CN1822794B - 单插管、多缝针的内窥镜缝合系统 - Google Patents

单插管、多缝针的内窥镜缝合系统 Download PDF

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CN1822794B
CN1822794B CN2004800204624A CN200480020462A CN1822794B CN 1822794 B CN1822794 B CN 1822794B CN 2004800204624 A CN2004800204624 A CN 2004800204624A CN 200480020462 A CN200480020462 A CN 200480020462A CN 1822794 B CN1822794 B CN 1822794B
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suture
pin
lock
far
equipment
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CN1822794A (zh
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R·A·加巴勒
P·J·鲁金
P·迪塞萨雷
C·巴特勒斯
J·拉德兹尤纳斯
D·弗里拉
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CR Bard 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
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0467—Instruments for cutting sutures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0487—Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00743—Type of operation; Specification of treatment sites
    • A61B2017/00818—Treatment of the gastro-intestinal system
    • A61B2017/00827—Treatment of gastro-esophageal reflux
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0448—Additional elements on or within the anchor
    • A61B2017/045—Additional elements on or within the anchor snug fit within the anchor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0464—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors for soft tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • A61B2017/047—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery having at least one proximally pointing needle located at the distal end of the instrument, e.g. for suturing trocar puncture wounds starting from inside the body

Abstract

提供了用于在各种各样的手术中连接内部身体组织的内窥镜缝合系统。该系统包括可以可释放地安装到内窥镜(10)的远端(14)的缝合小盒(100)，并且该缝合小盒(100)能够在不需要在缝针之间从病人体内抽回的情况下在多个位置在组织内形成多次缝针。还包括了用于固定放置的缝针的缝线锁(120)，缝线锁(120)通过经由存在的内窥镜(10)的工作通道引入的设备输送。提供了定位在内窥镜(10)的近端(12)处的用于缝合小盒(100)和用于缝线锁输送设备(500)的适合的控制手柄(16)以方便使用者操作。

Description

单插管、多缝针的内窥镜缝合系统
相关申请
本申请要求2003年5月16日提交的美国临时申请No.60/471,248的优先权，其全部教示在这里通过参考加入。
技术领域
本发明涉及将人体的组织固定到一起的设备和方法。特别地，本发明和内窥镜缝合系统有关。
背景技术
内窥镜对合设备为可以在病人身体内使用而不需要在病人身体内制造外部切口的设备，该设备可以通过内窥镜装置在病人的外部控制。该设备可以包括用于柔性内窥镜检查的缝纫或卡钉设备，然而其也适用于用于刚性内窥镜检查的设备。已经发现这样的设备可以用于治疗消化系统，通过病人的食道插入内窥镜。特别地，已经发现这样的设备可以用于治疗胃食管反流疾病(GERD)。在用于治疗胃食管反流疾病的手术中，放置缝针以在食道和胃的接合处形成组织褶皱。对某些病人，由褶皱形成产生的较小的解剖学上的改变减轻了胃食管反流疾病的症状。
此普通类型的缝纫设备在例如，美国专利No.5,080,663和5,792,153中描述，其在这里通过参考加入。那些专利披露了用于将线通过组织部分的缝纫设备，其包括可以在第一位置和第二位置之间运动的空心针，在第一位置中，空心针在组织部分外，在第二位置中，空心针通过组织部分，其还包括适合于接附到线并且可以被容纳在该空心针内的线运载器。该缝纫设备包括主体，该主体限定了腔，通过抽吸可以将组织部分保持在腔内，并且该空心针安装为在主体内在第一和第二位置之间运动。
描述了两个特别的实施例，单缝针缝纫设备和多缝针缝纫设备。在单缝针设备中，当针从其第一位置通过到其第二位置时，针传送线运载器通过组织。当针返回其第一位置时，线运载器留在缝纫小盒的远端。在多缝针设备中，相同的手术发生，但是接下来在还有的步骤中，空心针从其第一位置移动到其第二位置，拾取该线运载器，并且将其返回。在下一个步骤期间形成第二缝针。整个序列的步骤重复与形成希望的数量的缝针所需要的一样多的次数。
