CN1606968A - 具有用于防止发射的单锁机构的外科钉合装置 - Google Patents
具有用于防止发射的单锁机构的外科钉合装置 Download PDFInfo
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- 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
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- A—HUMAN NECESSITIES
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- 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
- A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
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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
- 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
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- 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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
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- A—HUMAN NECESSITIES
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- 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
一种用于腹腔镜和内窥镜临床过程中对夹持在端部动作器中的组织同时进行切割和钉合的外科器械,其中端部动作器包含支撑储钉筒的长通道和轴向附着的砧板。E形梁发射栓在远处发射过程中啮合长通道,并有选择地啮合砧板,其中组织从储钉筒中被向上驱动,以抵着砧板被切割和钉合。特别的,发射栓的中针驱动与储钉筒为一体的楔子远移以进行钉合。长通道的单锁装置响应于未发射状态的楔形滑板,以使发射栓发射。另外,储钉筒缺少或用尽时单锁装置防止发射。
Description
相关申请
本申请与四个同时申请、具有共同所有人的待审申请相关,每件申请在此作为整体通过引证被引入本申请中,这四个申请分别是:
(1)Frederick E.Shelton IV,Mike Setser和Bruce Weisenburgh的“具备用于未闭合砧板的发射锁的外科钉合器械”;
(2)Frederick E.Shelton,Mike Setser和Brian J.Hemmelgam的“具备分离且不同的闭合和发射系统的外科钉合器械”;
(3)Frederick E.Shelton IV,Mike Setser和Bruce Weisenburgh的“具备储钉筒用尽时锁定的外科钉合器械”;
和(4)Frederick E.Shelton IV,Mike Setser和Bruce Weisenburgh的“组合E形梁发射机构的外科钉合器械”。
技术领域
本发明一般涉及一种外科钉合器械,该外科钉合器械在切割钉线之间的组织时在组织上施加多行钉线,具体而言,本发明涉及钉合器械的改进以及涉及构形这种钉合器械的各种部件的处置的改进。
背景技术
现有技术中,外科钉合装置同时纵向切割组织并且在切口的相反一侧施加多行钉线。如果这些器械将用于进行腹腔镜检查和内窥镜检查时,则通常包括一对能够进出套管通道的协作夹钳部件(jaw member)。其中一个夹钳部件容纳一个横向布置至少两排钉的储钉筒。另一个夹钳部件限定一砧板,该砧板具有与隼钉筒中的钉排对齐的钉成形凹穴。这些器械包括许多往复作用的楔子,这些楔子在受驱动向远处移动时穿过储钉筒中的开口,并与支撑钉的驱动器啮合,以便有效地朝向砧板发射钉。
