CN106028965A - 模块化外科器械 - Google Patents

模块化外科器械 Download PDF

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CN106028965A
CN106028965A CN201480076160.2A CN201480076160A CN106028965A CN 106028965 A CN106028965 A CN 106028965A CN 201480076160 A CN201480076160 A CN 201480076160A CN 106028965 A CN106028965 A CN 106028965A
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assembly
joint motions
surgical
action
slender axles
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CN106028965B (zh
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C·O·巴克斯特三世
F·E·谢尔顿四世
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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
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • 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
    • A61B2017/00473—Distal part, e.g. tip or head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00477—Coupling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07257—Stapler heads characterised by its anvil
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07271—Stapler heads characterised by its cartridge
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07285—Stapler heads characterised by its cutter
    • 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
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0807—Indication means
    • A61B2090/0808—Indication means for indicating correct assembly of components, e.g. of the surgical apparatus

Abstract

本发明公开了一种外科器械(10)，该外科器械配备有联接器构造(400,425)以将端部执行器(20)联接到外科器械的细长轴组件(116)。端部执行器可包括一对钳口，该对钳口呈支撑外科钉仓(260)的载体(240)和砧座(220)的形式。砧座能够相对于载体在打开方向(OD)和闭合方向(CD)之间运动。端部执行器可包括关节运动接头(270)，该关节运动接头有利于载体和砧座作为整体相对于细长轴组件沿与砧座相对于载体打开和闭合的方向相同的方向枢转行进。

Description

模块化外科器械
技术领域
本发明涉及一种外科器械，并且在各种构造中，涉及被设计成用于切割和缝合组织的外科切割和缝合器械及其钉仓。
附图说明
通过结合附图来参考本发明实施方案的以下说明，本发明的特征和优点以及其获取方法将会变得更加明显，并可更好地理解发明本身，其中：
图1为本发明的外科器械构造的透视图；
图2为可结合本文所公开的各种外科器械使用的示例性加载单元的透视图；
图3为图2所示的加载单元的一部分的另一个局部剖视图；
图4为图2和图3的加载单元的分解透视图；
图5为载体和关节运动球组件实施方案的一部分的局部透视图；
图6为关节运动管实施方案的透视图；
图7为图2-4的加载单元的局部剖视图；
图8为处于非关节运动位置的图7的加载单元的另一个剖视图；
图9为图7和图8的加载单元的另一个剖视图，其中载体和砧座单元作为整体沿第二方向进行关节运动；
图10为开始加载单元与细长轴组件的远侧端部之间的联接操作之前的细长轴组件的一部分和加载单元的局部透视图；
图11为联接在一起之后的图10的加载单元和细长轴组件的部分的另一个透视图；
图12为图10的细长轴组件、联接组件和加载单元的部分的局部分解透视图；
图13为图10的轴组件、联接组件和加载单元的部分的另一个局部分解透视图；
图14为图10的加载单元的远侧附接部分的透视图；
图15为图10的加载单元的远侧附接部分的另一个透视图；
图16为图13的细长轴组件的近侧附接部分的透视图；
图17为图13的细长轴组件的近侧附接部分的另一个透视图；
图18为衬圈和击发轴构造的透视图；
图19为图13的加载单元、联接组件和细长轴组件的近侧端部的局部透视剖视图，其中示出附接到细长轴组件的加载单元；
图20为图13的加载单元、联接组件和细长轴组件的局部正视剖视图，其中示出未附接到细长轴组件的加载单元；
图21为图13的加载单元、联接组件和细长轴组件的局部正视剖视图，其中示出附接到细长轴组件的加载单元；
图22为沿图20所示的平面截取的图13的联接组件和细长轴组件的正视图；
图23为图13的加载单元、联接组件和细长轴组件的透视、局部剖视图，其中示出未附接到细长轴组件的加载单元，并且还示出相对于细长轴组件处于初始取向的联接衬圈；
图24为图13的加载单元、联接组件和细长轴组件的透视、局部剖视图，其中示出未附接到轴的加载单元，并且还示出相对于细长轴组件处于初始取向的联接衬圈；
图25为图13的加载单元、联接组件和细长轴组件的透视、局部剖视图，其中示出进入细长轴组件的加载单元，并且还示出相对于细长轴组件处于初始取向的联接衬圈；
图26为图13的加载单元、联接组件和细长轴组件的透视、局部剖视图，其中示出进入细长轴组件的加载单元，并且还示出相对于细长轴组件处于第二、旋转取向的联接衬圈；
图27为图13的加载单元、联接组件和细长轴组件的透视、局部剖视图，其中示出进入细长轴组件的加载单元，并且还示出相对于细长轴组件处于第二、旋转取向的联接衬圈；
图28为图13的加载单元、联接组件和细长轴组件的透视、局部剖视图，其中示出完全插入细长轴组件中的加载单元，并且还示出相对于细长轴组件处于第二、旋转取向的联接衬圈；
图29为图13的加载单元、联接组件和细长轴组件的透视、局部剖视图，其中示出完全插入细长轴组件中的加载单元，并且还示出相对于细长轴组件处于初始取向的联接衬圈；并且
图30为图13的加载单元、联接组件和细长轴组件的透视、局部剖视图，其中示出完全插入细长轴组件中的加载单元，并且还示出相对于细长轴组件处于初始取向的联接衬圈。
具体实施方式
本申请的申请人还拥有以下专利申请，所述专利申请与本申请同一天提交并且全文各自以引用方式并入本文：
-名称为“Surgical Staples and Staple Cartridges”的美国专利申请，代理人案卷号END7341USNP/130301；
