CN106061405A - 具有独立且不同的闭合系统和击发系统的可关节运动的外科器械 - Google Patents

具有独立且不同的闭合系统和击发系统的可关节运动的外科器械 Download PDF

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CN106061405A
CN106061405A CN201480076265.8A CN201480076265A CN106061405A CN 106061405 A CN106061405 A CN 106061405A CN 201480076265 A CN201480076265 A CN 201480076265A CN 106061405 A CN106061405 A CN 106061405A
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surgical
trigger shaft
cutting head
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assembly
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CN106061405B (zh
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C·O·巴克斯特三世
F·E·谢尔顿四世
J·R·摩根
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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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • 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
    • A61B17/3209—Incision instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A61B2017/00305—Constructional details of the flexible means
    • A61B2017/00309—Cut-outs or slits
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A61B2017/00305—Constructional details of the flexible means
    • A61B2017/00314—Separate linked members
    • 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
    • A61B2017/07278—Stapler heads characterised by its sled or its staple holder
    • 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
    • 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
    • A61B2090/0814—Preventing re-use

Abstract

本发明提供了一种外科器械(10)，所述外壳器械具有可关节运动的端部执行器(12)，所述端部执行器包括第二钳口(15)，在从闭合系统(190)向所述第二钳口施加闭合动作时，所述第二钳口可相对于第一钳口(13)沿第一方向选择性地运动，并且从所述闭合系统向所述第二钳口施加打开动作时，所述第二钳口还可相对于所述第一钳口沿第二方向运动。细长轴组件(100)联接至所述端部执行器并限定纵向工具轴线。向所述端部执行器施加关节运动动作时，所述端部执行器能够沿所述第一方向和所述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。所述端部执行器可包括击发构件(610)，所述击发构件可响应于从击发系统(600)向所述端部执行器施加击发动作而进行操作。所述闭合系统和所述击发系统可彼此独立地选择性进行操作。

Description

具有独立且不同的闭合系统和击发系统的可关节运动的外科 器械
背景技术
本发明涉及外科器械，并且在各种实施方案中，本发明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，本发明的各种特征和优点及其获取方法将会变得更加显而易见，并且将更好地理解发明本身，其中：
图1为一个外科器械结构的透视图；
图2为外科端部执行器结构的分解透视装配图；
图3为砧座的侧正视图；
图4为端部执行器和细长轴组件部分的侧面剖视图，其中端部执行器以实线示出在非关节运动位置中，并且端部执行器以虚线示出在关节运动位置中；
图5为端部执行器和细长轴组件部分的另一侧面剖视图，其中砧座在闭合位置中，并且切割头在朝远侧击发穿过钉仓之后在端部位置中；
图6为在切割头朝近侧往回回缩到其起始位置之后图5的端部执行器和细长轴组件部分的另一侧面剖视图；
图7为端部执行器和细长轴组件部分的另一侧面剖视图，其中砧座在打开位置中，并且切割头在起始位置中；
图8为图7的端部执行器和细长轴组件部分的放大剖视图；
图9为图8的端部执行器和细长轴组件部分的剖面透视图；
图10为端部执行器和细长轴组件的透视装配图；
图11为细长轴组件的远侧部分的剖视图；
图12为图11的细长轴组件的近侧部分以及关节运动系统的一部分的剖视图；
图13为细长轴组件和端部执行器的透视图；并且
图14为柄部组件的局部透视分解图。
在这些视图中，对应的参考符号表示对应的部件。本文示出的范例以一种形式示出本发明的优选实施方案，不应将这种范例理解为是以任何方式限制本发明的范围。
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“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；
-名称为“Surgical Cutting and Stapling Methods”的美国专利申请，代理人案卷号END7330USNP/130313；以及