美国专利US5465895描述了适用于内窥镜检查的外科钉合器的例子,该装置有利之处是提供了不同的闭合和发射。因而,医师可在发射装置之前先闭合组织上的夹钳单元以定位组织。一旦医师确定夹钳单元恰当地夹住了组织就可发射钉合装置以切割和钉合组织。切割和钉合同时进行可以避免在用不同的,只能分别进行切割或钉合的外科工具进行这样的操作时出现的繁琐。
为外科钉合器配备一个可重复利用的端部动作器通常是有益的。例如,一个患者可能需要进行一系列切割和钉合操作。为每次操作都更换整个端部动作器是不经济的。对于在重复操作中造得结实而耐用的端部动作器尤其如此。为实现这一点,在外科钉合器的每一次操作之前把储钉筒安装到端部动作器中。因此,每次使用之后只废弃很少的外科用钉。
尽管储钉筒有许多优点,还希望在未发射的储钉筒安装之前防止疏忽间发射钉合装置。否则,就可能在没有钉来减少失血时就切割组织。
特别希望可以通过一种可靠的方式来防止这种疏忽间发射钉合装置的情况出现,这种方式不受介入故障影响。进一步讲,为便于制造和安装,还希望用最少的部件来构成锁定装置。
所以,需要研制一种改进的外科钉合和切割器械,当储钉筒未安装时,或储钉筒中的钉已组用尽时,该器械不能进行发射(即切割和钉合)动作。
发明内容
本发明克服现有技术的上述缺陷或其它不足,提供一种储钉筒未安装或者用尽时防止发射外科钉合和切开装置的单锁机构。特别是,单锁机构在不同时进行钉合的情况下防止发射栓向远处移动而切割组织。
作为本发明的一个方面,外科器械包括产生发射以发射执行部件的可操纵手部分。该执行部件包括容纳储钉筒并在此处设有发射驱动槽的长通道。发射机构沿纵向与长通道跄合,并包括一横跨发射驱动槽向远处移动储钉筒中的楔形滑板的驱动部件。锁定机构优选定位成以被未发射附近位置的楔形滑板移出,从而允许发射栓发射。当楔形滑板不再处于未发射位置(即用尽或去掉储钉筒)时,锁定机构弹性移入发射驱动槽。处于发射驱动槽中的锁定机构的远近侧变形成允许发射栓的啮合装置回到附近的初始位置,但之后直到未发射的储钉筒安装时一直阻止驱动装置向远处移动。
本发明的这些以及其它目的和优点将通过附图和说明书来说明。
附图说明
组合在一起构成该说明书一部分的图阐释了本发明的实施例,并且和上述本发明的综述、下面的实施例具体描述一起用于解释本发明的原理。
图1为发射状态的外科钉合和切割器械的部分剖视正面图。
图2为沿图1中2-2线横切的外科钉合和切割器械的端部动作器正面详图。
图3为图2中外科钉合和切割器械的发射栓的放大正面图。
图4为图2中外科钉合和切割器械的发射栓放大的前视图。
图5为图1中外科钉合和切割器械可选择的端部动作器的横切正面详图,该端部动作器有一个缺少防止端部动作器收缩的中销的发射栓。
图6为处于未夹持,未发射(“启动”)状态并移去左侧面以显示内部组成的,图1中外科钉合和切割器械近端的手柄部分的正面图。
图7为图1中外科钉合和切割器械近端的手柄部分的透视分解图。
图8为处于关闭(“夹持”)状态并移去左侧面以显示内部组成的,图1中外科钉合和切割器械近端的手柄部分的正面图。
图9为处于钉合和切割(“发射”)状态并移去左侧面以显示内部组成的,图1中外科钉合和切割器械近端的手柄部分的正面图。
图10为图1中外科钉合和切割器械远侧的端部动作器的等大图,其中砧板处于上或开的状态,以显示储钉筒和发射栓切削沿。
图11为图1中外科钉合和切割器械的执行部分的等大分解图。
图12为图1中外科钉合和切割器械远端的端部动作器的等大图,其中砧板处于上和开的状态,储钉筒被切去大部分,以显示作为示例的单个钉驱动器和一对纤维驱动器,并且楔形滑板抵着发射栓在中销处于发射状态的。
图13为图1中外科钉合和切割器械在远端的等大图,其中砧板处于上和开的状态,储钉筒被完全移走并移去部分长通道,以显示发射栓的最低端。
图14为表示图1中外科钉合和切割器械处于关闭状态时砧板、长通道和储钉筒之间机械关系的截面的正面图,此截面通常沿着图10中14-14线切开,以显露楔形滑板、钉驱动器和钉,并且还显示了沿着纵向中心线的发射栓。
图15为储钉筒和发射栓处于发射状态的外科钉合和切割器械的端部动作器沿着图10中15-15线的截面图。
