CN104853688A - 多功能双极镊子 - Google Patents

多功能双极镊子 Download PDF

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CN104853688A
CN104853688A CN201380049869.9A CN201380049869A CN104853688A CN 104853688 A CN104853688 A CN 104853688A CN 201380049869 A CN201380049869 A CN 201380049869A CN 104853688 A CN104853688 A CN 104853688A
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jaw member
electrode
energy
end effector
proximal
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CN104853688B (zh
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C·P·布德罗克斯
A·C·沃格勒
C·J·沙伊布
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Ethicon Endo Surgery Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • 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
    • A61B2017/2945—Curved jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A61B2017/320093—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw additional movable means performing cutting operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A61B2017/320094—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw additional movable means performing clamping operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A61B2017/320097—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw with stapling means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00107—Coatings on the energy applicator
    • A61B2018/00148—Coatings on the energy applicator with metal
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00404—Blood vessels other than those in or around the heart
    • A61B2018/00428—Severing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/0063—Sealing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
    • A61B2018/1455—Probes having pivoting end effectors, e.g. forceps including means for cutting having a moving blade for cutting tissue grasped by the jaws
    • F—MECHANICAL ENGINEERING; LIGHTING; HEATING; WEAPONS; BLASTING
    • F04—POSITIVE - DISPLACEMENT MACHINES FOR LIQUIDS; PUMPS FOR LIQUIDS OR ELASTIC FLUIDS
    • F04C—ROTARY-PISTON, OR OSCILLATING-PISTON, POSITIVE-DISPLACEMENT MACHINES FOR LIQUIDS; ROTARY-PISTON, OR OSCILLATING-PISTON, POSITIVE-DISPLACEMENT PUMPS
    • F04C2270/00—Control; Monitoring or safety arrangements
    • F04C2270/04—Force
    • F04C2270/041—Controlled or regulated

Abstract

本发明公开了一种端部执行器。该端部执行器包括第一钳口构件。该第一钳口构件包括第一电极。第一钳口构件限定远侧端部处的第一孔。该端部执行器包括第二钳口构件。该第二钳口构件包括第二电极。第二钳口构件限定远侧端部处的第二孔。第二钳口构件操作地联接到第一钳口构件。当第一钳口构件和第二钳口构件处于闭合位置时，第一孔和第二孔能够限定单个孔。该第一电极和第二电极能够递送能量。

Description

多功能双极镊子
相关申请的交叉引用
本专利申请根据35 U.S.C.§ 119(e)要求提交于2012年9月28日、名称为“MULTI-FUNCTION BI-POLAR FORCEPS”的美国临时专利申请61/707,030的权益，该专利据此全文以引用方式并入本文。
背景技术
许多外科手术中会用到电外科装置。电外科装置向组织施加电能以便对组织进行处理。电外科装置可包括具有安装在远侧的端部执行器的器械，该端部执行器包括一个或多个电极。端部执行器可抵靠组织定位，使得电流被引入到组织中。电外科装置可被配置成用于双极性或单极性操作。在双极性操作期间，电流分别通过端部执行器的有源电极和返回电极被引入组织中并从组织返回。在单极操作期间，电流通过端部执行器的有源(或源极)电极被引入组织中，并通过返回电极(例如，接地垫)返回，所述有源电极与所述返回电极单独地位于患者的身体上。由流过组织的电流所产生的热可在组织内和/或在组织之间形成止血密封，并因此可尤其适用于例如密封血管。电外科装置的端部执行器还可包括能够相对于组织运动的切割构件以及用以横切组织的电极。
由电外科装置施加的电能可通过发生器传输至器械。电能可为射频(“RF”)能的形式。射频能量是可在100kHz至1MHz频率范围内的电能形式。在其操作期间，电外科装置可将低频射频能量传输通过组织，这会引起离子振荡或摩擦，实际上造成电阻性加热，从而升高组织的温度。由于可在受影响的组织和周围组织之间形成明显的边界，因此外科医生能够以高精确度进行操作和控制，而不损伤相邻的非目标组织。射频能量的低操作温度可适用于在密封血管的同时移除、收缩软组织，或对软组织塑形。射频能量可尤其良好地适用于结缔组织，该结缔组织主要包含胶原，并在接触热时收缩。
发明内容
在各种实施例中，公开了一种端部执行器。该端部执行器包括第一钳口构件。第一钳口构件包括第一电极。第一钳口构件限定远侧端部处的第一孔。该端部执行器包括第二钳口构件。第二钳口构件包括第二电极。第二钳口构件限定远侧端部处的第二孔。第二钳口构件操作地联接到第一钳口构件。当第一钳口构件和第二钳口构件处于闭合位置时，第一孔和第二孔能够限定单个孔。第一电极和第二电极能够递送能量。
在各种实施例中，公开了一种端部执行器。该端部执行器包括第一钳口构件。第一钳口构件包括第一近侧接触表面和第一远侧接触表面。第一近侧接触表面和第一远侧接触表面限定两者间的第一开口。该端部执行器包括第二钳口构件，第二钳口构件包括第二近侧接触表面和第二远侧接触表面。第二钳口构件操作地联接到第一钳口构件。第二近侧接触表面和第二远侧接触表面限定两者间的第二开口。当第一钳口构件和第二钳口构件处于闭合位置时，第一开口和第二开口限定一个孔。第一近侧电极联接到第一近侧接触表面。第一近侧电极能够递送能量。
在各种实施例中，公开了一种端部执行器。端部执行器包括第一钳口构件，其操作地联接到第二钳口构件。第一钳口构件和第二钳口构件各自包括由第一宽度限定的近侧接触区域和由第二宽度限定的远侧接触区域。第一宽度大于第二宽度。第一电极联接到第一钳口构件。第一电极能够递送能量。