-名称为“Modular Surgical Instruments”的美国专利申请，代理人案卷号END7342USNP/130311。
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。这些实施方案中的一个或多个示例示于附图中。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示出或描述的特征可与其他实施方案的特征进行组合。这种修改形式和变型形式旨在包括在本发明的范围内。
本说明书通篇提及的“各种实施方案”、“一些实施方案”、“一个实施方案”或“实施方案”等意指结合实施方案描述的具体特征、结构或特性包括在至少一个实施方案中。因此，本说明书中通篇出现的短语“在各种实施方案中”、“在一些实施方案中”、“在一个实施方案中”或“在实施方案中”等并不一定都指相同的实施方案。此外，在一个或多个实施方案中，具体特征、结构或特性可以任何合适的方式组合。因此，在没有限制的情况下，结合一个实施方案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方案的特征、结构或特性进行组合。这种修改形式和变型形式旨在包括在本发明的范围内。
本文所用术语“近侧”和“远侧”是相对于操纵外科器械的柄部部分的临床医生而言的。术语“近侧”是指最靠近临床医生的部分，并且术语“远侧”是指远离临床医生定位的部分。还应当理解，为简洁和清楚起见，在本文中可结合附图使用空间术语诸如“竖直”、“水平”、“上”和“下”。然而，外科器械能够在许多取向和位置使用，并且这些术语并非限制性和/或绝对化的。
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，本领域普通技术人员将容易认识到，本文所公开的多种方法和装置可被用于许多外科手术和应用中，包括例如与开放式外科手术相关的外科手术和应用。继续参阅本具体实施方式，本领域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及细长轴可通过所述工作通道而推进。
参见附图，其中在所有视图中，类似的数字代表类似的部件，图1描绘了能够实践本发明的多个独特有益效果的外科器械10。外科器械10被设计成操纵和/或致动多种形式和尺寸的端部执行器12，所述端部执行器可操作地附接到外科器械的细长轴组件100。在示出的实施方案中，例如，端部执行器12包括外科缝合装置，其具有可打开和可关闭的钳口13和15。更具体地，端部执行器12包括细长通道14，该通道形成端部执行器12的下钳口13。参见图2。在示出的结构中，细长通道14被构造成能够可操作地支撑钉仓30并且还可运动地支撑砧座20，该砧座充当端部执行器12的上钳口15。
现在参见图2和图3，砧座20可具有从其近端21突出的安装部分22。安装部分22可具有穿过其的侧面安装孔24，所述安装孔使得安装部分22通过砧座销18可枢转地固定到形成于细长通道14的直立枢轴凸块17上。通过沿远侧方向“DD”轴向推进远侧闭合管段190，砧座20可选择性地朝向安装在细长通道14中的外科钉仓30“运动”，如下文将进一步详细讨论。在各种具体实施中，例如第一砧座致动构件以砧座凸轮销19的形式可延伸穿过设置在砧座安装部分22中的凸轮狭槽23。凸轮销19安装在设置于远侧闭合管段190中的洞191中，使得远侧闭合管段190沿远侧和近侧方向运动，从而使凸轮销19在凸轮狭槽23中运动。此外，远侧闭合管段190还可以包括例如致动销193形式的第二砧座致动构件，所述致动销被定位在与砧座安装部分22的近端上形成的倾斜致动表面25发生交接的位置。图7至图9示出了在第一位置或打开位置中的砧座20。通过使远侧闭合管段190沿远侧方向“DD”运动，砧座20可运动至闭合位置。远侧闭合管段190沿远侧方向“DD”的运动引起第一凸轮销19在砧座安装部分22中的凸轮狭槽23内运动，从而引起砧座20围绕砧座销18枢转至闭合位置，如图4至图6所示。要使砧座20回到打开位置(图7至图9)，则使远侧闭合管段190沿近侧方向“PD”运动，引起第一凸轮销19在凸轮狭槽23中沿相反方向运动，并且砧座20朝打开位置进行凸轮运动。这种闭合管结构不同于之前的闭合管结构，其中闭合管段的远端被构造成能够接触砧座并使其枢转至闭合位置。使用本凸轮销结构时无需使用砧座，所述砧座具有被构造成能够致动接触闭合管段的更加稳固部分。
在各种结构中，端部执行器12被构造成能够围绕由细长轴组件100限定的纵向工具轴线LT-LT选择性地进行关节运动。例如，细长轴组件100可包括使端部执行器12被构造成能够沿第一方向“FD”进行关节运动的柔性颈杆组件110，所述第一方向“FD”与砧座20从打开位置运动到闭合位置(下文称为砧座闭合方向“CD”)时砧座20运动的方向基本相同。参见图4和图8。柔性颈杆组件110还将有利于端部执行器112沿第二关节运动方向“SD”的关节运动，所述第二关节运动方向“SD”与砧座从闭合位置运动到打开位置(下文称为砧座打开方向“OD”)的方向基本相同。参见图4和图7。
提交于2010年9月24日的美国临时专利申请序列号61/386,117中公开了多个柔性颈杆组件，该临时专利申请的全部公开内容以引用方式并入本文。其他柔性颈杆组件在提交于2011年9月23日的名称为“SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLEEND EFFECTOR”的美国专利申请公布No.US 2012/0074200 A1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。柔性颈杆组件110可以由例如Dow ChemicalCompany以ISOPLAST 2510级市售的刚性热塑性聚氨酯构成。柔性颈杆组件110可具有包括第一柔性颈杆部分或上部柔性颈杆部分112和第二柔性颈杆部分或下部柔性颈杆部分114的柔性颈杆区段111。这些颈杆部分112,114可由纵向肋状物部分116隔开。颈杆部分112,114可各自具有多个颈杆肋状物118，所述肋状物被基本上构造成半圆形盘，它们一起大致形成圆柱形构型。上狭槽120延伸穿过第一柔性颈杆部分或上部柔性颈杆部分112的每个颈杆肋状物118，以形成穿过第一柔性颈杆部分112的通道，所述通道用于容纳穿过其的第一柔性传输带组件150。类似地，下狭槽121延伸穿过第二或下部柔性颈杆部分114的每个颈杆肋状物118，以形成通道，该通道用于容纳穿过其的第二柔性传输带组件170。参见例如图4。柔性颈杆组件110可包括导轨面124(图10中仅能够看到一面)，所述导轨面从柔性颈杆区段111朝近侧延伸，用于支撑柔性传输带组件150,170的往复式运动。
