闭合齿轮组件6520驱动接合。参见图139。
在各种形式中，闭合齿轮组件6520包括闭合正齿轮6522，所述闭合正齿轮联接到工具安装板6202的适配器侧1307上相应的从动盘或从动元件1304中的第二个。参见图34。因此，当工具安装部分6202联接到工具驱动组件1010时，将来自机器人系统1000的工具驱动组件1010的第三旋转输出运动施加到相应的第二从动元件1304上将引起闭合正齿轮6522的旋转。闭合齿轮组件6520还包括以与闭合正齿轮6522和闭合齿条齿轮2106啮合的方式而被支撑的闭合减速齿轮组6524。因此，将来自机器人系统1000的工具驱动组件1010的第三旋转输出运动施加到相应的第二从动元件1304将引起闭合正齿轮6522和闭合传动装置6512的旋转，并且最终在近侧脊部分6110上轴向驱动闭合滑动件6510和近侧闭合管6040。近侧闭合管6040运动的轴向最终取决于第三从动元件1304旋转的方向。例如，响应于从机器人系统1000的工具驱动组件1010接收的一个旋转输出运动，将在远侧方向“DD”上驱动闭合滑动件6510并且最终在远侧方向“DD”上驱动近侧闭合管6040。当朝远侧驱动近侧闭合管6040时，通过其与近侧闭合管6040的连接，还朝远侧驱动远侧闭合管6042。当朝远侧驱动远侧闭合管6042时，闭合管6042的端部将接合砧座6024的一部分并使砧座6024枢转到闭合位置。当施加来自机器人系统1000的工具驱动组件1010的“开口”输出运动时，将在近侧脊部分6110上沿着近侧方向“PD”驱动闭合滑动件6510和近侧闭合管6040。当在近侧方向“PD”上驱动近侧闭合管6040时，还将在近侧方向“PD”上驱动远侧闭合管6042。当在近侧方向“PD”上驱动远侧闭合管6042时，其中的开口6045与砧座6024上的突出部6027相互作用以利于其打开。在各种实施例中，当远侧闭合管6042运动至其起始位置时，可使用弹簧（未示出）以将砧座6024偏置至打开位置。在各种实施例中，闭合齿轮组件6520的各种齿轮的尺寸设定成能够产生所需的必要的闭合力，所述闭合力满意地在待由外科端部执行器6012切割和缝合的组织上闭合砧座6024。例如，闭合传动装置6520的齿轮的尺寸设定成能够产生大约70-120磅的闭合力。
在各种实施例中，通过刀杆6530驱动切割器械穿过外科端部执行器6012。参见图139。在至少一种形式中，刀杆6530由接头布置（未示出）制成和/或由如下材料制成：所述材料在保持足够的刚性的同时可适应外科端部执行器6102围绕第一工具关节运动轴线和第二工具关节运动轴线而进行的关节运动，以推动切割器械穿过夹持在外科端部执行器6012中的组织。刀杆6530延伸穿过近侧脊部分6110中的中空通路6532。
在各种实施例中，刀杆6530的近端6534可旋转地附连到刀齿条齿轮6540上，使得刀杆6530相对于刀齿条齿轮6540自由旋转。刀杆6530的远端以上述各种方式附接到切割器械。如图139所示，刀齿条齿轮6540可滑动地支撑在附接到工具安装板6202的齿条外壳6542内，使得刀齿条齿轮6540保持与传动装置布置6204的刀驱动传动装置部分6550啮合。在各种实施例中，刀驱动传动装置部分6550包括刀齿轮组件6560。更具体地讲并结合图139，在至少一个实施例中，刀齿轮组件6560包括刀正齿轮6562，所述刀正齿轮联接到工具安装板6202的适配器侧1307上相应的从动盘或从动元件1304中的第四个。参见图34。因此，将来自机器人系统1000的另一旋转输出运动通过工具驱动组件1010施加到相应的第四从动元件1304将引起刀正齿轮6562的旋转。刀齿轮组件6560还包括刀减速齿轮组6564，所述刀减速齿轮组包括第一刀从动齿轮6566和第二刀传动齿轮6568。刀减速齿轮组6564可旋转地安装到工具安装板6202上，使得第一刀从动齿轮6566与刀正齿轮6562啮合。同样，第二刀传动齿轮6568与第三刀传动齿轮组件6570啮合。如图139所示，第二刀从动齿轮6568与第三刀传动齿轮组件6570的第四刀从动齿轮6572啮合。第四刀从动齿轮6572与第五刀从动齿轮组件6574啮合，所述第五刀从动齿轮组件与刀齿条齿轮6540啮合。在各种实施例中，刀齿轮组件6560的齿轮的尺寸设定成能够产生驱动切割器械穿过夹持在外科端部执行器6012中的组织并致动其中的钉所需的力。例如，刀齿轮组件6560的齿轮的尺寸可设定成能够产生大约40-100磅的驱动力。应当理解，在一个方向上施加来自工具驱动组件1010的旋转输出运动将引起切割器械在远侧方向上轴向运动，并且在相对的方向上施加旋转输出运动将引起切割器械在近侧方向上轴向运动。