-名称为“Surgical Staples and Staple Cartridges”的美国专利申请，代理人案卷号END7331USNP/130304；
-名称为“Surgical Staples and Methods For Making the Same”的美国专利申请，代理人案卷号END7335USNP/130305；
-名称为“Surgical Staples,Staple Cartridges and Surgical EndEffectors”的美国专利申请，代理人案卷号END7332USNP/130306；
-名称为“Surgical Fastener”的美国外观设计专利申请，代理人案卷号END7338USDP/130307；
-名称为“Fastener Cartridge Comprising an Extendable Firing Member”的美国专利申请，代理人案卷号END7344USNP/130308；
-名称为“Fastener Cartridge Comprising a Firing Member Configured toDirectly Engage and Eject Fasteners From the Fastener Cartridge”的美国专利申请，代理人案卷号END7339USNP/130309；
-名称为“Fastener Cartridge Comprising a Firing Member IncludingFastener Surfaces”的美国专利申请，代理人案卷号END7340USNP/130310；
-名称为“Surgical Instruments With Articulatable Shaft Arrangements”的美国专利申请，代理人案卷号END7343USNP/130300；
-名称为“Articulatable Surgical Instruments With Separate and DistinctClosing and Firing Systems”的美国专利申请，代理人案卷号END7333USNP/130322；
-名称为“Surgical Cutting and Stapling Instruments With IndependentJaw Control Features”的美国专利申请，代理人案卷号END7336USNP/130303；
-名称为“Surgical Cutting and Stapling Instruments With ArticulatableEnd Effectors”的美国专利申请，代理人案卷号END7334USNP/130312；和
-名称为“Surgical Cutting and Stapling Methods”的美国专利申请，代理人案卷号END7330USNP/130313。
现在将描述某些示例性实施方案，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。这些实施方案的一个或多个示例已在附图中示出。本领域的普通技术人员将会理解，在本文中具体描述并示出于附图中的装置和方法为非限制性的示例性实施方案，并且本发明的多个实施方案的范围仅由权利要求书限定。结合一个示例性实施方案进行图解说明或描述的特征可与其他实施方案的特征进行组合。这些修改和变型旨在包括在本发明的范围内。
术语“包含”(和包含的任何形式，诸如“包含(comprises)”和“包含(comprising)”)、“具有”(和具有的任何形式，诸如“具有(has)”和“具有(having)”)、“包括”(和包括的任何形式，诸如“包括(includes)、和“包括(including)以及“含有”(和含有的任何形式，诸如“含有(contains)”和“含有(containing)”)为开放式系动词。因此，“包含”、“具有”、“包括”或“含有”一个或多个元件的外科系统、装置、或设备具有这些一个或多个元件，但不限于仅具有这些一个或多个元件。同样，“包含”、“具有”、“包括”或“含有”一个或多个特征的系统、装置、或设备的元件具有这些一个或多个特征，但不限于仅具有这些一个或多个特征。
术语“近侧”和“远侧”在本文中是相对于操纵外科器械的柄部部分的临床医生来使用的。术语“近侧”是指最靠近临床医生的部分，并且术语“远侧”是指远离临床医生的部分。还应当理解，为简洁和清楚起见，本文可结合附图使用诸如“竖直”、“水平”、“上”和“下”之类的空间术语。然而，外科手术器械在许多方向和位置中使用，并且这些术语并非限制性的和/或绝对的。
提供各种示例性装置和方法以执行腹腔镜式和微创外科手术操作。然而，本领域的普通技术人员将容易理解，本文所公开的各种方法和装置可用于许多外科手术和应用中，包括例如与开放式外科手术相结合。继续参阅本具体实施方式，本领域中的普通技术人员将进一步理解，本文所公开的各种器械可以任何方式插入体内，诸如通过自然腔道、通过形成于组织中的切口或穿刺孔等。器械的工作部分或端部执行器部分可被直接插入患者体内或可通过具有工作通道的进入装置插入，外科器械的端部执行器和细长轴可通过该工作通道而推进。
动力外科器械在Zemlok等人的名称为POWERED SURGICALSTAPLING DEVICE的美国专利申请公布US 2009/0090763A1(下文中，“Zemlok‘763”)中有所公开，该专利申请公布的全部公开内容据此以引用方式并入本文。动力外科器械还在Zemlok等人的名称为POWEREDSURGICAL INSTRUMENT的美国专利申请公布US 2011/0278344A1(下文中，“Zemlok‘344”)(现在为美国专利8,201,721)中有所公开，该专利申请公布的全部公开内容据此以引用方式并入本文。图1示出了动力外科器械10，其在许多方面可类似于例如Zemlok‘763和/或Zemlok‘344中公开的外科器械(包括各种特征结构、部件、及其子部件)，这些专利的全文各自以引用方式并入本文。同样，外科器械10可类似于Shelton等人的2013年8月23日提交的名称为“ATTACHMENT PORTIONS FOR SURGICALINSTRUMENT ASSEMBLIES”的美国专利申请序列号13/974,205中的外科器械，该专利申请的全部公开内容以引用方式并入本文。图1所示的外科器械10包括外壳12，该外壳具有柄部部分14以有利于器械的手动操纵和操作。因此，本文所用的术语“外壳”可涵盖手持式构造或可以其他方式手动操纵的构造。然而，术语“外壳”还可涵盖自动化外壳器械系统(诸如，机器人控制的系统)的部分，该自动化外壳器械系统不旨在为手持式的，而是可通过该系统的各个部件、部分、和/或致动器以其他方式进行操纵和致动。例如，本文所述的外科器械的各种具体实施可结合以下机器人系统和构造来使用，所述机器人系统和构造在2012年6月28日提交的名称为“ROBOTICALLY POWERED SURGICAL DEVICE WITH MANUALLYACTUATABLE REVERSING SYSTEM”的美国专利申请序列号13/536,323中有所公开，该专利申请的全部公开内容以引用方式并入本文。此外，本文所述的联接构造和端部执行器构造还可有效地结合非动力手持式外科器械来使用。因此，本文所公开的端部执行器构造和联接构造不应限于结合动力器械(无论它们是手持式的还是以其他方式自动化的)的使用。
形式为内窥镜部分的细长轴组件116从外壳12突出并且被构造成能够可操作地附接到外科端部执行器，该外科端部执行器被构造成响应于对其施加的击发动作来执行至少一个外科手术。外科端部执行器可包括被构造成能够切割和缝合组织的装置，诸如如图2-9中所示的“加载单元”20。外科端部执行器(诸如加载单元20)例如能够可释放地附接到动力外科器械10的细长轴组件116，如本文更详细所述。
