CN1636525A - 具有支撑触发杆的转动关节支撑板的外科钉合装置 - Google Patents
具有支撑触发杆的转动关节支撑板的外科钉合装置 Download PDFInfo
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- 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
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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
- A61B17/00234—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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
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- A—HUMAN NECESSITIES
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- 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
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2933—Transmission of forces to jaw members camming or guiding means
- A61B2017/2937—Transmission of forces to jaw members camming or guiding means with flexible part
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2939—Details of linkages or pivot points
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2943—Toothed members, e.g. rack and pinion
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2947—Pivots
Abstract
一种特别适合用于内窥镜检查的钉合和切割装置由具有从把手部分转换转动动作的带齿轮的铰接机构连接端部受动器。触发杆在把手部分和端部受动器之间平移。为了提供不失真的切除边缘和接合零件到端部受动器的相对的钳,触发杆加厚。触发杆也有利地包括以通过铰接机构弯曲性的条或带的形式的变薄的或锥形的近端部分。为了防止触发时触发杆弯曲,有一对支持板可调整的通过铰接机构安装在触发杆带的侧面。已经示出了支撑板的各端部与铰接机构的近端侧面弹性和弹簧接合的各种形式,也可以是弹性支撑板。
Description
参照申请
本发明涉及四个与本申请日同一天提交的共同未决和共同拥有的申请。各申请的公开整体在此作为参考,这四个申请名称分别是:
(1)Frederick E.Shelton IV,Mike Setser,和Bruce Weisenburgh申请的“带有锥形触发杆用以增大转动的弯曲度的外科钉合装置”;
(2)Douglas B.Hoffman申请的“带有用于触发杆轨道的转动接头的钉合装置”;
(3)Kenneth.S.Wales Douglas B.Hoffman,Frederick.E.Shelton IV,和JeffSwayze申请的“带有可沿纵轴旋转的外科装置”;和
(4)Kenneth.S.Wales申请的“带有转动侧向移动控制的外科装置”。
技术领域
本发明涉及一种外科钉合装置(surgical stapler instruments),该外科钉合装置在组织上施加钉线,从而能够在那些钉线(staple lines)之间切开组织,本发明还涉及钉合装置的改进以及具有铰接杆的钉合装置的构成方式的改进。
背景技术
较小的切口可以减少手术后恢复时间和并发症,因此,相比传统的外科切割装置,人们宁愿使用内窥镜(endoscopic)外科装置。因此,内窥镜外科装置领域得到显著的发展,外科装置可以将远端部受动器精确放置在适当的手术位置上,远端部受动器与套管针套管相连。这些远端部受动器以许多方式处理组织,以实现诊断和治疗效果(例如,内部刀具、抓紧器、刀具、钉合装置、夹填充器、通道装置、药物/基因治疗传递装置、和使用超声、射频RF、激光等的能量装置。