图16为表示发射栓、长通道、楔形滑板、钉驱动器、钉和储钉筒之间交叉关系的沿着图15中16-16线的截面图。
图17为图1中外科钉合和切割器械沿着处于半闭未闭夹持着组织的端部动作器的纵向中心线的正面图。
图18为图1中外科钉合和切割器械处于关闭或夹持状态的部分剖面正视图。
图19为图1中沿着外科钉合和切割器械处于关闭或夹持状态,组织适当压缩时其远端中心线部分的正面图。
图20为图1中外科钉合和切割器械处于半发射状态时的部分截面图。
图21为图1中外科钉合和切割器械处于半发射状态时其远端中心线部分截面的正视图。
图22为图1中外科钉合和切割器械处于完全发射状态时的部分截面图。
图23为沿着图1中外科钉合和切割器械处于完全发射状态时其远端中心线部分截面图。
图24为图1中被部分切去以显露储钉筒体和与发射栓中销的单锁装置啮合的长通道远视剖视图。
图25-28为图24中单锁装置、储钉筒和发射栓的详细横截面图,依次为:图25为处于负载和未发射状态的储钉筒,图26为处于发射状态的储钉筒,图27为发射栓正处于缩进状态的用尽的储钉筒,图28为发射栓已经完成缩进的用尽的储钉筒。
图29为图24中还包括锁道的单锁装置。
图30为当储钉筒缺失时图1中长通道的底部剖视图,其中被部分切去,以显示另一个推动发射栓中销的单锁装置。
图31-34为图30中单锁装置的详细横截面图,依次为:图31为处于负载和未发射状态的储钉筒,图32为正在发射的储钉筒,图33为发射栓正在收缩的用尽的储钉筒,图34为发射栓已经完成发射的用尽的储钉筒。
具体实施方式
参见附图,其中相同的标号代表相同的部件,图1和图2描述了能够显示本发明独特优点的外科钉合和切割器械10。外科钉合和切割器械10配合端部动作器12,所述端部动作器具备E形梁发射装置(“发射栓”)14,其有效地控制该端部动作器12的间距。特别是,长通道16和枢轴活动的砧板18彼此隔开,以确保进行有效的钉合和切割。如果钉合和切割器械不能利用单锁机构就钉合,不会发生发射(即切割和钉合),这将进行详细描述。
外科钉合和切割器械10包括连接执行部件22的手柄部分20,执行部件22还包括一个轴23,该轴远端为端部动作器12。手柄部分20包括一个枪柄24,医师朝向该枪柄轴向牵拉闭合扳手26,使砧板18朝向端部动作器12的长通道16夹持或闭合。发射扳手28和闭合扳手26相比更向外,医师轴向牵拉发射扳手28,从而钉合和切割夹持在端部动作器中的组织。
本文中“近”和“远”的描述是以装置手柄作为参照点。这样,端部动作器12相应于较近的手柄部分20位于远处。为简便和清楚起见,附图中使用词语如“垂直”和“水平”。然而,使用中外科器械有许多方位,上述这些词语并非是绝对和起限定作用的。
首先驱动闭合板手26。当医师认为端部动作器12处于合适位置时,就向后拌动闭合扳手26至枪柄24附近的完全闭合、关锁位置。接着驱动发射板手28。当医师不再加压时,发射扳手28弹回。当向操作装置20的近端按下松开键30时,锁定的闭合扳手26被松开。
闭合套32封合框架34,框架34又封合由发射扳手28定位的发射驱动件36。框架34把手柄部分20连向端部动作器12。如前所述,随着闭合扳手26把闭合套32拉近,砧板18弹开,轴向离开长通道16并移向闭合套32附近。
长通道16接纳响应于发射栓14的储钉筒37,把钉压入通道,从而与砧板18相接触。显然,尽管此处描述的是优选采用易于更换的储钉筒37,永久固定于长通道16上或与之为一体的储钉筒37也符合本发明的要求,例如在每次发射后端部动作器12的大部分被替换。
E-形梁发射机构(E-Beam Firing Mechanism)
参见图2-4,发射栓14包括三个垂直隔开的销,它们可控制端部动作器12间距。上销38进入位于砧板18和长通道16之间在轴附近的砧板凹穴40。如果砧板18闭合,装置发射时,上销38沿着在砧板18中延伸的纵向砧板槽42中向远移动。上针38施加的向下的力克服了砧板18中的任何微小向上变形。
发射栓14还包括最下销或发射栓帽44,它们向上连接长通道16中的通道槽45,因而配合上销38,在过多的组织被砧板和长通道夹住时,砧板18和长通道16之间的距离减少。
