CN104684492A - 可拆卸的端部执行器和加载器 - Google Patents
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/2812—Surgical forceps with a single pivotal connection
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- A—HUMAN NECESSITIES
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2931—Details of heads or jaws with releasable head
Abstract
一种外科装置包括具有外管和定位在外管中的内杆的细长轴。外管和内杆各自包括远侧端部和近侧端部。致动器能够操作地连接到外管的近侧端部和内杆的近侧端部。端部执行器在体内能够附接到细长轴并且从该细长轴拆卸。端部执行器包括外部壳体,该外部壳体包括适于接合外管的远侧端部的第一止动器配合特征结构;能够相对外部壳体轴向地运动的内部梭动件,该梭动件包括适于接合内杆的远侧端部的第二止动器配合特征结构;和一对外科钳口,该一对外科钳口具有取决于梭动件和壳体的相对轴向位置的打开位置和闭合位置。管状加载器的尺寸设定成接收端部执行器,该管状加载器包括适于接合端部执行器的第三止动器配合特征结构。
Description
背景技术
本发明一般涉及外科装置和手术操作,更具体地涉及微创外科手术。
外科手术常用于治疗和治愈多种不同的疾病、病症和损伤。外科手术常常需要通过开放式外科手术或内窥镜式外科手术进入内部组织。术语“内窥镜式”是指所有类型的微创外科手术操作,包括腹腔镜式、关节镜式、自然腔道管腔内式、以及经自然腔道内镜手术。内窥镜式外科手术相比于传统的开放式外科手术具有许多优点,包括减少创伤、更快恢复、降低感染风险、和减少疤痕。内窥镜式外科手术经常利用存在于体腔内的充胀流体,诸如二氧化碳或盐水溶液来执行以提供足够的空间来执行预期的外科手术。所述充胀的体腔通常处于压力下并且有时被称作处于气腹状态。外科进入装置常常用于在保持气腹的同时促进内部组织的外科操纵。例如,套管针时常用于提供内窥镜式外科器械穿过的端口。套管针通常具有器械密封件,该密封件在防止充胀流体逸出的同时将器械定位在套管针中。
虽然多种不同的微创外科手术装置是已知的,但在此前还没有人研制出或使用根据本发明的外科装置和方法。
发明内容
在一个实施例中,外科装置包括具有外管和定位在外管中的内杆的细长轴。外管和内杆各自包括远侧端部和近侧端部。致动器能够操作地连接到外管的近侧端部和内杆的近侧端部。端部执行器在体内能够附接到细长轴并且从该细长轴拆卸。端部执行器包括外部壳体,该外部壳体包括适于接合外管的远侧端部的第一止动器配合特征结构;可相对外部壳体轴向地运动的内部梭动件,该梭动件包括适于接合内杆的远侧端部的第二止动器配合特征结构;和一对外科钳口,该一对外科钳口具有取决于梭动件和壳体的相对轴向位置的打开位置和闭合位置。管状加载器的尺寸设定成接收端部执行器,该管状加载器包括适于接合端部执行器的第三止动器配合特征结构。
第一止动器配合特征结构、第二止动器配合特征结构和第三止动器配合特征结构分别具有阈值脱离力F1、F2和F3,这三种阈值脱离力具有以下相对大小:F1<F3<F2。第一止动器配合特征结构可包括适于接合外管上的凹口的外部壳体上的片簧。第三止动器配合特征结构可包括适于接合外部壳体上的凹口的管状加载器上的片簧。第二止动器配合特征结构可包括一对朝近侧取向的插针,每个插针具有适于接合内杆上的凹口的朝内侧取向的齿状物。外管的远侧端部可包括适于接合并且侧向展开插针的倾斜表面,从而使齿状物从内杆上的凹口脱离。