定位端部受动器受套管针的限制。通常这些内窥镜检查外科装置包括端部受动器和由医生操作的把手部分之间的长杆,该长杆能够插到所需深度,并且绕杆的纵轴转动,从而将端部受动器定位到一定度数。随着套管针的明智布局和抓紧器的使用,例如通过另一套管针,通常这种定位的量是足够的。外科钉合和切割装置,例如在美国专利号5,465,895中所述的是通过插入和转动成功定位端部受动器的内窥镜外科装置的例子。
依据操作的性质,希望进一步调整内窥镜检查外科装置的端部受动器的位置,而不限于插入和转动。特别地,希望将端部受动器放置成横向于外科装置的杆的纵轴上。端部受动器相对装置的杆的横向移动按照惯例称为“转动(articulation)”。这种转动定位允许医生更容易地在一些情况下处理组织。另外,转动定位有利地允许内窥镜定位在端部受动器后,不由外科装置的杆防碍。
当前述非转动钉合和切割装置具有很大效用,并且可以在许多外科过程中成功使用,需要提高它们连接端部受动器的能力的操作,从而使它们在使用时提供更大的临床灵活性。可转动的外科装置一般使用一个或多个触发杆,这些触发杆在装置轴内纵向移动,并以从筒中激发钉,切割最里面的钉线之间的组织。这些外科装置的一个共同的问题是转动接头触发杆的控制。在转动接头处,端部受动器在纵向上远离该杆,以使转动连接时,端部受动器和杆不会碰撞。这个沟必须要填充支撑材料或结构,以当单一或多个触发杆受到纵向触发负载时,防止触发杆弯曲脱离接头。人们需要的是通过转动接头导向和支撑单一或多个触发杆,并且当端部受动器连接时转动接头弯曲。
美国专利号5,673,840中描述了一种弹性或塑料材料形成的可以弯曲的转动接头,该材料在可弯曲接头或“弯曲颈”弯曲。触发杆通过弯曲颈内的中空管支撑和导向。弯曲颈是咬合关闭装置的一部分,并且当咬合在组织上关闭时,该弯曲颈可以相对于端部受动器,杆和触发杆做纵向的运动。然后,当触发钉合和切割组织时,触发杆在弯曲颈内纵向移动。
美国专利号US5,797,537中描述了一种绕栓转动的的转动接头,优于在弯曲接头周围弯曲。在这个装置中,触发杆在一对隔开的支撑板之间支撑,该支撑板一端连接杆,另一端连接端部受动器。两个连接中的至少一个是可滑动连接。支持板贯穿靠近转动平面中的可弯曲驱动部件的转动接头,从而当尖端在一个方向从其排列位置连接时,支撑板通过转动平面中的沟弯曲,并且可弯曲触发杆靠着该支撑板弯曲。美国外科专利号6,330,965教导了支持板的使用,该支撑板与杆固定连接,并且可与端部受动器滑动连接。
尽管已知的支撑板通过转动接头导向,但是相信其性能可以提高。例如,在触发时为了保证有足够的动力来有效地切开组织,经常要求触发杆能够急剧的加速。刚性连接的支持板在响应上比较直接,允许触发杆迅速的从转动接头射出。作为另一个例子,在设计上要求设备能在无论是否使用转动的情况下,都按照同样的方式运作。如果需要施加变化的触发力,连接时增加摩擦力会给医生造成不便和使术者分心。
所以,对外科装置机构改进铰接机构存在明显需要,该外科装置机构通过转动接头提高对触发杆的支撑。
发明内容
本发明克服了上述的和先前技术的其它缺陷,提供一个可转动的外科装置(articulating surgical instrument),该装置带动端部受动器,一纵向传送触发机构最好由侧面支撑板(flanking support plate)穿过铰接机构支撑。为了更好的响应触发机构上的发射负载,每个支持板的一端或者多端都以弹性或弹簧接合到铰接机构的一侧上,这样还可以避免触发机构弯曲。
本发明的一方面中,外科装置具有一个产生转动动作(articulation motion)和触发动作(firing motion)的操纵把手,这两个动作都通过杆传递到铰接机构。该铰接机构响应弯曲动作,使端部受动器从杆的纵轴转动。触发机构响应触发动作,并且为移动通过铰接机构和端部受动器耦合。一对支撑板跨越转动位于触发机构侧面,每个支撑板包括弹性地接合到转动系统中形成的框架槽内的端部,用来辅助防止脱离铰接机构的触发机构弯曲。这样,各种制动的诊断或治疗作用的端部受动器可以整合入可转动的外科装置中,而不会在可转动的机构弯曲,即使触发力非常高和减小用于内窥镜的组件尺寸。
发明的另一个方面,外科装置具有用来产生触发动作、关闭动作和转动动作把手部分,各动作都通过杆带动。与杆远端连接的可转动的机构响应转动动作绕轴转动端部受动器。端部受动器包括与直杆耦合的伸长通道,绕轴转动地耦合伸长通道并响应来自杆的关闭动作的砧板(anvil)。触发机构具有伸长通道和砧板间纵向容纳的远端存在的切除边缘。铰接机构通过响应转动动作的杆绕轴转动伸长通道。一对支撑板位于触发机构的两侧,跨过铰接机构,每个支撑板包括弹性地接合到转动系统中形成的框架槽内的端部。从而,改进的钉合和切割装置可以结合当连接时即使抵抗高触发负载,也不会导致触发力明显增加的触发装置。