如图10中可见，第一传输带组件或上部传输带组件150可包括第一传输带152，并且第二传输带组件170可包括第二传输带172。此外，第一传输带150可具有第一细长结构部分154，并且第二传输带170可具有第二细长结构部分174。在器械组装过程中，使第一传输带150和第二传输带170彼此接触时，它们形成细长圆柱体，其具有同心延伸穿过自身的纵向腔体160，用于可操作地容纳穿过腔体的击发杆530。参见图11和图12。第一传输带152的第一结构部分154具有在其上形成的第一关节运动齿条156，并且第二传输带172的第二结构部分174具有在其上形成的第二关节运动齿条176，如下文将进一步详细讨论，它们与关节运动传输组件200驱动性交接。
再次参见图10，第一传输带152可具有从第一结构部分154朝远侧延伸的第一外部增强带部分157。同样，第二传输带172可具有从第二结构部分176朝远侧延伸的第二外部增强带部分177。每个外部增强带部分157,177可具有多个附接凸耳162，用于将第一内部关节运动带158和第二内部关节运动带178固定到其自身。例如，第一传输带152具有附接到其自身的第一内部关节运动带158，并且第二传输带172具有附接到其自身的第二内部关节运动带178。第一传输带152和第二传输带172可以由塑料构成，尤其是由EMS-American Grilon以商品名Grivory GV-6H市售的玻璃纤维强化的无定形聚酰胺构成。相反，传输带组件的内部关节运动带158,178可以由金属构成，有利地由全硬301不锈钢或其等同物构成。传输带152,172的外部增强带部分157,177上的附接凸耳162分别被容纳并固定到对应内部关节运动带158,178上的多个凸耳孔164中。参见图10。
在至少一个具体实施中，细长仓通道14的近端具有一对上下带连接器耳50。参见图2和图4至图8。将这些带连接器耳50分别插入并穿过内部关节运动带158,178的远端上的连接器环159,179。这样，将仓通道14联接到柔性颈杆组件110的内部关节运动带158,178。具体地，第一柔性传输带组件150和第二柔性传输带组件170在相对方向上的往复运动引起内部关节运动带158,178被容纳在柔性颈杆区段111上的上狭槽120和下狭槽121中，从而使其以类似方式往复运动。在内部关节运动带158,178往复运动时，具体地当第一带158朝近侧运动然后第二带178朝远侧运动时，由于第一柔性颈杆部分114的颈杆肋状物118朝向彼此运动并且第二柔性颈杆部分116的颈杆肋状物118同时远离彼此运动，第一柔性颈杆部分114和第二柔性颈杆部分116将弯曲。将内部关节运动带158,178分别联接到传输带152,172的外部增强带部分157,177防止内部关节运动带158,178在相邻的颈杆肋状物之间扣紧。
在各种结构中，远侧闭合管段190在柔性颈杆组件110的导槽128上方滑动。远侧闭合管段190的近端191在其中具有一对沿直径相对的狭槽192(在图1和图10中仅可看到一个狭槽)，用于容纳朝远侧突出的凸耳113，该凸耳从柔性颈杆部分111突出，以防止远侧闭合管段190相对于柔性颈杆部分111旋转。在各种实施方案中，利用保持凸片(未示出)可将远侧闭合管段190保持在导槽128上，该凸片延伸进入导槽128中的紧固件孔(未示出)。然而，也可以采用例如其他紧固结构。此类结构引起闭合管段190与柔性颈杆组件110轴向运动。
利用关节运动传输组件200可控制第一传输带152和第二传输带172的运动。图10示出了关节运动传输组件200的一种形式的组成部件。在一种形式中，关节运动传输组件200可包括致动器210、关节运动主体220和喷嘴250(图1和图13)。致动器210的旋转运动引起喷嘴250内的关节运动主体220发生相应旋转。因此，第一细长传输带152和第二细长传输带172沿平行于细长轴组件100的纵向工具轴线LT-LT的相对方向轴向往复运动，引起端部执行器12进行远程关节运动。
仍参见图10，关节运动主体220具有平台222，该平台由空间上隔开的第一半圆形平台半部224和第二半圆形平台半部226组成。平台半部彼此相对并且基本代表彼此的镜像。第一平台半部224和第二平台半部226分别具有从它们的表面突出的彼此相对的第一止动器225和第二止动器227。每个平台半部224,226具有一组平台齿228，其与另一个平台半部上的一组平台齿间隔约180度。关节运动主体220具有从其表面突出的一对旋转阻挡件230以及一对指状凹槽232。传动齿轮240从关节运动主体22侧向突出。传动齿轮240具有穿过其自身的扩张开口242以及侧向枢轴244。在传动齿轮240的扩张开口242中，存在击发杆孔口(未示出)，用于容纳穿过其中的击发杆530，从而实现对端部执行器12施加击发动作。传动齿轮240被构造成能够分别与第一传动齿条156和第二传动齿条176互相啮合，从而实现第一传输带152和第二传输带172的所需的往复式运动。参见图12。
关节运动传输组件200的喷嘴250可包括喷嘴主体252。喷嘴主体252可具有穿过其中的轴向孔254，该孔便于第一传输带组件150和第二传输带组件170以及击发杆530和器械10的其他有效部件穿过，所述有效部件包括近侧外部轴段300的近端306。参见图12。喷嘴主体252还可具有框架沟槽256和凸缘258，用于将喷嘴主体252可旋转地紧固到外壳400。在各种形式中，止动器外壳260包括喷嘴主体252的一部分。参见图13。止动器外壳260内形成有环形阵列的止动器齿(未示出)。止动器外壳基底与止动器齿间隔开。所述基底可具有一对壁架，它们在关节运动主体220的旋转阻挡件230内相互作用，从而限制旋转程度。将关节运动主体220插入止动器外壳260时，关节运动主体220的基座支撑在止动器外壳260内的基底上，并且第一平台半部224和第二平台半部226的平台齿228对齐，从而与止动器外壳260的止动器啮合接合。将弹簧构件268支撑在关节运动主体内，以将平台齿228偏压成与止动器啮合接合。