在通过组织放置缝线以后，缝线必须通过打结或通过机械锁定设备紧紧地固定。美国申请No.10/220,413(“Suture Clips，DeliveryDevices and Methods”，2003年3月13日提交)和10/275,534(“Tissue Capturing and Suturing Device and Method”，2002年11月6日提交)，其在这里全文通过参考加入，披露了用于在身体内的位置固定缝线的机械锁定设备，其可以通过内窥镜输送。这些申请分别对应PCT公布物No.WO01/66001和WO01/89393。然而，由于它们的尺寸大，这些系统要求从病人移除内窥镜，以便将传送设备导航到缝合位置。
在任何内窥镜手术中，将插管的数量减到最少并且减少病人必须保持在清醒性镇静下的手术时间是重要的需要考虑的事项。现有技术的缝合设备对于用单缝针实施例进行的每个连续的缝针必须从病人抽回。因此，使用该设备是费时的、麻烦的并且由于多次插管对于病人存在一些风险并且存在食道穿孔的危险。希望提供一种内窥镜组织对合设备，其将手术时间和插管的数量减到最少，同时仍然在手术期间形成并且固定多个缝针。
发明内容
本发明提供了一种内窥镜组织对合设备，其能够仅用在其远端携带了缝合小盒的内窥镜一次插管到病人体内，将多个组织位置固定在一起。为了放置缝线，系统提供了可以可释放地固定到各种各样的通常使用的内窥镜的远端的缝合小盒。该缝合小盒包括用于捕获组织部分的组织抽吸腔室、沿针轨道通过抽吸腔室可滑动的针和连接到缝线的可以可释放地固定到针的缝线箍(tag)。
为了在不需要移除设备以重新装载缝线的情况下进行多次缝针，该小盒在其远端、抽吸腔室远端还包括缝线捕捉器，以当针通过捕获的组织时从针接收缝线箍。在将缝线箍和缝线从捕获的组织的近端侧运载通过组织到达组织的远端侧以后，该箍可以留在缝线箍捕捉器内并且针近端地抽回，留下缝线通过捕获的组织部分。在针上提供缝线箍锁，以当缝线箍在小盒的远端被输送和从缝线箍捕捉器拾取时，选择地在针上捕获缝线箍。组织随后可以从小盒释放并且针再次捕获箍准备好另一次通过不同的捕获的组织部分的缝针(从组织的近端侧接近)或者该箍可以留在适当的位置并且捕获另一个组织部分，使得当针远端地前进以捕获该箍时，近端地抽回的针可以携带缝线在近端的方向通过组织。通过以此方式穿梭该箍及其关联的缝线通过一系列捕获的组织部分，可以在不需要移除小盒以重新装载的情况下形成多次缝针。
通过控制手柄从内窥镜的近端选择地操作针和缝线箍锁。控制手柄可以可释放地固定到内窥镜的近端，使得其与内窥镜手柄的工作通道口连通。连接到手柄的控制轴延伸通过内窥镜的工作通道，并且通过它们的纵向运动在手柄处开始针和缝线箍锁的控制操作。手柄可以具有一个纵向操作构件以控制针的运动和缝线箍锁的释放和固定。
因为在箍穿梭通过组织部分期间存在四个阶段的针操作，当仅有单一的纵向构件提供在手柄上时，纵向控制构件的分段的操作是优选指示使用者正在发生的是哪个阶段的针操作。例如，当纵向构件没有压下并且装载了箍的针在抽吸腔室的近端时，控制构件应该指示使用者第一阶段。当针前进通过组织并且正在释放箍时，靠着手柄从纵向构件的底部出来指示操作的第二阶段。纵向构件应自动返回以近端地抽回针，同时将箍留在缝线箍捕捉器内(第三阶段)。手柄应该在第三阶段提供空闲位置，其中没有箍的针从组织近端地抽回，并且准备好再次远端地驱动以拾取箍。在针诸如通过返回弹簧近端地自动返回期间，真空也可以在返回行程的端部自动停止，使得现在具有缝线通过其中的组织部分被释放。当针再次远端地前进以再捕获缝线箍时(组织已经抽吸到腔室内或者在组织捕获以前重新定位箍)第四阶段发生。当针已经到达其行程的远端并且再次捕获缝线箍时，再次压下纵向操作构件开始阶段四。从阶段四释放纵向操作构件将手柄和针返回到它们的初始状态：阶段一。
缝合小盒控制手柄也可以包括真空控制器，以在缝合过程期间选择地将组织抽吸到抽吸腔室内。随后，通过手柄上的开关，使用者可以方便地开启路线通过手柄的真空供给。可选的，可以提供真空互锁特征部，如果没有获得足够的管线负压以确保组织完全被吸入腔室，使得针和缝线获得足够的刺穿深度，其防止设备的操作。真空控制器也可以包括一旦针已经完成其从组织近端地抽回的行程，自动地停止到腔室的真空的特征。另外，控制手柄可以使用其它有用的特征部，诸如用来在手术期间保持缝线拉紧的缝线张紧机构，使得其与针的运动一起近端和远端地运动而不是仅仅远端地运动，仅仅远端地运动可以导致在抽吸腔室区域内缝线材料形成拱堆。
在已经通过数个选择的组织位置形成缝针后，缝线引线必须被固定以将缝线紧紧地保持在通过组织的位置。本缝合系统还提供了缝线锁，其可以供给到缝线引线以将它们与输送设备固定，该输送设备可以通过内窥镜的工作通道，使得不需要为了完成手术移除内窥镜。缝线锁包括环和塞，塞定尺寸为摩擦接合环的内表面，使得通过环的缝线引线被捕获在两个部件之间。为了固定缝线，引导缝线引线通过环，并且其前进到缝线位置，在该位置塞可以插入环内同时保持缝线拉紧，使得其以通过组织的拉紧的状态被捕获。
缝线锁可以输送到组织位置并且通过输送设备固定，该输送设备包括可以通过内窥镜的工作通道的轴和远端操作端以及在轴的近端用于控制操作端以装配环和塞的控制手柄。输送设备的远端操作端应该包括容器以保持在分解构造的至少一个环和一个塞，使得其可以被引导到缝线位置，使得缝线引线通过开口环。该容器可以构造为通过四个臂限定的笼，该四个臂仅在它们的近端以铰链的方式接附到中心衬套构件，以允许它们的远端可选择地闭合或打开以释放装配的塞和环。在将塞装配到环内期间，笼的指状物必须保持闭合以抵抗将环插入塞的装配力，但是随后可以可选择地打开以释放固定的缝线锁。
为了选择地打开和关闭笼的臂并且在完成缝线锁的装配以后切断缝线引线，可以提供在笼的指状物上可滑动的外部套。当笼构件在套内的近端，使得套在指状物的远端上时，指状物的自由的远端保持径向向内以闭合的构造保持该环和塞。当笼相对于套远端地运动，使得套定位在指状物的铰接的区域的近端上时，允许指状物的远端自由端径向舒展开以允许释放环和塞。为了在约束塞的指状物闭合的同时装配环和塞，通过推动器轴将塞远端地推入环，该推动器轴相对于在装配期间保持环不纵向运动的笼纵向地滑动。在塞已经被插入环并且笼已经相对于套远端地运动以后，铰接的指状物有弹性地弹开(远端径向向外运动)以释放塞和环组件。
笼、外部套和推动器应该在内窥镜的近端通过控制轴连接到控制手柄，纵向可滑动通过内窥镜的工作通道以导致远端部件运动以有效地操作远端，该手柄可以包括两个控制构件，使用者可以使用该两个控制构件以获得需要的相对运动，以装配和释放环和塞。手柄应该包括至少一个纵向可滑动的构件，该构件连接到推动器，以便使塞前进进入环，和连接到笼的外部护套，和抵抗推动器远端地纵向运动并且实现外部套的滑动运动以打开笼指状物的外部护套。
