CN1843302A - 具有导向横向运动的关节运动构件的外科器械 - Google Patents

具有导向横向运动的关节运动构件的外科器械 Download PDF

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CN1843302A
CN1843302A CNA2006100725514A CN200610072551A CN1843302A CN 1843302 A CN1843302 A CN 1843302A CN A2006100725514 A CNA2006100725514 A CN A2006100725514A CN 200610072551 A CN200610072551 A CN 200610072551A CN 1843302 A CN1843302 A CN 1843302A
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CN100508899C (zh
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约瑟夫·C·赫艾尔
肯尼斯·S·威尔士
查德·P·布德罗克斯
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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
    • 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
    • A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • 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
    • 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

Abstract

一种特别适用于内窥镜使用的外科器械，通过在使端部执行器枢转到所选择的一侧的轴的近侧部分包括一横向滑动构件，使端部执行器关节运动。通过将引导机构结合于横向滑动构件和轴的框架之间，差动的相对致动力(例如水压、流体的、机械的)无束缚地作用在横向滑动构件上。

Description

具有导向横向运动的关节运动 构件的外科器械
相关申请的交叉参考
本发明要求Kenneth Wales和Chad Boudreaux于2005年2月18日申请的题为“SURGICAL INSTRUMENT INCORPORATING AFLUID TRANSFER CONTROLLED ARTICULATION MECHANISM”的共有美国专利申请的优先权，其内容在此全部引用作为参考。
技术领域
本发明总的通常涉及外科器械，其适用于将端部执行器(例如，末端切割器，抓钳，切割器，缝合器、夹钳施放器、接触装置、药物/基因治疗传送装置，以及采用超声波、RF、激光等的能量装置)以内窥镜检查的方式插入到手术部位，更具体地说，本发明涉及带有关节运动轴的这种外科器械。
背景技术
内窥镜外科器械通常比传统的开放手术装置更优越，是由于较小的切口减少了术后康复时间和并发症。因此，适于将远侧端部执行器经套管针插管精确放置到所需的手术部位的各种内窥镜外科器械得到了极大的发展。这些远侧端部执行器以多种方式与组织接合，实现诊断或治疗的效果(例如，末端切割器、抓钳、切割器、缝合器、夹钳施放器、接触装置、药物/基因治疗传送装置，以及采用超声波、RF、激光等的能量装置)。
端部执行器的定位受到套管针的约束。通常，这些内窥镜外科器械包括位于端部执行器和由临床医生操纵的手柄部分之间的长杆。该长杆可插入到所需的深度并围绕杆的纵向轴线旋转，由此将端部执行器定位到某种程度。例如，通过另一个套管针正确放置套管针并使用抓钳，这种定位的量常常就足够了。手术缝合以及切割器械(例如在美国专利No.5,465,895中描述的器械)是一成功地通过插入和旋转来定位端部执行器的内窥镜外科器械的例子。