再次参见图10，致动器210可由杠杆臂212、顶盖214和一对保持指状物216组成。杠杆臂212安装在顶盖214的顶部上。所述一对保持指状物216从顶盖214的下侧侧向突出。每个保持指状物216具有保持夹。将保持指状物216容纳在关节运动主体220的指状凹槽232内。将关节运动主体的平台半部上的第一止动器225和第二止动器227插入圆形顶盖214下侧内的狭槽凹陷。有利的是，关节运动传输组件的三个重要部件中的每一个，即致动器、关节运动主体和喷嘴可以是注塑成型部件。例如，此类部件可以由EMS--American Grilon150以商品名Grivory GV-4H市售的玻璃纤维强化的无定形聚酰胺制成。
致动器210的棘轮旋转引起端部执行器12沿第一方向或第二方向相对于纵向工具轴线LT-LT进行关节运动。图4以实线示出了在非关节运动位置中的端部执行器12，并以虚线示出了关节运动的示例性范围。当旋转关节运动传输装置200的关节运动主体220上的传动齿轮240，从而沿“DD”方向朝远侧驱动第一传输带组件150并沿近侧方向“PD”朝近侧驱动第二传输带组件170时，端部执行器12将沿第一关节运动方向“FD”相对于纵向工具轴线LT-LT进行关节运动。当旋转关节运动传输装置200的关节运动主体220上的传动齿轮240，从而沿远侧方向“DD”驱动第二关节运动带组件170并沿近侧方向“PD”驱动第一关节运动带组件150时，端部执行器12将沿第二方向“SD”相对于纵向工具轴线LT-LT枢转。
如在图10中可见，细长轴组件100还包括附接到柔性颈杆组件110的近侧外部轴段300。近侧外部轴段300为基本上刚性的，并且可以通过例如压力配合、粘合剂或其他合适的紧固件结构附接到柔性颈杆组件110的柔性颈杆部分111。如在图10中可见，在至少一个实施方案中，近侧外部轴段300的远端302在其中具有一对相对的凹口304，所述凹口能够接收从柔性颈杆部分111突出的对应凸耳115，使得近侧外部轴段300的旋转引起柔性颈杆组件110旋转并最终引起端部执行器12旋转。
仍参见图10，近侧外部轴段300具有近端306，该近端具有狭槽308，用于容纳穿过其的传动齿轮240，使得近侧外部轴段300可以相对于该狭槽轴向运动。此外，近侧外部轴段300的近端306具有在其上形成的凸缘310，这有利于旋转附接到可操作地支撑在外壳组件400内的致动系统的闭合托架422。闭合托架和致动系统可以具有与美国专利申请公布No.US2012/0074200A1中所公开的闭合托架和致动系统相同或相似的类型、构造和操作，所述专利申请公布的全文以引用方式并入本文。
现在参见图14，闭合托架420可包括两个托架区段422(图中仅示出一个)，它们通过粘合剂、按扣特征结构、螺钉等互连在一起。如本文所用，术语“按扣特征结构”包括但不限于，例如在其上具有突出物的凸片，所述凸片被构造成能够固定地接合另一部件的相应配合部分。这类特征结构可以被设计用于可释放地接合配合部分，或者可以不被设计成或不旨在用于被移除。在至少一种形式中，闭合托架420具有远端424，该远端具有沟槽结构426，其能够接收近侧外部轴段300的带凸缘端部310。此类结构用于将近侧外部轴段300的近端306附接到闭合托架420，同时有利于近侧外部轴段300相对于闭合托架420选择性地旋转。因此，细长轴组件100和可操作地联接到其上的端部执行器12可以围绕纵向工具轴线LT-LT相对于外壳组件400选择性地旋转。
在各种具体实施中，外壳组件400包括手枪形柄部外壳，出于组装目的，该外壳可以由两个或更多个零件加工而成。例如，如图所示的外壳组件400包括由聚合物或塑性材料模塑或以其他方式制成的、并被设计成配合在一起的右手壳体构件402和左手壳体构件404(图1)。此类壳体构件402和404可以通过在其中模制或以其他方式形成的按扣特征结构、钉和承窝和/或通过粘合剂、螺钉等附接到一起。组装时，外壳组件400可运动地支撑闭合托架420，用于响应于触发器组件(通常标记为430)的致动动作而在其中选择性地轴向运动。继续参阅本具体实施方式，然而，应当理解，当与机器人控制或以其他方式远程控制的系统一起使用时，可有效地得到本发明的各种具体实施的各种独特且新型的方面和属性。因此，术语“外壳”或“外壳组件”也可涵盖机器人系统的容纳或以其他方式可操作地支撑至少一个驱动系统的外壳或类似部分，其中所述至少一个驱动系统被构造成能够产生并施加可用于致动其上附接的各种形式的外科端部执行器的至少一种控制动作。例如，本文所述的外科器械的各种具体实施可与提交于2012年6月28日的名称为“ROBOTICALLY-POWEREDSURGICAL DEVICE WITH MANUALLY ACTUATABLE REVERSING SYSTEM”的美国专利申请序列号13/536,323中公开的那些机器人系统和结构结合使用，该专利申请的全部公开内容以引用方式并入本文。
触发器组件430可包括例如主要触发器440和次要触发器460。主要触发器440和次要触发器460可枢转地穿在外壳组件400中形成的枢轴销组件430上，使得触发器440和460基本上可以相对于彼此运动。此类结构使得触发器组件430可相对于外壳组件400围绕枢轴PA-PA枢转。参见图14。主要触发器440具有细长的可抓握的主要触发器桨叶442，该桨叶从主要驱动部分444突出，该主要驱动部分具有在其上形成的击发齿条446。在一个实施方案中，次要触发器460具有从次要驱动部分464(如下文进一步详细讨论)突出的次要触发器桨叶462，该次要驱动部分可枢转地穿在枢轴销组件430上。主要驱动部分444具有狭槽448，随着主要触发器桨叶442朝向外壳组件400的手枪式握把部分406枢转，该狭槽能够将次要触发器460的次要驱动部分464接收到其中。在致动过程中，此类结构基本使得次要触发器460“嵌套”在主要触发器440内。如下文将详细讨论，通过枢转主要触发器440可枢转地致动次要触发器460。因此，在其他实施方案中，次要触发器460可以没有次要触发器桨叶442。在各种形式中，可利用触发器弹簧(未示出)将触发器组件430偏压到未致动位置。
如在图14中可见，次要触发器460的次要驱动部分464可具有在其上形成的闭合齿轮区段466，该区段被构造成能够与闭合托架420下侧上形成的托架齿轮齿条423啮合接合。因此，将次要触发器460朝向手枪式握把406枢转时，将沿远侧方向“DD”驱动闭合托架420。