本发明的这些和其它目的和优点将通过附图和说明书描述。
附图说明
与说明书结合并且是说明书的一部分,并且同上述本发明的基本描述一起的附图描述了本发明的实施例,并且实施例的详细描述将在下面给出,提供对本发明原理的解释。
图1为可转动的外科装置的非转动状态的透视图。
图2为可转动的外科装置的转动状态的透视图。
图3为图1、2的可转动的外科装置的打开的端部受动器的透视图。
图4为图1所示的外科器械的图3的端部受动器的截面侧视图,这一部分通常是沿图3上的线4-4露出钉筒部分,但是也示出了沿纵向中心线的触发杆。
图5为图4所示的端部受动器在触发杆完全触发后的侧视图。
图6为图1所示的包括转动控制的外科装置的近端的把手部分的截面侧视图。
图7为图1所示外科装置近端的把手部分的透视分解图。
图8为图1的外科器械的把手部分的远端部分从右侧向下,向前的透视图,该装置部分切除以显示转动控制机构。
图9为图8的把手部分的远端部分从右侧向上,向后的透视图,该装置部分切除以显示转动控制机构,并且具有分解的转动控制旋钮。
图10为去除了触发和框架部分的图1的外科装置的齿轮管铰接机构的顶部透视图。
图11为包括齿轮管铰接机构的图1的外科装置的器械部分的透视分解图。
图12为图11正齿轮铰接机构的截面顶视图。
图13为现有技术的转动支撑板的截面顶视图。
图14为图13的转动支撑板在转动状态的截面顶视图。
图15为图1所示的外科装置的支撑板的截面顶视图,支撑板连接到弹簧和有单一自由端。
图16为图1外科装置的支撑板的截面顶视图,支撑板连接到弹簧和有单一自由端。
图17为图1所示的外科装置的支撑板的截面顶视图,支撑板组件具有弹簧指状物和单一自由端。
图18为图17的有弹簧指状物和单一自由端的支撑板的透视图。
图19为图1的外科装置的支撑板的截面顶视图,支撑板连接到弹簧且有双自由端。
图20为图1的外科装置的支撑板的截面顶视图,支撑板连接到弹簧且有双自由端。
图21为图1所示的外科装置的支撑板的截面顶视图,支撑板有弹簧指状物耦合和双自由端。
图22为图1所示的外科装置的弹性支撑板的截面顶视图。
图23为图1所示的外科装置的一对支撑板的分解透视图,支撑板与触发杆轴承连接。
图24为低摩擦支撑板460、462的分解图。
具体实施方式
参考附图,在图中相同的附图标记表示相同的组件,图1-3示出了一种外科装置,在描述的实施例中,该外科装置指的是一种外科钉合和切割装置10,该外科装置能够实现本发明的独特优点。具体地,外科钉合和切割装置10的尺寸可被调整,以便在为病人进行手术时,将如图1所示的非转动状态的外科钉合和切割装置插入到手术位置。如图2所示,一旦铰接机构11和远端连接的端部受动器12通过套管通道插入,铰接机构11就可以由转动控制器13进行遥远转动。从而,端部受动器12可以到达器官后面,或根据需要从一角度接近器官。例如,触发机构示出为E梁触发杆14(由图3中所示),E梁触发杆14切割被夹住的组织,并接合长通道16和枢轴连接的砧板18。
外科钉合和切割装置10包括连接到器械部分22的把手部分20,该器械部分还包括铰接机构11中远端终止的杆23和端部受动器12。把手部分20包括手枪式握把24,其中医生以绕枢轴转动的方式朝握把24握紧关闭扳机26,使扳机朝端部受动器12的长通道16夹紧或关闭。触发扳机28在关闭扳机26的更外侧,并且由医生以绕枢轴转动的方式握紧,而使在端部受动器12夹住的组织钉合和切割。其后,按下释放按钮30以释放夹住的器官。
杆23的最外面的关闭套32响应关闭扳机26纵向地平移,以绕枢轴转动地关闭砧板18。特别地,关于铰接机构11的关闭套32的远端部分、或关闭环33由器械部分22(在铰接机构11部分可见)的框34间接支撑。在铰接机构11上,关闭套32的近端部分或关闭管35与远端部分(关闭环)33相通。框34通过铰接机构11可弯曲的连接到长通道,使得能够在一个平面中连接。框34还纵向滑动的支撑触发驱动部件36,该元件从触发扳机28到触发杆14连通触发动作。图3中仅示出了触发驱动部件36的触发杆14,但是有关触发驱动部件36的各种控制铰接机构11的各种形式,在下面会更详细地描述。
应当意识到,术语“近端”和“远端”在这里指的是相对医生握住装置把手的位置。因此,端部受动器12是远的而把手部分20是近的。还应当意识到,为了方便和清楚,在这里关于附图使用有关空间的术语,如“垂直的”和“水平的”。然而,外科手术装置用于许多的方向和位置,这些术语并不应受到限制。
E梁触发杆(E-Beam Firing Bar)