在另一个实施例中,外科装置包括细长轴,该细长轴包括外管和定位在外管中的内杆,外管和内杆各自包括远侧端部和近侧端部。致动器能够操作地连接到外管的近侧端部和内杆的近侧端部。端部执行器适于体内附接到细长轴并且从该细长轴拆卸。端部执行器包括外部壳体,该外部壳体包括适于接合外管的远侧端部的第一配合特征结构;可相对外部壳体轴向运动的内部梭动件,该梭动件包括适于接合内杆的远侧端部的第二配合特征结构;和一对外科钳口,该一对外科钳口具有取决于梭动件和壳体的相对轴向位置的打开位置和闭合位置。第二配合特征结构包括一对朝近侧取向的插针,每个插针具有适于接合内杆上的凹口的朝内侧取向的齿状物。外管的远侧端部包括适于接合并且侧向展开插针的倾斜表面,从而使齿状物从内杆上的凹口脱离。第一配合特征结构可包括止动器机构。
在另一个实施例中,外科装置包括细长轴,该细长轴包括外管和定位在外管中的内杆,外管和内杆各自包括远侧端部和近侧端部。致动器能够操作地连接到外管的近侧端部和内杆的近侧端部。端部执行器在体内能够附接到细长轴并且从该细长轴拆卸。端部执行器包括外部壳体和将该外部壳体附接到外管的部件;能够相对外部壳体轴向运动的内部梭动件和将该梭动件附接到内杆的部件;以及一对外科钳口,该一对外科钳口具有取决于梭动件和壳体的相对轴向位置的打开位置和闭合位置。管状加载器的尺寸设定成接收端部执行器并且包括将该端部执行器附接到管状加载器中的部件。
附图说明
尽管本说明书包括特别指出并明确要求本发明权利的权利要求书,但据信,根据以下结合示出本发明的一些非限制性实例的附图的描述,将会更好地理解本发明。除非另外指明,否则附图未必按比例绘制,而是为了示出本发明的原理。
图1描绘了加载器、端部执行器、轴和致动器的示例;
图2描绘了轴的分解图;
图3描绘了轴的一部分的剖面图;
图4描绘了端部执行器的透视图;
图5描绘了端部执行器的分解图;
图6描绘了加载器和端部执行器的侧视图;
图7描绘了被锁定在加载器中的端部执行器的剖面图;以及
图8描绘了附接到轴并且在加载器中被解锁的端部执行器的剖面图。
具体实施方式
这些图示出了腹腔镜式外科器械系统的一个示例。细长轴20包括外管23和定位在外管23中的内杆24。细长轴包括远侧端部21和近侧端部22。细长轴20可以是刚性的,并且该细长轴20能够通过进入装置诸如套管针插入到体腔中,或通过直接经皮插入而无需进入装置插入体腔内。细长轴20也可以是柔性的,并且其尺寸设定成用于插入通过柔性内窥镜的工作通道。刚性轴实施例非常适合于腹腔镜式外科手术,而柔性轴实施例非常适合于自然腔道管腔内式手术和经自然腔道内镜手术。
致动器30能够操作地连接到外管23和内杆24的近侧端部22。致动器30使内杆24相对外管23运动。在该实施例中,致动器30是手动手枪式握把柄部;然而,也可使用多种其他的手动致动器,包括剪刀式握把柄部、注射器式握把柄部、内窥镜式旋钮等。致动器30也可采用机器人式接口诸如DAVINCI弹力盘,包括齿轮或滑轮、伺服机构等的外壳的形式。
端部执行器10在体内能够附接到细长轴20并且从该细长轴20拆卸。内部梭动件14可相对外部壳体12轴向运动。梭动件包括适于附接到内杆24的远侧端部的配合特征结构。具体的配合特征结构可以是变化的,但在该实施例中,配合特征结构包括具有一对朝近侧取向的插针14A的止动器类型的机构,每个插针起片簧的作用以偏置朝内侧取向的齿状物14B,从而接合内杆24上的凹口27B。
一对外科钳口11A、11B具有取决于梭动件14和外部壳体12的相对轴向位置的打开位置和闭合位置。连接叉15固定到外部壳体12。杆联动机构13与连接叉15配合以平移梭动件14的轴向运动,从而打开和闭合钳口11;然而,可使用多种其他已知的机构对钳口11进行操作。在该实施例中,钳口11示为抓紧器;然而,也可使用多种其他的组织操纵钳口,包括解剖器、剪刀、巴布科克钳、镊子、缝合器、施夹钳等。也可采用无钳口的端部执行器,诸如钩刀、圈套、牵开器等。就需要能量的端部执行器而言,可以添加在本领域中是已知的适当能量传输机构。例如,可以在轴20和端部执行器10之间添加适当的电连接以启用双极镊子。相似地,可为超声剪切端部执行器添加超声换能器和波导。
端部执行器10包括适于将外部壳体12附接到外管23的配合特征结构17。在该实施例中,配合特征结构17是包括两个片簧的止动器类型的机构,所述两个片簧在外部壳体12上定位成彼此成180度,每个片簧具有面向中间的齿状物。随着外管23朝远侧滑动到外部壳体12中,片簧提供齿状物到凹口27A中的偏置按扣锁定接合。也可使用其他的配合特征结构,包括螺纹、夹头、卡口等。键槽配合特征结构19的尺寸设定成并且适于接合外管23上的花键特征结构28,以在外管23附接到外部壳体12时有利于旋转联接。