本发明的一个目的为提供一种内窥镜缝合系统，其能够在多个不同的内部组织区域内形成缝针，而仅需要一次内窥镜的插管或者腹腔镜插入。
本发明的另一个目的为提供一种内窥镜缝合小盒，其提供了组织抽吸腔室和针，该针可滑动地通过捕获在组织抽吸腔室中的组织以输送携带箍的缝线通过相继捕获的组织部分，以在每个分开的部分内形成缝针。
本发明的另一个目的为提供一种用于多缝针内窥镜缝合小盒的控制手柄，其允许使用者仅输入单一的控制机构的纵向运动，以便完成缝线通过组织部分的缝针并且将系统返回到准备好第二缝针的状态。
本发明的另一个目的为提供一种内窥镜缝合系统，其包括缝合小盒，用于操作缝合小盒的部件的控制手柄，用于固定输送到组织的缝线的引线的缝线锁和用于在内部组织位置装配和释放缝线锁的缝线锁输送设备，该缝合小盒具有针和可以通过缝线锁捕获在针上的缝线箍和在小盒内的缝线捕捉器。
本发明的另一个目的为提供一种包括环和可摩擦地接合在环内以在其间捕获缝线引线的塞的缝线锁，和一种具有轴和远端可操作构件和安装的缝线锁输送设备，其可以通过内窥镜的工作通道以及可以定位在内窥镜近端以操作远端构件来输送、装配和释放缝线锁的环和塞部件以固定缝线的控制手柄。
附图说明
本发明的上述和其它目的和优势将从接下来参考后附的简图对其进行的进一步描述来更加全面地理解，其中：
图1为携带了本发明的缝合系统的内窥镜的图解表示；
图2为本发明的缝线锁输送设备的图解表示；
图3A和3B为环和塞缝线锁的图解表示；
图4为缝合小盒的等距透视图；
图5为接附到内窥镜的远端的缝合小盒壳的等距透视图；
图6为通过倒楔接附机构接附到内窥镜的远端的缝合小盒的侧视图；
图7A为本发明的缝合小盒的侧视图，指出了在图7B上详细示出的区域A；
图7B为图7A所示区域A的详细视图；
图8为针和通过缝线箍锁定设备锁定在针上的缝线箍的侧视图；
图9为携带了缝线箍的针的侧视图，缝线箍锁在未锁定位置；
图10为针和缝线箍远端地前进到缝线捕捉器的缝合小盒的等距透视图；
图11-14示出了缝线箍和针进入小盒内的缝线箍捕捉器的不同阶段；
图15为捕获了缝线箍的缝线箍捕捉器的俯视图；
图16为缝合小盒控制手柄的侧视图；
图17为缝线控制手柄的截面图；
图18为图17所示控制手柄的详细截面图；
图19A为缝线控制手柄的截面图；图19B和19C为在图19A的截面图中所示的部件的详细视图；
图20为全程(around-the-word)棘爪轨道的俯视图；
图21为沿图20所示线A-A截取的截面图；
图22示出了棘齿爪轨道；
图23为圆筒形的棘齿爪的等距视图；
图24为在远端方向完全地前进的控制手柄的截面图；
图25为控制手柄在中间阶段的截面图，在该中间阶段，针已经将缝线箍放置在小盒的远端处的缝线捕捉器内；
图26A和26B为本发明的缝线锁的侧视图；
图27为缝线锁输送设备的等距视图；
图28为缝线锁输送设备的截面图；
图29为缝线锁输送设备的侧视图；
图30为缝线锁输送设备的等距视图；
图31为沿图29所示线A-A截取的缝线锁输送设备的等距截面图；
图32为具有装配的环和塞的缝线锁输送设备的截面图；
图33为从图29在正交平面截取的缝线锁输送设备的截面图；
图34为具有衬套和远端地延伸的笼的缝线锁输送设备的截面图；
图35为具有衬套和远端地延伸的笼的缝线锁输送设备的截面等距视图；
图36为具有远端地向外延伸以释放环和塞的指状物的缝线锁输送设备的截面图；
图37为缝线锁输送设备控制手柄的侧视截面图；
图38为在压下的构造的缝线锁输送设备控制手柄的侧视截面图；
图39-54概略地示出了本发明的缝合过程的不同步骤；
图55-63为表示本发明的缝合过程的不同阶段的图。
具体实施方式
图1-3B示出了单插管、多缝针内窥镜缝合系统的部件。在图1中示出的内窥镜缝合设备包括缝合小盒100，缝合小盒100可释放地固定到内窥镜10的远端14。小盒100通过控制手柄200操作，控制手柄200可释放地安装到邻接内窥镜控制手柄16的内窥镜10的近端12。操作缝合系统以将缝线放置通过在病人体内可以被内窥镜到达的内部的位置的组织。
图2示出了单插管系统的另一个部件：缝线锁输送设备500，其定尺寸为延伸通过内窥镜的工作通道。延伸通过内窥镜，该输送设备的远端操作端540延伸到内窥镜的远端14外部，同时控制手柄16从内窥镜的近端12延伸，使得其可以被使用者操作。输送设备500构造为供应如图3A和3B所示的缝线锁设备。图3A和3B所示缝线锁包括环502，塞504插入环502中，塞504定尺寸为在环的开口中摩擦接合。如图3B所示，当缝线18通过环502时，塞504的插入导致缝线变成被捕获并且锁定在塞的外表面和环的内表面之间，有效地将缝线引线18固定在组织内。对适合的缝线锁设备的全面的讨论，包括这样的缝线锁的替代的适合的示例的介绍在未决的美国申请No.10/220,413和10/275,534中提出，其在这里通过参考加入。虽然图1-3B所示的部件的每个可以在内窥镜缝合手术中分别使用并且为它们预期的目的提供效用，将这些部件一起使用使得内窥镜缝合能够提供对多个内部位置的多次缝针，并且通过内窥镜单次插管到病人体内来固定它们。
缝合小盒
图4为缝合小盒100的等距透视图。小盒100包括圆筒形主体102，圆筒形主体102具有防止损伤的形状以减小在操作期间损伤内部组织的可能。小盒在构造和操作上与上面讨论的美国专利5,792,153所披露的类似。小盒包括对组织抽吸腔室106打开的抽吸口104，要被缝合的组织部分在引入腔室内的真空作用下可以被采集到组织抽吸腔室106内。小盒构造为容纳针108，针108可以通过经由小盒形成的针轨道110滑动。针可以为具有锋利的远端顶112的实心的不锈钢轴，并且在其近端连接到从缝合小盒通过内窥镜的工作通道近端地延伸的推动器轴184。推动器轴离开内窥镜的近端，在那里其可以连接到控制手柄并且通过控制手柄操纵，如接下来将要讨论的。当针纵向运动通过针轨道时，其横穿抽吸腔室106，使得抽吸进入腔室的组织将被远端地前进的针穿透。
针108携带了环形缝线箍114，环形缝线箍114紧密地围绕针的外表面配合。该箍具有近端和远端，并且可以具有从其近端到其远端渐减的锥形，以在针和缝线箍远端地前进通过组织时形成低型面(profile)。连接到缝线箍的是缝线18的一端，当携带缝线箍114的针远端地前进时，缝线将被携带通过抽吸的组织部分。缝线可以由通过在箍内的开口并且在缝线上形成扩大的顶或结，使得其太大以至于不能后退通过箍来接附。通过缝线箍锁120，缝线箍可释放地并且选择地固定到针的外表面。缝线箍锁还可以远程地从内窥镜的近端通过在针控制轴和针108上可滑动的缝线箍锁轴122操作。