图3-5示出了采用E梁触发杆14以实现许多功能的端部受动器12。在图3中,触发杆14在近端定位,允许未用完的钉盒37安装在长通道16中。特别是,触发杆14的上部栓38位于一凹进内,凹进示出为板袋40,它允许砧板18可以被重复打开和关闭。如图4所示,随着端部受动器关闭,通过使上部栓38进入纵向的砧板槽42,使触发杆14前进与砧板18接合。最低的栓,或触发杆帽44通过使触发杆14贯穿通道槽45而接合长通道16的较低表面。中间栓46滑动地接合长通道16的上表面,与触发杆帽44共同作用。因此,在触发时,触发杆14肯定分隔端部受动器12,从而可以解决当夹紧小量组织时收缩(pinching)的问题和当夹紧太多组织时钳变形的问题。
在触发时,在触发杆的上部栓38和中间栓46之间的存在于远端的切除边缘48进入存在于近端的钉盒37的垂直槽49,钉盒37和砧板18之间夹住的被切割的组织。如图4所示,中间栓46通过进入钉盒37内的触发槽促动钉盒37,以驱动楔形橇41向上进入与钉驱动器43接触的凸轮系统,该钉驱动器43反过来驱动在钉盒37内的钳孔51外面的多个钳47,以在砧板18的内表面上形成与袋53的接触。图5示出了在完成切割和钉组织后,触发杆14完全向远端平移。
两轴把手(Two-Axis Handle)
参考图6-7,把手部分20由第一和第二基底部件(base section)50和52组成,这两个基底部件由聚合材料,例如玻璃填充聚碳酸酯(glass-filledpolycarbonate)模制。第一基底部件50配有许多圆柱形栓54。第二基底部件52包括许多伸长部件56,各具有六边形开口58。该圆柱形栓54容纳在六边形开口58中,并且通过摩擦力保持在此,用于保持第一和第二基底部件50和52的结合。
壳体帽60具有通孔62,用于接合器械部分22并使其绕纵轴转动。壳体帽60包括沿通孔62的至少一部分延长的向内突出的凸台64。该凸台64容纳在纵向槽66中,该纵向槽在关闭套32的近端部分形成,从而壳体帽60的转动产生关闭套32的转动。可以意识到凸台64进一步贯通框架34,并与触发驱动部件36的一部分接触,从而也实现它们的转动。因此,端部受动器12(图3-4中未示出)随壳体帽60转动。
框架34的近端68穿过壳体帽60,并且设置有圆周槽70,该圆周槽通过相应从基底部件50和52延伸的槽形固定部件72被接合。图中仅示出了第二基底部件52的槽形固定部件72。该槽形固定部件72从基底部件50、52伸出,用于将框架34固定到把手部分20,从而该框架34不会相对把手部分20纵向移动。
关闭扳机26具有把手部件74、齿轮部件76和中间部件78。孔80贯通中间部件78。为了以绕枢轴转动的方式在把手部分20上安装关闭扳机26,从第二基底部件52延伸的圆柱支撑部件82穿过该孔80。从第二基底部件延伸的圆柱支撑部件83穿过触发扳机28的孔81,用于以枢轴转动的方式将其安装在把手部分20上。在圆柱支撑部件83中设有六边形开口84,用于容纳从第一基底部件50延伸的固定栓(未示出)。
关闭轭86嵌在把手部分20内,用于在其中往复移动,并且该关闭轭提供从关闭扳机26到关闭套32的平移。从第二基底部件52延伸的支撑部件88和固定部件72在把手部分20内支撑该轭86,该支撑部件延伸贯通轭86中的凹槽89。
关闭套32的近端90配有凸缘92,其咬合装配在轭86的远端部96中形成的接收凹槽94内。轭86的近端98具有齿轮架100,其通过关闭扳机26的齿轮部件76进行接合。因此,当关闭扳机26向把手部分20的手枪式柄24移动时,轭86和关闭套32向远端移动,同时压缩将轭86向近端偏移的弹簧102。如下所述,关闭套32的离心运动实现了砧板18向远端并且向端部受动器12的伸长通道16的绕枢轴的平移,并且该关闭套的近端移动实现砧板的关闭。
通过与触发扳机28的接合表面128相互作用的前表面130,关闭扳机26向前偏移(forward biased)到打开位置。夹紧第一钩104,第一钩104在把手部分20中绕栓106从顶部旋转到后面,限制触发扳机28向手枪式柄24的移动,直到关闭扳机26夹住到其关闭位置。该钩104通过接合触发扳机28中的锁定栓107来限制触发扳机28的动作。该钩104也与关闭扳机26接触。特别是,该钩104的前突出108在关闭扳机26的中间部件78上接合部件110,接合部件110位孔80外,朝向把手部件74。钩104向接触关闭扳机26的部件110的方向偏移,并且通过释放弹簧112接合触发扳机28中的锁定栓107。当压下关闭扳机26时,该钩104从顶部向后面移动,压缩释放弹簧112,该弹簧在该钩104上的向后突出114和释放按钮30上的向前突出116之间捕获。