发射栓14优选包括一个中销,该中销穿过形成于储钉筒37的下部表面和长通道上表面的发射驱动槽47,从而如下所述驱动钉。中销46沿长通道16滑行,中销46防止端部动作器12在其远端被夹住的任何趋势。为阐释中销46的好处,图5示出了一个发射栓14′缺少中钉的可选择的端部动作器12′。图5中,端部动作器12′在其远端可被夹住,这将不利于形成预期的钉构造。
参见图2-4,位于发射栓14上的上针和中针38、46之间的切削沿48横穿近处储钉筒37中的垂直槽49,以切削被夹持的组织。发射栓14与长通道16和砧板18间的确定位置可以确保有效的切削。
带有选定的储钉筒缝隙的弧形砧板(Cambered anvil with selected cartridge gap)
E形梁发射栓14提供的确定的纵向间距与内窥镜装置有限的空间相适应。而且,E形梁发射栓14可以组合显示与图5中位置相似的远端垂向缺陷的拱形的砧板16。甚至对为适应内窥镜装置有限尺寸而减少厚度的砧板16,拱形的砧板16也可以有利的帮助达到端部动作器12中预期的空隙。
E形梁发射栓14还可射出更多的钉,利用不同的储钉筒。例如,医师可选择能产生0.02mm组织间隙的灰色储钉筒,产生0.04mm组织间隙的白色储钉筒,产生0.06mm组织间隙的蓝色储钉筒,或者产生0.10mm组织间隙的绿色储钉筒。每一个储钉筒的垂向高度和钉的长度一起连同整个楔形滑板(下文详述)预先确定了组织的期望厚度,同时砧板18被E形梁发射栓14固定在垂直方向的合适位置上。
双轴手柄(Two-Axis Handle)
参见图6-9,手柄部分20包括由聚合材料,例如玻璃填充的聚碳酸酯铸模而成的第一和第二基部50和52。第一基部50上设有许多柱形销54。第二基部52包括许多各个具备六角形开口58的延伸单元56。柱形销54容纳于六角形开口58中,两者之间的摩擦力使第一和第二基部50和52保持在装配中的位置。
旋钮60具有一个完全贯通的钻孔62,以便与执行部件22啮合并使其绕纵轴旋转。旋钮60包括一个至少伸进钻孔62一部分的向内的凸台64。凸台64容纳于闭合套32近端部分形成的纵向槽66中,以使旋钮60的旋转带动闭合套32的转动。显然,凸台64在框架34中进一步延伸,并和发射驱动器36的一部分接触,以使两者转动。因此,端部动作器12(图6-9中未示出)随着旋钮60而转动。
框架34的近端68从近处贯穿旋钮60,并设有与分别从基部50和52延伸的反向通道紧固件72啮合的环槽70。图中只示出了第二基部52的通道紧固件72。从基部50,52延伸的通道紧固件72使框架34紧固在手柄部分20上,使得框架34不会相对于手柄部分20纵向移动。
闭合扳手26包含手柄部件74、传动部件76和中间部件78。钻孔80穿过中间部件78。从第二基部52延伸出的柱状支撑件82穿过钻孔80,以把闭合扳手26轴向固定在手柄部分20上。从第二基部52延伸出的柱状支撑件83穿过发射扳手28的钻孔81,以把发射扳手26轴向固定在手柄部分20上。柱状支撑件83内设有六角开口84,以容纳由第一基部50延伸出的紧固销(未示出)。
闭合轭架86罩于手柄部分20中以在其中往复运动,并用于在闭合扳手26和闭合套32之间传递运动。由第二基部52延伸出的支撑件88和由闭合轭架86中的凹槽89延伸出的紧固件72共同支撑手柄部分20中的闭合轭架86。
闭合套32的近端90设有嵌入闭合轭架86远端96处凹槽94内的凸缘92。闭合轭架86的近端98具有与闭合扳手26的传动部件76啮合的齿条100。当闭合扳手26移向手柄部分20的枪柄24时,闭合轭架86以及闭合套32向远处移动,压缩就近偏向闭合轭架86的弹簧102。如下面要讨论的,闭合套32向远处的移动导致砧板18轴向远移到端部动作器12的长通道16,并且就近移动造成闭合。
与发射扳手28的接合表面128相互作用的前表面130使得闭合扳手26向前偏至发射状态。绕销106轴向上移至手柄部分20后部的第一夹钩104制止发射扳手28向枪柄24移动,直到闭合扳手26受夹持处于关闭状态。钩104通过啮合发射扳手28中的锁定销107限制发射扳手28的移动。钩104还与闭合扳手26相接触。特别是,钩104向前的突起108与闭合扳手26的中间部件78上的部件110啮合,部件110由钻孔80向外延伸到操作部件74。钩104偏向接触闭合扳手的部件110并通过弹簧112与发射扳手28中的锁定销107啮合。按下闭合扳手26时,钩104上移至后部,同时压缩钩104的后部突起114和松开键30的前部突起116之间布置的弹簧112。