在各种具体实施中，致动系统410还可包括致动杆470。致动杆470具有在其上形成的第一致动齿条472，该齿条被构造成能够与主要触发器440上的主要齿轮区段446啮合接合。因此，当主要齿轮区段446与第一致动齿条472啮合接合时，并且主要触发器440朝向手枪式握把406枢转时，沿远侧方向“DD”驱动致动杆470。致动杆470具有在其上形成的第二致动齿条474，该齿条被构造成能够与离合器组件480的离合器轴482上的离合器齿484啮合。在各种实施方案中，将离合器轴482可旋转地支撑在外壳组件400内，并且还可以在其中横向运动。离合器轴482具有轮毂部分486，该轮毂部分具有多个间隔的齿488，所述齿被构造成能够驱动地接合可旋转地支撑在离合器轴482上的传动齿轮490中的齿开口492。传动齿轮490在其上具有传动齿轮区段494，该区段能够与可运动地支撑在外壳组件400中的击发齿条500啮合接合。
离合器组件480的各种实施方案还可包括离合器板510，该离合器板可滑动地穿在主要触发器440的主要驱动部分444上的离合器销449上。离合器销449可以可运动地容纳在离合器板510中的竖直狭槽512内。离合器板510还具有朝远侧延伸的离合器臂514，该离合器臂能够可致动地接合离合器轴482上形成的斜板489。此外，使用离合器弹簧520横向地偏压离合器轴480，使得离合器轴482上的齿488与传动齿轮490中的齿开口492啮合接合。
如在图10和图14中可见，击发齿条500联接到击发杆530，该击发杆附接到刀杆组件600的近端。在各种实施方案中，刀杆组件600可包括上部杆区段602和下部杆区段604。这种结构使刀杆组件600能够在端部执行器12进行关节运动时弯曲，同时保持足够的刚性，以通过轴组件100朝远侧驱动。在示出的实施方案中，上部刀杆区段602和下部刀杆区段604各自附接到“E型横梁”切割头610。在示出的构型中，E型横梁切割头610包括竖直取向的主体部分612，该主体部分具有上部615和下部617。底部支脚614形成于下部617之上或附接到该下部。在另选的实施方案中，底部支脚基本上可包括从下部侧向突出的侧向延伸下凸片。类似地，至少一个上凸片616形成于竖直取向的主体部分612的上部615上，或以其他方式附接到该上部。此外，如在图2中可见，竖直取向的主体部分612还包括至少一个中间凸片部分618(仅示出一个)和组织切割刃620。
参见图2，竖直取向的主体部分612延伸穿过细长通道14中的纵向延伸狭槽622以及砧座20中的纵向延伸狭槽624。组装时，细长通道14的某些部分被容纳在底部支脚614与中间凸片部分618之间。上凸片部分616被布置成容纳在砧座20的部分623之上的砧座20内，上凸片部分限定砧座狭槽624。为便于组装，砧座20可以具有活动的砧座盖626，并且细长通道14可具有可移除的通道盖628。一旦被组装，可分别安装砧座盖626和通道盖628用于防止组织、体液等进入砧座20和细长通道14，这些盖可能会妨碍切割头610的操作。
在各种结构中，每个钉仓30包括仓体31，所述仓体具有可操作地支撑在其中的滑动件组件630。滑动件组件630可具有被构造成能够延伸到在切割头610的竖直取向主体部分612中形成的滑动件狭槽613中的安装部分632。参见图2和图4。滑动件组件630可被构造为具有被布置成接触钉驱动器636的楔形物634，所述钉驱动器可操作地支撑在钉仓30内。钉驱动器636可以通过已知的方式在其上支撑一个或多个钉638。沿远侧方向驱动滑动件组件630穿过钉仓30时，楔形物632以一种已知的方式在仓30内向上驱动驱动器。向上运动的驱动器636驱动钉638，使其接触砧座20的钉成型下表面。下表面可例如包括对应于每个钉的钉成型凹坑。
端部执行器12也可采用切割头闭锁系统(通常标记为640)，该系统用于在细长通道14中没有新的钉仓30时防止切割头630的远侧推进。在至少一个结构中，例如切割头闭锁系统640可包括安装到细长通道14底部的闭锁弹簧642。在切割头组件610在起始位置中时，闭锁弹簧642可被构造成能够接触切割头组件610的底部支脚614。参见图4、图6和图9。可提供穿过细长通道14底部的开口644，使得在该位置中时，闭锁弹簧642使底部支脚614偏压，促使底部支脚与细长通道14的底部交接。因此，当底部支脚614在该位置中时，如果临床医生尝试朝远侧推进切割头610穿过细长通道14，底部支脚部分614将接触细长通道14的一部分，以防止切割头610的这种推进。当仓30正确安装有细长通道14时，滑动件组件630的安装部分632延伸到滑动件狭槽613中，并且用于使切割头组件610运动至某一位置，由此使支脚部分614移出而不妨碍与细长通道14底部的接触。当在该位置中时，切割头组件610自由地朝远侧推进穿过细长通道14。当不存在新的仓(可能会通过其他方式导致组织被切割但不缝合)时，这种结构有助于防止临床医生意外击发端部执行器。当切割头610朝远侧推进时，底部支脚614、中间凸片部分618和上凸片616配合以使砧座20相对于钉仓平台以相对于彼此呈所需的间隔关系取向。上凸片616与中间凸片部分618之间的远侧存在的组织切刃620切断被夹住的组织，同时引起钉仓30内的钉638对端部执行器12内夹住的组织形成缝合。
如在图2中可见，上击发杆602附接到上端部615，并且下击发杆604与上击发杆602间隔开，并且下击发杆附接到切割头610的竖直延伸部分612的下端部617。这种结构有助于以相同的方式将击发动作传递到切割头610的上部分和下部分，以便于切割头对齐运动穿过砧座20、外科钉仓30和细长通道14。在各种结构中，例如上击发杆602可被附接到位于上凸片正后方的上端部，使得上击发杆602与上凸片从上端部侧向突出的点基本上轴向地对齐。类似地，下击发杆604可附接到底部支脚正后方的底部端部或附接到侧向突出底部凸片从底部侧向突出的点，使得下击发杆604与该点轴向地对齐。上击发杆602和下击发杆604可焊接到这些位置中的竖直延伸部分612。例如，焊接可以从击发杆的一侧或两侧施加。在至少一个具体实施中，上击发杆602和下击发杆604并非直接彼此附接。上击发杆602和下击发杆604的一些部分延伸穿过将联接至击发杆530的远端部分532的细长轴组件100，它们以相对于彼此连续取向的方式被支撑。上击发杆602和下击发杆604的近端可通过联接器构件650附接到击发杆530的远端部分532。参见图10。如下文将进一步详细讨论，击发杆530有利于通过致动系统410对刀杆组件600施加击发和回缩动作。在至少一个具体实施中，砧座安装部分22在其上具有楔形物样构造27，当沿远侧方向“DD”驱动刀杆组件600时，这种构造有助于分离上击发杆602和下击发杆604。参见例如图9。