当轭86响应关闭扳机26的近端移动而向远端移动时,释放按钮30的上部闩臂118沿轭86上的上表面120移动,直到落入在轭86近端的,较低部分中的向上存在的凹槽122中。释放弹簧112促使释放按钮30向外,该按钮绕上部闩臂118向下转动到与向上存在的凹槽122接合,从而在组织夹住位置锁定关闭扳机26。
通过向内推释放按钮30,闩臂118可以移出凹槽122,以释放砧板18。特别是,上部闩臂118绕第二基底部件52的栓123向上转动。然后,允许轭86响应关闭扳机26的返回移动而向近端移动。
触发扳机返回弹簧124定位在把手部分20内,该弹簧的一端连接到第二基底部件52的栓106,另一端连接到触发扳机28上的栓126。为了将触发扳机28在远离把手部分20的手枪式柄24的方向偏移,触发返回弹簧124向栓126施加返回力。通过偏移关闭扳机26前表面130的触发扳机28的接合表面128,关闭扳机26也远离手枪式柄24偏移。
当关闭扳机26向手枪式柄24移动时,其前表面130与触发扳机28上的接合表面128接合,导致触发扳机28移动到其“触发”位置。当在其触发位置时,该触发扳机28设置在相对手枪式柄24成大约45°角的位置。在钳触发后,弹簧124导致触发扳机28返回其初始位置。当触发扳机28返回移动时,其接合表面128反向推动关闭扳机26的前表面130,导致关闭扳机26返回其初始位置。止推部件132从第二基底部件52延伸,以防止关闭扳机26转动超过其初始位置。
外科钉合和切割装置10还包括往复运动部件134、增效器(multiplier)136和驱动部件138。该往复运动部件134包括器械部分中的楔形橇(wedge sled)、或楔形橇(图6-7中未示出),和金属驱动杆140。
驱动部件138包括第一和第二齿条141和142。在第一和第二齿条141、142中间的驱动部件138上设置有第一槽口144。在触发扳机28返回移动时,触发扳机28上的齿146与第一凹槽144接合,用于在钳触发后使驱动部件138返回其初始位置。第二凹槽148在金属驱动杆140的近端部定位,用于在其非触发位置将金属驱动杆140锁定到释放按钮30的上部闩臂118。
增效器136包括第一和第二集成小齿轮150和152。第一小齿轮150与金属驱动杆140上配备的第一齿条154接合。第二小齿轮152与驱动部件138上的齿条141接合。第一小齿轮150具有第一直径,第二小齿轮152具有比第一直径小的第二直径。
转动控制器(Rotational Articulation Control)
参考图6-9,把手部分20最好结合转动控制器13,该转动控制器绕外科装置10的纵轴转动器械部分22,并且接合端部受动器12使之与纵轴成一角度。中空转动驱动管200同心地定位在关闭套32内,并且可操作地耦合到致动控制杆202,从而致动控制杆202的转动使管200纵轴转动,并且导致垂直转动,或关闭环250和端部受动器12的连接。关闭环250的这种连接符合由医生观察和操纵的致动控制杆202的转动程度和方向。在所述的形式中,由于致动控制杆202的转动程度与杆23的纵轴的连接程度对应,关系是一对一的,这样,医生可以得到明确的指示,应当意识到可以选择其它角度关系。
转动控制器13包括一对转动传送壳体204,它们固定在壳体帽60上。此外,转动传送壳体204包括纵向排列的外部翼片206,该翼片由医生扭转以实现转动传送壳体204以及因此端部受动器12绕器械部分22的纵轴转动。致动控制杆202连接到圆柱连接体208,该连接体通常向上开口位于圆柱凹槽210内,并且垂直与杆23。连接体208的最低部分包括尖头212,该尖头咬合进入靠近杆23的连接传送壳体208中的开口214,该尖头212防止连接体208从圆柱凹槽210脱离。
环状的齿轮齿216位于连接体208的下部,并且与转动轭220上的齿218相啮合。转动轭220跨在关闭套32中形成的连接矩形窗口222上。关闭套32在转动控制器13(在纵向)内是可滑动移动的,以关闭和打开端部受动器12。转动驱动管200随关闭套32相对转动控制器13纵向移动。转动轭窗口222为转动轭220向内存在的凸台224提供间隙,该转动轭220穿过矩形窗口222,以接合在转动驱动管200中的槽226,为转动纵向定位转动驱动管200。中空的转动驱动管200在关闭套32内从铰接机构11纵向延伸,并且向远端终止于关闭套32的锁定翼片227之前。翼片227在转动驱动管200的近端表面后向内弯曲,并且从而在杆23中保持转动驱动管200。
应当意识到转动传送壳体204操作地连接到杆23的关闭管35。通过近端的外径圆形凹槽228,该凹槽在基底部件50、52的远端开口接合圆形向内凸缘230,转动轭转动控制器壳体帽60使转动轭220保持在连接传送壳体60中,并且使转动控制器13保持在把手部分20中。