针完全地远端前进将缝线箍114放置在缝线箍捕捉器140的范围内。在穿透捕获的组织部分并且进入缝线捕捉器以后，缝线箍锁120可以被释放并且针近端地抽出，将缝线箍114留在缝线箍捕捉器的座区域142内。缝线箍捕捉器包括具有两个弹性臂146的Y形结构144。该弹性臂在Y形构件144的基部连接在一起并且在近端方向纵向延伸，终止于具有向内弯曲的尖头148的自由端，以在箍114已经进入座142以后捕捉面向近端的表面116。在捕获并且将缝线箍释放到缝线箍捕捉器140内以后，针可以近端地抽回并且组织从抽吸腔室106释放，留下缝线18通过组织，并且使缝线18的一端连接到在小盒的远端103捕获的缝线箍，并且缝线18的另一端延伸进入针轨道110，通过内窥镜的工作通道并且离开内窥镜的近端。
图5示出了内馈镜10的缝合远端的另一等距视图，内部部件移除的缝合小盒100的壳接附到内馈镜10。抽吸口104对抽吸腔室106打开。在抽吸腔室的底部有数个抽气口160，以虚线示出，负压通过抽气口引入到抽吸腔室，以选择地捕获要缝合的组织部分。通过从小盒100近端地延伸并且连接到沿内馈镜10的外部延伸的分开的真空管线(没有示出)的真空管162，将真空引入到抽气口160。
图5所示的内馈镜10的远端14的剖视图示出了工作通道20和观察通道22。为了清晰，省略了其它可以通过内馈镜的通道，诸如用于光源或用于液体清洗源的通道。小盒100通过插入内馈镜的工作通道20的近端延伸的引导管164(以虚线示出)连接到内馈镜的远端。引导管164是刚性的并且从小盒的小盒近端105近端地延伸，以伸出进入内馈镜的工作通道20一段短的距离。引导管164开口以接收针轨道110组件，在操作中针通过针轨道110滑动。
如图5和6所示，小盒可以通过倒楔固定机构170固定到内馈镜的远端14。倒楔和内馈镜附件固定机构在未决的2003年2月11日提交的题目为“Endoscopic Accessory Attachment Mechanism”的美国专利申请No.10/275,226中全面地描述，其在这里通过参考全文加入。其还在公布的PCT申请WO01/87144中披露。倒楔固定机构的基本元件包括可在斜坡表面174上滑动的楔部件172，当楔部件172滑上斜坡时，楔部件172变成楔入内馈镜14的远端和斜坡表面174之间。由通过工作通道20的引导管164的存在，保持靠着内馈镜远端的杠杆作用。返回弹簧176保持靠着楔构件172的力，使得楔构件172沿斜坡表面174向上偏置以保持与内馈镜楔接触。
图7A为没有安装在内馈镜上的缝合小盒100的侧视图，并且指出了在图7B中呈现的针轨道110的细节的区域。如图7B所示，针轨道110存在于从小盒100近端地延伸的引导管164内。引导管164为针轨道的最外面的管状结构，并且如上述提供用于接合内馈镜的工作通道的内表面以牢固地安装小盒的安装结构。引导管可以形成为小盒的一部分并且因此以相同的刚性材料形成，诸如不锈钢。引导管的近端166具有横过其开口的有斜面的切口，其向下渐缩以当控制部件，包括其它针轨道部件从内馈镜的近端通过工作通道前进进入小盒100时，能够周界地对准它们，如接下来将要解释的。
针轨道的部件的大部分包含在外部护套180内，外部护套180延伸内馈镜的工作通道的整个长度，从在近端的控制手柄到小盒100的引导管164。在小盒已经安装到内馈镜的远端以后，外部护套180和与其有关的针轨道部件前进通过内馈镜的近端进入引导管164。引导管可以由任何坚固但是柔性的材料制造，诸如聚合体聚醚醚酮(PEEK)。外部护套具有沿其远端部分的变平的部分182，该部分在装配以后留在引导管164内，以允许缝线18通过，使得其可以向近端继续通过内馈镜的工作通道并且从近端出去，而不需要延伸通过外部护套180。
针轨道的最里面的部件为针108。该针可以具有扩大的矛形远端109，以与缝线箍锁相互作用，如后面将要讨论的。针的远端顶112是锋利的，用于刺穿组织，并且针的近端连接到推动器轴184，推动器轴184延伸到安装在内馈镜的近端的控制手柄。
缝线箍锁系统120的锁定套124在针108的轴上在其整个长度上可滑动。锁定套124为大约0.016英寸I.D.的不锈钢hypotube，其定尺寸为紧密地配合在针轴的外表面上，其测量为大约0.0155英寸。锁定套还在内馈镜近端邻接到控制手柄。锁定套的远端具有两个从套的远端顶近端地延伸到大约0.080英寸深度的纵向凹口，以限定两个锁定键126。如接下来更加全面地描述的，当锁定套相对于针远端地前进时，锁定键压制针108的扩大的矛形109，变得径向向外张开以形成防止缝线箍114远端地滑动的锁定表面128。
加强套130定位在锁定套外部。由诸如不锈钢hypotubing的刚性材料形成的加强套在针和锁定套上仅沿针和锁定套的远端部分延伸，包含在引导管164内。在小盒100内纵向滑动运动期间，锁定套帮助确保针保持与内馈镜的纵轴线平行。
在外部护套180的外面结合了外部遮盖物132，由诸如PEEK的半刚性聚合体材料形成，用来附加地保持针和针轨道组件110在小盒100的引导管164内对准。外部遮盖物132用作吸收外部护套180和引导管164的内表面之间的空间的衬套。遮盖物的顶部具有纵向槽133，纵向槽133延伸遮盖物的整个长度以允许缝线18通过而不会在缝线18滑动时与缝线箍114和针108干涉。遮盖物132的底部接收横向地插入的对准销134，对准销134稍微从遮盖物的外表面伸出。对准销134的伸出部分与引导管的近端166的劈开切口干涉。在系统装配期间，当外部护套和针轨道组件110远端地前进通过内馈镜的工作通道时，引导销捕捉在引导管164的远端166上并且外部套和遮盖物进一步远端地前进导致对准销跟随劈开切口并且根据需要旋转组件，使得对准销变成在劈开切口167的最远端部分的底部出来。此对准销的定位确保针轨道110与引导管164和缝合小盒100周界地对准，使得在缝合期间操作针和箍期间，缝线不会变得缠绕或缠结。
图8示出了携带缝线箍114的针108的侧视图，其中通过缝线箍锁120锁定缝线箍114防止远端滑动运动。缝线箍114为环形，限定了定尺寸为紧密地配合在锁定套124上的通孔。附着到锁定套124的加强套130正好在锁定套的远端之前终止，留下携带空间，在针108上输送期间，缝线箍114可以存在于该携带空间上。加强套130的直径稍微大于缝线箍114的通孔的直径，以提供止回器以防止缝线箍相对于针和锁定套124近端地滑动。