图2-9示出了可与外科器械10一起使用的端部执行器或加载单元20的一种示例性形式。如在图2中可见，加载单元20包括砧座组件220，该砧座组件被支撑以相对于载体240枢转行进，该载体在其中可操作地支撑钉仓260。钉仓260可包括被设计成“植入”患者内的外科钉仓。例如，植入式外科钉仓260可包括以下各种外科钉仓构造中的任一个，所述各种外科钉仓构造在2010年9月30日提交的名称为“SURGICAL STAPLINGINSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM”的美国专利申请公布US 2012-0080484中有所公开，该专利申请公布的全部公开内容以引用方式并入本文。在例如至少一个具体实施中，钉仓260包括主体部分261，该主体部分由可压缩的止血材料(诸如例如氧化再生纤维素(“ORC”)或可生物吸收的泡沫)组成，该主体部分中支撑有多排未成形的金属钉。在至少一些实施方案中，为防止钉受影响并防止止血材料在引入和定位过程期间被活化，整个仓可涂覆有或包裹有可生物降解的膜，诸如以商品名PDS.RTM.出售的聚二氧六环酮膜或聚甘油癸二酸酯(PGS)膜，或由PGA(聚乙醇酸，以商品名Vicryl出售)、PCL(聚己内酯)、PLA或PLLA(聚乳酸)、PHA(聚羟基脂肪酸酯)、PGCL(聚卡普隆25，以商品名Monocryl出售)，或由PGA、PCL、PLA、PDS的复合物形成的其它可生物降解的膜，所述膜只有在破裂时才可渗透。钉仓260的主体261的尺寸被设定成可移除地支撑在如图所示的载体240内，使得其中的每个钉与砧座组件220中的对应钉成形凹坑对准。
砧座组件220具有形成于其上的一对凸耳221，该对凸耳能够可枢转地接收在载体240的近侧端部241中的凸耳狭槽242内，使得砧座组件220可相对于载体240围绕砧座枢转轴线ANV-ANV在打开位置和闭合位置之间运动或枢转。砧座枢转轴线ANV-ANV横向于由细长轴组件116限定的纵向延伸的工具轴线LA-LA。当砧座组件220从打开位置枢转到闭合位置时，砧座组件220围绕砧座枢转轴线ANV-ANV沿闭合方向“CD”运动。反之，当砧座组件220从闭合位置运动到打开位置时，砧座组件220围绕砧座枢转轴线ANV-ANV沿打开方向“OD”运动。
加载单元20采用独特和新颖的关节运动接头270，该关节运动接头有利于载体240和砧座组件220的关节运动以围绕横向于纵向工具轴线“LA-LA”的关节运动轴线“AA-AA”枢转。例如，加载单元20可包括端部执行器外壳400，该端部执行器外壳被构造成能够被接收在外部壳体450内。端部执行器外壳400的远侧端部402可具有在其上由两个朝远侧突出的凸块406形成的连接叉404。每个凸块406具有形成于其中的枢转孔408，该枢转孔能够在其中接收形成于关节运动球组件272上的对应枢转销274。参见图4。关节运动球组件272可通过例如焊接或其他合适的紧固构造来刚性地附连到载体240的近侧端部241。如将在下文中更详细地论述，当组装在一起时，载体240和砧座组件220可作为整体围绕关节运动轴线AA-AA沿第一方向“FD”(其为与砧座闭合方向“CD”相同的方向)和第二方向“SD”(其为与砧座打开方向“OD”相同的方向)来选择性地进行关节运动。参见图9。
仍参见图4，端部执行器外壳400可设置有通道410以用于在其中可滑动地接收关节运动联接件420。关节运动联接件420包括近端部分422和远侧端部424。关节运动管426固定地附接到远端部分424。关节运动管426可包括中空管并且通过例如焊接或其他合适的方式附接到远侧端部424。如在图6中可见，关节运动管426可具有形成于其中的一系列关节运动齿428，关节运动齿428被构造成能够啮合接合形成于关节运动球272上的各组关节运动齿276。因此，关节运动联接件420沿远侧方向“DD”的运动将导致载体240和砧座组件220围绕关节运动轴线AA-AA沿第一方向“FD”枢转。反之，关节运动联接件420沿近侧方向“PD”的运动将导致载体240和砧座组件220作为整体围绕关节运动轴线AA-AA沿第二方向“SD”枢转。关节运动联接件420和关节运动管426可在本文中统称为关节运动联接件组件425。参见图4。
加载单元20还可配备有驱动组件460，该驱动组件被构造成能够轴向地运动穿过端部执行器外壳400。在至少一种具体实施中，驱动组件460包括驱动梁组件461，该驱动梁组件包括附接到切割头470的上驱动梁462和下驱动梁464。切割头470可包括主体部分471，该主体部分具有形成于其上的组织切割刃472。主体部分471的上部部分473具有形成于其上的上凸块474。底部支脚或凸块476形成于主体部分471的下部部分475上。竖直取向的主体部分471延伸穿过载体240中的纵向延伸的狭槽245和砧座组件220中的纵向延伸的狭槽222。当被组装时，底部支脚476被构造成能够沿载体240的底部滑动。上凸块部分474被布置成可滑动地接收在形成于砧座组件220中的细长通道223内。
如在图4中可见，上击发杆462附接到上端部分473，并且下击发杆464与上击发杆462间隔开并且附接到切割头470的竖直延伸部分471的下端部分475。此类构造用于将击发动作以同样的方式传输到切割头470的上部部分和下部部分，以有利于切割头470穿过砧座组件220、外科钉仓260、和载体240的对准的运动。在各种构造中，例如，上击发杆462可在上凸块474的正后方附接到上端部分473，使得上击发杆462与如下点基本上轴向地对准，在该点处上凸块474从上端部分473侧向地突出。相似地，下击发杆464可在底部支脚476或者以下点的正后方附接到底端部分475，在该点处侧向突出的底部凸块476从底端部分475侧向地突出，使得下击发杆464与所述点轴向地对准。上击发杆462和下击发杆464可在这些位置中焊接到竖直延伸部分471。例如，可从击发杆的一侧或两侧对击发杆应用焊接。当切割头470沿远侧方向“DD”朝远侧驱动时，砧座组件220在上凸块474和下凸块或支脚476之间枢转闭合。切割头组件470的进一步推进导致外科钉仓260在砧座组件220和载体240之间被挤压，由此导致支撑于其中的外科钉在接触砧座组件220的钉成形底面时在组织切割线的两侧上成形。在切割头组件470已推进到载体240的远侧端部之后，用户将切割头组件470回缩到起始位置，由此砧座组件220可被打开以释放钉仓260和缝合的组织。在一种具体实施中，例如，上凸块474被构造成能够与砧座组件220的上表面进行交互，以使砧座组件220凸轮运动或枢转返回到打开位置。在另选的构造中，可使用弹簧或其他偏压构件(未示出)以在切割头组件470处于起始位置时将砧座组件220偏压到打开位置。
驱动梁组件460还可包括近侧接合构件467，该近侧接合构件包括被构造成能够可操作地接合击发杆104的远侧端部522的一对接合指状物468，如将在下文中更详细地论述。如在图4中可见，例如，近侧接合构件467可枢转地联接到上击发杆462和下击发杆464，以有利于其在载体240的关节运动期间围绕关节运动轴线AA-AA进行关节运动和挠曲而无需粘结驱动梁组件461。在至少一种具体实施中，例如，近侧接合构件467通过一对枢转联接件466可枢转地联接到上击发杆462和下击发杆464。此类联接件466使上击发杆462能够独立于下击发杆464来相对于近侧接合构件467枢转，反之亦然。