图10和11以正齿轮铰接机构240形式示出图1-2的齿轮铰接机构11,该齿轮铰接机构与上述的一样,但是在铰接机构240的其它边上带有附加的转动驱动组件,从而提高性能。铰接机构240具有可转动的中空转动驱动管242,其同心地位于关闭管32中,并且该铰接机构240在第一圆周部分246的周围具有远端突出齿轮部件244。齿轮部件244与连接到柄在近端从关闭环250伸出的正齿轮248接合,该关闭环绕贯通第一和第二枢轴点252,260的栓253转动,所述枢轴点从关闭套32向远端伸出。从而,转动枢轴线穿过第一和第二枢轴点252、260和栓253,该栓将关闭环250可转动地耦合到关闭套32。驱动器242的转动接合齿轮242和248,并且在第一和第二枢轴点252、260周围连接关闭环250。
为了增加在中空转动驱动管242和关闭环250之间的齿轮接触的有效表面积,中空转动驱动管242的第二圆周部分254具有向远端凹进的从那里延伸的突出齿轮部件256。通过由框架34枢轴支撑的反向齿轮262,该齿轮部件256可操作地耦合到正齿轮258,该正齿轮连接并从关闭环250的反向侧边向近端突出。反向齿轮262在一边接合向远端凹进的突出齿轮部件256,在另一边接合关闭环250的第二正齿轮258。
当关闭扳机26被致动时,关闭套32的中空转动驱动管242和绕枢轴连接的关闭管250两者都向远端移动以靠近砧板18。通过钉到正齿轮248、258中心的枢轴孔264和266的枢轴点252,260,以及通过那里延伸的框架开口264,关闭套32的关闭管35远离关闭环33。框架开口268提供间隙,从而在连接时关闭环33的近端边缘和关闭套32的关闭管35的远端边缘不会碰撞。
图11以分解方式示出了器械部分270,该器械部分包括正齿轮铰接机构240。框架272可纵向连接到在其近端部带有轴套274的把手部分20(在图1和2中示出),与框架272的中心纵向对准的开口278所形成的框架槽276比在框架槽276内纵向滑动的触发连接器280长。触发连接器280的近端部转动地接合金属驱动杆140(图6中示出)的远端部。触发连接器280的远端部包括容纳触发杆14近端部的槽282,由栓284在其中连接。触发杆14的更远端部分在开槽导向器288的触发杆中的较低凹槽286中定位,该导向器288向远端与可转动的框架部件290和框架272接合。
关节连接的框架部件290具有锚定通道部件292,该部件向远端连接到在伸长通道16中的近端部分的连接套环294。触发杆14穿过可转动的框架部件290中的较低槽295。关节连接框架部件290由开槽导向器288的触发杆远离框架272的远端部,并且为连接由弹性连接器296柔性地连接到那里。弹性连接器296的加宽近端部298接合框架272远端部中向远端连通的上部凹进300,并且弹性连接器296的加宽远端部302接合连接框架部件290中向近端连通的上部凹进304。从而,虽然在其之间带有柔性部分,伸长通道16连接到把手部分20。
伸长通道16还具有砧板凸轮槽306,该凸轮槽绕轴转动的容纳砧板18的砧板枢轴308。包围关节连接的框架部件290的关闭环250包括向远端存在的翼片310,该翼片接合最近的但位于砧板18上砧板枢轴308远端的砧板零件312,从而实现开口。当关闭环250向前移动时,其向远端存在的关闭面314接触倾斜圆柱关闭面316,该面位于砧板18的翼片312的远端。这种凸轮动作向下关闭砧板18,直到关闭环250的关闭面314接触砧板18的平圆柱面318。
支撑板
图12-13示出绕铰枢轴的铰接机构240,铰接机构240位于杆23与端部受动器12之间,进行切割的触发杆14是柔性的,足以进行转动活动。中空的转动驱动管道242与闭合环33上的正齿轮248相接合。该图上省略了关闭套32的近端部分35(即关闭管35),该关闭套为了在上部枢轴点252和下部枢轴点260的正齿轮248的连接纵向定位。
铰接机构240中的弹性支撑使得关于转动枢轴该转动可以包括一对支撑板400和402,其在触发杆14的近端部分的侧面,防止它们穿过框架开口268时弯曲。从而,当触发杆14弯曲时能够传送很大的负载。触发杆14的近端部分是作为伸长锥形触发带404示出的,该触发带由弹簧材料的一个或多个平片形成,该材料为关于转动枢轴弯曲而布置。该锥形发射带404远端变得比较厚,作为触发杆头406描述,该远端包括切除边缘48,上部栓38,中部栓46和触发杆帽44(在图12中省略掉的栓)。该较厚的触发杆头406具有增加的厚度以防止在触发过程中产生偏移,从而确保进行有效的切除和钉筒的制动。通过在铰接机构240的近端408和远端410的一个或全部上引入易弯曲的配合,支持板400和402可以有利减小锥形发射带404的发射负载峰值的影响。