如上所述，针的远端形成为具有矛形109，矛形109通过近端增大的筒锥体111与远端增大的筒锥体113会合形成，以形成矛形顶109的直径增大的部分115。
当针近端地抽回进入缝线箍锁120的锁定套124时，锁定键126压制在针的近端筒锥体上，导致它们变得径向向外张开。张开的键126有效地增大它们的型面到这样的程度，使得缝线箍的通孔118不能配合到其上，这将缝线箍114锁定在针上适当的位置。
为了释放缝线箍，使得其可以相对于针远端地滑动，如当在缝合手术期间将箍留在缝线箍捕捉器140内时可能需要的，针108相对于锁定套124远端地运动。针相对于锁定套远端地运动将近端的筒锥体运动到针轴107的减小的直径，并且键126有弹性地与该减小的直径一致，径向向内返回以限定较小的型面，缝线箍114的通孔118可以通过其上。没有来自锁定套124的两个键126的增加的厚度的针的直径扩大的部分115也限定了型面，缝线箍114的通孔118可以自由地通过其上。
示出了缝线箍捕捉器140的小盒100的等距透视图在图10中示出。图中，在缝线箍114通过缝线箍锁120锁定在针上适当的位置时，针正在接近缝线箍捕捉器140。在将箍输送到缝线箍捕捉器140的途中，针横穿抽吸腔室106，缝线箍捕捉器140定位在抽吸腔室106的远端。为了清晰，在图中没有显示组织。缝线箍捕捉器140包括具有两个弹性臂146的Y形构件144，该弹性臂146在Y的基部处连接在一起并且具有自由端，该自由端终止于面向内的尖头148，以捕捉缝线箍114的近端面116。围绕弹性指状物146的区域构造为紧密地配合缝线箍114的圆筒形成锥形的顶，以牢固地保持缝线箍114，并且限定座142，在缝线箍114保留在捕捉器内期间，缝线箍114可以牢固地保持在座142内。
操作中，缝线箍捕捉器140操作以通过如接下来参考图11-14中所示的截面图描述的步骤来保持该箍。在图11中，针示出为前进进入Y形构件144，使得其远端顶112在座区域142内，但是缝线箍114还没有通过臂146的向内伸出的尖头148。如图11和12中的截面图所示，当针继续向远端移动，针的锋利的远端顶112进入Y形构件144的基部147，导致弹性臂146展开以帮助缝线箍114通过向内伸出的尖头148进入座142。在此阶段期间，针相对于缝线箍锁120的缝线箍124的锁定套124远端地前进，以释放缝线箍锁并且允许针在其近端抽回行程期间从缝线箍滑出。
在将缝线箍114就位在座142内以后，如图12所示，开始近端抽回行程可以发现在缝线箍捕捉器处的弹性臂146仍然由于在Y形构件144的基部147内的针112的锋利的顶的存在而稍微打开。在此情况下，针近端抽回可以导致缝线箍由于残留的摩擦力在针上卡住，并且从而没有被尖头148靠着缝线箍近端116捕获。因此，摩擦的摩擦条149可以附加地通过座区域142提供，以在座区域内的小盒上提供摩擦表面，其作用为将箍保持在座内，即使弹性的臂146还没有回弹以围绕箍的近端面116闭合(图12)。该摩擦的摩擦条可以为聚合体嵌入物。
在针稍微地向近端抽出，使得锋利的顶112从Y的基部147移除以后，臂146将围绕缝线箍114闭合，使得尖头148接合箍的近端面116(图14)。如图14的俯视图中所示，在针108近端地抽回以后，箍保持被缝线箍捕捉器140捕获在座142内。在捕获位置内，弹性臂146返回闭合的位置，使得向内伸出的尖头148接合缝线箍114的近端面116，保持缝线箍114防止近端地运动出座。座142还用来保持箍114对准，使得在缝合手术中，箍114不会远端地或侧向地运动，使得当针返回以拾取该箍时，针将与缝线箍114的通孔118对准。
取回箍的步骤基本上是说明的用于将箍输送到缝线捕捉器的步骤的倒转。在返回以取回箍时，针再次远端地前进进入缝线箍捕捉器的区域，同时处于未锁定的位置(图10所示)。在针已经在Y的基部147出来以后，针可以相对于缝线箍锁120近端地滑动，使得锁定键126压制在针的近端筒锥体111上，形成如图15所示的锁定状态。在锁定的位置，用于施加到针的近端抽出将克服通过尖头148靠着箍的近端面116引起的保持力，导致弹性的臂146稍微变形并且允许箍114与针一起在其近端抽回行程中通过。
缝合小盒控制手柄
适合的缝合控制手柄200的侧视图在图16中示出。虽然内馈镜的一个示例已经在这里作为说明性的实施例描述，需要理解其它构造的控制手柄也可以适合于根据需要操作缝合小盒。控制手柄必须提供这样的装置，该装置允许操作者纵向地并且相对于彼此驱动针推动器轴和缝线箍锁定套124，以操作小盒通过上面概述的步骤。另外，该手柄应该可以可释放地在针推动器轴和缝线箍锁定套将插入其中的内馈镜的工作通道的开口处固定到内馈镜210的近端手柄组件。另外，真空源管线的路线通过控制手柄是优选的，这使得操作者可以在缝合手术期间根据需要选择地引入和停止真空以捕获和释放组织。替代地，控制手柄可以包括真空控制开关，其包括互锁特征部，以防止控制手柄构件纵向运动，直到在抽吸腔室内达到预先确定的真空压力。
图16所示控制手柄包括在其远端202的筒夹204，用于连接到在内馈镜10的近端12的内馈镜控制手柄210。该筒夹拧到通常为大多数内馈镜的工作通道准备的口，同时该筒夹具有通孔，针推动器轴184和缝线箍锁护套124可以以可滑动的方式通过其中。
控制手柄还包括连接到筒夹204的真空开关壳体208，并且引导真空管线组件通过手柄200的主体。该手柄还包括容纳将柱塞216的纵向运动转换成针推动器轴184和缝线箍锁定套124的分段纵向运动的部件的主体部分206。可视的标志218可以放置在柱塞上以指示使用者(通过显示没有插入主体206的标志的剩下的条)在给定的时刻控制手柄部署的阶段。
图17为控制手柄的主体206的截面图，示出了将柱塞216的纵向运动转换为针和缝线箍锁组件的运动的机构。图18为图17所示主体206的详细的截面图。需要注意，图16-18所示的手柄位置表示系统的初始状态，其中在首次缝合行程以前，针和箍保持在抽吸腔室106的近端侧上的针轨道110内。
图17、18和19A示出了控制手柄在其初始位置的截面图。柱塞216与连接到缝线箍锁定套124的锁定护套运载器220接合，并且与和针推动器轴184接合的针运载器230接合。通过推压柱塞运载器240推压针部署弹簧244，柱塞与针运载器230接合，当相对于手柄的主体206远端地推柱塞时，其与针运载器230接合。当柱塞运载器240远端地滑动时，其滑动通过主运载器248以保持其在手柄内纵向对准。