如在图1中可见，外科器械10可包括被构造成能够生成旋转致动动作的马达100，该旋转致动动作可用于例如将击发动作施加到加载单元20，如将在下文中更详细地论述。在至少一种形式中，例如，马达100被构造成能够将旋转致动动作施加到通常标定为82的击发构件组件。在一种构造中，例如，击发构件组件82包括驱动管102，该驱动管可旋转地支撑在外壳12内并且具有形成于其中的内螺纹(未示出)。击发构件或击发杆104的近侧螺纹部分被支撑以与驱动管102螺纹接合，使得驱动管102的旋转导致击发杆104的轴向运动。击发杆104可与加载单元20中的驱动组件460的内部交接。如上述引用的Zemlok‘763和Zemlok‘344中更详细地论述，驱动管102沿第一方向(例如，逆时针)的旋转导致击发杆104沿远侧方向推进驱动组件460。
如在图1中进一步可见，外科器械10可包括通常命名为109的关节运动系统。然而，外科器械10可包括本文详细公开的各种其他关节运动系统构造。在至少一种形式中，关节运动系统109可包括关节运动机构110，该关节运动机构包括关节运动马达112和手动关节运动钮114。关节运动马达112可通过动力关节运动开关116或者通过枢转手动关节运动钮114来致动。关节运动马达112的致动用于旋转关节运动机构110的关节运动齿轮118。关节运动机构110的致动可导致端部执行器(例如，加载单元20的仓/砧座部分)从其第一位置(其中其轴线与细长轴组件116的纵向工具轴线“LA-LA”基本上对准)运动到以下位置，在该位置中，端部执行器的轴线围绕例如关节运动轴线“AA-AA”相对于细长轴组件的纵向工具轴线“LA-LA”成角度设置。有关关节运动机构110的各个方面的其他论述可见于此前全文以引用方式并入本文的Zemlok‘763中。另外，整个公开内容以引用方式并入本文的名称为SURGICAL STAPLING APPARATUS WITHPOWERED ARTICULATION的美国专利7,431,188公开了可结合外科器械10使用的马达动力的能够关节运动的端部执行器。然而，本领域的普通技术人员应当理解，本文所公开的独特和新颖的联接和端部执行器构造也可有效地结合本领域已知的手动操作的(即，非动力的)关节运动系统来使用。
在各种实施方案中，外科器械可包括至少一个马达，该至少一个马达可将击发动作施加到加载单元20并且/或者可将关节运动动作施加到关节运动系统109，如在别处更详细所述。马达100可例如由在Zemlok‘763中更详细描述的类型的功率源200来提供功率。例如，功率源200可包括可再充电电池(例如，铅基、镍基、锂离子基等等)。还可设想到，功率源200可包括至少一个一次性电池。一次性电池可例如在约9伏和约30伏之间。然而，可使用其他功率源。图1示出了其中功率源200包括多个电池单元202的一个示例。所使用的电池单元202的数量可取决于器械10的电流负载需求。
参见图1，功率源(例如功率源200)可提供功率以用于外科器械10的操作。例如，功率源200可向马达(例如马达100)提供功率以导致驱动管102沿第一方向的旋转并且最终导致击发杆104的轴向推进，由此将驱动组件460朝远侧驱动穿过加载单元20。另选地，功率源200可向马达100提供功率以导致驱动管102沿与第一方向相反的第二方向的旋转并且最终导致击发杆104的轴向回缩，由此可使驱动梁60朝近侧运动到其起始和/或默认位置。
外科端部执行器(例如一次性加载单元20)能够可操作地联接到动力外科器械10(图1)的细长轴组件116。在各种实施方案中，外科器械10可包括细长轴组件116，该细长轴组件可接合例如加载单元20。在各种实施方案中，包括可旋转联接衬圈500的联接组件115例如可相对于细长轴组件116可释放地锁定加载单元20。此外，在各种实施方案中，联接衬圈500的旋转可有利于击发组件和/或关节运动组件的附接和/或对准，如本文所述。在各种实施方案中，加载单元20可包括远侧附接部分480，并且细长轴组件116可包括外管30和远侧附接部分32。当加载单元20固定到细长轴组件116(图11)时，加载单元20的远侧附接部分480可接收轴组件116的远侧附接部分32。此外，可旋转联接衬圈500可定位在轴组件116的远侧附接部分32周围，使得加载单元20的远侧附接部分480也可定位在可旋转联接衬圈500内。可旋转联接衬圈500可固定到细长轴组件116和/或近侧附接部分480，并且在某些实施方案中能够可旋转地固定到例如轴组件116的远侧附接部分32。在某些实施方案中，当加载单元20固定到轴组件116时，轴组件116的近侧附接部分可接收加载单元20的远侧附接部分480。此外，在某些实施方案中，联接衬圈500能够可旋转地固定到加载单元20。
参见图10和图11，当加载单元20相对于外科器械10的细长轴组件116在非附接位置和附接位置之间运动时，加载单元20可沿由细长轴组件116限定的纵向工具轴线LA-LA平移。当加载单元20从非附接位置运动到附接位置时，加载单元20的远侧附接部分480可插入细长轴组件116的远侧附接部分32中。例如，当加载单元20在非附接位置和附接位置之间运动时，加载单元20可沿近侧方向“PD”(图11)平移。在某些实施方案中，远侧附接部分480和远侧附接部分32之间的沟槽-狭槽接合可沿由细长轴组件116限定的纵向工具轴线LA-LA来引导加载单元20。主要参见图14，远侧附接部分480可包括导轨482。此外，主要参见图16，远侧附接部分32可包括导槽34。导槽34的尺寸和构造可被设计成在加载单元20的近侧附接部分480插入细长轴组件116的远侧附接部分32中时接收并引导导轨482。例如，导槽34可包括纵向狭槽，并且导轨482可包括例如纵向脊。在某些实施方案中，导槽34和导轨482可阻止加载单元20相对于纵向工具轴线LA-LA的扭转和/或旋转。
主要参见图10，远侧附接部分480可包括第一对准标记484(诸如，第一箭头)，并且细长轴组件116和/或联接衬圈500可包括第二对准标记502(诸如，第二箭头)。第一对准标记484和第二对准标记502的对准可使导轨482和导槽34对准，这可有利于远侧附接部分480附接到远侧附接部分32。如本文所述，加载单元20沿纵向路径朝细长轴组件116的平移可相对于细长轴组件116可释放地锁定加载单元20。在此类实施方案中，可不需要加载单元20相对于细长轴组件116的旋转，以相对于细长轴组件160附接加载单元20。事实上，可通过远侧附接部分32和远侧附接部分480之间的沟槽-狭槽接合来限制和/或阻止加载单元20相对于细长轴组件116的旋转，如本文所述。在各种实施方案中，联接衬圈500可相对于加载单元20和/或细长轴组件116旋转以将加载单元20可释放地锁定到细长轴组件116。例如，如本文所述，联接衬圈500可从初始取向(图25)旋转到第二取向(图26)并且随后返回到初始取向(图29)以将加载单元20锁定到细长轴组件116。
主要参见图14和图15，加载单元20的近侧部分480可包括旋转键或肋486。当加载单元20在非附接位置(图10)和附接位置(图11)之间沿近侧方向“PD”(图10)运动时，旋转键486可影响联接衬圈500的旋转。例如，旋转键486可使联接衬圈500沿方向B(图11)从初始取向旋转和/或偏压到第二取向。当联接衬圈500偏压到第二取向时，远侧附接部分480可插入远侧附接部分32中。此外，当远侧附接部分480完全插入远侧附接部分32中时，旋转键486可允许联接衬圈500沿方向C(图11)从第二取向旋转到初始取向。如本文所用，相对于加载单元20与细长轴组件116的联接使用的术语“完全插入”是指加载单元20的远侧附接部分480已完全插入成与细长轴组件116的远侧附接部分32配合或可操作的接合。方向C可例如与方向B相反。如本文所述，当联接衬圈500返回到初始取向时，联接衬圈500可相对于远侧附接部分32锁定远侧附接部分480。参见图14和图15，旋转键486可包括位于其近侧端部处的旋转斜坡488。旋转斜坡488可接合轴组件116的元件以影响例如联接衬圈500的旋转。