在各种结构中，击发杆530延伸穿过安装在外壳组件400内的闭合轴衬540。在至少一个形式中，一对安装螺柱407从柄部壳体402,404突出并延伸穿过闭合托架420中的对应狭槽，从而容纳到轴衬540中的保持狭槽中。附接到保持夹552的闭合弹簧550穿在闭合轴衬540上。闭合弹簧550在喷嘴主体252与闭合托架420的内壁425之间延伸。因此，闭合弹簧550用于沿近侧方向“PD”偏压闭合托架420。
多个实施方案还可包括可释放的闭合锁定组件560，该组件与闭合托架420交接，以将闭合托架420选择性地保持在其最远侧闭合位置或夹紧位置。在至少一种形式中，闭合锁定组件560包括锁定按钮562，该按钮可枢转地支撑在外壳组件400中。锁定按钮562具有锁臂564，当按钮562在锁定位置时，该锁臂被构造成能够邻接闭合托架420上形成的闭锁横档426。此外，锁臂564具有在其上形成的扣件566，该扣件被构造成能够可释放地锁闭击发齿条500的近端上的锁定插销502。锁定弹簧568用于将锁定按钮562偏压到锁定位置。
现在将描述外科器械10的操作。图7和图9示出了在打开位置中的端部执行器12的钳口13和15。当端部执行器12在打开位置中时，锁臂564位于闭合托架420上形成的闭锁横档426的顶部，使得锁臂564的扣件566保持与击发齿条500上的锁定插销502接合。因此，当在该起始位置中时，不能无意地致动刀杆组件600。离合器板510和闭合托架各自位于其最近侧未致动位置。当在该位置中时，离合器轴482上的离合器传动斜边489与闭合托架420的一部分接触，这防止了离合器轴482在离合器弹簧520的偏压下横向运动至与传动齿轮490啮合接合。
为了开始闭合过程，将第一行程施加到触发器组件430。也就是说，触发器组件430初始朝向手枪式握把406枢转。这样的枢转动作用于通过次要触发器460上的闭合齿轮区段466与闭合托架420的下侧上形成的托架齿条423之间的啮合接合，沿远侧方向“DD”驱动闭合托架420。闭合托架420的这种远侧运动还沿远侧方向“DD”轴向推进近侧外部轴段300和远侧闭合管段190。当远侧闭合管段190朝远侧运动时，延伸穿过砧座安装部分22中的狭槽23的销19从图8和图9所示的位置行进到图4至图6所示的位置，以使砧座20枢转至闭合位置。如果外科医生希望只是在将组织夹在砧座20与外科钉仓30间之前抓紧和操纵组织，可以枢转触发器组件430以打开和闭合砧座20，而无需使触发器组件430完全枢转到完全闭合位置。
本领域普通技术人员将理解到，朝向手枪式握把406枢转触发器组件430时，也必然将通过主要触发器440上的主要齿轮区段446与致动杆470上的第一致动齿条472之间的啮合接合，朝远侧驱动致动杆470。致动杆470的远侧运动还将通过离合器轴482上的离合器齿484与致动杆470上的第二致动齿条474之间的啮合接合，向离合器轴482施加旋转致动动作。然而，不向传动齿轮490施加这种旋转动作，因为离合器板510的离合器臂514与离合器轴482上的离合器传动斜边489接触防止了离合器轴482轴向运动至与传动齿轮490啮合接合。因此，离合器轴482相对于传动齿轮490自由地旋转。因此，在触发器组件430的初始致动过程中，离合器组件480自动地防止击发齿条500的激活。
一旦触发器组件430已初始地完全压缩到闭合位置，砧座20将通过闭合锁定组件560保持在锁定位置或夹紧位置，从而防止闭合托架420的近侧运动。为了驱动刀杆组件600朝远侧穿过夹在端部执行器12中的组织，外科医生朝向外壳组件400的手枪式握把406再次枢转主要触发器440。在枢转主要触发器440时，将沿远侧方向“DD”驱动击发齿条500、击发杆530和刀杆组件600。在驱动刀杆组件600穿过夹在端部执行器12中的组织后，外科医生释放主要触发器440，从而允许主要触发器440在击发弹簧432的偏压下枢转到其未致动位置。在主要触发器440枢转回到起始位置时，将击发齿条500、击发杆530和刀杆组件600朝近侧牵引回到其相应起始位置。端部执行器12保持在其如图6所示的夹紧位置中。从图中也可以看到，当刀杆组件600返回到起始位置时，滑动件组件630保持在仓30的远端。
为了对闭合托架420和次要触发器460解锁，外科医生按压锁定按钮562。在按压锁定按钮562时，枢转锁定臂564，使其脱离与闭合托架420上的闭锁横档426的邻接接合。有关击发和闭合系统操作的其他细节可见于美国专利申请公布US 2012/0074200中，该专利申请的全文以引用方式并入本文。在闭合托架420朝近侧运动时，将近侧外部轴段300、柔性颈杆组件110和远侧闭合管段190朝近侧牵引。在远侧闭合管段190朝近侧运动时，轴19在砧座安装部分22中的狭槽23内朝近侧行进，以使砧座20运动至打开位置。
通过上述说明可以理解，本文所公开的各种外科器械为临床医生提供了改善的可操作性以及各种其他优势，这些其他优势在使用先前的被构造成能够切割和固定组织的外科器械时却不具有。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相对于彼此运动的相同方向选择性地进行关节运动。换言之，外科端部执行器的钳口被限制在一个平面中运动。在本文所公开的各种具体实施中，端部执行器也能够在相同平面中运动。先前的端部执行器通常被限制在不同于钳口运动平面的平面上运动。
本发明的具体实施中的一些提供的另一优势是击发杆的使用，所述击发杆包括形成层状结构的至少上击发杆和至少下击发杆。上杆和下杆可在某些点彼此附接，或者它们也可不附接而仅是彼此连续。在任一结构中，上杆附接到切割头的上端，并且下杆可附接到下头，使得它们在附接到切割头的点处彼此间隔开。这种结构有助于提供更稳定的切割头结构，这种切割头结构在致动过程中不易被扭曲和/或弯曲。另外，切割头可配备有接合砧座的一部分的侧向突出的上凸片和接合细长通道的下凸片。上击发杆可附接到上凸片附接点的正后方，使得上击发杆与附接点轴向地对齐。同样，下击发杆可附接到下凸片附接点的正后方的底部，使得下击发杆与附接点轴向地对齐。这种轴向对齐有利于在切割头与砧座和细长通道接合处将驱动或致动动作转移至切割头，从而可进一步防止致动过程中切割头的扭曲和/或弯曲。
因此，通过上述说明可以理解，本发明的至少一个外科器械实施方案包括采用钳口的端部执行器，所述钳口通过闭合系统可在打开位置与闭合位置之间选择性地运动。外科器械还包括可独立于闭合系统致动以便部署或以其他方式致动端部执行器的击发构件部分的击发系统。仪器还采用了可用于使端部执行器选择性地进行关节运动的关节运动系统，其关节运动方向与钳口相对于彼此运动的方向相同。