加载器40包括柄部45、轴43和可相对轴43呈关节状连接的远侧管41。管41的尺寸设定成接收端部执行器10。管41包括适于将端部执行器10附接到管41的内部的配合特征结构42。在该实施例中,配合特征结构42是包括两个片簧的止动器类型的机构,所述两个片簧在管41上定位成彼此成180度,每个片簧具有面向中间的齿状物。随着端部执行器10滑动到管41中,片簧提供齿状物到凹口18中的偏置按扣锁定接合。也可使用其他的配合特征结构,包括螺纹、夹头、卡口等。
三个配合特征结构17,14A和42各自具有将使相应的部件脱离的阈值轴向力。例如,配合特征结构17的阈值脱离力是将外部壳体12从外管23分离所需的轴向力。优选地,阈值脱离力的相对大小根据以下公式:
F1<F3<F2
其中,
F1是外部壳体12和外管23之间的阈值脱离力;
F2是梭动件14和内杆24之间的阈值脱离力;
F3是加载器管41和端部执行器10之间的阈值脱离力;
在外科手术期间,轴20的远侧端部21被插入体腔中,诸如腹腔、骨盆、胸腔等。端部执行器10附接到管41中并且通常通过入口也被引入体腔中。加载器管41可呈关节状连接,以便使端部执行器10与轴20轴向对齐。然后,远侧端部21被插入端部执行器10中。外管23朝远侧滑动到外部壳体12中,直到配合特征结构17的片簧提供到凹口27A中的偏置按扣锁定接合,从而将外部壳体12附接到外管23。内杆24朝远侧滑动到梭动件14中,直到插针14A提供与齿状物14B到凹口27B中的偏置按扣锁定接合,从而将梭动件14附接到内杆24。现在,端部执行器10完全体内附接到轴20,并且然后可从管41牵拉该端部执行器10。因为F2>F1,所以朝近侧牵拉轴20将使端部执行器10从加载器管41中被牵拉出。加载器40可从外科区域移除。致动器30的操作转化成操作钳口11,从而使外科医生能够操纵组织并且执行微创外科手术操作。
通过颠倒上一段落中概述的附接步骤实现体内拆卸。加载器40被引入体腔中并且端部执行器10滑动到管41中。外管23的远侧端部21包括倾斜表面29。当滑块25朝远侧推进并且压缩弹簧26时,倾斜表面29也朝远侧推进,以接合并且侧向展开梭动件插针14A,从而使齿状物14B从内杆24上的凹口27B脱离。销25A在L形狭槽中滑动,从而使外科医生能够将倾斜表面29保持在其最远侧位置中。现在,可从梭动件14牵拉内杆24,从而有效地使F2等于零(倾斜表面29也可用于有利于内杆24体内插入梭动件14中)。因为F3>F2,所以朝近侧牵拉轴20将使端部执行器10从内杆24拆卸,从而使端部执行器10附接在加载器管41内部。
本文已经示出和描述了本发明的多个实施例和实例,在不脱离本发明的范围的情况下,通过本领域普通技术人员进行适当的修改,可以实现本文描述的方法和设备的进一步改进。已经提及若干此类潜在修改形式,并且其它修改形式对于本领域的技术人员而言将会显而易见。例如,附图中的具体材料、量纲和比例将会被理解为非限制性实例。因此,本发明的范围应该以下面的权利要求书考虑,并且应被理解为不限于说明书和附图所示和所述的结构、材料或操作细节。
Claims (11)
1.一种外科装置,包括:
a)细长轴,所述细长轴包括外管和定位在所述外管中的内杆,所述外管和所述内杆各自包括远侧端部和近侧端部;
b)致动器,所述致动器能够操作地连接到所述外管的近侧端部和所述内杆的近侧端部;
c)端部执行器,所述端部执行器在体内能够附接到所述细长轴并且从所述细长轴拆卸,所述端部执行器包括:
i)外部壳体,所述外部壳体包括适于接合所述外管的远侧端部的第一止动器配合特征结构;
ii)内部梭动件,所述内部梭动件能够相对所述外部壳体轴向地运动,所述梭动件包括适于接合所述内杆的远侧端部的第二止动器配合特征结构;
iii)一对外科钳口,所述一对外科钳口具有取决于所述梭动件和所述壳体的相对轴向位置的打开位置和闭合位置;