在各种实施方案中，旋转斜坡488可影响定位在细长轴组件116内的击发轴104的旋转。例如，主要参见图19-22，击发轴104可包括可从击发轴104径向向外延伸的击发轴旋转器600。当加载单元20插入细长轴组件116中时，旋转键486的旋转斜坡488可接合击发轴旋转器600。在各种实施方案中，旋转斜坡448可旋转击发轴旋转器600，该击发轴旋转器可旋转击发轴104。例如，击发轴104和击发轴旋转器600可在第一取向(图25)和第二取向(图26)之间沿方向B旋转。仍参见图19-22，击发轴104可与可旋转联接衬圈500接合。例如，可旋转联接衬圈500可包括旋转器沟槽502，该旋转器沟槽的构造和尺寸可被设计成接收并且/或者保持击发轴旋转器600。击发轴旋转器600可被旋转器沟槽600保持，使得击发轴旋转器600的旋转使可旋转联接衬圈500旋转。在此类实施方案中，将加载单元20插入细长轴组件116中可例如通过击发轴旋转器600沿方向B的旋转来导致可旋转联接衬圈500沿方向B的旋转(图26)。
主要参见图16和图17，远侧附接部分32可包括旋转键狭槽510，该旋转键狭槽可在远侧附接部分480插入远侧附接部分32中时接收旋转键486。在各种实施方案中，旋转键狭槽510可包括间隙凹口512以用于接收击发轴旋转器600。例如，旋转键486的近侧端部处的旋转斜坡488可使击发轴旋转器600旋转到第二取向并且旋转到间隙凹口512(图26)中。当加载单元20插入细长轴组件116中时，旋转键486可继续沿旋转键狭槽510运动。此外，当旋转键486的远侧端部490运动经过击发轴旋转器600时，击发轴旋转器600可反向旋转到第一取向(图30)，这可相应地使可旋转衬圈500反向旋转到其初始取向。
在各种实施方案中，可旋转联接衬圈500可相对于细长轴组件116和/或远侧附接部分32偏压到初始取向。例如，弹簧514可将联接衬圈500偏压到初始取向。弹簧514可包括可相对于细长轴组件116固定的近侧端部516和可相对于联接衬圈500固定的远侧端部550。例如，弹簧514的近侧端部516可保持在轴组件116的近侧弹簧狭槽556(图23)中，并且弹簧514的远侧端部550可保持在例如可旋转联接衬圈500的远侧弹簧狭槽552(图18)中。在此类实施方案中，联接衬圈500的旋转可相对于弹簧514的近侧端部516移动弹簧514的远侧端部550，这可生成扭转力。因此，联接衬圈500可阻止从初始取向到第二取向的旋转，并且当联接衬圈旋转到第二取向时，弹簧514可将联接衬圈500反向偏压到初始取向。由于击发轴旋转器600与联接衬圈500接合，弹簧514还可将击发轴104偏压到其第一取向。
在各种实施方案中，可旋转联接衬圈500可包括将加载单元20可释放地锁定到细长轴组件116的锁定棘爪518。主要参见图18，锁定棘爪518可从可旋转联接衬圈500的内周边径向向内延伸。在各种实施方案中，锁定棘爪518可延伸到远侧附接部分32中的棘爪狭槽520(图16)中。主要参见图16，棘爪狭槽520可形成导槽34中的凹口。在各种实施例中，棘爪狭槽520可从导槽34延伸，并且可垂直于或基本上垂直于例如导槽34。此外，当可旋转联接衬圈500相对于细长轴组件116在初始取向和第二取向之间旋转时，锁定棘爪518可沿棘爪狭槽520运动。
在各种实施方案中，锁定棘爪518可接合加载单元20的远侧附接部分480以相对于细长轴组件116锁定加载单元20。例如，再次参见图14，远侧附接部分480可包括导轨482，该导轨可具有限定于其中的锁定凹口489。锁定凹口489的构造和尺寸可被设计成在加载单元20完全插入远侧附接部分32中时接收可旋转联接衬圈500的锁定棘爪518。例如，当远侧附接部分480完全插入远侧附接部分32中时，远侧附接部分480的锁定凹口489可与远侧附接部分32的棘爪狭槽520对准。因此，锁定棘爪518可沿远侧附接部分32中的棘爪狭槽520滑动并且滑动到远侧附接部分中的锁定凹口489中。此外，锁定棘爪518可通过扭转弹簧514偏压成与锁定凹口489接合。例如，在击发轴旋转器600离开旋转键486的远侧端部490之后，击发轴104可反向偏压到第一取向并且可旋转联接衬圈500可通过扭转弹簧514反向偏压到初始取向。此外，当联接衬圈500从第二取向反向旋转到初始取向时，其锁定棘爪518可与导轨482中的锁定凹口489对准并接合。
在各种实施方案中，联接衬圈500的旋转可有利于击发组件的附接和/或对准。例如，击发轴104可在近侧端部524和远侧端部522之间延伸。近侧端部524可具有旋转接头，该旋转接头可允许击发轴104在第一构型和第二构型之间旋转。此外，远侧端部522可具有联接器以用于将驱动梁组件461的近侧接合构件467附接到击发轴104。击发轴104的旋转可有利于近侧接合构件467的附接。例如，当击发轴104的远侧端部522处的联接器旋转时，远侧端部522可操作地联接到近侧接合构件467。在某些实施方案中，联接器可包括卡口座，该卡口座可接合加载单元20中的切割元件的对应卡口接收器。主要参见图12和图13，击发组件还可包括例如围绕击发轴104定位在近侧端部524和远侧端部522之间的套管526。
在各种实施方案中，当击发轴104在细长轴组件116内旋转时，击发轴104可旋转成与加载单元20中的击发轴狭槽528对准。例如，当加载单元20完全插入并且附接到细长轴组件116时，击发轴旋转器600可与击发轴狭槽528对准。然而，在各种实施方案中，当加载单元20仅部分地插入细长轴组件116中时，击发轴旋转器600可通过旋转键486旋转成不与击发轴狭槽528对准。换句话讲，击发轴旋转器600可在击发轴104处于第一取向时与击发轴狭槽482对准，并且可在击发轴104旋转到第二取向时与击发轴狭槽482不对准。在此类实施方案中，当加载单元仅部分地插入细长轴组件116中时并且/或者在加载单元20通过可旋转联接衬圈500可释放地锁定到细长轴组件116之前，击发轴旋转器600的击发路径可被远侧附接部分480阻挡。击发轴104和联接衬圈500的整合可确保加载单元20在击发轴104可击发和/或推进之前牢固地附接到细长轴组件116。例如，外科器械不能击发，直至加载单元20中的切割元件联接到击发轴104并且/或者直至击发轴104例如在细长轴组件116内适当地对准。
在某些实施方案中，联接衬圈500的旋转可有利于关节运动组件530的附接和/或对准。主要参见图12和图13，关节运动组件530可包括近侧关节运动杆538、远侧关节运动杆420、和关节运动连接器532。此外，轴组件116可包括近侧关节运动杆狭槽534，并且加载单元20可包括例如远侧关节运动杆狭槽410。在某些实施方案中，近侧关节运动杆538可与近侧关节运动杆狭槽534对准，并且远侧关节运动杆420可与远侧关节运动杆狭槽410对准。现在参见图18，关节运动连接器532可容纳在可旋转联接衬圈500中。例如，可旋转联接衬圈500可包括关节运动连接器狭槽536，并且关节运动连接器532能够可动地定位在其中。
在各种实施方案中，再次参见图12和图13，近侧关节运动杆538可具有近侧凹口540，并且远侧关节运动杆420可具有远侧凹口423。此外，关节运动连接器532可包括近侧关节运动凸耳533和远侧关节运动凸耳540。近侧关节运动凸耳533可保持在近侧关节运动杆538的近侧凹口540中。在某些实施方案中，远侧关节运动凸耳535能够可操作地接合远侧关节运动杆420的远侧凹口423。如本文所述，可旋转联接衬圈500可在初始构型和第二构型之间旋转。当联接衬圈500旋转时，容纳在其中的关节运动连接器532也可相对于由轴组件116限定的纵向轴线旋转。在各种实施方案中，当关节运动连接器532旋转时，关节运动连接器532的近侧关节运动凸耳533可保持定位在近侧关节运动杆538的近侧凹口540中。此外，当关节运动连接器532与联接衬圈500从第二取向旋转到初始取向时，关节运动连接器532的远侧关节运动凸耳535可运动成与远侧关节运动杆420的远侧凹口423接合。例如，当加载单元20完全插入轴488中时，远侧关节运动杆420的远侧凹口423可与关节运动连接器532的远侧关节运动凸耳533对准。在此类实施方案中，当可旋转衬圈500反向旋转到初始构型时，远侧关节运动凸耳533可滑动到远侧关节运动杆420的远侧凹口423中。当远侧关节运动凸耳533定位在远侧凹口423中时，关节运动组件530可为已完全组装的。