柱塞216还通过棘爪臂250的接合与锁定护套运载器220接合。棘爪臂的远端252通过与小弹簧254接触直接地接合锁定护套运载器220。棘爪臂在针部署弹簧上方近端地延伸，使得其近端256接合保持在柱塞运载器240内的全程棘爪轨道258，如图19B中详细所示的。在图20中示出了棘爪轨道258的俯视图，沿线A-A截取的截面图在图21中所示。全程轨道为三维的，使得当近端棘爪臂在轨道中移动时，其高度改变以在一个方向完全地沿着轨道引导棘爪，尽管从柱塞仅输入纵向运动。
手柄返回弹簧260围绕柱塞运载器240针部署运载器和棘爪臂的整个组件，使得在部署期间一直存在靠着柱塞216的近端弹回力。附加的特征部可以添加到手柄，以确保部分部署的针不会过早地近端抽回。
柱塞棘齿组件270确保在允许柱塞近端返回前柱塞仅在远端方向移动，直到其已经到达其最大远端行程长度。此特征确保操作者必须完成针的远端输送行程以确保其在近端的方向完全释放，使得当针部分或完全地插入通过抽吸的组织部分时，不试图抽回缝合小盒组件。棘齿组件270包括成形为具有远端地延伸的直的轨道部分274的平行四边形的棘齿轨道272。具有构造为在柱塞216纵向运动期间安放在道内的伸出的棘爪臂278的圆筒状的棘齿爪组件276固定在形成在壳体的主体206内的棘齿爪凹进处280内。棘齿的齿282形成在平行四边形棘齿轨道272的一侧，使得棘齿仅在在针横穿小盒的抽吸腔室期间柱塞216远端地运动期间发生作用。棘齿轨道274的线性部分表示针在横穿抽吸腔室以前远端地移动。平行四边形的没有棘齿的侧表示在柱塞216近端地返回行程期间棘爪臂278的移动，出于安全原因，其不需要通过棘齿作用控制。
下面将结合附图17、18、19A、24和25描述控制手柄的操作和缝合小盒的部件的相应的运动。从图17、18、19A所示初始位置，使用者开始操作控制手柄，首先开启真空供应开关224(图16)以将真空输入管线214(连接到真空供应源)对沿内窥镜延伸到缝合小盒100的真空输出管线212打开。真空的引入导致组织被抽吸到抽吸腔室106内并且缝合过程可以开始。
从图17、18、和19A所示的手柄的初始位置，使用者如图24所示完全地压下柱塞216以远端地驱动针横穿抽吸腔室106并且驱动缝线箍114进入缝线捕捉组件140，如图14所示。压下柱塞216的作用为远端地推动柱塞运载器240通过手柄，压缩针部署弹簧244并且跟随弹簧的压缩，使得针运载器230远端地运动等于柱塞216移动的行程长度。在柱塞216的全部远端行程期间，锁定护套运载器220也远端地运动，虽然由于在柱塞运载器240远端运动期间棘爪256和棘爪轨道258的移动，锁定护套运载器220的运动幅度稍微小于针运载器230。
如图20中最佳地示出的，棘爪臂的近端256和棘爪轨道258的初始位置通过参考数字261表示。当柱塞运载器240首先远端地运动时，在棘爪臂250的任何运动以前，棘爪臂在棘爪轨道内滑动到标示为262的第二位置。在到达第二位置262以后，在剩下的柱塞216的初始远端行程期间，棘爪臂随后开始与柱塞运载器240一起运动。跟随棘爪臂在位置262从底部出来的运动用作远端地运动锁定套，但是不是与针的远端运动一样远。通过棘爪机构产生的针的进一步远端地前进导致缝线箍锁120脱落，如图9所示，使得缝线箍114可以留在缝线箍捕捉器140内。
当使用者从如图24所示完全压下的构造释放柱塞时，柱塞返回到如图25所示的中间位置。在此位置，针从缝线箍捕捉器近端地抽回到抽吸腔室106近端的位置。箍114留在缝线箍捕捉器114内。在此阶段，针和缝线箍锁保持在相同的相对解锁的位置。由于棘爪轨道258的锁定效果，针和缝线箍锁定套124保持在相同的相对位置。如图25和图20所示，现在棘爪臂256保持在棘爪轨道在参考数字263示出的第三位置，其作用为保持针运载器230相对于锁定护套运载器220前进。通过手柄返回弹簧260的返回力，整个组件已经近端地运动，该返回力为所有部件产生自动的近端返回行程，这些部件包括柱塞216、柱塞运载器240、并且由于棘爪臂250，包括针运载器230和锁定护套运载器220。
为了再次前进针以取回缝线箍，在第二组织部分已经被抽吸到抽吸腔室106内以后或者在抽吸另一个组织区域以前，使用者再次远端地前进柱塞216达到其完全远端行程。此序列中的最终行程用作将全部部件运动到最大远端移动，如之前在图24所示。然而，因为棘爪臂256被引导到在棘爪轨道258内通过参考数字264标示的位置，如图20所示，在手柄弹簧260的弹回力作用下手柄经历的近端返回的行程将导致棘爪臂256跟随轨道回到其初始位置261。
由于在图21的横截面图中所示的道的每个部分的高度变化，棘爪臂256在全程轨道258内被引导通过此特定的图形。因为棘爪臂形成为具有弹性向下偏置，当其移动通过每段高度变化时，一旦其到达，其弹性地向下弹到下一个水平。从而，在最终近端返回行程期间，棘爪返回到初始位置261，其在缝线箍锁护套124和针108之间产生相对运动，使得锁定键126再次被针的矛形远端109向外展开，以将缝线箍114锁定在适当的位置。柱塞棘齿机构允许完全返回到如图17所示的其初始位置。当棘爪臂278跟随三维轨道272内的下降路径以从棘齿的齿282离开前往在274的行程的底部。针部署弹簧244也弹性地扩张以为整个针和缝线箍护套组件提供近端运动。得到的手柄的构造如图17所示，并且小盒返回其初始状态，在该状态，针、缝线箍抽回到抽吸腔室106的近端侧。
缝线锁和输送设备
本发明的缝线锁和缝线锁输送设备通过提供了用于固定缝线的机构有助于系统的效用，该机构避免了麻烦的打结作业，该机构提供了机械式缝线保持器，其可以被输送通过内窥镜的工作通道，从而不需要再次插管另一个器械来完成手术。这里描述的缝线锁和输送设备与对应PCT公布物No.WO01/89393的未决的美国专利申请No.10/275,534中披露的相似。该美国专利申请在这里通过参考全文加入。
在图26A和26B中示出了本发明的缝线锁。图26A所示的分解的缝线锁包括具有通孔503的环502，通孔503定尺寸为摩擦接合地容纳塞504，以捕获通过通孔503的缝线18。图26B示出了装配的环和塞缝线锁构造，其中塞504插入环502的通孔503，以在塞和环的表面之间捕获缝线18。需要注意，在图26B中，在塞和环之间的间隙已经被夸大以示出缝线18存在于那两个部件之间，但是应该理解，缝线紧密地接合在它们之间，使得缝线不能滑动通过。
图27示出了缝线锁输送设备512的操作远端510。该操作远端接附到轴514，轴514的长度足够延伸通过内窥镜的工作通道的全部长度并且在近端伸出以与控制手柄550(如图27和接下来的28-36所示)接合，可以看到缝线锁输送设备的远端操作端的部件。该设备包括外部套516，笼518可以通过外部套516滑动，笼518通过在它们的近端522有英寸刻度地接附到衬套构件524的多个刚性指状物520限定。沿圆周方向隔开的指状物安装到衬套224的远端226，使得当指状物延伸超出套516时，它们在它们的远端521弹性地径向弹开。在它们闭合的构造，指状物限定了笼，该笼用作必须通过内窥镜的工作通道引导到缝合位置的分解的塞和环部件的容器528。通过笼518限定的容器用作保持塞和环对准，使得它们可以在远程的位置容易地装配。