通过上述说明可以理解，外科工具6000代表对现有机器人工具布置的大幅改进。外科工具6000采用的独特的和新颖的传动装置布置使该工具可操作地联接到仅具有四个旋转输出主体的机器人系统的工具架部分1010，另外从其获得旋转输出运动以：(i)围绕基本上彼此横向的以及横向于纵向工具轴线的两条不同的关节运动轴线使端部执行器进行关节运动；(ii)围绕纵向工具轴线旋转端部执行器6012；(iii)相对于外科钉仓6034不同程度地闭合砧座6024以使端部执行器6012能够用于操纵组织然后将其夹紧到适当位置以用于切割和缝合；以及(iv)击发切割器械以切割夹持在端部执行器6012中的组织。上述本发明的各种实施例的独特的和新颖的移位器布置使得两种不同的关节运动动作从机器人系统的单个旋转主体部分获得功率。
以上已经结合切割型外科器械对本发明的各种实施例进行了描述。然而，应该指出的是，在其他实施例中，本文公开的本发明的外科器械不必为切割型外科器械，而是可被用于包括遥感器转发器的任何类型的外科器械中。例如，其可为非切割内窥镜式器械、抓紧器、缝合器、施夹钳、进入装置、药物/基因治疗递送装置、利用超声波、射频、激光等的能量装置。此外，本发明例如可为腹腔镜式器械。本发明也可在传统的内窥镜式和开放式外科器械以及机器人辅助的手术中得到应用。
图141示出了结合具有超声功率的端部执行器7012的外科工具7000使用本发明的某些实施例的各个方面。端部执行器7012通过细长轴组件7008可操作地附接到工具安装部分7100。工具安装部分7100可基本上类似于上述各种工具安装部分。在一个实施例中，端部执行器7012包括超声功率的钳口部分7014，所述超声功率的钳口部分由交流电或直流电以已知方式提供功率。此类超声功率的装置在例如名称为“Robotic Surgical ToolWith Ultrasound Cauterizing and Cutting Instrument”的美国专利No.6,783,524中公开，该专利的全部公开内容以引用的方式并入本文。在图示实施例中，示出了单独的功率源线7020。然而，应当理解，可通过工具安装部分7100从机器人控制器1001对其提供功率。外科端部执行器7012还包括可用于将组织夹持到超声钳口部分7014上的可移动钳口7016。可以本文所述的各种方式中的任意一种通过机器人控制器1001选择性地致动可移动的钳口部分7016穿过工具安装部分7100。
图142示出了结合具有包括线型缝合装置的端部执行器8012的外科工具8000使用本发明的某些实施例的各个方面。端部执行器8012通过上述类型和构造的细长轴组件3700可操作地附接到工具安装部分8100。然而，端部执行器8012可通过本文所述的各种其他细长轴组件附接到工具安装部分8100。在一个实施例中，工具安装部分8100可基本上类似于工具安装部分3750。然而，还可使用本文详细描述的各种其他工具安装部分和它们各自的传动装置布置。此类线性缝合压头部分也在例如名称为“SurgicalStapling Device With Staple Driver That Supports Multiple Wire DiameterStaples”的美国专利No.7,673,781中公开，该专利的全部公开内容以引用的方式并入本文。
在授予Shelton,IV等人的美国专利公布No.2011/0062212A1中描述的各种传感器实施例可以与本文所公开的许多外科工具实施例一起使用，该专利的公开内容全文以引用的方式并入本文。如上所述，主控制器1001通常包括主控制器（一般表示为1003），在外科医生通过立体显示器1002观察手术的同时，所述主控制器由外科医生抓持并在空中操控。参见图25。主控制器1001是手动输入装置，其优选地以多个自由度运动，并且通常还具有用于致动外科工具的致动手柄。本文所公开的一些外科工具实施例在其工具驱动部分中采用一个或多个马达，以为工具端部执行器提供各种控制运动。此类实施例也可从机器人系统部件中所采用的马达布置中获得另外的控制运动。本文中所公开的其他实施例从机器人系统内的马达布置获得全部的控制运动。