主要参见图17，在各种实施方案中，近侧关节运动杆狭槽534可包括第一间隙542和第二间隙544。关节运动连接器532的近侧关节运动凸耳533和远侧关节运动凸耳535可分别延伸到第一间隙542和第二间隙544中。在某些实施方案中，当衬圈500旋转时并且/或者当关节运动组件530例如进行关节运动时，第一间隙542和第二间隙544可提供空间以供近侧关节运动凸耳533和远侧关节运动凸耳535运动。
现在参见图23-30，为了将加载单元连接到外科器械的细长轴组件116，用户可使加载单元20的对准标记484与细长轴组件116和/或联接衬圈500(图23)的对准标记502对准。在保持对准标记484,502的对准期间，用户可使加载单元20相对于细长轴组件116沿纵向轴线LA-LA运动。用户可沿直线或基本上直线的路径移动加载单元20，并且在各种实施方案中，不必相对于例如细长轴组件116来旋转加载单元20。主要参见图25，加载单元20可继续相对于细长轴组件116平移，并且远侧附接部分480的导轨482可装配到细长轴组件116的远侧附接部分32中的导槽34(图16)中。当远侧附接部分480运动到远侧附接部分32中时，导槽34可引导导轨482并且可保持例如对准标记484,502的对准。换句话讲，导槽34和导轨482可阻止加载单元20相对于细长轴组件116的纵向轴线的旋转。主要参见图24，关节运动连接器32的近侧关节运动凸耳533可延伸到第一间隙542中并且可定位在近侧关节运动杆420的近侧凹口540中，并且关节运动连接器32的远侧关节运动凸耳535可延伸穿过例如第二间隙544。
主要参见图26，当远侧附接部分480插入远侧附接部分32中时，旋转键486的旋转键斜坡488可邻接击发轴旋转器600。旋转键斜坡488可将击发轴旋转器600引导并且/或者导向到从旋转键狭槽510延伸的间隙凹口512中。此外，当击发轴旋转器600运动到间隙凹口512中时，击发轴104可沿方向B旋转。击发轴104可从第一取向旋转到第二取向。击发轴104的此类旋转可有利于击发轴104的远侧端部522与枢转地联接到驱动梁组件461的近侧接合构件467的附接。此外，击发轴旋转器600的旋转可通过击发轴旋转器600与联接衬圈500中的击发轴旋转器沟槽600的接合来使联接衬圈500沿方向B旋转。联接衬圈500可例如从初始取向旋转到第二取向。另外，当联接衬圈500旋转时，锁定棘爪518可沿轴组件116中的棘爪狭槽520运动。另外，联接衬圈500的旋转可使弹簧514的远侧端部550旋转，因为弹簧514的远侧端部550可保持在联接衬圈500中的远侧弹簧狭槽552(图18)中。远侧端部550相对于近侧端部516的移位可生成扭转回弹力，该扭转回弹力可例如将联接衬圈500从第二取向偏压到初始取向并且可例如将击发轴104从第二取向偏压到第一取向。
主要参见图27，当联接衬圈500朝第二取向旋转时，近侧关节运动凸耳533可与近侧关节运动杆538中的近侧凹口540保持接合。此外，远侧关节运动凸耳535可旋转，使得远侧关节运动凸耳535提供用于加载单元20的远侧关节运动杆420的间隙。参见图28，当联接衬圈500和定位在其中的关节运动连接器532旋转到第二取向时，加载单元20可完全插入细长轴组件116中。在各种实施方案中，当关节运动连接器532旋转到第二取向时，远侧关节运动杆420可离开关节运动连接器532的远侧关节运动凸耳535。此外，远侧关节运动凸耳535能够与关节运动连接器532中的远侧凹口423可旋转地对准。仍参见图28，当加载单元20完全插入细长轴组件116中时，击发杆旋转器600可离开旋转键486的远侧端部490。
现在参见图29，当旋转键486的远侧端部490经过击发轴旋转器600时，击发轴旋转器600可沿方向C旋转。例如，击发轴旋转器600可沿方向C从第二取向旋转到第一取向。此外，击发轴旋转器600的旋转可导致联接衬圈500沿方向C从第二取向旋转到初始取向。在各种实施例中，弹簧514可将击发杆104偏压到其第一取向，并且可将衬圈500偏压到其初始取向。例如，击发轴旋转器600可定位在联接衬圈500中的击发轴旋转器沟槽602(图18)中，使得击发轴旋转器600的旋转使联接衬圈500旋转。由于关节运动连接器532的远侧关节运动凸耳535和远侧关节运动杆420的远侧凹口423的对准，关节运动连接器532可随着联接衬圈500的旋转而旋转，并且远侧关节运动凸耳535可旋转成与远侧凹口423接合。当远侧关节运动凸耳535接合远侧凹口423时，关节运动组件530可为已组装的。此外，当击发轴旋转器600沿方向C旋转时，击发轴104的远侧端部522可沿方向C旋转，这可有利于驱动梁组件461的近侧附接构件467附接到击发轴104的远侧端部522。
现在参见图30，联接衬圈500的旋转还可使衬圈500的锁定棘爪518旋转到远侧附接部分480的导轨482中的锁定凹口489中。例如，当加载单元20完全插入细长轴组件116中时，锁定凹口489可与棘爪狭槽520对准，使得锁定棘爪518可通过棘爪狭槽520旋转到锁定凹口489中。如本文所述，在击发轴旋转器600离开旋转键486的远侧端部490之后，弹簧514可偏压联接衬圈500以使其沿方向C(图29)旋转。仍参见图30，当击发轴旋转器600沿方向C旋转时，击发轴旋转器600可运动成与加载单元20中的击发轴狭槽528对准。击发轴旋转器600与击发轴狭槽528的对准可允许例如击发轴104朝远侧推进以击发加载单元20。
如本文所述，可旋转联接衬圈500可相对于细长轴组件116可释放地锁定加载单元20。此外，联接衬圈500的旋转可有利于例如关节运动组件530的附接和/或对准，以及击发轴104与加载单元20中的切割头组件的附接和/或对准。此外，联接衬圈500的旋转还可同时从细长轴组件116解锁加载单元20、断开关节运动组件530、和/或从加载单元20中的切割元件断开击发轴104。例如，当联接衬圈500再次从初始取向旋转到第二取向时，锁定棘爪518可脱离远侧附接部分480中的锁定凹口489。因此，远侧附接部分480可例如沿由细长轴组件116限定的纵向轴线从远侧附接部分32退出。在各种实施方案中，加载单元20可从细长轴组件116脱离，而无需相对于细长轴组件116旋转加载单元20。然而，联接衬圈500可相对于细长轴组件116旋转，这例如可使远侧关节运动杆420与联接衬圈500中的关节运动连接器532断开并且可使击发轴104与加载单元20中的切割元件或驱动梁组件断开。
从上述内容应当理解，本文所公开的各种外科器械为临床医生提供利用能够切割和紧固组织的现有外科器械不能获得的改善的可操作性和各种其他优点以及将端部执行器快速联接到外科器械的细长轴的方式。例如，在本文所公开的各种具体实施中，端部执行器能够沿钳口可相对于彼此运动的相同方向来选择性地进行关节运动。换句话讲，外科端部执行器被约束为在一个平面中运动。在本文所公开的各种具体实施中，端部执行器也能够在同一平面内运动。现有端部执行器通常被约束为在不同于钳口进行运动的平面的平面中运动。