如图27所示，当已经完成将缝线放置在组织内时，针和缝线箍锁组件的部件，与控制手柄一起全部从内窥镜工作通道移除。虽然小盒保持安装在内窥镜的远端，工作通道提供足够用于引入缝线锁输送系统设备512的空间。当远端操作构件510从内窥镜的工作通道的远端伸出到小盒的抽吸腔室106内时，远端操作构件510具有足够的空间来操作。当缝线锁输送设备的远端操作构件插入内窥镜的工作通道的近端内时，延伸通过工作通道并且通过组织的缝线引线18首先通过环502的远端插入通过环502，从环502的近端出来并且围绕塞504定位，使得它们延伸通过套516的近端开口530，使得当设备前进到达内部位置时它们可以保持紧密(图28-30)。
由缝线穿过通过该设备并且设备前进到缝合位置，缝线可以被拉紧以积聚已经被缝合的组织部分，并且该设备操作以捆紧缝线引线并且将它们锁定在适当的位置以保持组织。优选地，以控制手柄促动器的单次远端行程完成缝线锁输送设备的操作和装配环和塞的操作以及释放装配的部件。
图37和38示出了构造为用于以控制机构的单次远端行程操作输送设备的控制手柄。该控制手柄550包括壳体552，壳体552具有形成的指状物环554以在远端地压下柱塞556时，提供使用者手中的杠杆机构。外部轴558从控制手柄550远端地延伸，外部轴558通过短的应变消除器560保护，以防止在邻近手柄的区域扭曲。外部轴的近端562连接到手柄的主体552。外部轴的近端562通过结合到焊接在手柄主体552内部的衬套566来牢固地固定到手柄的主体。外部轴的远端564连接到外部套516。可以看到内部轴570通过外部轴558以操作推动器534，在笼518内装配期间，推动器534推动塞504进入环502。内部轴570在其近端571连接到柱塞主体556。当柱塞被压下时，内部轴570远端地运动以推动塞进入环以进行装配。柱塞轴556连接到衬套574，衬套574可以在手柄的主体552内的通道576内以紧密配合滑动。安装在柱塞衬套574和外部管衬套566之间的通道576内的返回弹簧578用作在柱塞完全地远端压下以后弹性地推动柱塞回到其近端位置。可以为内部轴增加推动器加强器580以提高其对在将塞装配到环内期间产生的压缩负载的作用下翘曲的抵抗力。
虽然以柱塞556的形式为手柄提供了单一的纵向推动器控制，在远端执行数个功能的能力通过锁定结构提供，该锁定结构仅通过推动器通过其环和塞装配行程的纵向运动自动释放。如图31-36所示，在装配以前(图31)，衬套524、环502和塞504保持在通过笼518限定的容器528内。环502保持远端地靠着指状物520的径向向内弯曲的顶523。因为向内弯曲的顶523限定的直径小于环的直径，环不能滑动通过顶，直到指状物打开。通过放置在衬套524的孔内，塞504保持与环的通孔503对准。
如图31所示，推动器534的远端532在对准的塞504直接近端。当远端地推动控制手柄550的柱塞556时，内部轴570远端地推动推动器以将塞504插入环502，如图32所示。在此阶段，缝线已经被捕获在塞504和环502之间，但是装配的环和塞必须从笼518限定的容器528中释放。为了实现此目的，衬套524和笼518制造为可以相对于外部套516滑动达到指状物的近端铰接到衬套的位置，使得指状物521的远端可以弹性地弹开以释放装配的环和塞。
为了在环和塞装配期间保持衬套和指状物在外部套内静止，但是在环和塞装配以后触发释放衬套和笼以相对于套向远端滑动，使用安放在形成在衬套524内的凹进处544内的锁定球542。推动器轴534形成保持锁定球的凹进处的底面。凹进处544的空间推动球，使球与形成在外部套516内的锁定孔546接合。当推动锁定球进入锁定孔546内时，衬套524和笼518不能相对于外部套516滑动。
在塞已经完全插入环502时，通过对应完成将塞插入环所需要的行程长度沿推动器轴形成直径减小的部分，可以触发锁定球以使其从锁定孔546释放。当直径减小的部分到达锁定球时，容纳锁定球的凹进处扩大，立即释放了它们对外部套516的锁定孔546的接合力。球的圆的表面立即允许从锁定孔546脱离并且如果远端的力保持在推动器轴534上，使得衬套524与笼518和装配的环和塞全部能够相对于套远端地运动。推动器的直径减小的部分在图32中以548标示，其在推动器已经充分延伸以将推动器塞504放置到环502内时到达锁定球542。通过在549开始的推动器的直径扩大的部分与衬套541的近端接合来保持作用在衬套524上的远端力(图32)。
推动器534继续远端地运动，衬套和笼组件相对于外部套516远端地滑动，如图34和35所示。在笼已经完全从外部套暴露以后，指状物520弹性地径向弹开以允许装配的环和塞释放，如图36所示。在衬套和笼518远端地前进期间，当衬套靠着套开口530的锋利的边缘531压断缝线时，切断多余的缝线引线。当柱塞556在控制手柄550释放时，返回弹簧578导致柱塞近端地运动，从而近端地抽回推动器，直到第一大直径部分接合衬套524的近端，在推动器534的连续的近端运动下将衬套和笼拉回到套516内。
操作
现在将参考图39-54所示的示意图，连同图55-63所示的图，解释上述单插管缝合系统的操作。在操作该设备时，首先将缝合小盒100安装到内窥镜10的远端，如图39所示。针108和缝线箍114定位在抽吸腔室106的近端，小盒内窥镜组件前进通过自然的身体腔到达想要的组织位置。此构造也在图55中示出。
在到达想要的组织位置以后，施加真空以将组织部分117吸引到抽吸腔室106内，如图41和56所示。
在已经抽吸组织117以后，针108和缝线箍114可以远端地前进通过组织，使得针和箍离开并且进入缝线箍捕捉器140，如图42、57和58所示。接下来，释放缝线箍114并且缝线箍捕捉器140和针近端地抽回，留下通过组织部分放置的缝线18，如图43和59所示。
如图45、60和61所示，停止真空并且从抽吸腔室106释放组织，缝线18穿过组织。在已经释放组织以后，在缝线箍114通过组织近端地抽回行程期间，在不同的位置的另一个组织部分可以被抽吸以被打开的针刺穿并且缝合，或者在施加抽吸以捕获另一个组织部分以前，针可以远端地前进以拾取缝线箍114并且将缝线箍114近端地抽回，使得缝线将在远端的方向前进通过捕获的第二组织部分。在图中示出了后面的方法，其中，在下一次缝合以前，首先将缝线箍取回并且将其近端地带回。