在各种实施例中，公开了一种端部执行器。该端部执行器包括第一钳口构件。第一钳口构件包括带电极，其联接到第一钳口构件的外表面。在第一位置处，带电极能够被放置为与第一钳口构件齐平。在第二位置处，带电极能够被从第一钳口构件向外挠曲。带电极能够递送能量。第二钳口构件操作地联接到第一钳口构件。
附图说明
多个实施例的特征结构在所附权利要求书中进行了详细描述。然而，参考结合如下附图的下列描述可最好地理解多个实施例(有关手术的组织和方法两者)及其优点：
图1示出了电能外科器械的一个实施例的透视图。
图2示出了图1的外科器械的一个实施例的柄部的侧视图，其中移除了柄部主体的一半以示出其中的一些部件。
图3示出了图1的外科器械的端部执行器的一个实施例的透视图，其中钳口打开并且可轴向运动的构件的远侧端部处于回缩位置。
图4示出了图1的外科器械的端部执行器的一个实施例的透视图，其中钳口闭合并且可轴向运动的构件的远侧端部处于部分推进的位置。
图5示出了图1的外科器械的可轴向运动的构件的一个实施例的透视图。
图6示出了图1的外科器械的端部执行器的一个实施例的截面图。
图7示出了无绳电能外科器械的一个实施例的透视图。
图8A示出了图7的外科器械的一个实施例的柄部的侧视图，其中移除了柄部主体的一半以示出其中的各种部件。
图8B示出了射频驱动和控制电路的一个实施例。
图8C示出了控制电路的主要部件的一个实施例。
图9示出了包括孔的端部执行器的一个实施例。
图10示出了图9的端部执行器的透视图。
图11示出了图9的端部执行器的俯视图。
图12示出了包括多个电极的图9的端部执行器的一个实施例。
图13a示出了联接到伸长轴并且处于打开位置的图9的端部执行器的一个实施例。
图13b示出了处于闭合位置的图13a的端部执行器的一个实施例。
图14示出了端部执行器的一个实施例，该端部执行器包括近侧夹持区域和远侧夹持区域并且限定两者间的孔。
图15示出了处于打开位置的图14的端部执行器的侧视图。
图16示出了处于闭合位置的图14的端部执行器的侧视图。
图17示出了处于闭合位置的图14的端部执行器的透视图。
图18示出了图14的端部执行器的俯视图。
图19A示出了处于打开位置的端部执行器的一个实施例，该端部执行器包括近侧夹持区域和远侧夹持区域并且限定两者间的孔。
图19B示出了处于闭合位置的图19A的端部执行器的一个实施例。
图19C示出了处于击发位置的图19A的端部执行器的一个实施例。
图20示出了图19A的端部执行器的分解图。
图21示出了端部执行器的一个实施例，该端部执行器包括近侧夹持区域和远侧夹持区域，其中近侧夹持区域包括近侧电极，远侧夹持区域包括远侧电极。
图22示出了图21的端部执行器的俯视图。
图23示出了图21的端部执行器的透视图。
图24示出了图21的端部执行器的分解图。
图25示出了端部执行器的一个实施例，该端部执行器包括近侧接触区域和远侧接触区域。
图26示出了图25的端部执行器的俯视图。
图27示出了处于打开位置的图25的端部执行器的侧视图。
图28示出了处于闭合位置的图25的端部执行器的侧视图。
图29示出了端部执行器的一个实施例，该端部执行器包括近侧接触区域和远侧接触区域，并且近侧接触区域和远侧接触区域包括连续电极。
图30A示出了处于打开位置的端部执行器的一个实施例，该端部执行器包括近侧接触区域和远侧接触区域。
图30B示出了处于闭合位置的图30A的端部执行器。
图30C示出了处于击发位置的图30A的端部执行器。
图31示出了图30A的端部执行器的分解图。
图32示出了处于展开位置的包括带电极的端部执行器的一个实施例。
图33示出了处于回缩位置的图32的端部执行器。
具体实施方式
现在将具体地参考若干实施例，包括示出了用于切割和凝固组织的电外科医疗器械的示例性实施例的实施例。只要可行，相似或相同的参考编号可用于多个附图并可指示相似或相同的功能。附图仅出于举例说明的目的描绘了所公开的外科器械和/或使用方法的示例性实施例。本领域的技术人员将通过以下描述容易地认识到：可在不脱离本文所述原理的情况下采用本文所示的结构和方法的另选的示例性实施例。
本发明公开了利用治疗和/或亚治疗电能来处理组织或向发生器提供反馈(例如电外科器械)的外科器械的各种实施例。所述实施例适于以手动或用手操作的方式使用，但电外科器械也可用于机器人应用中。图1为包括电能外科器械110的外科器械系统100的一个示例性实施例的透视图。电外科器械110可包括近侧柄部112、远侧工作端部或端部执行器126，以及设置在它们之间的导引器或伸长轴114。
例如，电外科系统100能够独立地或者同时地向患者的组织提供能量诸如电能、超声能量、热能、或它们的任意组合。在一个示例性实施例中，电外科系统100包括与电外科器械110电连通的发生器120。发生器120经由合适的传输介质(诸如缆线122)连接到电外科器械110。在一个示例性实施例中，发生器120联接到控制器，诸如控制单元125。在各种实施例中，控制单元125可与发生器120整体形成或者可作为电联接到发生器120(以虚线显示以示出该部分)的独立的电路模块或装置而提供。虽然在本发明所公开的实施例中，发生器120被显示为与电外科器械110分开，但在一个示例性实施例中，发生器120(和/或控制单元125)可与电外科器械110整体形成，以形成一体的电外科系统100，在该情况下，位于电外科器械110内的电池为能量源，而联接到电池的电路产生合适的电能、超声能量或热能。下文结合图7-图8C描述了一个此类例子。
发生器120可包括位于发生器120控制台的前面板上的输入装置135。输入装置135可包括生成适于对发生器120的操作进行程控的信号的任何合适装置，例如键盘或输入端口。在一个示例性实施例中，第一钳口164a和第二钳口164b中的各种电极可联接至发生器120。缆线122可包括多个电导体，用于将电能施加到电外科器械110的正(+)电极和负(-)电极。控制单元125可用于激活发生器120，所述发生器可用作电源。在各种实施例中，发生器120可包括例如可被独立地或同时地激活的射频源、超声波源、直流电源、和/或任何其他合适类型的电能量源。
在各种实施例中，电外科系统100可包括至少一个供给导体131和至少一个返回导体133，其中电流能够经由供给导体131供给电外科器械100并且其中电流能够经由返回导体133流回发生器120。在各种实施例中，供给导体131和返回导体133可包括绝缘线和/或任何其他合适类型的导体。在某些实施例中，如下文所述，供给导体131和返回导体133可包含在缆线122内并且/或者可包括：在发生器120与电外科器械110的端部执行器126之间或至少部分地在它们之间延伸的缆线122。在任何情况下，发生器120能够在供给导体131和返回导体133之间提供足够的电压差，使得可将足够的电流供给到端部执行器126。
图2为外科器械110的柄部112的一个示例性实施例的侧视图。在图2中，显示柄部112，其中第一柄部主体112a(参见图1)的一半被移除以示出第二柄部主体112b内的各种部件。柄部112可以包括杠杆臂121(例如，触发器)，该杠杆臂可以沿着路径33被牵拉。杠杆臂121可以通过往复运动件184联接到设置在伸长轴114内的可轴向运动的构件178(图3-图6)，并且往复运动件184可操作地接合到杠杆臂121的延伸部198。往复运动件184还可以连接到偏置装置，诸如弹簧188，以沿近侧方向偏置往复运动件184并因而沿近侧方向偏置可轴向运动的构件178，由此将钳口164a和164b推压到打开位置，如图1中所见，其中该偏置装置还可以连接至第二柄部主体112b。另外，参见图1-图2，锁定构件190(参见图2)可通过锁定开关128(参见图1)在锁定位置和解锁位置之间运动，在锁定位置，基本上防止往复运动件184朝远侧运动，如图所示；在解锁位置，可允许往复运动件184自由地沿远侧方向朝伸长轴114运动。柄部112可以为任何类型的手枪式握把或本领域中已知的其他类型的柄部，其能够承载致动器杠杆、触发器或滑动件，以用于致动第一钳口164a和第二钳口164b。在一些实施例中，柄部112可包括铅笔式柄部。伸长轴114可具有例如圆柱形或矩形横截面，并且可包括从柄部112延伸的薄壁管状套筒。伸长轴114可包括贯穿其延伸的镗孔，用于承载用于致动钳口的致动器机构(例如，可轴向运动的构件178)，以及用于承载将电能递送到端部执行器126的电外科部件的电引线。
端部执行器126能够捕获并横切组织，并且能够同时通过能量(例如，射频能量)的受控施加而焊接所捕获的组织。第一钳口164a和第二钳口164b可以闭合，由此围绕由可轴向运动的构件178限定的纵向轴线“T”来捕获或接合组织。第一钳口164a和第二钳口164b还可对组织施加压缩。在一些实施例中，伸长轴114连同第一钳口164A和第二钳口164B一起能够相对于柄部112旋转完整的360°，如箭头196(参见1)所示。例如，旋钮148可绕轴114的纵向轴线旋转，并且可联接到轴114以使得旋钮148的旋转导致轴114的相应旋转。第一钳口164a和第二钳口164b可在旋转的同时保持为可打开和/或可闭合的。