最近，Shelton IV等于2003年5月20日申请的题为“SURGICALSTAMPLING INSTRUMENT INCORPORATING AN E-BEAMFIRING MECHANISM”的美国专利No.10/443,617公开了一种用于切割组织并致动缝钉的改进的“E形梁”发射杆，其全部内容在此引入作为参考。该装置的一些其它优点包括确保将端部执行器的钳夹间隔开，或者更具体地说，将缝钉施加组件间隔开，即使夹钳了比最佳缝合形成略多或略少的组织也是如此。而且，E形梁发射杆与端部执行器和缝钉筒以能进行几种有益的锁定的方式接合。
根据手术的性质，可能需要进一步调节内窥镜外科器械的端部执行器的定位。具体地说，通常需要将端部执行器在相对于器械的轴的纵向轴线为横向的轴线上定位。端部执行器相对于器械的轴的横向运动通常称为“关节运动”(articulation)。这通常可通过将枢轴(或关节)接头设置于与缝钉施加组件近侧伸出的轴中来实现。这使得外科医生可在远处将缝钉施加组件关节运到任一侧，以更好的放置缝合线，并更容易进行组织操纵和定向。在一些情况下，例如在器官的后面这种关节运动定位使临床医生能够更容易地接合组织。另外，有利地，关节运动定位可使内窥镜定位于端部执行器的后面，而不受器械轴的阻碍。
通过将对关节运动的控制与对闭合端部执行器以夹钳组织和在内窥镜检查器械的很小直径范围内发射端部执行器(即缝合及切除)的控制一体化，来使手术缝合及切割器械进行关节运动的方法显得非常复杂。通常，当纵向平移时，这三种控制运动都通过轴来传送。例如，美国专利No.5,673,840公开了一种折叠式关节运动机构(“挠性颈”)，其通过执行轴选择性拉回两个连接杆中的一个而进行关节运动，每个杆分别在轴的中心线的相对侧上偏置。连接杆借助一系列不连续位置步进运动。
关节运动机构纵向控制的另一例子是美国专利No.5,865,361，其包括从凸轮枢轴偏置的关节运动连接件，使关节运动连接件的推拉纵向平移致动关节运动到相应侧。同样地，美国专利No.5,797,537公开了一种类似的杆，其穿过轴进行关节运动。
在Frederick E.Shelton IV等的题为“SURGICAL INSTRUMENTINCORPORATING AN ARTICULATION MECHANISM HAVINGROTATION ABOUT THE LONGITUDINAL AXIS”的共同未决和共有美国专利申请No.10/615,973中，作为纵向运动的替代，其采用旋转运动来传送关节运动，其内容在此通过引入作为参考。
尽管这些机械传送的关节运动成功地使内窥镜手术缝合和切割器械进行关节运动，发展趋势造成了进入市场的极大挑战和障碍。相矛盾的设计目标包括一直径尽可能小的轴，以减小手术开口的尺寸，但仍具有足够的强度来进行几种运动(例如，闭合、发射、关节运动、旋转等)。此外，在没有束缚以及其它摩擦问题的情况下传递足够的力会限制设计的所需特征和可靠性。
因此，非常需要一种关节运动外科器械，其包含采用可包含于其闭合范围中的关节运动力的关节运动机构，而不会干扰发射和闭合运动。
发明内容
本发明通过提供一种外科器械，其具有连接于手柄和端部执行器之间的关节运动轴，所述端部执行器采用一在对端部执行器的枢转结构起作用的轴的近侧部分的横向滑动元件，克服了现有技术的上述及其它缺点。横向滑动构件的相对侧上的横向运动致动器控制的枢转运动到任一侧。该横向运动元件具有在其上作用的大的纵向表面积。有利地，将运动元件支撑于其中的轴的框架包括一与横向滑动构件接合的横向引导机构，从而避免了可能对性能造成损害的束缚。
在本发明的一个方面，该外科器械包括一近侧部分，其在患者的体外操纵，以将相连的细长轴和端部执行器定位于患者体内需要手术的部位。一关节运动接头将端部执行器与细长轴相连，以在以所需的角度达到组织时提供进一步的临床弹性。一与近侧部分相连的关节运动控制器沿着轴向下传送差动纵向运动，以对横向滑动构件的每一侧协同作用。在所述框架或横向滑动构件一个中形成的横向通道通过在另一个中形成的相应横向轨道接合。因此，防止了横向滑动构件以不同于与轴的纵向轴线对准的定向角度被致动。
本发明的另一方面，膨胀和压缩的囊与横向滑动构件的每一侧相对。
(1)本发明涉及一种外科器械，包括：
端部执行器，其具有近侧凸轮表面；
细长轴，其包括限定了一与纵向轴线对准的横向凹槽的框架；
关节运动接头，其将端部执行器枢转地连接到细长轴的远端上；
位于横向凹槽中的滑动杆，其具有与端部执行器的近侧凸轮表面接合的远端；
横向引导机构，其将滑动杆与框架接合，用于滑动杆的横向运动和纵向对准的运动；以及
手柄部分，其与细长轴的近端连接，并被可操作地构造成能产生关节运动，以使滑动杆横向运动。