在一个具体实施中，例如钳口之一被构造成能够可操作地支撑在其中支撑多个外科钉的外科钉仓。外科钉支撑在驱动器上，所述驱动器可操作地支撑在钉仓中所提供的凹坑内。滑动件组件也支撑在该仓内。滑动件组件被构造成能够与外科器械的击发构件可操作地交接。另一钳口包括砧座组件，在至少一个具体实施中，该砧座组件可相对于细长通道选择性地运动，以使组织能够夹在砧座与支撑在通道中的钉仓之间。闭合系统控制砧座的运动，并且闭合系统可以在不致动击发系统的情况下进行致动。在至少一个具体实施中，如果砧座未保持在闭合位置，则器械采用一个或多个闭锁结构，以防止击发系统的致动。
上述结构中的击发构件包括具有组织切割表面或刀片的切割头。在致动击发系统时，将支持击发构件朝远侧行进穿过外科钉仓。切割头被构造成能够可运动地与细长通道和砧座交接，以便当切割头在外科钉仓内从起始位置被推进或“被击发”至结束位置时，维持外科钉仓与砧座下侧之间所需的间距量。切割头还被构造成能够与滑动件组件交接，以便当切割头朝远侧推进穿过钉仓时，切割头与钉仓一起运动至滑动件组件。滑动件组件朝远侧驱动穿过仓时，滑动件组件向上驱动仓中的钉驱动器。钉驱动器在其凹坑中向上运动时，钉被驱动穿过夹住的组织并与砧座的下表面形成接触。在切割头被驱动至仓内的端部位置后，可使用击发系统将击发头回缩至起始位置。
在至少一个具体实施中，外科器械可以采用闭锁系统，该系统被构造成不仅被构造成能够防止击发系统的致动，或者换言之，当不存在仓时，防止切割头推进穿过细长通道，而且在新的仓未能正确支撑在细长通道中时，能够防止这种击发系统致动。在这类具体实施中，每个新仓都具有支撑在起始位置中的滑动件组件。当仓正确安装在细长通道中时，滑动件组件与闭锁系统交接，从而使切割头朝远侧推进穿过仓。但是，如果无意中将已空仓安装在细长通道中，则闭锁系统将防止切割头的致动，因为滑动件组件将位于仓的远端，因此不能与闭锁系统交接。这种系统将防止击发系统的再致动，临床医生将不能替换已空仓并尝试致动击发系统。
本文所公开的装置可被设计为单次使用后丢弃，或者它们可被设计为可使用多次。然而无论是哪种情况，该装置都可在至少使用一次后经过重新修复再行使用。重新修复可包括以下步骤中的任意组合：拆卸该装置、然后清洗或更换特定零件、以及随后重新组装。具体地，可拆卸所述装置，并且可选择性地以任何组合形式来更换或移除所述装置的任意数量的特定零件或部件。在清洁和/或更换特定部件时，所述装置可在修复设施处重新组装或者在即将进行手术前由手术团队重新组装以供随后使用。本领域的技术人员将会了解，装置的修复可以利用多种技术来进行拆卸、清洁/更换以及重新组装。这些技术的使用以及所得的重新修复装置均在本发明的范围内。
优选地，将在手术前处理本文所述的发明。首先，获取新的或用过的器械，并根据需要进行清洗。然后可对器械进行消毒。在一种灭菌技术中，将该器械放置在闭合且密封的容器中，诸如塑料或TYVEK袋中。然后将容器和器械放置在可穿透该容器的辐射场诸如γ辐射、x射线或高能电子中。辐射将杀死器械上及容器中的细菌。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为止。
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。因此，在必要的情况下，本文明确陈述的公开内容可取代任何与之抵触的以引用方式并入本文的材料。任何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，但可以在本公开的实质和范围内对本发明进行进一步修改。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：
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，其中在向所述第二端部执行器部分施加打开动作时，所述第二端部执行器部分能够沿第一方向相对于所述第一端部执行器部分选择性地运动，在向所述第二端部执行器部分施加闭合动作时，所述第二端部执行器部分还能够沿第二方向选择性地运动；
细长轴组件，所述细长轴组件限定纵向工具轴线并且可操作地联接至所述外科端部执行器，所述细长轴组件包括关节运动部分，以在向所述外科端部执行器施加关节运动动作时有助于所述外科端部执行器沿所述第一方向和所述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；
击发构件，所述击发构件被可操作地支撑，以便在向所述击发构件施加击发和回缩动作时使其在所述外科端部执行器内进行可操作地运动；
击发系统，所述击发系统被构造成能够向所述击发构件选择性地施加所述击发和回缩动作；
闭合系统，所述闭合系统被构造成能够向所述第一端部执行器部分和所述第二端部执行器部分选择性地施加所述打开和闭合动作；以及
关节运动控制系统，所述关节运动控制系统用于向所述外科端部执行器施加所述关节运动动作。
2.根据权利要求1所述的外科器械，其中所述闭合系统可独立于所述击发系统进行操作。
3.根据权利要求1所述的外科器械，其中所述第一端部执行器部分和所述第二端部执行器部分中的一个被构造成能够在其中可操作地支撑外科钉仓，并且其中所述外科器械还包括用于防止所述击发系统的致动的闭锁系统，除非所述外科钉仓已安装在所述第一端部执行器部分和所述第二端部执行器部分中的所述一个中。
4.根据权利要求3所述的外科器械，其中所述外科钉仓包括：
仓体；
多个外科钉，所述多个外科钉可操作地支撑在所述仓体中；和
滑动件组件，所述滑动件组件可操作地支撑在所述仓体中并且能够从所述仓体内的第一位置运动至第二位置，使得当所述滑动件组件被从所述第一位置驱动至所述第二位置时，所述滑动件组件引起所述外科钉被从所述仓体驱动。
5.根据权利要求4所述的外科器械，其中所述击发构件包括被构造成能够在锁定位置与解锁位置之间运动的切割头，在所述锁定位置，所述切割头被防止穿过所述仓体朝远侧推进，在所述解锁位置，所述切割头能够在被施加所述击发动作时穿过所述仓体朝远侧推进，并且其中所述闭锁系统包括在所述端部执行器中用于将所述切割头偏压到所述锁定位置的偏压构件。
6.根据权利要求5所述的外科器械，其中所述滑动件组件被构造成能够在所述钉仓安装在所述第一端部执行器部分和所述第二端部执行器部分中的一个中并且所述滑动件组件处于所述第一位置时将所述切割头偏压到所述解锁位置。