如图12所示,一对支持板400和402各有近端和远端滑动弹性端部412和414,分别由框架32内的框架袋416以及关节连接的框架部件290上的端部框架袋418接收。当铰接机构240连接时,这两个袋416和418为支持板400和402上的弹性终端412和414提供一个间隙,减小向内的框架开口268,加长向外的框架开口268。反方向弯曲端部受动器12使弹性端部412和414(未示出)的位置反向。只要当近端弹性端部412趋于非刚性接合到框架袋416的最远端表面420时,支持板400和402能够响应触发杆14的峰值触发负载弯曲地向远端移动。
作为对照,图14~15描述的是现有技术的支持部件421、422,其由弹簧材料制成,该弹簧材料刚性地连接到已知铰接机构25的近侧423,并且可滑动地与该已知铰接机构的远侧424接触。在图14中的装置是伸直或不弯曲的,并且一对支持板421和422的自由或远端429在框架袋418中处于中间位置,固定端427、428固定地连接到近侧423。特别的根据图15所示,端部受动器处于弯曲位置,触发杆426和支撑板421,422也在转动弯曲。由于支撑板421,422是弹性的悬臂梁,它们与触发杆426产生如图所示的接触,支撑板421,422的自由远端429可以在框架套418中自由的分别向远端或近端移动。支撑板421,422的自由或远端429与触发杆426的接触,能够引入拉力负载和增加移动触发杆426时所需的力。
图16示出了支撑板430、432,在框架带418内,该支撑板各交替地各包括一刚性连接的近端434和弹簧连接的远端436,由相反压缩弹簧438接合各端436的。将远端436弹簧连接到框架带418提供自由远端的附加控制,以减小触发杆14的拉力,并且使远端436在转动弯曲时也能纵向移动。作为替换方式,通过压缩弹簧438提供的弹簧连接可以反向,将近端434与刚性连接的远端436接合。
图17示出了带有接合各支撑板430、432的各远端436的弹性部件440的图16的支撑板430、432。作为替换方式,由弹性部件440形成的弹性连接可以变化,即将近端434与远端436刚性连接。弹性部件可以由多种弹性材料,如硅树脂,橡胶,布纳n(buna-n)或许多已知具有弹性的人造橡胶的任何一种形成。泡沫材料也可以作为弹簧,并且可以包括由各种材料,例如硅树脂泡沫,基于橡胶的泡沫或聚乙烯泡沫形成的关闭或打开室的泡沫。
图18~19示出了包括内部和外部弯曲弹簧指状物446、448的支撑板442、444,该弹簧指状物弹簧地接合框架袋418的端部,从而弹簧板442、444从触发杆14吸收触发负载。作为替换方式,随着包括内部和外部弹簧指状物446、448的近端将近端框架袋416(图18-19中未示出)与刚性连接的远端436接合,弹簧接合可以反向。图19示出了如何由其中引入的开口450沿支撑板442、444间距获得附加的柔性。
图20示出图16的支撑板430、432,其中框架袋416和端部框架袋418带有相对的压缩弹簧438,以进一步减少触发杆负载(firing loads)的影响。
图21示出图17的支撑板430、432,其中框架袋416和端部框架袋418带有弹性部件440,以进一步减少触发杆的触发负载的影响。
图22示出了在两端部都包括内部和外部弯曲弹簧指状物446、448的支撑板452、454,两弹簧指状物都弹性接合框架袋416和端部框架袋418,以进一步减少触发杆负载的影响。
图23示出了弹性支撑板456、458,两个支撑板分别接合框架袋416和端部框架袋418,以通过响应到那里的伸展和压缩,调整在框架开口268上间隔中的变化。弹性支撑板可以由许多具有柔性和弹性的材料制作,这些材料包括:硅树脂、橡胶、同基布纳n或具有弹性或弹回性的许多已知人造橡胶中的任何一种。
图24是低摩擦支撑板460、462的分解图,所述支撑板460、462结合滚珠464,以减少触发杆14和支撑板460、462之间的摩擦力。支撑板460、462分别具有凹口466,用于容纳滚珠464,以将它们保持在内与触发杆14接触。作为替换方式,为了触发杆14的远端移动,圆柱滚珠可以与导向的圆柱滚珠结合。
尽管本发明已经通过对几个实施方式的说明进行了描述,并且尽管已经非常详尽地描述了说明性的实施方式,但是并不意味着将随附的权利要求的范围限定或者以任何方式限制为这样的细节。本领域的普通技术人员可以容易地看出附加的优点和改进。
本发明已经在内窥镜检查过程和装置方面进行了讨论。然而,在此使用的术语例如“内窥镜检查”不应当解释为将本发明限定为仅用于与内窥镜管(即,套管针)结合的外科钉合和切割装置。正相反,应当相信本发明可以在通道限定为小切口的任何过程中得到应用,包括但不限定在腹腔镜检查过程,也包括开口过程。