(2)如项目(1)所述的外科器械，其中，端部执行器的近侧凸轮表面包括指向近侧的凸轮凹槽，用于收纳滑动杆的远端。
(3)如项目(1)所述的外科器械，其中，端部执行器的近侧凸轮表面包括一扇形齿轮，并且滑动杆的远端包括一齿条。
(4)如项目(3)所述的外科器械，其中，横向引导机构包括一在框架中横向形成的通道和一收纳于该通道中的肋，该横向引导机构垂直地连接到滑动杆上，该滑动杆还包括将所述肋连接到齿条上的挠性纵向部分，其中，对端部执行器的操纵引起扇形齿轮的向回驱动，该驱动使纵向部分挠曲，从而使肋束缚地接合于通道中。
(5)如项目(1)所述的外科器械，其中，横向引导机构包括：
左支承面和右支承面，其经过细长通道中的横向凹槽而横向间隔开；
滑动杆中的至少一个横向通孔，其与所述左支承面和右支承面对准；以及
至少一个滑动销，其收纳于滑动杆的横向通孔中并连接到每个支承面上。
(6)如项目(1)所述的外科器械，其中，所述横向引导机构包括：
一形成于横向凹槽的附近的框架上的横向通道；以及
一连接到所述滑动杆上并滑动地收纳于横向通道中的横向肋。
(7)如项目(1)所述的外科器械，其中，横向引导机构包括：
一形成于框架附近的滑动杆上的横向通道；以及
一横向肋，其连接到延伸到横向凹槽中的框架表面上并滑动地收纳于滑动杆的横向通道中。
(8)如项目(1)所述的外科器械，其中，横向引导机构包括：
一形成于框架附近的滑动杆上的横向通道；
一形成于横向凹槽和滑动杆横向通道附近的框架上的相应的横向通道；以及
一支承构件，其收纳于由滑动杆横向通道和框架横向通道限定的横向导向凹槽中。
(9)如项目(8)所述的外科器械，其中，支承构件包括至少一个球面轴承。
(10)如项目(8)所述的外科器械，其中，支承构件包括一圆柱形轴承。
(11)如项目(1)所述的外科器械，其中，滑动杆和细长轴的横向凹槽附近的框架的表面中的一个包括一横向肋，并且另一个包括一个横向通道，其大小设置成能容纳横向肋和多个轴承。
(12)如项目(1)所述的外科器械，其中，将滑动杆与框架接合用于滑动杆的横向和纵向对准运动的横向引导机构包括一个与滑动杆平行对准并与所述细长轴的垂直中心线对准的旋转连接件，所述旋转连接件与滑动杆的邻近表面枢转连接，导致其随着旋转连接件的旋转而横向运动。
(13)如项目(12)所述的外科器械，其中，可旋转的连接件包括多个与滑动杆连接的枢转接头，它们沿着其纵向长度间隔，以在致动过程中保持对准。
(14)如项目(1)所述的外科器械，其中，左右远侧流体致动囊分别设置于滑动杆的相应侧，所述手柄部分包括一个关节运动控制器，其可操作地构造成能将流体差动地传送到左右远侧流体致动囊。
(15)如项目(1)所述的外科器械，其中，左右远侧流体致动囊分别设置于滑动杆的相应侧，所述手柄部分包括一个关节运动控制器，其可操作地构造成能将差动纵向运动施加到左右机械致动器上，以使滑动杆横向移位。
(16)本发明还涉及一种外科器械，包括：
端部执行器，其具有近侧凸轮表面；
细长轴，其连接到端部执行器上并且包括限定了一与纵向轴线对准的横向凹槽的框架；
关节运动接头，其将端部执行器枢转地连接到细长轴的远端上；
位于横向凹槽中的滑动杆，其具有与端部执行器的近侧凸轮表面接合的远端；
在横向凹槽中的滑动杆的相应侧上的右致动器和左致动器；
横向引导机构，其包括在滑动杆和框架的一个中形成的横向通道和在滑动杆和框架的另一个中形成的横向肋；以及
手柄部分，其与细长轴的近端连接，并被可操作地构造成能对相应的致动器产生差动纵向运动，以使滑动杆横向运动。
(17)如项目(16)所述的外科器械，其中左右致动器包括囊，手柄部分可操作地构造为将流体传送到左右囊致动器中的一个，并从另一个中传送流体。
(18)如项目(16)所述的外科器械，其中左右致动器包括纵向弯曲构件，每个具有可移动的近端，所述手柄部分可操作地构造成能将纵向弯曲构件的近端差别定位。
(19)如项目(16)所述的外科器械，还包括一支承构件，其选自插入框架和滑杆之间的球面轴承和圆柱形轴承。
(20)一种外科器械，包括：
一缝钉施加组件；
一细长轴，其与缝钉施加组件相连并包括限定了一与纵向轴线对准的横向凹槽的框架；
一关节运动接头，其将缝钉施加组件与细长轴的远端枢转连接；
一位于横向凹槽内的滑动杆，其具有与端部执行器的近侧凸轮表面接合的远端；
分别位于横向凹槽中的滑动杆的相应侧的左右致动器；
一用于横向引导由框架限定的凹槽中的滑动杆的部件，其将滑动杆与细长轴的纵向轴线保持为平行对准；以及
一手柄部分，其与细长轴近侧连接，并被可操作地构造成能对相应的致动器产生差动纵向运动，以使滑动杆横向运动