由本发明具体实施中的多个提供的另一个优点在于击发杆的使用，该击发杆包括形成层合结构的至少上击发杆和至少下击发杆。上杆可附接到切割头的上端，并且下杆可附接到下部头部，使得它们在其附接到切割头的点处彼此间隔开。此类构造用于提供较稳定的切割头构造，该切割头构造可不太可能在致动期间扭曲和/或扣紧。此外，切割头可配备有接合砧座的一部分的侧向突出的上凸块和接合载体的下凸块。上击发杆可附接在上凸块的附接点的正后方，使得其与所述点轴向地对准。同样，下击发杆可在底部凸块的附接点的正后方附接到底部部分，使得其与所述点轴向地对准。此类轴向对准有利于将驱动或致动运动在切割头接合砧座和载体的点处传送到切割头，由此可进一步阻止切割头在致动期间的扣紧和/或扭曲。
尽管本文已结合用于快速且同时地联接驱动梁组件和关节运动梁与外科器械的对应致动部分的联接系统来描述加载单元，但本领域的普通人员应当理解，本文所公开的具有独特关节运动能力的各种端部执行器也可有效地结合不包括本文所公开的联接器组件的外科器械来使用。
根据至少一种形式，提供了一种外科器械，该外科器械可包括限定纵向工具轴线的细长轴组件。细长轴组件可包括近侧击发构件，该近侧击发构件与击发系统可操作地交接以从其接收击发动作和回缩动作。细长轴组件还可包括近侧关节运动组件，该近侧关节运动组件与关节运动系统可操作地交接以从其接收关节运动动作。外科器械还可包括外科端部执行器。在各种具体实施中，外科端部执行器可包括第一端部执行器部分和第二端部执行器部分，其中第二端部执行器部分能够在打开动作施加到第二端部执行器部分时相对于第一端部执行器部分沿第一方向选择性地运动。第二端部执行器部分还可在闭合动作施加到第二端部执行器部分时沿第二方向选择性地运动。端部执行器还可包括关节运动接头，该关节运动接头被构造成能够使第一端部执行器部分围绕关节运动轴线沿第一方向和第二方向相对于纵向工具轴线选择性地进行关节运动。关节运动联接件组件可与关节运动接头可操作地交接以将关节运动动作施加到关节运动接头。驱动组件可被支撑以在击发动作和回缩动作施加到其时在外科端部执行器内可操作地运动。驱动组件被构造成能够将打开动作和闭合动作施加到第二端部执行器部分。外科器械还可包括用于同时进行如下所述联接的：(i)将第一端部执行器部分的远侧端部联接到细长轴组件；(ii)将关节运动联接件联接到关节运动组件；以及(ii)将驱动组件联接到近侧击发构件。
根据至少一种其他一般形式，提供了一种用于将细长轴组件附接到外科器械的一次性加载单元。在各种具体实施中，一次性加载单元可包括具有远侧端部和近侧端部的外壳组件，其中近侧端部能够可操作地联接到细长轴组件。一次性加载单元还可包括载体，该载体在其中可操作地支撑外科钉仓。砧座能够可动地支撑在载体上并且能够在打开动作施加到砧座时相对于载体沿第二方向选择性地运动。砧座还可在闭合动作施加到砧座时沿第二方向选择性地运动。关节运动接头被构造成能够使载体围绕关节运动轴线沿第一方向和第二方向来选择性地进行关节运动。关节运动联接件组件能够与关节运动接头可操作地交接以将关节运动动作施加到关节运动接头，并且能够选择性地联接到细长轴组件的对应部分。驱动组件可被支撑以在从细长轴组件的对应击发部分施加击发动作和回缩动作时在外科端部执行器内可操作地运动。驱动组件被构造成能够将打开动作和闭合动作施加到砧座。
根据另一种一般形式，提供了一种外科器械，该外科器械可包括限定纵向工具轴线的细长轴组件。细长轴组件可包括近侧击发构件，该近侧击发构件与击发系统可操作地交接以从其接收击发动作和回缩动作。细长轴组件还可包括近侧关节运动组件，该近侧关节运动组件与关节运动系统可操作地交接以从其接收关节运动动作。外科器械还可包括外科端部执行器。在各种具体实施中，外科端部执行器可包括第一端部执行器部分和第二端部执行器部分，其中第二端部执行器部分能够在打开动作施加到第二端部执行器部分时相对于第一端部执行器部分沿第一方向选择性地运动。第二端部执行器部分还可在闭合动作施加到第二端部执行器部分时沿第二方向选择性地运动。关节运动接头可被构造成能够使第一端部执行器部分围绕关节运动轴线沿第一方向和第二方向相对于纵向工具轴线选择性地进行关节运动。关节运动联接件组件可与关节运动接头可操作地交接以将关节运动动作施加到关节运动接头。驱动组件可被支撑以在击发动作和回缩动作施加到其时在外科端部执行器内可操作地运动。驱动组件可被构造成能够对其施加打开动作和闭合动作。外科器械还可包括联接器组件，该联接器组件可包括第一联接器部分，该第一联接器部分被构造成能够将第一端部执行器部分的远侧端部联接到细长轴组件。联接器组件还可包括第二联接器部分，该第二联接器部分被构造成能够在第一联接器部分联接到第一端部执行器部分的远侧端部的同时将关节运动联接件联接到关节运动组件。第三联接器部分可被构造成能够在第一联接器部分已将第一端部执行器部分的远侧端部联接到细长轴组件时并且在第二联接器部分已将关节运动联接件联接到关节运动组件时将驱动组件联接到近侧击发构件。
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，在任一种情形下，装置均可进行修复，以在至少一次使用后再次使用。修复可包括拆卸装置、清洗或更换具体部件以及后续重新组装的其中任意几个步骤的组合。具体地，装置可以拆卸，并且可以任意组合选择性地更换或移除所述装置的任意数目的特定零件或部件。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/更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。
优选的是，本文所述的本发明将在手术前得以处理。首先，获取新的或用过的器械，并根据需要进行清洗。然后可对器械进行灭菌。在一种消毒技术中，将器械放置在闭合且密封的容器中，诸如塑料或TYVEK袋中。然后将容器和器械置于可穿透该容器的辐射场，诸如γ辐射、x-射线或高能电子。辐射杀死器械上和容器中的细菌。然后可将灭菌后的器械储存在无菌容器中。该密封容器使器械保持无菌直到在医疗设施中打开该容器。
以引用方式全文或部分地并入本文的任何专利、公布或其他公开材料均仅在所并入的材料不与本公开所述的现有定义、陈述或其他公开材料相冲突的范围内并入本文。同样地并且在必要的程度下，本申请明确阐述的公开内容取代了以引证方式并入本申请的任何冲突材料。据称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。
尽管本发明已被描述为具有示例性的设计，但还能够在本公开的实质和范围内对本发明进行修改。因此本申请旨在涵盖采用本发明一般原理的任何变型、用途或修改型式。此外，本申请旨在涵盖本发明所属领域中属于已知或惯有实践范围内的与本公开不同的此类型式。

Claims (20)

1.一种外科器械，包括：
限定纵向工具轴线的细长轴组件，所述细长轴组件包括：
近侧击发构件，所述近侧击发构件与击发系统可操作地交接以从所述击发系统接收击发动作和回缩动作；
近侧关节运动组件，所述近侧关节运动组件与关节运动系统可操作地交接以从所述关节运动系统接收关节运动动作，并且其中所述外科器械还包括：
外科端部执行器，所述外科端部执行器包括：
第一端部执行器部分和第二端部执行器部分，其中所述第二端部执行器部分能够在打开动作施加到所述第二端部执行器部分时相对于所述第一端部执行器部分沿第一方向选择性地运动，所述第二端部执行器部分还能够在闭合动作施加到所述第二端部执行器部分时沿第二方向选择性地运动；
关节运动接头，所述关节运动接头被构造成能够使所述第一端部执行器部分围绕关节运动轴线沿所述第一方向和第二方向相对于所述纵向工具轴线选择性地进行关节运动；
关节运动联接件组件，所述关节运动联接件组件与所述关节运动接头可操作地交接以将所述关节运动动作施加到所述关节运动接头；
驱动组件，所述驱动组件被支撑以在所述击发动作和回缩动作施加到其时在所述外科端部执行器内可操作地运动，所述驱动组件被构造成能够将所述打开动作和闭合动作施加到所述第二端部执行器部分，并且其中所述外科器械还包括：