当轭架86响应闭合扳手26的近移而远移时,松开键30的上闩臂118沿着轭架86的上表面120移动,一直到落入处于轭架86近端下部的向上布置的沟槽122中。如图8,弹簧112把松开键30推出,使上闩臂118向下轴向旋转与向上的沟槽122啮合,以此把闭合扳手26锁定在组织夹持状态。
把松开键30向内按可使得闩臂118从沟槽122中移出,以松开砧板18。具体而言,上闩臂118绕第二基部52的销123轴向上移。之后轭架86可以响应于闭合扳手26的回移向远处移动。
发射扳手恢复弹簧124布置在手柄部分20中,其一端与第二基部52的销106相连,另一端与发射扳手28的销126相连。发射灰复弹簧124对销126施加一个回复力,以把发射扳手28向偏离手柄部分20的枪柄24的方向移动。使发射扳手28的接合面128偏向闭合扳手26的前表面130也使得闭合扳手26偏离枪柄24。
闭合扳手26向枪柄24移动时,闭合扳手的前表面130与发射扳手的接合表面128啮合,使得发射扳手28处于“发射”位置。处于发射位置时,发射扳手28与枪柄24成约45度角。钉发射后,弹簧124把发射扳手28恢复到初始位置。在发射扳手恢复移动过程中,其接合表面128按向闭合扳手26的前表面130,使得闭合扳手26恢复到初始位置。由第二基部52延伸的限制器132阻止闭合扳手26转离初始位置。
外科钉合和切割器械10还包括往复部件134,倍增器136和驱动器138。往复部件134由执行部件22(图6-9中未示出)中的楔形滑板和金属驱动棒140组成。
驱动器138包括第一和第二齿条141和142。第一沟槽144位于第一和第二齿条141和142之间的驱动器138上。在发射扳手28往复移动过程中,发射扳手28上的齿146与第一沟槽144啮合,以在钉发射后把驱动器138恢复至其初始位置。第二沟槽148位于金属驱动棒140的近端,用以把金属驱动棒140锁定在处于未发射状态的松开键30的上闩臂118上。
倍增器136包括第一和第二一体式小齿轮150和152。第一一体式小齿轮150与金属驱动棒140上的第一齿条154啮合。第二一体式小齿轮152与驱动器138上的第一齿条141啮合。第一一体式小齿轮150具备第一直径,第二一体式小齿轮152具备小于第一直径的第二直径。
图6、8和9分别描绘了处于初始(打开并未发射)状态、夹持(合上并未发射)状态和发射状态的手柄部分20。发射扳手28具备齿部156。齿部156与驱动器138上的第二齿条142啮合,这样发射扳手28的运动使得驱动器138在图8所示的第一驱动位置和图9所示的第二驱动位置之间来回运动。为防止组织夹持之前钉发射,松开键30上的上闩臂118与驱动器138上的第二沟槽啮合,从而如图6所示金属驱动棒被锁定在最近的位置。当上闩臂118落入沟槽122中时,如图9所示上架臂118不与第二沟槽148啮合,使得金属驱动棒140向远处移动。
因为驱动器138上的第一齿条141和金属驱动棒140上的齿条154与倍增器136啮合,发射扳手28的移动使得金属驱动棒140在图8中的第一往复位置与图9中的第二往复位置之间往复运动。由于第一小齿轮150的直径大于第二小齿轮152的直径,倍增器136移动往复部件134的距离大于发射扳手28移动驱动器138的距离。第一和第二小齿轮150和152的直径可以变化,以使发射扳手28的行程和移动发射扳手28所需的力变化。
显然,手柄部分20是示意性的,并可采用其它传动机构。例如,可以通过自动装置来实现闭合和发射。
分别进行闭合和发射的端部动作器
图10-16详细描述了外科钉合和切割装置10的端部动作器12。如上所述,手柄部分20分别进行发射端部动作器12的闭合和发射。端部动作器12最好可以分别进行闭合和发射(即钉合和切割)。此外,端部动作器12有这种能力,确保在医师定位和夹持组织后的发射过程中保持闭合位置。通过在组织被夹持部分不足时确保足够的空间以及在过多的组织被夹持时增强夹持的方式这两个特征在程序上和结构上增强了外科钉合和切割器械10的能力。