图3显示了钳口164a、164b打开的端部执行器126的一个示例性实施例的透视图，而图4显示了钳口164a、164b闭合的端部执行器126的一个实施例的透视图。如上所述，端部执行器126可以包括上部第一钳口164a和下部第二钳口164b，它们可以是直的或弯曲的。第一钳口164a和第二钳口164b各自可以分别包括沿它们的相应中间部分向外设置的细长狭槽或通道162a和162b。另外，第一钳口164a和第二钳口164b可各自具有设置在第一钳口164a和第二钳口164b的内部上的组织夹持元件，例如齿状物163。第一钳口164a可以包括上部第一钳口主体162a，该上部第一钳口主体具有上部第一向外表面和上部第一能量递送表面165a。第二钳口164b可以包括下部第二钳口主体162b，该下部第二钳口主体具有下部第二向外表面和下部第二能量递送表面165b。第一能量递送表面165a和第二能量递送表面165b可围绕端部执行器126的远侧端部以“U”形延伸。
柄部112的杠杆臂121(图2)可适于致动可轴向运动的构件178，该可轴向运动的构件还可以充当钳口闭合机构。例如，当沿路径33朝近侧牵拉杠杆臂121时，可经由往复运动件184朝远侧推可轴向运动的构件178，如图2所示且如上所述。图5是外科器械110的可轴向运动的构件178的一个示例性实施例的透视图。可轴向运动的构件178可以包括一个或若干个零件，但是在任何情况下，其均可以相对于伸长轴114和/或钳口164a、164b运动或平移。另外，在至少一个示例性实施例中，可轴向运动的构件178可以由17-4沉淀硬化不锈钢制成。可轴向运动的构件178的远侧端部可以包括带凸缘的“I”形梁，该“I”形梁能够在钳口164a和164b中的通道162a和162b内滑动。可轴向运动的构件178可在通道162a、162b内滑动，以打开和闭合第一钳口164a和第二钳口164b。可轴向运动的构件178的远侧端部还可包括上凸缘或“c”形部分178a，以及下凸缘或“c”形部分178b。凸缘178a、178b分别限定内部凸轮表面167a和167b，用于与第一钳口164a和第二钳口164b的向外表面接合。钳口164a和164b的打开和闭合可以使用凸轮机构在组织上施加非常高的压缩力，所述凸轮机构可以包括可运动的“I形梁”、可轴向运动的构件178以及钳口164a、164b的向外表面169a、169b。
更具体地，现在参见图3-图5，可轴向运动的构件178的远侧端部的内部凸轮表面167a和167b可共同地适于分别可滑动地接合第一钳口164a的第一向外表面169a和第二钳口164b的第二向外表面169b。第一钳口164a内的通道162a和第二钳口164b内的通道162b可被设定尺寸并且被配置成适应可轴向运动的构件178的移动，该可轴向运动的构件可包括组织切割元件171，例如，包括锐利的远侧边缘。例如，图4示出了至少部分地推进穿过通道162a和162b(图3)的可轴向运动的构件178的远侧端部。可轴向运动的构件178的推进可将端部执行器126从图3中所示的打开构型闭合。在图4所示的闭合位置，上部第一钳口164a和下部第二钳口164b分别限定第一钳口164a的第一能量递送表面165a与第二钳口164b的第二能量递送表面165b之间的间隙或尺寸D。在各种实施例中，尺寸D可例如等于约0.0005英寸至约0.040英寸，并且在一些实施例中，例如介于约0.001英寸至约0.010英寸之间。另外，第一能量递送表面165a和第二能量递送表面165b的边缘可为圆形的以防止切开组织。
图6是外科器械110的端部执行器126的一个示例性实施例的截面图。下部钳口164b的接合组织接触表面165b适于至少部分地通过导电-电阻基质(诸如可变电阻PTC主体)向组织递送能量，如下文更详细地讨论。上部钳口164a和下部钳口164b中的至少一者可以承载至少一个能够将能量从发生器120递送到捕获组织的电极173。上部钳口164a的接合组织接触表面165a可承载类似的导电-电阻基质(即，PTC材料)，或者在一些实施例中，该表面可为例如导电电极或绝缘层。另选地，钳口的接合表面可以承载2001年10月22日提交的名称为“ELECTROSURGICAL JAW STRUCTUREFOR CONTROLLED ENERGY DELIVERY”的美国专利6,773,409中所公开的任何能量递送部件，该专利的全部公开内容以引用方式并入本文。
第一能量递送表面165a和第二能量递送表面165b各自可以与发生器120电连通。第一能量递送表面165a和第二能量递送表面165b能够接触组织并将适于密封或焊接组织的电外科能量递送到捕获的组织。控制单元125调节由电发生器120递送的电能，而电发生器120继而向第一能量递送表面165a和第二能量递送表面165b递送电外科能量。可通过激活按钮128(图2)来发起能量递送，该激活按钮与杠杆臂121可操作地接合并且经由缆线122与发生器120电连通。在一个示例性实施例中，电外科器械110可通过脚踏开关129(图1)经由发生器120通电。当致动时，脚踏开关129触发发生器120以例如将电能递送到端部执行器126。控制单元125可在启动期间对由发生器120生成的功率进行调节。虽然脚踏开关129可适用于多种情况，但也可采用其他合适类型的开关，例如拇指开关。
如上所述，由电发生器120递送并且由控制单元125调节或以其他方式控制的电外科能量可包括射频(RF)能量，或其他合适形式的电能。另外，相对的第一能量递送表面165a和第二能量递送表面165b可以承载可变电阻PTC主体，该主体与发生器120和控制单元125电连通。有关电外科端部执行器、钳口闭合机构、以及电外科能量递送表面的额外细节在以下美国专利和已公布的专利申请中有所描述：美国专利No.7,087,054；No.7,083,619；No.7,070,597；No.7,041,102；No.7,011,657；No.6,929,644；No.6,926,716；No.6,913,579；No.6,905,497；No.6,802,843；No.6,770,072；No.6,656,177；No.6,533,784；和No.6,500,112；以及美国专利申请公布No.2010/0036370和2009/0076506，这些专利全文均以引用方式并入本文并成为本说明书的一部分。
在一个示例性实施例中，发生器120可被实施为电外科单元(ESU)，该电外科单元能够利用射频(RF)能量来提供足以执行双极电外科的功率。在一个示例性实施例中，ESU可以是ERBE USA,Inc.(Marietta,Georgia)销售的双极ERBE ICC 150。在一些实施例中，诸如对于双极电外科应用，可以利用具有有源电极和返回电极的外科器械，其中有源电极和返回电极可以抵靠、邻近待处理的组织定位以及/或者被定位成与待处理的组织电连通，使得电流能够从有源电极通过PTC主体并通过组织而流至返回电极。因此，在各种实施例中，电外科系统100可包括供给路径和返回路径，其中正被处理的所捕获组织完成或闭合电路。在一个示例性实施例中，发生器120可以是单极射频ESU并且电外科器械110可以包括单极端部执行器126，在该单极端部执行器中整合一个或多个有源电极。对于此类系统而言，发生器120可需要位于远离操作位点的位置处与患者紧密接触的返回垫，和/或其他合适的返回路径。返回垫可通过缆线连接到发生器120。在其他实施例中，操作员可提供亚治疗射频能级以用于在电外科系统100中评估组织状态以及提供反馈的目的。可使用这种反馈来控制电外科器械110的治疗性射频能量输出。
在电外科器械100的操作过程中，使用者通常抓紧组织，向捕获的组织提供能量以形成焊接或密封(例如，通过致动按钮128和/或踏板129)，并且然后驱动位于可轴向运动的构件178远侧端部处的组织切割元件171穿过被抓紧的组织。根据各种实施例，可轴向运动的构件178的轴向运动的平移可为有节奏的或以其他方式受控制的，以有助于以合适的行进速率来驱动可轴向运动的构件178。通过控制行进速率，所捕获组织在经切割元件171横断之前已被适当地和功能性地密封的可能性增加。
图7为包括无绳电能外科器械210的外科器械系统200的一个示例性实施例的透视图。电外科系统200与电外科系统100类似。电外科系统200能够独立地或者同时地向患者的组织提供能量诸如电能、超声能量、热能或它们的任意组合，例如，如结合图1所述。电外科器械210可利用本文结合无绳近侧柄部212所述的端部执行器126和伸长轴114。在一个示例性实施例中，柄部212包括发生器电路220(参见图8A)。发生器电路220执行基本上与发生器120的电路类似的功能。在一个示例性实施例中，发生器电路220联接到控制器，诸如控制电路。在例示的实施例中，控制电路整合到发生器电路220中。在其他实施例中，控制电路可与发生器电路220分开。