用于同时进行如下所述联接的装置：
将所述第一端部执行器部分的远侧端部联接到所述细长轴组件；
将所述关节运动联接件联接到所述关节运动组件；以及
将所述驱动组件联接到所述近侧击发构件。
2.根据权利要求1所述的外科器械，其中所述外科端部执行器还包括具有远侧端部和近侧端部的端部执行器外壳，并且其中所述第一端部执行器部分通过所述关节运动接头可动地联接到所述端部执行器外壳的远侧端部，并且其中所述联接装置将所述端部执行器外壳的近侧端部联接到所述细长轴组件。
3.根据权利要求2所述的外科器械，其中所述外科端部执行器包括一次性加载单元。
4.根据权利要求1所述的外科器械，其中所述外科器械的第一部分包括被构造成能够在其中可操作地支撑外科钉仓的载体，并且其中所述第二部分包括砧座组件。
5.根据权利要求4所述的外科器械，其中所述驱动组件包括：
切割头，所述切割头包括：
竖直延伸部分，所述竖直延伸部分包括上端和下端以及在所述上端和所述下端之间取向的组织切割部分；
底部支脚，所述底部支脚从所述竖直延伸部分的下端突出并且被构造成能够可动地接合所述载体的底部部分；
上凸块部分，所述上凸块部分从所述竖直延伸部分的上端突出并且被构造成能够接合所述砧座组件的一部分；和
驱动梁组件，所述驱动梁组件可操作地联接到所述切割头并且被构造成能够与所述联接装置交接。
6.根据权利要求5所述的外科器械，其中所述驱动梁组件包括：
上击发杆段，所述上击发杆段联接到所述切割头的竖直延伸部分的上端；和
下击发杆段，所述下击发杆段联接到所述切割头的竖直延伸部分的下端。
7.根据权利要求6所述的外科器械，其中所述上击发杆和下击发杆联接到近侧接合构件，所述近侧接合构件被构造成能够与所述联接装置可操作地交接。
8.根据权利要求7所述的外科器械，其中所述上击发杆和下击发杆各自枢转地联接到所述近侧接合构件。
9.根据权利要求4所述的外科器械，其中所述外科钉仓包括植入式仓体，所述植入式仓体在其中可操作地支撑多个外科钉。
10.根据权利要求1所述的外科器械，其中所述关节运动接头包括联接到所述第一端部执行器部分的关节运动球，所述关节运动球包括第一组齿轮齿，并且其中所述关节运动联接件组件包括与所述关节运动球上的所述第一组齿轮齿啮合接合的关节运动管。
11.一种用于附接到外科器械的细长轴组件的一次性加载单元，所述一次性加载单元包括：
具有远侧端部和近侧端部的外壳组件，所述近侧端部能够可操作地联接到所述细长轴组件；
载体，所述载体在其中可操作地支撑外科钉仓；
砧座，所述砧座可动地支撑在所述载体上并且能够在打开动作施加到所述砧座时相对于所述载体沿第一方向选择性地运动，所述砧座还能够在闭合动作施加到所述砧座时沿第二方向选择性地运动；
关节运动接头，所述关节运动接头被构造成能够使所述载体围绕关节运动轴线沿所述第一方向和第二方向选择性地进行关节运动；
关节运动联接件组件，所述关节运动联接件组件与所述关节运动接头可操作地交接以将所述关节运动动作施加到所述关节运动接头，并且能够选择性地联接到所述细长轴组件的对应部分；和
驱动组件，所述驱动组件被支撑以在从所述细长轴组件的对应击发部分施加击发动作和回缩动作时在所述外科端部执行器内可操作地运动，所述驱动组件被构造成能够将所述打开动作和闭合动作施加到所述砧座。
12.根据权利要求11所述的一次性加载单元，其中所述驱动组件包括：
切割头，所述切割头包括：
竖直延伸部分，所述竖直延伸部分包括上端和下端以及在所述上端和所述下端之间取向的组织切割部分；
底部支脚，所述底部支脚从所述竖直延伸部分的下端突出并且被构造成能够可动地接合所述载体的底部部分；
上凸块部分，所述上凸块部分从所述竖直延伸部分的上端突出并且被构造成能够接合所述砧座的一部分；和
驱动梁组件，所述驱动梁组件可操作地联接到所述切割头并且被构造成能够与所述细长轴组件的对应击发部分交接。
13.根据权利要求12所述的一次性加载单元，其中所述驱动梁组件包括：
上击发杆段，所述上击发杆段联接到所述切割头的竖直延伸部分的上端；和
下击发杆段，所述下击发杆段联接到所述切割头的竖直延伸部分的下端。
14.根据权利要求13所述的一次性加载单元，其中所述上击发杆和下击发杆联接到近侧接合构件，所述近侧接合构件被构造成能够与所述细长轴组件的对应击发部分可操作地交接。
15.根据权利要求14所述的一次性加载单元，其中所述上击发杆和下击发杆各自枢转地联接到所述近侧接合构件。
16.根据权利要求11所述的一次性加载单元，其中所述外科钉仓包括植入式仓体，所述植入式仓体在其中可操作地支撑多个外科钉。
17.根据权利要求1所述的一次性加载单元，其中所述关节运动接头包括联接到所述载体的关节运动球，所述关节运动球包括第一组齿轮齿，并且其中所述关节运动联接件组件包括与所述关节运动球上的所述第一组齿轮齿啮合接合的关节运动管。
18.一种外科器械，包括：
限定纵向工具轴线的细长轴组件，所述细长轴组件包括：
近侧击发构件，所述近侧击发构件与击发系统可操作地交接以从所述击发系统接收击发动作和回缩动作；
近侧关节运动组件，所述近侧关节运动组件与关节运动系统可操作地交接以从所述关节运动系统接收关节运动动作，并且其中所述外科器械还包括：
外科端部执行器，所述外科端部执行器包括：
第一端部执行器部分和第二端部执行器部分，其中所述第二端部执行器部分能够在打开动作施加到所述第二端部执行器部分时相对于所述第一端部执行器部分沿第一方向选择性地运动，所述第二端部执行器部分还能够在闭合动作施加到所述第二端部执行器部分时沿第二方向选择性地运动；
关节运动接头，所述关节运动接头被构造成能够使所述第一端部执行器部分围绕关节运动轴线沿所述第一方向和第二方向相对于所述纵向工具轴线选择性地进行关节运动；
关节运动联接件组件，所述关节运动联接件组件与所述关节运动接头可操作地交接以将所述关节运动动作施加到所述关节运动接头；
驱动组件，所述驱动组件被支撑以在所述击发动作和回缩动作施加到其时在所述外科端部执行器内可操作地运动，所述驱动组件被构造成能够将所述打开动作和闭合动作施加到所述外科端部执行器，并且其中所述外科器械还包括：
联接器组件，所述联接器组件包括：
第一联接器部分，所述第一联接器部分被构造成能够将所述第一端部执行器部分的远侧端部联接到所述细长轴组件；
第二联接器部分，所述第二联接器部分被构造成能够在所述第一联接器部分联接到所述第一端部执行器部分的远侧端部的同时将所述关节运动联接件联接到所述关节运动组件；和
第三联接器部分，所述第三联接器部分被构造成能够在所述第一联接器部分已将所述第一端部执行器部分的远侧端部联接到所述细长轴组件时并且在所述第二联接器部分已将所述关节运动联接件联接到所述关节运动组件时将所述驱动组件联接到所述近侧击发构件。
19.根据权利要求18所述的外科器械，其中所述外科端部执行器还包括具有远侧端部和近侧端部的端部执行器外壳，并且其中所述第一端部执行器部分通过所述关节运动接头可动地联接到所述端部执行器外壳的远侧端部，并且其中所述第一联接器部分将所述端部执行器外壳的近侧端部联接到所述细长轴组件。
20.根据权利要求18所述的外科器械，其中所述外科器械的第一部分包括被构造成能够在其中可操作地支撑外科钉仓的载体，并且其中所述第二部分包括砧座组件。
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US20150173747A1 (en) 2015-06-25
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RU2678365C1 (ru) 2019-01-28
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