图10示出端部动作器12,其中缩回的闭合套32使得端部动作器12处于打开状态,储钉筒37安装在长通道16中,因而端部动作器12处于发射位置。在砧板18的一个下表面200上,许多钉合槽202(stapling forming pocket)排列成与储钉筒37的上表面206的许多储钉筒口204对应。发射栓14位于其近处位置,这时上销38以不干扰的方式与砧板凹穴40对齐。砧板凹穴40如图所示与砧板18中的纵向砧板槽42相通。发射栓14远处的切削沿48与储钉筒37的垂向槽49对齐并从中凸出来,因而使得能够取走用尽的储钉筒并插入未发射的卡入纵向通道16的储钉筒。具体而言,储钉筒37的伸展部分208、210与长通道16的凹槽212、214(图12所示)啮合。
图11为外科钉合和切割器械10的执行部件22的分解图。所示的储钉筒37由筒体216、楔形滑板218、单双驱动器220、钉222和筒托盘224组成。组装后筒托盘224支撑楔形滑板218、单双驱动器220和筒体216中的钉222。
具有与储钉筒37为一体的楔形滑板218与把凸轮系统表面组合在发射栓上相比有更多种灵活的设计选择。例如,可以选取许多不同的储钉筒用在装置10上,而每个储钉筒具备不同的钉排列方式,这样每个储钉筒具备独特的楔形滑板,其形状使得可在驱动钉222的同时与发射栓14的中销46接触。另如,一体的楔形滑板218提供了采用多种锁定特征的机会,这一点在前述的第一、三个待审申请中有更详细的论述。
长通道16具有容纳框架34的通道锚固部件228的附着腔226,以使端部动作器12和手柄部分20相连。长通道16还具有轴向容纳砧板18的砧板轴232的砧板凸轮槽230。包围框架34的闭合套32包括与近处的砧板部件236啮合但远离砧板18的砧板轴232的远处的键234,从而使得砧板18发射和闭合。如图所示发射驱动器36如图所示由销240与附着于发射连接器238的发射栓14组装在一起,发射栓14然后旋转、就近连接在金属驱动棒140上。发射栓14由插在框架远端的槽轨239导向。
特别参见图12,拆除部分储钉筒37,以显示诸如刻槽212、214的长通道16部分和未发射状态下的储钉筒37的一些组成部件。特别是,拆除储钉筒体216(如图11所示)。图12显示出当推进块242接触发射栓14的中销46(图12中未示出)时处于近处未发射位置的楔形滑板218。楔形滑板218处于与筒托盘224上部接触纵向滑动状态,并包括当楔形滑板218远移时把单双驱动器220上推的楔子218。支于驱动器220上的钉222(图12未示出)也被上推,与砧板18上的砧板成形凹穴202接触,以形成闭合的钉。图中还描述了长通道16中与储钉筒37中的垂向槽49对齐的通道槽45。
图13示出图12中的端部动作器12,其中省略全部储钉筒37,以显示发射栓14的中部销钉46,省略长通道16靠近通道槽45的部分,以显示发射栓帽45。此外,省略部分轴23以显示发射栓14的近部。自轴附近的砧板18向下突起的一对反向组织限制器244在夹持过程中防止组织向上进入端部动作器12得过多。
图14示出发射栓14未发射时在组织夹持位置的闭合的端部动作器12。上部销钉38处于砧板凹穴40中,与砧板槽42垂直对齐,以在发射时向远处纵向移动发射栓14。中部销钉46定位成向远处推动楔形滑板218,从而使得楔子228依次接触并提升双驱动器220和各条钉222,使之呈与砧板18低表面200中的钉成形凹穴202相接触状态。
图15示出储钉筒37的上表面206,其中发射栓14处于未发射、近处位置。储钉筒开口204布置在储钉筒37中的垂直向通道槽49的每一侧。
图16描绘了轴附近的端部动作器12,显示了具备反斜面246部件的长通道16,其与砧板18(图中未示)的组织限制器244组合用于防止组织挤塞端部动作器12。图中还详细描述了双驱动器220及其与钉222的关系。
外科钉合和切割装置的操作
使用时,外科钉合和切割装置10的使用如图1、2和17-23所示。图1-2所示的装置10处于开始状态,有一个未发射的,满负载的储钉筒37卡入在长通道16的远端。扳手26、28都向前,端部动作器12发射,例如把端部动作器12通过套管针或其它开口插入体腔后这样的典型状态。如图17所示,随后医师操纵装置10,以使将进行钉合和切割的组织处于储钉筒37和砧板18之间。