在不脱离本发明的实质和范围的情况下，此类马达功率布置可采用各种传感器装置，所述传感器布置在上述引用的已公布美国专利申请中公开以为外科医生提供多种形式的反馈。例如，采用手动致动击发触发器的那些主控制器布置1003可使用马达运转传感器以为外科医生提供与施加到切割构件或由其承受的力的大小相关的反馈。马达运转传感器能够与击发触发器部分连通，以检测击发触发器部分何时致动而由端部执行器开始切割/缝合操作。马达运转传感器可以为比例传感器，例如变阻器或可变电阻器。当击发触发器被拉近时，传感器检测此运动，并发送电信号，所述电信号指示提供给相应电机的电压（或功率）。当传感器为可变电阻器等时，马达的转速可与击发触发器的运动量大致成比例。即，如果操作者仅少量牵拉或者闭合击发触发器，则马达的转速相对较低。当完全拉近击发触发器（或者处于完全闭合位置）时，马达的转速为其最大值。换句话讲，外科医生越用力牵拉击发触发器，则施加到马达上的电压就越大，从而转速就越大。其他布置可为外科医生提供反馈计1005并为外科医生提供力的大小的视觉指示，所述反馈计可通过显示器1002观察，并且所述力的大小为施加到切割器械或动态夹紧构件的力的大小。其他传感器布置可用于为主控制器1001提供指示，以指示钉仓是否已加载到端部执行器中、砧座是否在击发之前已运动至闭合位置等。
在可供选择的实施例中，可结合控制器1001使用马达控制的接口，所述控制器根据外科端部执行器承受的负载（如，夹紧力、切割力等）来限制最大的触发器牵拉力。例如，越难驱动切割器械穿过夹持在端部执行器中的组织，则越难牵拉/致动击发触发器。在其他实施例中，将控制器1001上的触发器布置成使得触发器牵拉位置与端部执行器位置/状态相当。例如，仅当完全击发端部执行器时完全按下触发器。
在另有其他实施例中，本文所公开的各种机器人系统和工具可利用多个上述公开的传感器/转发器装置布置。此类传感器布置可以包括但不限于马达运转传感器、反向马达传感器、止动马达传感器、行程结束传感器、行程开始传感器、钉仓闭锁传感器、传感器转发器、充电蓄电池装置、开关电路、可拆卸电池组等。所述传感器可以结合本文所公开的任何外科工具使用，所述外科工具适于与机器人系统一起使用。传感器可以能够与机器人系统控制器连通。在其他实施例中，轴/端部执行器的部件可充当天线在传感器和机器人控制器之间连通。在另有其他实施例中，上述各种远程编程装置布置也可以与机器人控制器一起使用。
可将本文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，所述装置均可进行修复，以在至少一次使用后再次使用。重新修复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分以及随后组装。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/或置换特定部分后，该装置可以在修复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，装置的修复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修复装置均在本发明的范围内。
尽管本文已经结合某些公开的实施例描述了本发明，但是可对那些实施例进行多种修改和变型。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部件的材料的情形均可使用其他材料。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。
以引用方式全文或部分地并入本文的任何专利、公布或其他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、陈述或其他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。

Claims (18)

1.一种机器人控制的外科器械系统，包括：
端部执行器，所述端部执行器包括可运动的切割器械；