在一个示例性实施例中，端部执行器126(包括其第一钳口164a和第二钳口164b)中的各种电极可以联接到发生器电路220。控制电路可用于激活可充当电源的发生器220。在各种实施例中，发生器220可包括例如射频源、超声波源、直流电源、和/或任何其他合适类型的电能源。在一个示例性实施例中，可提供按钮128，用于激活发生器电路220从而向端部执行器126提供能量。
图8A为无绳外科器械210的柄部212的一个示例性实施例的侧视图。在图8A中，显示柄部212，其中第一柄部主体的一半被移除以示出第二柄部主体234内的各种部件。柄部212可以包括杠杆臂224(例如，触发器)，该杠杆臂可以沿着路径33围绕枢转点被牵拉。杠杆臂224可以通过往复运动件联接到设置在伸长轴114内的可轴向运动的构件278，该往复运动件可操作地接合到杠杆臂221的延伸部。在一个示例性实施例中，杠杆臂221限定包括远侧触发器钩221a和近侧触发器部分221b的牧羊杖钩形状。如图所示，远侧触发器钩221a可具有第一长度，而近侧触发器部分221b可具有第二长度，其中第二长度大于第一长度。
在一个示例性实施例中，无绳电外科器械包括电池237。电池237向发生器电路220提供电能。电池237可以是适于以所需的能级驱动发生器电路220的任何电池。在一个示例性实施例中，电池237为1030mAhr三芯锂离子聚合物电池。该电池可在用于外科手术之前充满电，并且可保持约12.6V的电压。电池237可具有装配到无绳电外科器械210的两条保险丝，它们被布置成符合每个电池端子。在一个示例性实施例中，提供充电端口239，用于将电池237连接到直流电源(未示出)。
发生器电路220可以任何合适的方式配置。在一些实施例中，发生器电路包括射频驱动和控制电路240以及控制器电路282。图8B示出了根据一个实施例的射频驱动和控制电路240。图8B是示出了在该实施例中用于生成和控制提供给端部执行器126的射频电能的射频驱动和控制电路240的局部方框示意图。如下文将更详细地解释，在该实施例中，驱动电路240是包括关于射频放大器输出的并联谐振网络的谐振模式射频放大器，而控制电路用于控制驱动信号的工作频率以使得其保持在驱动电路的谐振频率下，继而控制提供给端部执行器126的功率的量。根据以下说明，实现这点的方式将是显而易见的。
如图8B所示，射频驱动和控制电路240包括上述电池237，在该示例中其被布置成提供约0V和约12V的导轨。输入电容器(Cin)242连接在0V导轨与12V导轨之间，用于提供低源阻抗。一对FET开关243-1和243-2(在该实施例中，此二者均为N型通道以减少功率损耗)串联连接在0V导轨与12V导轨之间。提供FET栅极驱动电路245，其生成两个驱动信号，每个驱动信号用于驱动两个FET 243中的一个。FET栅极驱动电路245生成驱动信号，其在下部FET(243-2)关闭时使得上部FET(243-1)接通，反之亦然。这使得节点247交替地连接到12V导轨(当FET 243-1接通时)和0V导轨(当FET 243-2接通时)。图8B还显示相应FET 243的内部寄生二极管248-1和248-2，它们在FET 243接通的任意期间导电。
如图8B所示，节点247连接到由电感器Ls252和电感器Lm254形成的电感器-电感器谐振电路250。FET栅极驱动电路245被布置成以驱动频率(fd)生成驱动信号，用于以并联谐振电路250的谐振频率打开和断开FET开关243。由于谐振电路250的谐振特性，在节点247处的方波电压将使得在驱动频率(fd)下的基本上呈正弦的电流在谐振电路250内流动。如图8B所示，电感器Lm254是变压器255的主线圈，该变压器的次线圈由电感器Lsec256形成。变压器255次线圈的电感器Lsec256连接到由电感器L2258、电容器C4260和电容器C2262形成的电感器-电容器-电容器并联谐振电路257。变压器255将电感器Lm254两端的驱动电压(Vd)升压转换成施加到输出并联谐振电路257的电压。负载电压(VL)由并联谐振电路257输出，并施加到与镊子的钳口以及端部执行器126所夹持的任何组织或血管的阻抗对应的负载(在图8B中由负载电阻R负载259表示)。如图8B所示，提供了一对直流阻塞电容器CbI280-1和280-2以防止任何直流电信号施加到负载259。
在一个实施例中，变压器255可由符合以下规格的芯径(mm)、线径(mm)、以及次级线圈之间的间隙实施：
芯径，D(mm)
D＝19.9×10-3
22AWG线的线径，W(mm)
W＝7.366×10-4
次级线圈之间的间隙，间隙＝0.125
G＝间隙/25.4
在该实施例中，通过改变用于切换FET 243的转换信号的频率而对提供给端部执行器126的电量进行控制。这是可行的，因为谐振电路250充当频率相依性(较少损耗)衰减器。驱动信号越接近谐振电路250的谐振频率，驱动信号衰减得就越少。相似地，随着驱动信号的频率移动远离电路250的谐振频率，驱动信号衰减得越多，因此提供给负载的功率减少。在该实施例中，基于待递送到负载259的期望功率和由常规电压感测电路283和电流感测电路285获得的负载电压(VL)和负载电流(IL)的测量值，由控制器281对FET栅极驱动电路245所生成的转换信号的频率进行控制。控制器281运行的方式将在下文中更详细地描述。
在一个实施例中，电压感测电路283和电流感测电路285可以用高带宽、高速轨到轨放大器(例如，由National Semiconductor制造的LMH6643)实施。然而，此类放大器在其工作时消耗相对高的电流。因此，可提供节电电路以降低放大器在不用于电压感测电路283和电流感测电路285中时的供电电压。在一个实施例中，节电电路可使用降压稳压器(例如，由Linear Technologies制造的LT1502)来降低轨到轨放大器的供电电压并因此延长电池237的寿命。
图8C示出了根据一个实施例的控制器281的主要部件。在图8C所示的实施例中，控制器281是基于微处理器的控制器，因此图8C中所示的大部分部件为基于软件的部件。然而，也可以使用基于硬件的控制器281。如图所示，控制器281包括同步I,Q取样电路291，其从感测电路283和285接收感测到的电压和电流信号，并且获得传送到功率、Vrms和Irms计算模块293的相应样本。计算模块293使用接收到的样本来计算施加到负载259(图8B；端部执行器126及因而夹持的组织/血管)的RMS电压和RMS电流，并通过它们计算目前正施加给负载259的功率。然后将确定值传送到频率控制模块295和医疗装置控制模块297。医疗装置控制模块297使用该值确定负载259的当前阻抗，并且基于确定的阻抗和预定义的算法，确定应当将何种设定点功率(P设定)施加到频率控制模块295。医疗装置控制模块297继而由从使用者输入模块299接收的信号来控制，使用者输入模块从使用者接收输入(例如，按下按钮或启动柄部104上的控制杠杆114、110)，并且还经由使用者输出模块261来控制柄部104上的输出装置(灯、显示器、扬声器等)。
频率控制模块295使用得自计算模块293的值和得自医疗装置控制模块297的设定点功率(P设定)以及预定义的系统限制(将在下文中阐释)确定是否要提高或降低所施加的频率。然后，将该决定的结果传送到方波发生模块263，其在该实施例中根据接收到的决定将自身生成的方波信号的频率提高或降低1kHz。如本领域的技术人员将会知道的那样，在另选的实施例中，频率控制模块295可不仅确定是否要提高或降低频率，还确定所需的频率变化的量。在这种情况下，方波发生模块263将生成与期望的频移对应的方波信号。在该实施例中，将由方波发生模块263生成的方波信号输出到FET栅极驱动电路245，FET栅极驱动电路245将该信号放大然后将其施加到FET243-1。FET栅极驱动电路245还转换施加到FET 243-1的信号并且将所转换的信号施加到FET 243-2。
电外科器械210可包括如结合图1-图6所示的电外科系统100所述的另外的特征。本领域的技术人员将认识到，电外科器械210可包括旋钮148、伸长轴114和端部执行器126。这些元件以基本上类似于上文结合图1-图6所示的电外科系统100所述的那些方式的方式发挥作用。在一个示例性实施例中，无绳电外科器械210可包括视觉指示器235。视觉指示器235可向操作员提供视觉指示信号。在一个示例性实施例中，视觉指示信号可警示操作员装置已开启，或者装置正在向端部执行器施加能量。本领域的技术人员将认识到，视觉指示器235能够提供关于装置的多种状态的信息。