参照图18-19,然后医师近移闭合扳手26,直到处于与枪柄24直接相邻的位置,同时把手柄部分20锁定为闭合夹持状态。回缩端部动作器12中的发射栓14并不阻碍端部动作器12的开与关,而是留在砧板凹穴40中。砧板18闭合夹持时,E形梁发射栓14对齐,以穿过端部动作器12发射。特别是,上销38与砧板槽42对齐,并通过中销46和发射栓帽44确保长通道16与通道槽45啮合。
参照图20-21,夹持组织后,医师把发射扳手28移近,使得发射栓14向远处移向端部动作器12。特别是,中销46穿过发射驱动槽47进入储钉筒37,以通过对着砧板18的楔形滑板218使钉222(图20-21未示出)发射。最低销钉或发射栓帽44与中销46配合滑动定位发射栓14的切削沿48,以切割组织。两销44、46还在砧板18的纵向砧板槽42中定位发射栓14的上销38,以确保维持在向其远处发射移动的整个过程中砧板18和长通道16之间的空间。
参照图22-23,医师继续移动发射扳手28直到靠近闭合扳手26和枪柄24。因而,钉222的所有端头由于和砧板18接合而弯曲。发射栓帽44止于伸向通道槽45远端的发射栓止动块250处。切削沿48完全横跨组织。松发射射扳手28然后按下松开键30,同时压下闭合扳手26以打开端部动作器12,整个过程结束。
缺少/用尽储钉筒时的单锁
如上所述,E形梁发射栓14在切开组织和在切口的每一面成形钉的同时定位端部动作器12方面具备特有的能力。参照图24,阻止发射栓14向远处移动就防止了无意间切割组织。单锁机构270优选通过阻碍发射栓的中销46(图24中只显示了发射栓的中销)响应于储钉筒37缺少或图24中描述的储钉筒37用尽的情况。
特别的,单锁机构270表现为处于长通道16中的一对弯曲的弹簧爪272,以响应于两种情况:储钉筒缺少和储钉筒用尽。特别的,当例如移走储钉筒37或已经发射储钉筒37而没有楔形滑板218(图24为示出)时,弯曲的弹簧爪272上升挡住发射栓14的中销46。
图25-28依次描绘了当外科钉合和切割装置10发射时的单锁装置270,具体而言指的是弯曲的弹簧爪272。在图25中,随着楔形滑板218按下弯曲的弹簧爪272,未发射的储钉筒37插入长通道16中,从而使得储钉筒37和长通道16之间的发射驱动槽47畅通。
图26中,储钉筒37开始发射后,楔形滑板218和发射栓14的中销46横向远离弯曲弹簧爪272,弹簧爪然后弹入发射驱动槽47中。
图27中,楔形滑板218完全驱离至远处不再示出,储钉筒37用尽。发射栓14向近处回缩。由于弯曲的弹簧爪272绕一个更远点旋转,发射栓14可以在回缩中绞跨在弯曲弹簧指272上,使两者从发射驱动槽47中按出。
图28中,发射栓14完全回缩碰到一对未受压的弯曲弹簧爪272,以防止其远移。单锁机构270由此被发射,并在移走用尽储钉筒的过程中一直保持发射状态,直到安装未发射的储钉筒37。
图29描绘了为增强机械强度而优选包括在单锁机构270中的锁道274。一些应用中,为避免损坏弯曲的弹簧爪272而防止强烈的发射是有益的。弯曲弹簧爪272未按下时,锁道274和发射槽相通。而且,锁道274朝下向远处倾斜,这样发射栓14的中销46指向锁道274远端处的相邻表面276,以此使发射栓14向远处移进长通道16′中。特别是,起始位置处的发射栓14移向以14′表示的远处较低位置,其中中销46移向以46′表示的位置。显然,分别移向远处较低位置38′和44′的上销38和下发射栓帽44把中销46定位成朝向长通道16,以使中销46进入锁道274。
还可以理解,发射栓14′可从锁道274轻易回缩。而且,就上销38′可在此位置与砧板18(图29中未示出)啮合而言,医师必须回缩发射栓14′,从而可打开砧板18而插入未发射的储钉筒37,这样发射栓14可完全回缩,而且不会阻碍把弯曲的弹簧爪272按向未激发的位置。
图30描绘了另一种单锁机构270,这里描述为一对锁钩280,其相对于通过开口286插入长通道16中的附着装置284而言的远端为斜端头282的,。斜端头282位于长通道16中的钩槽288上。因此,当未发射的储钉筒37(图30中未示出)的楔形滑板218接触每一个斜端头282时,斜端头282被按入钩槽288中,从而为发射栓14(图30只示出了中销)的中销46远移以发射储钉筒37铺平道路。如图示,为弹性回应于楔形滑板的去掉,细轴290使附着装置284分别与每一个锁钩280的斜端头282匹配,在,此处斜端头282恢复至阻止驱动槽47发射,从而阻碍发射栓回缩的中销46。