d)管状加载器,所述管状加载器的尺寸设定成接收所述端部执行器,所述管状加载器包括适于接合所述端部执行器的第三止动器配合特征结构。
2.根据权利要求1所述的外科装置,其中所述第一止动器配合特征结构、所述第二止动器配合特征结构和所述第三止动器配合特征结构分别具有阈值脱离力F1、F2和F3,所述阈值脱离力具有以下相对大小:
F1<F3<F2。
3.根据权利要求1所述的外科装置,其中所述第一止动器配合特征结构包括适于接合所述外管上的凹口的所述外部壳体上的片簧。
4.根据权利要求1所述的外科装置,其中所述第三止动器配合特征结构包括适于接合所述外部壳体上的凹口的所述管状加载器上的片簧。
5.根据权利要求1所述的外科装置,其中所述第二止动器配合特征结构包括一对朝近侧取向的插针,每个插针具有适于接合所述内杆上的凹口的朝内侧取向的齿状物。
6.根据权利要求5所述的外科装置,其中所述外管的远侧端部包括适于接合并且侧向展开所述插针的倾斜表面,从而使所述齿状物从所述内杆上的所述凹口脱离。
7.根据权利要求6所述的外科装置,还包括能够操作地连接到所述外管以朝远侧推进所述倾斜表面的推动器。
8.根据权利要求7所述的外科装置,其中销将所述外管连接到所述推动器,并且所述销骑在L形狭槽中。
9.一种外科装置,包括:
a)细长轴,所述细长轴包括外管和定位在所述外管中的内杆,所述外管和所述内杆各自包括远侧端部和近侧端部;
b)致动器,所述致动器能够操作地连接到所述外管的近侧端部和所述内杆的近侧端部;
c)端部执行器,所述端部执行器在体内能够附接到所述细长轴并且从所述细长轴拆卸,所述端部执行器包括:
i)外部壳体,所述外部壳体包括适于接合所述外管的远侧端部的第一配合特征结构;
ii)内部梭动件,所述内部梭动件能够相对所述外部壳体轴向地运动,所述梭动件包括适于接合所述内杆的远侧端部的第二配合特征结构;
iii)一对外科钳口,所述一对外科钳口具有取决于所述梭动件和所述壳体的相对轴向位置的打开位置和闭合位置;
其中所述第二配合特征结构包括一对朝近侧取向的插针,每个插针具有适于接合所述内杆上的凹口的朝内侧取向的齿状物;并且
其中所述外管的远侧端部包括适于接合并且侧向展开所述插针的倾斜表面,从而使所述齿状物从所述内杆上的所述凹口脱离。
10.根据权利要求9所述的外科装置,其中所述第一配合特征结构包括止动器机构。
11.一种外科装置,包括:
a)细长轴,所述细长轴包括外管和定位在所述外管中的内杆,所述外管和所述内杆各自包括远侧端部和近侧端部;
b)致动器,所述致动器能够操作地连接到所述外管的近侧端部和所述内杆的近侧端部;
c)端部执行器,所述端部执行器在体内能够附接到所述细长轴并且从所述细长轴拆卸,所述端部执行器包括:
i)外部壳体和将所述外部壳体附接到所述外管的部件;
ii)能够相对所述外部壳体轴向地运动的内部梭动件和将所述梭动件附接到所述内杆的部件;
iii)一对外科钳口,所述一对外科钳口具有取决于所述梭动件和所述壳体的相对轴向位置的打开位置和闭合位置;
d)尺寸设定成接收所述端部执行器的管状加载器和将所述端部执行器附接到所述管状加载器中的部件。
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EP2900151B1 (en) | 2020-04-29 |
JP6279587B2 (ja) | 2018-02-14 |
CN104684492B (zh) | 2018-01-23 |
JP2015530190A (ja) | 2015-10-15 |
US20140088569A1 (en) | 2014-03-27 |
EP2900151A1 (en) | 2015-08-05 |
US9125681B2 (en) | 2015-09-08 |
US20160022298A1 (en) | 2016-01-28 |
US9526516B2 (en) | 2016-12-27 |
WO2014052177A1 (en) | 2014-04-03 |
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