图9示出了包括孔的端部执行器326的一个实施例。端部执行器326能够与电外科器械一起使用，诸如图1-图8C所示的电外科器械110、210。端部执行器326包括第一钳口构件364a和第二钳口构件364b。第一钳口构件364a包括由第一钳口构件364a的远侧部分限定的第一孔366a。第二钳口构件364b包括由第二钳口构件364b的远侧部分限定的第二孔366b。端部执行器326类似于图3-图5所示的端部执行器126。例如，端部执行器326可包括一个或多个钉363、在第一钳口364a和第二钳口364b两者上形成的I形梁通道362a、362b，以及/或者可部署在通道362a、362b内的切割器械(参见图11)。
图10示出了处于闭合位置的端部执行器326。可通过例如致动柄部112上的一个或多个杠杆，将端部执行器326从如图9所示的打开位置转变到图10所示的闭合位置。当端部执行器326处于闭合位置时，第一孔366a和第二孔366b对准以限定单个孔366。孔366为端部执行器326提供经改善的尖端夹持。图11示出了端部执行器326的俯视图。端部执行器326的远侧端部限定孔366，其能够在施加能量(诸如电外科和/或超声能量)之前、期间和之后夹持材料，诸如组织。端部执行器326可称为有孔端部执行器。
图11示出了图9的端部执行器326的俯视图。第一通道362a和第二通道362b对准以限定纵向通道362。切割构件371能够以可滑动的方式接收在纵向通道362内。切割构件371可部署成切割定位在第一钳口构件364a和第二钳口构件364b之间的组织和/或其他材料。在一些实施例中，切割构件371包括I形梁。图11示出了用于限定单个孔366的第一孔366a和第二孔366b的对准。在一些实施例中，端部执行器326具有适用于穿过套管针插入的宽度。例如，端部执行器可具有约4.50毫米的宽度。
图12示出了端部执行器326的一个实施例，其中端部执行器326包括能量递送表面，诸如第一电极365a和第二电极365b。电极365a、365b能够将能量递送到在第一钳口构件364a和第二钳口构件364b之间夹持的组织切片上。电极365a、365b能够为组织切片提供单极射频能量、双极射频能量、超声能量、或它们的任何组合。在一些实施例中，电极365a、365b被配置为源电极并且例如通过供给导体131联接到发生器120。第二钳口构件364b和/或第二钳口构件364b中的第二接触表面365c可被配置为通过返回导体133联接到发生器120的返回电极。在一些实施例中，能量接触表面365a-365c包括正温度系数(PTC)材料。当能量接触表面365a-365c的温度在处理期间升高时，PTC材料可以限制由能量接触表面365a-365c递送的能量。能量接触表面365a-365c可能够提供治疗性射频能量、亚治疗性射频能量、超声能量、或它们的任何组合。
图13A示出了联接到伸长轴314的端部执行器326的一个实施例。端部执行器326被示出为处于打开位置。伸长轴314内的致动器能够使端部执行器326从图13a所示的打开位置转变到如图13B所示的闭合位置。在一个实施例中，一个或多个致动器延伸穿过轴314。该一个或多个致动器能够使端部执行器326的第一钳口364a和第二钳口364b从打开位置转变到闭合位置。在一个实施例中，该一个或多个致动器联接到一个或多个致动柄部368a、368b。第一致动柄部368a从图13A所示的第一位置移动到图13B所示的第二位置。第一致动柄部368a的移动导致第一钳口构件364a转变到闭合位置。第二致动柄部368b能够例如推动切割器械371进入纵向通道362。
在操作中，端部执行器326由外科医生定位在手术部位处。端部执行器326通过例如内窥镜式、腹腔镜式或开放式手术技术定位。外科医生将组织切片定位在第一钳口构件364a和第二钳口构件364b之间。外科医生操作致动器(诸如联接到柄部的触发器或联接到伸长轴314的第一致动环368a)，使第一钳口构件364a旋转或转变到闭合位置，从而夹持位于第一钳口构件364a和第二钳口构件364b之间的组织切片。在一些实施例中，端部执行器326包括能量递送表面，诸如能够递送能量的一个或多个电极365a、365b。外科医生可以启动到电极365a、365b的能量递送。电极365a、365b将能量递送到在第一钳口构件364a和第二钳口构件364b之间夹持的组织切片上。所递送的能量可以焊接、烧灼、切开并且/或者以其他方式处理组织切片。在一些实施例中，第一钳口构件364a限定第一通道362a，第二钳口构件364b限定第二通道362b。第一通道362a和第二通道362b限定纵向通道362。切割构件371能够以可滑动的方式接收在纵向通道362内。切割构件371可部署成在组织处理之前、期间或之后切割组织切片。
图14示出了端部执行器426的一个实施例，该端部执行器包括近侧夹持区域和远侧夹持区域。端部执行器426包括第一钳口构件464a和第二钳口构件464b。第一钳口构件464a和第二钳口构件464b能够操作以夹持在两者间的组织和/或其他材料。端部执行器426能够提供无创伤夹持。第一钳口构件464a包括第一近侧接触表面465a和第一远侧接触表面467a。第一近侧接触表面465a和第一远侧接触表面467a限定两者间的第一开口466a。第二钳口构件464b包括第二近侧接触表面465b和第二远侧接触表面467b。第二近侧接触表面465b和第二远侧接触表面467b限定两者间的第二开口466b。当第一钳口构件464a和第二钳口构件464b处于闭合位置时，第一开口466a和第二开口466b限定孔466。孔466能够在其内接收组织。孔466提供无创伤夹持。端部执行器426可称为Babcock端部执行器。
近侧接触表面465a、465b位于相应的第一钳口构件464a和第二钳口构件464b的近侧部分中并且限定近侧夹持区域469。在一些实施例中，近侧接触表面465a、465b包括能够递送能量的能量递送表面。近侧接触表面465a、465b能够为在第一钳口构件464a和第二钳口构件464b之间夹持的组织切片提供单极射频能量、双极射频能量、超声能量、或它们的任何组合。近侧接触表面465a、465b限定纵向通道462。切割构件471(参见图18)以可滑动的方式接收在通道462内。切割构件471可部署在纵向通道462内以切割在近侧接触表面465a、465b之间夹持的组织。
图15-图18示出了端部执行器426的各种视图，该端部执行器包括近侧夹持区域469和远侧夹持区域470。图16示出了处于闭合位置的端部执行器426。当端部执行器426处于闭合位置时，第一开口466a和第二开口466b对准以限定孔466。近侧夹持区域469定位在孔466的近侧，远侧夹持区域470定位在孔466的远侧。用远侧夹持区域470夹持组织可减少被夹持组织的表面区域并且提供无创伤夹持。图17和图18示出了端部执行器426的俯视图。纵向通道462能够在其内以可滑动的方式接收切割构件471。在所示实施例中，纵向通道462沿近侧夹持区域469延伸，但并未延伸进入孔466或远侧夹持区域470内。因此，组织的切割限于在近侧夹持区域内夹持的组织。
在一些实施例中，第一近侧接触表面465a和/或第二近侧接触表面465b包括能量递送表面。能量递送表面465a、465b能够递送能量。能量递送表面465a、465b包括例如一个或多个电极。能量递送表面465a、465b能够为在第一钳口构件464a和第二钳口构件464b之间夹持的组织切片递送单极射频能量、双极射频能量、超声能量、或它们的任何组合。所递送的能量可包括能够密封或焊接组织切片的治疗性信号和/或亚治疗性信号。在一些实施例中，第一近侧接触表面465a和/或第二近侧接触表面465b包括PTC材料，该PTC材料能够在被处理组织温度升高时限制所递送的能量。在一些实施例中，第一近侧接触表面465a和/或第二近侧接触表面465b可包括金属接触电极和/或绝缘层。
在各种实施例中，远侧接触表面467a、467b限定远侧夹持区域470。远侧夹持区域470能够提供无创伤夹持。孔466被限定在近侧夹持区域469和远侧夹持区域470之间。远侧夹持区域470和孔466允许无创伤地夹持组织切片。在一些实施例中，远侧夹持区域470能够将电外科能量递送到在其内夹持的组织切片上。在其他实施例中，远侧夹持区域470是电惰性的。
图19A示出了联接到伸长轴414的端部执行器426的一个实施例，该端部执行器包括近侧夹持区域和远侧夹持区域。在操作中，端部执行器426用被定位在第一钳口构件464a和第二钳口构件464b之间的组织切片或其他材料定位。第一钳口构件464a枢转到闭合位置，如图19B所示，以夹持位于第一钳口构件464a和第二钳口构件464b之间的组织。第一钳口构件464a可通过例如致动联接到伸长轴414的柄部上的触发器或联接到伸长轴414的致动环468a进行枢转。组织可由近侧夹持区域469、远侧夹持区域470、或近侧夹持区域469和远侧夹持区域470两者夹持。在一些实施例中，近侧夹持区域469能够例如通过递送能量、缝合和/或切割在近侧夹持区域内夹持的组织切片来处理在近侧夹持区域469内夹持的组织。图19C示出了处于击发位置的端部执行器426。在一些实施例中，切割器械471能够以可滑动的方式接收在由第一钳口构件464a和第二钳口构件464b限定的纵向通道462内。切割器械471可通过例如推动第二致动环468b进行部署。第二致动环468b使切割器械471横穿纵向通道462并切割在其内夹持的组织。