7.根据权利要求1所述的外科器械，其中所述击发构件包括：
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与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所述下端突出，并且被构造成能够可运动地接合所述细长通道的底部；
上凸片部分，所述上凸片部分从所述竖直延伸部分的所述上端突出，并且被构造成能够接合所述砧座的一部分；和
击发杆组件，所述击发杆组件可操作地联接至所述切割头并且可操作地交接所述击发系统。
8.根据权利要求7所述的外科器械，其中所述击发杆组件包括：
上击发杆区段，所述上击发杆区段联接至所述切割头的所述竖直延伸部分的所述上端；和
下击发杆区段，所述下击发杆区段联接至所述切割头的所述竖直延伸部分的所述下端。
9.根据权利要求8所述的外科器械，其中所述上击发杆和所述下击发杆在其附接到所述竖直延伸部分的相应点处彼此间隔开，并且所述上击发杆和所述下击发杆的其余部分相对于彼此连续取向。
10.根据权利要求9所述的外科器械，其中相对于彼此连续取向的所述上击发杆和所述下击发杆的所述其余部分可操作地联接至所述击发系统的击发杆构件。
11.一种外科器械，包括：
外壳；
闭合系统，所述闭合系统由所述外壳可操作地支撑并且被构造成能够选择性地产生打开动作和闭合动作；
击发系统，所述击发系统由所述外壳可操作地支撑，所述击发系统被构造成能够选择性地产生击发动作和回缩动作；
外科端部执行器，所述外科端部执行器包括：
细长通道，所述细长通道被构造成能够可移除地支撑外科钉仓；
砧座，所述砧座相对于所述细长通道可运动地受到支撑，在向所述砧座施加所述闭合动作时，所述砧座能够沿第一方向从打开位置运动到闭合位置，在向所述砧座施加所述打开动作时，所述砧座还能够沿第二方向从所述闭合位置运动到所述打开位置；和
击发构件，所述击发构件被可操作地支撑，以便在被施加所述击发和回缩动作时在所述外科端部执行器内可操作地运动，并且其中所述外科器械还包括：
细长轴组件，所述细长轴组件限定纵向工具轴线并且可操作地联接至所述外科端部执行器的所述细长通道，所述细长轴组件包括关节运动部分，以在自由所述外壳可操作地支撑的关节运动系统向所述外科端部执行器施加关节运动动作时有助于所述外科端部执行器沿所述第一方向和所述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。
12.根据权利要求11所述的外科器械，其中所述外壳包括柄部。
13.根据权利要求11所述的外科器械，其中所述外科钉仓包括：
仓体；
多个外科钉，所述多个外科钉可操作地支撑在所述仓体中；和
滑动件组件，所述滑动件组件可操作地支撑在所述仓体中并且能够在所述仓体内从第一位置运动至第二位置，使得当所述滑动件组件从所述第一位置被驱动至所述第二位置时，所述滑动件组件引起所述外科钉被从所述钉仓驱动。
14.根据权利要求13所述的外科器械，其中所述击发构件包括被构造成能够在锁定位置与解锁位置之间运动的切割头，在所述锁定位置，所述切割头被防止穿过所述仓体朝远侧推进，在所述解锁位置，所述切割头能够在被施加所述击发动作时穿过所述仓体朝远侧推进，并且其中所述闭锁系统包括在所述端部执行器中用于将所述切割头偏压到所述锁定位置的偏压构件。
15.根据权利要求14所述的外科器械，其中所述滑动件组件被构造成能够在所述钉仓安装在所述第一端部执行器部分和所述第二端部执行器部分中的一个中并且所述滑动件组件处于所述第一位置时将所述切割头偏压到所述解锁位置。
16.根据权利要求11所述的外科器械，其中所述击发构件包括：
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与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所述下端突出，并且被构造成能够可运动地接合所述细长通道的底部；
上凸片部分，所述上凸片部分从所述竖直延伸部分的所述上端突出，并且被构造成能够接合所述砧座的一部分；和
击发杆组件，所述击发杆组件可操作地联接至所述切割头并且可操作地交接所述击发系统。
17.根据权利要求16所述的外科器械，其中所述击发杆组件包括：
上击发杆区段，所述上击发杆区段联接至所述切割头的所述竖直延伸部分的所述上端；和
下击发杆区段，所述下击发杆区段联接至所述切割头的所述竖直延伸部分的所述下端。
18.一种外科缝合器械，包括：
细长通道，所述细长通道被构造成能够可移除地支撑外科钉仓；
砧座，所述砧座相对于所述细长通道被可运动地支撑；
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与所述下端之间取向的组织切割部分；
至少一个下凸片，所述下凸片从所述竖直延伸部分的所述下端突出，并且被构造成能够可运动地接合所述细长通道的底部；
至少一个上凸片部分，所述上凸片部分从所述竖直延伸部分的所述上端突出，并且被构造成能够接合所述砧座的一部分；和
击发杆组件，所述击发杆组件可操作地联接至所述切割头并且可操作地交接击发系统，所述击发杆组件包括：
上击发杆区段，所述上击发杆区段联接至所述切割头的所述竖直延伸部分的所述上端；和
下击发杆区段，所述下击发杆区段联接至所述切割头的所述竖直延伸部分的所述下端。
19.根据权利要求18所述的外科器械，其中所述上击发杆和所述下击发杆在其附接到所述竖直延伸部分的相应点处彼此间隔开，并且所述上击发杆和所述下击发杆的其余部分相对于彼此连续取向。
20.根据权利要求19所述的外科器械，其中相对于彼此连续取向的所述上击发杆和所述下击发杆的所述其余部分可操作地联接至所述击发系统的击发杆构件。
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CN108888309B (zh) * 2018-08-01 2023-08-25 苏州法兰克曼医疗器械有限公司 一种具有稳定夹持力的轻便吻合器
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CN112294384A (zh) * 2020-10-30 2021-02-02 苏州贝诺医疗器械有限公司 一种吻合器改进型驱动组件、端部执行器及腔内吻合器

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