另一个例子,虽然E形杆触发杆14对于内窥镜检查采用的外科切割和钉合装置10是有利的,但是较小的E形杆也可以用在其它临床过程中。人们通常接受的是内窥镜检查过程比腹腔镜检查过程更普通。因此,本发明已经在内窥镜检查过程和装置方面进行了讨论。然而,在此使用的术语例如“内窥镜检查”不应当解释为将本发明限定到仅用于与内窥镜管(即,套管针)结合的外科固定和切除装置。正相反,应当相信本发明可以在通道限定到小切口的任何过程中得到应用,包括但不限定在腹腔镜检查过程,也包括开口过程。
另一个例子,虽然在此描述的说明性的把手部分20由医生用手操作,但是用能量(例如风力、水力、电动机械、超声等)驱动把手部分的一些或全部功能与本发明的方面也是一致的。此外,对这些功能的每一个的控制可以采取对把手部分的手动操纵或遥控(例如无线遥控,制动控制台等)。
作为另外的例子,虽然这里有利地描述了同时钉合和切割装置,但是用其他类型的端部受动器转动地控制连接与本发明的方面也是一致的,如抓紧器、刀具、钉合装置、夹填充器、通道装置、药物/基因治疗传递装置以及使用超声、射频(RF)、激光等的能量装置。
例如,可以使用刚性连接、弹性连接、和弹簧连接的支持板端部各种结合,例如弹性连接的近端部和弹簧连接的远端部。
Claims (8)
1.一种外科装置,该转置包括:
一把手,可操作地设置成能产生转动动作和触发动作;
具有纵轴的杆,连接到把手部分,用于促使转动动作和触发动作;
铰接机构,将所述杆连接到端部受动器,并且响应转动动作绕所述杆的纵轴转动端部受动器;
远端连接到铰接机构的端部受动器;
对触发动作起反应的触发机构,触发机构被移动连接到铰接机构和端部受动器,以响应触发动作;和
一对支持板,位于触发机构的两侧,跨过铰接机构,每个支撑板包括弹性地接合到框架槽内的端部,所述框架槽在铰接机构中形成。
2.如权利要求1所述的外科装置,其中还包括一个弹簧,所述弹簧纵向连接到框架槽的选定的侧面和支撑板端部。
3.如权利要求2所述的外科装置,其中各支撑板的其它端部接合到端部框架槽内,并且由弹簧偏置。
4.如权利要求2所述的外科装置,其中所述弹簧包括在支撑板端部形成的弹簧指状物。
5.如权利要求4所述的外科装置,其中该弹簧指状物远端定向成朝向框架槽的一侧,支撑板包括另一个弹簧指状物,所述另一个弹簧指状物近端定向成朝向框架槽的另一侧。
6.如权利要求1所述的外科装置,其中还包括在框架槽中接合,并且耦合到该支撑板端部的弹性部件。
7.如权利要求6所述的外科装置,其中各支撑板的其它端部接合在端部框架槽中,并且由另一接合在其中的弹性部件支撑。
8.如权利要求1所述的外科装置,其中各支撑板包括响应转动动作以改变纵向长度的弹性材料。
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US10/615,971 US6964363B2 (en) | 2003-07-09 | 2003-07-09 | Surgical stapling instrument having articulation joint support plates for supporting a firing bar |
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Also Published As
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CN100355400C (zh) | 2007-12-19 |
BRPI0402657B1 (pt) | 2014-06-24 |
CA2473612A1 (en) | 2005-01-09 |
US6964363B2 (en) | 2005-11-15 |
JP4606796B2 (ja) | 2011-01-05 |
AU2004203120A1 (en) | 2005-01-27 |
BRPI0402657A (pt) | 2005-03-29 |
CA2473612C (en) | 2012-04-24 |
EP1520520A1 (en) | 2005-04-06 |
EP1520520B1 (en) | 2013-05-22 |
MXPA04006763A (es) | 2005-05-27 |
AU2004203120B2 (en) | 2008-12-11 |
US20050006429A1 (en) | 2005-01-13 |
JP2005028150A (ja) | 2005-02-03 |
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