图20示出了端部执行器426和伸长轴414的分解图。如图20所示，端部执行器426包括第一钳口构件464a和第二钳口构件464b。多个电极465a、465c联接到第一钳口构件464a，以限定近侧能量递送表面。源导体431将多个电极465a、465c联接到发生器(未示出)。返回电极465b联接到第二钳口构件464b。返回导体433将返回电极465b联接到发生器。致动器424联接到第一钳口构件464a，使第一钳口构件464a从打开位置枢转到闭合位置。
图21-图24示出了端部执行器526的一个实施例，该端部执行器包括能够递送能量的近侧夹持区域和能够递送能量的远侧夹持区域。第一钳口构件564a包括第一近侧接触区域565a和第一远侧接触区域567a。第一近侧接触区域565a和第一远侧接触区域567a限定两者间的第一开口566a。第二钳口构件564b包括第二近侧接触区域565b和第二远侧接触区域567b。第二近侧接触区域565b和第二远侧接触区域567b限定两者间的第二开口566b。当第一钳口构件564a和第二钳口构件564b处于闭合位置时，第一开口566a和第二开口566b限定孔566。第一近侧接触区域565a和第二近侧接触区域565b限定近侧夹持区域569，第一远侧接触区域567a和第二远侧接触区域567b限定远侧夹持区域570。
在一些实施例中，第一近侧接触表面565a和/或第二近侧接触表面565b包括能量递送表面。能量递送表面565a、565b能够递送能量。能量递送表面565a、565b能够为在第一钳口构件564a和第二钳口构件564b之间夹持的组织切片递送单极射频能量、双极射频能量、超声能量、或它们的任何组合。所递送的能量可包括能够密封或焊接组织切片的治疗性信号和/或亚治疗性信号。在一些实施例中，第一近侧接触表面565a和/或第二近侧接触表面565b包括PTC材料，该PTC材料能够在被处理组织温度升高时限制所递送的能量。在一些实施例中，第一近侧接触表面565a和/或第二近侧接触表面565b可包括金属接触电极和/或绝缘层。在一些实施例中，第一近侧接触表面565a和/或第二近侧接触表面565b可包括返回电极。
在各种实施例中，远侧接触表面567a、567b限定远侧夹持区域570。远侧夹持区域570能够提供无创伤夹持。孔566被限定在近侧夹持区域569和远侧夹持区域570之间。远侧夹持区域570和孔566允许无创伤地夹持组织切片。在一些实施例中，远侧夹持区域570能够将电外科能量递送到在其内夹持的组织切片上。在其他实施例中，远侧夹持区域570是电惰性的。
在一些实施例中，第一远侧接触表面567a和/或第二远侧接触表面567b包括能量递送表面，诸如一个或多个电极。远侧能量递送表面567a、567b能够递送能量。能量被递送到在远侧夹持区域570内夹持的组织切片上。远侧能量递送表面567a、567b能够递送单极射频能量、双极射频能量、超声能量、或它们的任何组合。远侧能量递送表面667a、667b能够提供治疗性信号和/或亚治疗性信号，其中治疗性信号能够焊接或密封组织切片。在一些实施例中，在经近侧夹持区域569的一般处理之后，远侧夹持区域570允许操作员点焊并且/或者执行修补灼烧。
在一些实施例中，近侧夹持区域569和远侧夹持区域570包括能量递送表面。近侧能量递送表面565a、565b能够独立于远侧能量递送表面567a、567b进行操作。例如，在一些实施例中，柄部(诸如图1所示的柄部112)包括第一按钮和第二按钮，其中，第一按钮用于控制到近侧夹持区域569的能量递送，第二按钮用于控制到远侧夹持区域570的能量递送。在其他实施例中，单个按钮能够控制到近侧夹持区域569和远侧夹持区域570两者的能量递送。
现在参见图22，在一些实施例中，第一钳口构件564a和第二钳口构件564b限定纵向通道562。切割器械571能够以可滑动的方式接收在纵向通道纵向通道562内。切割器械571可部署成切割在近侧夹持区域569内夹持的组织。在所示实施例中，纵向通道562沿近侧夹持区域569的长度延伸，但并未延伸进入孔566。因此，组织的切割限于在近侧夹持区域569内夹持的组织。
如图23所示，在一些实施例中，第一近侧接触区域565a包括第一电极572a和第二电极572b。第一电极572a和第二电极572b能够递送能量。第一电极572a和第二电极572b能够将能量递送到例如在近侧夹持区域569内夹持的组织切片上。在一个实施例中，第一电极572a包括源电极，第二电极572b包括返回电极。在其他实施例中，第一电极572a和第二电极572b均包括源电极。第二近侧接触区域565b被配置为返回电极。在一些实施例中，第一电极572a和第二电极572b包括PTC材料。
图24示出了端部执行器526和伸长轴514的分解图。如图24所示，端部执行器526包括第一钳口构件564a和第二钳口构件564b。多个电极565a、565c联接到第一钳口构件564a，以限定近侧能量递送表面。源导体531将多个电极565a、565c联接到发生器(未示出)。返回电极565b联接到第二钳口构件564b。返回导体533将返回电极565b联接到发生器。致动器524联接到第一钳口构件564a，使第一钳口构件564a从打开位置枢转到闭合位置。
图25-图28示出了端部执行器626的一个实施例，该端部执行器包括近侧接触区域和远侧接触区域。端部执行器626包括第一钳口构件664a和第二钳口构件664b。第一钳口构件664a包括第一近侧接触区域665a和第一远侧接触区域667a。第二钳口构件664b包括第二近侧接触区域665b和第二远侧接触区域667b。第一近侧接触区域665a和第二近侧接触区域665b具有第一宽度。第一远侧接触区域667a和第二远侧接触区域667b具有第二宽度。第一宽度大于第二宽度。第一钳口构件664a和第二钳口构件664b的近侧接触区域665a、665b提供用于夹持较大组织切片的接触区域。第一钳口构件664a和第二钳口构件664b的远侧接触区域667a、667b提供用于夹持和处理较小组织切片的接触区域。在一些实施例中，远侧接触区域667a、667b可包括钩形状。与近侧接触区域665a、665b相比，远侧接触区域667a、667b的较小宽度容许外科医生操纵端部执行器626来处理难以触及的组织切片和/或将能量施加到较小的组织切片。例如，在一个实施例中，第一宽度为约5.0mm，第二宽度为约3.0mm，容许外科医生触及不易用5.0mm的外科器械触及的较小区域。
图26示出了端部执行器626的俯视图。第一钳口构件646a和第二钳口构件664b限定纵向通道662。切割构件671能够以可滑动的方式接收在纵向通道662内。切割构件671可包括例如I形梁。切割构件671可部署成切割在第一钳口构件664a和第二钳口构件664b之间夹持的组织。在一些实施例中，切割构件671包括超声刀片。在所示实施例中，纵向通道662延伸穿过近侧夹持区域669和远侧夹持区域670两者，从而允许切割构件671切割在近侧夹持区域669和远侧夹持区域670之间夹持的组织。
图29示出了端部执行器626的透视图。在一些实施例中，端部执行器626包括一个或多个连续电极666。连续电极666能够将能量提供到在第一钳口构件664a和第二钳口构件664b之间夹持的组织切片上。连续电极666在第一近侧接触区域665a和第一远侧接触区域667a的上方延伸。连续电极666能够将能量提供到在第一钳口构件664a和第二钳口构件664b的任何部分之间夹持的组织上。在一些实施例中，连续电极666包括单极电极。在其他实施例中，连续电极666包括双极电极。第二钳口构件664b可包括返回电极(未示出)。连续电极666能够递送治疗性射频能量、亚治疗性射频能量、超声能量、或它们的任何组合。