如图45和62所示，示出了在释放第一缝合组织部分117以后，针108远端地前进以再捕获缝线箍捕捉器140内的缝线箍。在箍已经通过缝线箍锁120固定到针上以后，针和箍组件可以近端地抽回到抽吸腔室的近端位置处的针轨道110内，如图46、47和63所示。在针已经与缝线箍一起近端地缩回以后，可以将第二组织部分119抽吸到抽吸腔室内并且重复上述过程，以使用相同的缝线18将另一根缝线放置在第二组织位置，如图48-50所示。在利用缝线材料18缝合需要的数量的组织部分以后，可以从内窥镜的工作通道移除与缝合设备有关的针和控制手柄部件，并且可以将装载有环502和塞504锁设备的缝线锁输送设备500插入通过内窥镜的工作通道，使得该设备的远操作端510延伸进入小盒100的抽吸腔室106。如图52和53所示，可以将环502和塞504施加到缝线18的端以固定缝线，以将组织部分117和119紧密地保持在一起。如图54所示，在施加缝线锁以后，可以从内窥镜的工作通道移除缝线锁输送设备500，并且从病人体内移除内窥镜。
虽然已经对本发明进行了这样的描述，我们希望通过本发明要求和保护的内容为。

Claims (15)

1.一种内窥镜组织缝合设备，其包括：
缝合小盒，其具有组织抽吸腔室、针轨道和缝线箍捕捉器，其中，缝线箍捕捉器定位在组织抽吸腔室的远端，
在针轨道内且沿通过组织抽吸腔室的路径可滑动的针，
在针的外表面上的缝线箍锁，和
缝线箍，其可以通过缝线箍锁捕获在针的外表面上，并且当释放缝线箍锁时，可以将缝线箍从针释放到缝线箍捕捉器内。
2.如权利要求1所述的内窥镜组织缝合设备，其中，缝线箍锁相对于针的外表面改变其位置，以形成接合缝线箍以防止该箍相对于针远端地滑动运动的锁定表面。
3.如权利要求2所述的内窥镜组织缝合设备，其中，针的外表面成形为当缝线箍锁相对于针纵向运动时接合缝线箍锁，以形成锁定表面。
4.如权利要求3所述的内窥镜组织缝合设备，其中，缝线箍锁包括至少两个锁定键，当它们在针的扩大的表面上滑动时，该两个锁定键展开，以形成保持缝线箍使其不能纵向运动的锁定表面。
5.如权利要求1所述的内窥镜组织缝合设备，其中，缝线箍捕捉器包括两个弹性臂，该两个弹性臂在它们端部的一端以Y形构造结合在一起，每个弹性臂具有带有构造为接合缝线箍的表面的向内伸出的边缘的尖头形状的自由端。
6.如权利要求5所述的内窥镜组织缝合设备，其中，缝合小盒还包括腔，其构造为在允许缝线箍捕捉器的弹性臂运动的同时紧密地围绕缝线箍的表面配合。
7.如权利要求1所述的内窥镜组织缝合设备，其中，缝线箍为环形的并且在针的外表面上滑动。
8.如权利要求7所述的内窥镜组织缝合设备，其中，该箍具有近端和远端，并且至少在其远端成锥形，以当针远端地前进通过组织时呈现低的型面。
9.如权利要求4所述的内窥镜组织缝合设备，其中，针是实心的并且具有矛形远端，该矛形远端具有直的成锥形的桶表面，其在近端和远端方向延伸并且在中央直径增加的部分会合，以限定扩大的形状。
10.如权利要求1所述的内窥镜组织缝合设备，还包括控制手柄，其可以可释放地固定到内窥镜的近端，并且具有至少一个连接到延伸通过内窥镜的工作通道的轴的纵向控制构件，以控制针的纵向运动。
11.如权利要求10所述的内窥镜组织缝合设备，其中，手柄还包括用于在操作针的纵向控制构件的行程的一部分期间促动缝线箍锁的控制机构。
12.如权利要求11所述的内窥镜组织缝合设备，其中，手柄的纵向控制构件包括全程棘爪和轨道机构，其定向为仅在操作针的控制构件的纵向行程的一部分期间导致缝线箍锁控制轴运动。
13.如权利要求10所述的内窥镜组织缝合设备，其中，控制手柄还包括真空控制开关，该真空控制开关具有互锁特征部，其防止手柄控制构件纵向运动，直到小盒的抽吸腔室达到预先设定的真空压力。
14.如权利要求1所述的内窥镜组织缝合设备，其中，针具有用于刺穿组织的锋利端。
15.一种单插管多缝针内窥镜缝合系统，其包括：
可以可释放地固定到内窥镜的远端并且具有可以在针轨道内滑动的针的缝合小盒；
用于接收组织的抽吸腔室；
连接到缝线并且可以在针上滑动的缝线箍；
在针上的可以选择地释放的缝线箍锁；
在抽吸腔室远端并且构造为摩擦地接合缝线箍的缝线箍捕捉器；
缝合小盒控制手柄，其可以可释放地固定到内窥镜的近端，并且包括至少一个接附到控制轴的一端的纵向控制构件，控制轴在其另一端连接到针，使得控制构件的纵向运动导致相应的针的运动；
缝线锁，其包括可以摩擦地接合在环内以捕获其间的缝线的塞；
缝线锁输送设备，其包括具有远端和近端的轴，并且该轴具有充分小的直径以可以被可滑动地通过内窥镜的工作通道接收，并且该轴的长度足够长以延伸至少内窥镜的长度；
缝线锁运载器，在其远端包括通过多个纵向设置并且在它们的近端铰接的臂限定的笼；
可以在笼上滑动的缝线切割器；
缝线锁输送设备控制手柄，其包括纵向滑块，用于促动延伸通过该轴的推动器，以推动塞进入环，并且相对于套远端地前进该笼，以打开指状物并且释放装配的环和塞。
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EP1631201A4 (en) 2012-04-18
EP1631201A1 (en) 2006-03-08
NO339143B1 (no) 2016-11-14
BRPI0410376A (pt) 2006-06-13
WO2004103189A1 (en) 2004-12-02
US8075573B2 (en) 2011-12-13
AU2004240645B2 (en) 2010-05-13
EP1631201B1 (en) 2018-11-07
AU2004240645A1 (en) 2004-12-02
CA2525275A1 (en) 2004-12-02
BRPI0410376B1 (pt) 2016-06-14
NO20055381L (no) 2005-12-15
US20050033319A1 (en) 2005-02-10
CA2525275C (en) 2012-02-07
ES2705604T3 (es) 2019-03-26
JP2010246939A (ja) 2010-11-04
JP4565218B2 (ja) 2010-10-20
JP2007500575A (ja) 2007-01-18
CN1822794A (zh) 2006-08-23
MXPA05012303A (es) 2006-02-22

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