图31-34描述了锁钩280的操作顺序。图31中,储钉筒37未发射,因而布置在远处的楔形滑板218把斜端头282按入钩槽288中,这使得如图32所示,发射栓14的中销46可在发射时远移。随着楔形滑板218和中销46相对于单锁装置270远移,斜端头282从钩槽282中弹出并占据发射驱动槽47。
图33中,发射栓14缩回到与锁沟280的斜端头282接触的那一点。由于斜端头282的远端低于斜端头282的近端,发射栓14的中销46停留在斜端头282上,如图34所示,促使斜端头进入钩槽288中,直到中销46经过斜端头282,其中斜端头282弹回以阻止中销46。因此,当以未发射的储钉筒替换用尽的储钉筒37时,发射栓14受阻不会向远处移动。
尽管通过几个实施例阐述了本发明并详细介绍了实施例,但申请人并不打算以任何方式用这些详细描述来限定所附的权利要求。其余的优点和改动对本领域技术人员而言是显然的。
例如,单锁机构可以由装载弹簧的位于长通道16中的塞子组成,此塞子在因楔形滑板218而不与钩状或其它的塞子接触时向上移动进入发射驱动槽47中。
Claims (8)
1、一种外科器械,包括:
设置成可产生发射作用的手柄部分;
连接到手柄部分的长通道;
枢轴连接到长通道的砧板;
与长通道连接的钉装置,该钉装置包括许多钉驱动器和布置在钉装置远处的楔子部件,使钉驱动器移向砧板;
响应于发射把楔子部件远移的发射装置;
由布置在近处的楔子部件禁止其动作的锁定装置,该锁定装置可操作地构造成以防止发射装置远移。
2、如权利要求1所述的外科器械,其中钉装置包括一个可替换的装置。
3、如权利要求1所述的外科器械,其中钉装置包括一个发射驱动槽,发射装置的至少一部分穿过该发射驱动槽,以驱动楔子部件,锁定装置从长通道弹性凹进该发射驱动槽。
4、如权利要求3所述的外科器械,其中锁定装置具有发射驱动槽中的斜面,该斜面倾斜于长通道。
5、如权利要求4所述的外科器械,其中锁定装置包括朝向近处的弹簧爪。
6、如权利要求5所述的外科器械,其中长通道包括弹簧爪下的用于接纳发射装置一部分的沟槽。
7、如权利要求4所述的外科器械,其中锁定装置包括一个弹簧偏置塞。
8、如权利要求4所述的外科器械,其中锁定装置包括一个弹性连接到长通道的斜钩。
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US10/687,503 US7380695B2 (en) | 2003-05-20 | 2003-10-15 | Surgical stapling instrument having a single lockout mechanism for prevention of firing |
US10/687503 | 2003-10-15 |
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US (1) | US7380695B2 (zh) |
EP (1) | EP1523944A1 (zh) |
CN (1) | CN1606968A (zh) |
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Also Published As
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BRPI0406039A (pt) | 2005-06-28 |
US7380695B2 (en) | 2008-06-03 |
CA2485021A1 (en) | 2005-04-15 |
CA2485021C (en) | 2012-07-10 |
US20050023324A1 (en) | 2005-02-03 |
AU2010241206B2 (en) | 2012-03-22 |
AU2010241206A1 (en) | 2010-11-25 |
EP1523944A1 (en) | 2005-04-20 |
AU2004220721A1 (en) | 2005-05-05 |
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