图30A-图30C示出了端部执行器626的操作。端部执行器626联接到伸长轴614。图30A示出了处于打开位置的第一钳口构件664a和第二钳口构件664b。在操作中，端部执行器626由外科医生定位在手术部位处。端部执行器626通过例如内窥镜式、腹腔镜式或开放式手术技术定位。外科医生将组织切片定位在第一钳口构件664a和第二钳口构件664b之间。外科医生操作第二致动柄部668b，使第一钳口构件664a旋转或转变到闭合位置，从而夹持位于第一钳口构件664a和第二钳口构件664b之间的组织切片，如图30B所示。组织可被夹持在近侧接触区域665a、665b，远侧接触区域667a、667b，或两者之间。在一些实施例中，端部执行器626包括能够递送能量的一个或多个连续电极666。外科医生可以启动到电极666的能量递送。连续电极666将能量递送到在第一钳口构件664a和第二钳口构件664b之间夹持的组织切片上。所递送的能量可以焊接、烧灼、切开并且/或者以其他方式处理组织切片。在一些实施例中，第一钳口构件664a和第二钳口构件664b限定纵向通道662。切割构件671能够以可滑动的方式接收在纵向通道662内。切割构件671可部署成切割组织切片。切割构件671可例如通过如下方式进行部署：朝远侧滑动致动柄部668a，从而朝远侧以可滑动的方式将切割构件671推入纵向通道662。图30C示出了处于击发位置的端部执行器626，其中切割构件671已被推入纵向通道662的远侧端部。
图31示出了端部执行器626和伸长轴614的分解图。如图31所示，端部执行器626包括第一钳口构件664a和第二钳口构件664b。连续电极666联接到第一钳口构件664a，以限定近侧能量递送表面。源导体631将连续电极666联接到发生器(未示出)。返回电极665联接到第二钳口构件664b。返回导体633将返回电极665联接到发生器。致动器624联接到第一钳口构件664a，使第一钳口构件664a从打开位置枢转到闭合位置。
图32示出了包括带电极766的端部执行器726的一个实施例。端部执行器726包括第一钳口构件764a和第二钳口构件764b。带电极766联接到第一钳口构件764a的外表面。带电极766可以联接到例如第一钳口构件764a的顶部部分。带电极766可部署成递送能量。带电极766能够将能量递送到例如与带电极766接触的组织切片。图33示出了处于回缩位置的带电极766。在一些实施例中，带电极766能够被放置为与处于第一位置或回缩位置的第一钳口构件764a齐平。带电极766能够从处于第二位置或展开位置的第一钳口构件764a向外挠曲，如图32所示。
第一钳口构件764a包括第一接触区域765a，第二钳口构件764b包括第二接触区域765b。第一钳口构件764a和第二钳口构件764b能够夹持两者间的组织。在一些实施例中，第一接触区域765a和/或第二接触区域765b包括能够递送能量的能量递送表面。能量递送表面765a、765b可递送治疗性射频能量、亚治疗性射频能量、超声能量、或它们的任何组合。第一接触区域765a和第二接触区域765b能够将能量提供到在第一钳口构件764a和第二钳口构件764b之间夹持的组织切片上。在一些实施例中，第一接触区域765a和/或第二接触区域765b包括返回电极，其用于通过带电极766递送到组织切片的能量。
在一些实施例中，带电极766的远侧端部固定地连接到第一钳口构件764a的远侧端部。带电极766能够相对于固定远侧端部沿纵向以可滑动的方式移动。当带电极766沿远侧方向以可滑动的方式移动时，带电极766的固定远侧端部使带电极766远离第一钳口构件764a挠曲。当带电极沿近侧方向以可滑动的方式移动时，该固定远侧端部使带电极766被放置为与第一钳口构件764a齐平。
在一些实施例中，第一钳口构件764a包括带通道768。带电极766能够以回缩状态接收在带通道768内。例如，如果带电极766相对于固定远侧端部沿近侧方向移动，则带电极766将被放置为与第一钳口构件764a齐平。带通道768接收带电极766。当带电极766处于回缩状态时，带电极766与第一钳口构件764a的外表面齐平或在其下方。在各种实施例中，带通道768包括由第一钳口构件764a的外表面限定的纵向通道。
应当理解，根据操纵用来治疗患者的器械的一端的临床医生来在说明书中通篇使用术语“近侧”和“远侧”。术语“近侧”是指器械的最靠近临床医生的部分，术语“远侧”是指离临床医生最远的部分。还应当理解，为简明和清楚起见，本文可以参考所示实施例使用诸如“竖直”、“水平”、“上”或“下”之类的空间术语。然而，外科器械可以在许多取向和位置使用，并且这些术语并非意图是限制的或绝对的。
本文描述了外科器械和机器人外科系统的各种实施例。本领域的技术人员应当理解，本文所述的各种实施例可以与所述的外科器械和机器人外科系统一起使用。提供的说明只是为了举例，本领域的技术人员应当理解，所公开的实施例不只是限于本文所公开的装置，而是可以与任何兼容的外科器械或机器人外科系统一起使用。
本说明书通篇提及的“各种实施例”、“一些实施例”、“一个示例性实施例”或“实施例”意味着结合所述实施例描述的具体特征、结构或特性包括在至少一个示例性实施例中。因此，在整篇说明书中出现的短语“在各种实施例中”、“在一些实施例中”、“在一个示例性实施例中”或“在实施例中”并不一定都指相同的实施例。此外，在没有限制的情况下，结合一个示例性实施例示出或描述的具体特征、结构或特性可全部或部分地与一个或多个其他实施例的特征、结构或特性组合。
虽然已经通过描述若干实施例来例示了本文的各种实施例，并且虽然已经相当详细地描述了例示性实施例，但是申请人的意图不在于将所附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另外的优点和修改形式。例如，普遍认为，内窥镜式手术比腹腔镜式手术更常见。因此，本发明对内窥镜式手术和设备进行了讨论。然而，本文使用的诸如“内窥镜式”的术语不应被理解为将本发明限于仅结合内窥镜式管(例如，套管针)使用的器械。与此相反，本发明据认为可用于进入受限于小切口的任何手术中，包括但不限于腹腔镜式手术以及开放式手术。
应当理解，本文的附图和描述中的至少一些已被简化以示出适于清楚地理解本公开的元件，同时为清晰起见移除了其他元件。然而，本领域的普通技术人员将认识到，这些和其他元件可为所需的。然而，由于此类元件为本领域所熟知并且由于它们不利于较好地理解本公开，因此本文未提供对这些元件的论述。
虽然已经描述了若干实施例，但应当知道，本领域技术人员在掌握了本公开的一些或全部优点之后可能对这些实施例作出各种修改、改变和改型。例如，根据各种实施例，单个部件可替换为多个部件，并且多个部件也可替换为单个部件，以执行给定的一种或多种功能。因此，在不脱离所附权利要求书限定的本公开的范围和实质的情况下，本专利申请旨在涵盖所有此类修改、变型和改型形式。
以引用方式全文或部分地并入本文的任何专利、专利公开或其它公开材料均仅在所并入的材料不与本发明所述的现有定义、陈述或其它公开材料相冲突的范围内并入本文。由此，在必要程度下，本文所明确阐述的公开内容将会取代以引用的方式并入本文中的任何相冲突的材料。如果据述以引用的方式并入本文但与本文所述现有定义、陈述或者其它公开材料相冲突的任何材料或其部分，仅在所并入的材料与现有公开材料之间不产生冲突的程度下并入本文。
本文所述主题的各个方面在以下带编号条目中陈述：
1.一种端部执行器，包括：第一钳口构件，所述第一钳口构件限定远侧端部处的第一孔，并且所述第一钳口构件包括定位在所述第一孔近侧的第一电极，其中所述第一电极包括正温度系数(PTC)材料；以及第二钳口构件，所述第二钳口构件限定远侧端部处的第二孔，并且所述第二钳口构件包括定位在所述第二孔的近侧的第二电极，其中所述第二钳口构件操作地联接到所述第一钳口构件，其中当所述第一钳口构件和所述第二钳口构件处于闭合位置时，所述第一孔和第二孔能够限定单个孔，其中所述第二电极包括PTC材料，并且其中所述第一电极和所述第二电极能够递送能量。
2.根据条目1所述的端部执行器，其中所述第一钳口构件和所述第二钳口构件限定纵向通道，所述端部执行器包括能够以可滑动的方式接收在所述纵向通道内的切割构件，其中所述切割构件能够沿所述纵向通道部署，并且其中所述纵向通道定位在所述第一孔和所述第二孔的近侧。
3.根据条目2所述的端部执行器，其中所述第一电极包括第一PTC(正温度系数)电极和第二PTC电极，其中所述第一PTC电极位于所述通道的第一侧上，并且所述第二PTC电极位于所述通道的第二侧上，并且其中所述第一PTC电极和所述第二PTC电极限定处理区域。
4.根据条目2所述的端部执行器，其中所述切割构件包括I形梁。
5.根据条目1所述的端部执行器，其中由所述第一电极递送的能量包括单极电外科能量、双极电外科能量、超声能量、或它们的任何组合中的至少一者。
6.一种端部执行器，包括：第一钳口构件，所述第一钳口构件包括第一近侧接触表面和第一远侧接触表面，其中所述第一近侧接触表面和所述第一远侧接触表面限定两者间的第一开口；第二钳口构件，所述第二钳口构件包括第二近侧接触表面和第二远侧接触表面，其中所述第二钳口构件操作地联接到所述第一钳口构件，其中所述第二近侧接触表面和所述第二远侧接触表面限定两者间的第二开口，并且其中当所述第一钳口构件和所述第二钳口构件处于闭合位置时，所述第一开口和所述第二开口限定孔；以及第一近侧电极，所述第一近侧电极联接到所述第一近侧接触表面，其中所述第一近侧电极能够递送能量。