电动马达，所述电动马达与所述端部执行器连通，用于致动所述切割器械；
用于控制所述马达的马达控制电路，其中所述马达控制电路包括：
机器人系统，所述机器人系统与用于为其提供功率的所述电动马达可操作地连通；
充电蓄电池装置；以及
开关电路，所述开关电路与所述机器人系统和所述充电蓄电池装置连通，用于(i)将所述充电蓄电池装置临时连接到所述机器人系统以为所述充电蓄电池装置充电，以及(ii)将所述充电蓄电池装置与所述机器人系统选择性地串联连接以为所述马达提供附加的功率。
2.根据权利要求1所述的外科器械系统，其中所述充电蓄电池装置包括电容器。
3.根据权利要求2所述的外科器械系统，其中所述充电蓄电池装置包括超级电容器。
4.根据权利要求1所述的外科器械系统，其中所述机器人系统包括多个功率源。
5.根据权利要求4所述的外科器械，其中所述多个功率源包括串联连接的电池单元。
6.根据权利要求4所述的外科器械系统，还包括功率源选择开关，所述功率源选择开关连接到所述机器人系统，以在处于第一状态时将所述功率源全部连接到所述马达，以及在处于第二状态时将所述功率源的子集连接到所述马达。
7.根据权利要求1所述的外科器械系统，其中所述端部执行器包括圆形切割端部执行器。
8.根据权利要求1所述的外科器械系统，其中所述端部执行器包括线切割端部执行器。
9.根据权利要求1所述的外科器械系统，其中所述马达控制电路还包括电流控制电路，所述电流控制电路连接到所述功率源，以改变从所述功率源提供至所述马达的电流，使得所述马达具有至少：
第一低功率运行模式，其用于所述切割器械的切割行程循环的第一部分；和
第二高功率运行模式，其用于所述切割器械的所述切割行程循环的第二部分。
10.根据权利要求1所述的外科器械系统，其中：
所述马达包括至少两个线圈；并且所述马达控制电路用于将所述至少两个线圈选择性地串联或并联连接。
11.一种外科器械系统，包括：
机器人系统；
端部执行器，所述端部执行器联接到所述机器人系统的一部分，所述端部执行器包括可运动的切割器械；
用于致动所述切割器械的电动马达，其中所述马达包括至少两个线圈；
连接到所述马达的马达控制电路，所述马达控制电路将所述至少两个马达线圈选择性地串联或并联连接。
12.根据权利要求11所述的外科器械系统，其中所述机器人系统包括连接到所述马达的功率源。
13.根据权利要求12所述的外科器械系统，其中所述功率源包括多个串联连接的功率源。
14.根据权利要求13所述的外科器械系统，还包括功率源选择开关，所述功率源选择开关连接到所述功率源，以在处于第一状态时将所述功率源全部连接到所述马达，以及在处于第二状态时将所述功率源的子集连接到所述马达。
15.一种外科器械系统，包括：
端部执行器，所述端部执行器可操作地联接到机器人系统，所述端部执行器包括：
可运动的切割器械；
用于致动所述切割器械的电动马达；
所述机器人系统内用于为所述马达提供功率的可移除电池组，其中所述电池组包括多个电池单元，其中所述多个电池单元包括多个第一串联连接的电池单元和多个第二串联连接的电池单元；以及
与所述电池组分隔开的电池单元连接器，在所述电池组与所述器械连通时，所述电池单元连接器将所述多个第一串联连接的电池单元串联连接到所述多个第二串联连接的电池单元。
16.根据权利要求15所述的外科器械系统，其中所述电池组包括多个第三串联连接的电池单元，并且其中在所述电池组与所述器械连通时，所述电池单元连接器将所述多个第一串联连接的电池单元、所述多个第二串联连接的电池单元和所述多个第三串联连接的电池单元串联连接。
17.根据权利要求15所述的外科器械系统，其中所述多个第一串联连接的电池单元包括三个串联连接的锂一次电池单元，并且所述多个第二串联连接的电池单元包括三个串联连接的锂一次电池单元。
18.根据权利要求15所述的外科器械系统，其中所述外科器械系统还包括：
充电蓄电池装置；以及
开关电路，所述开关电路连接到所述电池组和所述充电蓄电池装置，用于(i)将所述充电蓄电池装置临时连接到所述电池组以为所述充电蓄电池装置充电，以及(ii)将所述充电蓄电池装置与功率组选择性地串联连接以为所述马达提供附加的功率。
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