7.根据条目6所述的端部执行器，其中当所述第一钳口构件和所述第二钳口构件处于闭合位置时，所述近侧接触表面限定近侧夹持区域并且所述远侧接触表面限定远侧夹持区域。
8.根据条目6所述的端部执行器，其中递送到所述第一端部执行器的所述能量包括单极电外科能量、双极电外科能量、超声能量、或它们的任何组合中的至少一者。
9.根据条目8所述的端部执行器，包括联接到所述第二近侧接触表面的第二近侧电极，其中所述第二近侧电极被配置为返回电极，以用于通过所述第一近侧电极递送的电外科能量。
10.根据条目8所述的端部执行器，包括联接到所述第一远侧接触表面的第一远侧电极，其中所述第一远侧电极能够递送能量，其中递送到所述第一远侧电极的所述能量包括单极电外科能量、双极电外科能量、超声能量、或它们的任何组合中的至少一者。
11.根据条目10所述的端部执行器，包括联接到所述第二远侧接触表面的第二远侧电极，其中所述第二远侧电极被配置为返回电极，以用于通过所述第一远侧电极递送的电外科信号。
12.根据条目6所述的端部执行器，其中所述第一钳口构件和所述第二钳口构件限定纵向通道，所述端部执行器包括能够以可滑动的方式接收在所述纵向通道内的切割构件，其中所述切割构件能够沿所述纵向通道部署。
13.一种端部执行器，包括：第一钳口构件，所述第一钳口构件操作地联接到第二钳口构件，并且所述第一钳口构件和所述第二钳口构件各自包括由第一宽度限定的近侧接触区域和由第二宽度限定的远侧接触区域，其中所述第一宽度大于所述第二宽度，并且其中所述远侧接触区域包括钩形状；第一电极，所述第一电极联接到所述第一钳口构件并且能够递送能量；以及切割构件，其中所述切割构件能够以可滑动的方式接收在由所述第一钳口构件和所述第二钳口构件限定的纵向通道内，并且能够沿所述纵向通道部署。
14.根据条目13所述的端部执行器，其中所述切割构件包括I形梁。
15.根据条目13所述的端部执行器，其中所述第一电极包括连续电极，所述连续电极联接到所述第一钳口构件的所述近侧接触区域和所述远侧接触区域。
16.根据条目15所述的端部执行器，其中由所述第一电极递送的所述能量包括单极电外科能量、双极电外科能量、超声能量、或它们的任何组合中的一者。
17.根据条目16所述的端部执行器，其中所述第二电极包括连续电极，所述连续电极联接到所述第二钳口构件的所述近侧接触区域和所述远侧接触区域。
18.根据条目16所述的端部执行器，包括联接到所述第二钳口构件的第二电极，其中所述第一电极包括能够递送双极电外科能量的源电极，并且其中所述第二电极包括返回电极。
19.根据条目11所述的端部执行器，其中所述第一宽度为约三毫米，并且其中所述第二宽度为约五毫米。
20.一种端部执行器，包括：第一钳口构件，所述第一钳口构件包括联接到所述第一钳口构件的外表面的带电极，其中所述带电极能够被放置为与处于第一位置的所述第一钳口构件齐平，并且其中所述带电极能够从处于第二位置的所述第一钳口构件向外挠曲，并且其中所述带电极能够递送能量；和第二钳口构件，所述第二钳口构件操作地联接到所述第一钳口构件。
21.根据条目20所述的端部执行器，其中由所述带电极递送的所述能量包括单极电外科能量、双极电外科能量、超声能量、或它们的任何组合。
22.根据条目20所述的端部执行器，包括：第一电极，所述第一电极设置在所述第一钳口构件的内表面上；和第二电极，所述第二电极设置在所述第二钳口构件的内表面上，其中所述第一电极和所述第二电极能够递送能量。
23.根据条目20所述的端部执行器，其中所述带电极的远侧端部固定地连接到所述第一钳口构件的远侧端部，其中所述带电极能够相对于所述固定远侧端部以可滑动的方式纵向移动。
24.根据条目23所述的端部执行器，其中所述带电极相对于固定远侧端部的所述纵向移动使所述带电极从所述第一钳口构件向外挠曲。
25.根据条目24所述的端部执行器，其中所述第一钳口构件限定所述外表面上的通道，并且其中所述带电极定位在处于所述第一位置的所述通道内。

Claims (19)

1.一种端部执行器，包括：
第一钳口构件，所述第一钳口构件限定远侧端部处的第一孔，所述第一钳口构件包括定位在所述第一孔近侧的第一电极，其中所述第一电极包括正温度系数(PTC)材料；以及
第二钳口构件，所述第二钳口构件限定远侧端部处的第二孔，所述第二钳口构件包括定位在所述第二孔的近侧的第二电极，其中所述第二钳口构件操作地联接到所述第一钳口构件，其中当所述第一钳口构件和所述第二钳口构件处于闭合位置时，所述第一孔和第二孔能够限定单个孔，其中所述第二电极包括PTC材料，并且其中所述第一电极和所述第二电极能够递送能量。
2.根据权利要求1所述的端部执行器，其中所述第一钳口构件和所述第二钳口构件限定纵向通道，所述端部执行器包括能够以可滑动的方式接收在所述纵向通道内的切割构件，其中所述切割构件能够沿所述纵向通道部署，并且其中所述纵向通道定位在所述第一孔和所述第二孔的近侧。
3.根据权利要求2所述的端部执行器，其中所述第一电极包括第一PTC(正温度系数)电极和第二PTC电极，其中所述第一PTC电极位于所述通道的第一侧上，并且所述第二PTC电极位于所述通道的第二侧上，并且其中所述第一PTC电极和所述第二PTC电极限定处理区域。
4.根据权利要求2所述的端部执行器，其中所述切割构件包括I形梁。
5.根据权利要求1所述的端部执行器，其中由所述第一电极递送的能量包括单极电外科能量、双极电外科能量、超声能量、或它们的任何组合中的至少一者。
6.一种端部执行器，包括：
第一钳口构件，所述第一钳口构件包括第一近侧接触表面和第一远侧接触表面，其中所述第一近侧接触表面和所述第一远侧接触表面限定两者间的第一开口；
第二钳口构件，所述第二钳口构件包括第二近侧接触表面和第二远侧接触表面，其中所述第二钳口构件操作地联接到所述第一钳口构件，其中所述第二近侧接触表面和所述第二远侧接触表面限定两者间的第二开口，并且其中当所述第一钳口构件和所述第二钳口构件处于闭合位置时，所述第一开口和所述第二开口限定孔；以及
第一近侧电极，所述第一近侧电极联接到所述第一近侧接触表面，其中所述第一近侧电极能够递送能量。
7.根据权利要求6所述的端部执行器，其中当所述第一钳口构件和所述第二钳口构件处于闭合位置时，所述近侧接触表面限定近侧夹持区域并且所述远侧接触表面限定远侧夹持区域。
8.根据权利要求6所述的端部执行器，其中递送到所述第一端部执行器的所述能量包括单极电外科能量、双极电外科能量、超声能量、或它们的任何组合中的至少一者。
9.根据权利要求8所述的端部执行器，包括联接到所述第二近侧接触表面的第二近侧电极，其中所述第二近侧电极被配置为返回电极，以用于通过所述第一近侧电极递送的电外科能量。
10.根据权利要求8所述的端部执行器，包括联接到所述第一远侧接触表面的第一远侧电极，其中所述第一远侧电极能够递送能量，其中递送到所述第一远侧电极的所述能量包括单极电外科能量、双极电外科能量、超声能量、或它们的任何组合中的至少一者。
11.根据权利要求10所述的端部执行器，包括联接到所述第二远侧接触表面的第二远侧电极，其中所述第二远侧电极被配置为返回电极，以用于通过所述第一远侧电极递送的电外科信号。
12.根据权利要求6所述的端部执行器，其中所述第一钳口构件和所述第二钳口构件限定纵向通道，所述端部执行器包括能够以可滑动的方式接收在所述纵向通道内的切割构件，其中所述切割构件能够沿所述纵向通道部署。
13.一种端部执行器，包括：
第一钳口构件，所述第一钳口构件操作地联接到第二钳口构件，所述第一钳口构件和所述第二钳口构件各自包括由第一宽度限定的近侧接触区域和由第二宽度限定的远侧接触区域，其中所述第一宽度大于所述第二宽度，并且其中所述远侧接触区域包括钩形状；
第一电极，所述第一电极联接到所述第一钳口构件，所述第一电极能够递送能量；以及
切割构件，其中所述切割构件能够以可滑动的方式接收在由所述第一钳口构件和所述第二钳口构件限定的纵向通道内，其中所述切割构件能够沿所述纵向通道部署。
14.根据权利要求13所述的端部执行器，其中所述切割构件包括I形梁。
15.根据权利要求13所述的端部执行器，其中所述第一电极包括连续电极，所述连续电极联接到所述第一钳口构件的所述近侧接触区域和所述远侧接触区域。
16.根据权利要求15所述的端部执行器，其中由所述第一电极递送的所述能量包括单极电外科能量、双极电外科能量、超声能量、或它们的任何组合中的一者。
17.根据权利要求16所述的端部执行器，其中所述第二电极包括连续电极，所述连续电极联接到所述第二钳口构件的所述近侧接触区域和所述远侧接触区域。
18.根据权利要求16所述的端部执行器，包括联接到所述第二钳口构件的第二电极，其中所述第一电极包括能够递送双极电外科能量的源电极，并且其中所述第二电极包括返回电极。
19.根据权利要求11所述的端部执行器，其中所述第一宽度为约三毫米，并且其中所述第二宽度为约五毫米。
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