通过附图及其描述，本发明的这些和其它目的和优点将更加明显。
附图简述
包含于并构成说明书的一部分的附图，与上面给出的本发明的总的描述以及下面给出的实施例的详细描述一起示出了本发明的实施例，用于解释本发明的原理，其中：
图1是手术缝合及切割器械的前俯视透视图，其具有开口的端部执行器，或者缝钉施加组件，并且其中去除了缝钉筒。
图2是图1中的手术缝合及切割器械的前俯视透视图，其中关节运动机构由流体致动控制器所致动。
图3是图1的手术缝合及切割器械的细长轴和关节运动机构的分解透视图。
图4是图1的手术缝合及切割器械的执行部分的远侧部分的分解透视图，包括缝钉施加组件和关节运动机构。
图5是图1及图4的缝钉施加组件的俯视透视图，其中去除了缝钉筒的侧面半部，以暴露由发射运动所驱动的组成元件。
图6是图1的外科器械的执行部分的前方透视图，其中去除了双枢轴闭合套管组件和端部执行器，以显示通过流控关节运动机构而进行关节运动的单枢轴框架底。
图7是图1的外科器械的一种作为选择的关节接头的透视详示图，显示出具有单枢轴框架底的位于近侧位置处的双枢轴闭合套管。
图8是图7的作为替代的关节接头的底部右侧分解透视图，包括双枢轴固定壁狗骨形连接件和具有用于横向运动构件(T形杆)的导轨的框架底。
图9是图1的外科器械的另一作为选择的关节接头的顶部左侧分解透视图，包括一结合于下部双枢轴连接件中的作为替代的坚固壁支撑板机构，以支撑发射杆，并包括受导轨引导的横向运动构件(T形杆)。
图10是用于图1的外科器械的一种作为选择的关节运动锁定机构的顶部示意图，其中去除了闭合的套管组件，以暴露用于自动的关节运动锁定接合和脱离接合的支撑负载(backloading)的脱离接合T形杆。
图11是用于图1的外科器械的另一种作为选择的关节运动锁定机构的顶部示意图，T形杆具有由弹簧偏置的齿条，其具有由于端部执行器的支撑负载而接合的锁定结构。
图12是用于图1的外科器械的一种作为选择的T形杆和带有横向导向件的框架底。
图13是用于图1的外科器械的另一种作为选择的T形杆和带有横向导向件的框架底。
图14是用于图1的外科器械的一种作为选择的关节运动机构的左侧顶部分解透视图，包括一双枢轴框架组件和一单枢轴闭合套管组件。
图15是图14的作为选择的关节运动机构的左侧底部透视图。
图16是具有齿条和处于非关节运动状态的齿轮部分的横向运动的流控关节运动机构的示意图。
图17是图16中的流控关节运动机构沿着线17-17截取的前剖视图。
图18是横向运动流控关节运动机构的示意图，具有齿条和处于关节运动状态的齿轮部分。
图19是图18中的流控关节运动机构沿着线19-19的前剖视图。
图20是由至少一使滑动杆横向凸出的纵向运动构件导致关节运动的外科器械的顶部示意图，所述外科器械又使端部执行器关节运动。
图21是处于关节运动状态的图20的外科器械的顶部示意图。
图22是用于图16或20的外科器械的一种作为选择的旋转连接件机械控制系统的前剖视图，该系统用于分别在非关节运动状态横向平移T形杆或滑动。
图23是处于关节运动状态的图22的可选择的旋转连接件机械控制系统的前剖视图。
图24是外科器械的顶部示意图，具有由一对纵向弯曲构件横向定位的滑动杆，所述构件每个具有可纵向调节的近侧端点，以使端部执行器关节运动。
图25是处于关节运动状态的图24的外科器械的顶部示意图。
图26是具有电磁横向关节运动控制机构的外科器械的顶部示意图。
图27是处于关节运动状态的图26的外科器械的顶部示意图。
具体实施方式
关节运动轴概述
参照附图，其中在所有附图中，相同的附图标记表示相同的元件，图1描绘了一种外科器械，在该示例性方案中具体为手术缝合和切割器械10，能够实现本发明的独特优点。具体地说，手术缝合和切割装置10的大小设置为能够以如图1所示的非关节运动状态，通过套管针插管通道插入到患者(未显示)体内的手术部位，以进行外科手术。一旦执行部分12通过插管通道插入，如图2中所示，就可通过关节运动控制器18遥控使执行部分12的细长轴16的远侧部分中结合有的关节运动机构14进行关节运动。在示例性方案中描述为缝钉施加组件20的端部执行器与铰接机构14远侧相连。因此，远程使关节运动机构14关节运动使缝钉施加组件20从细长轴16的纵向轴线关节运动。这种成角度的定位可具有根据切割和缝合所需的角度来接近组织的优点，避免了在接近组织时其它器官和组织所造成的障碍，和/或使内窥镜能够定位于后面并与缝钉施加组件20对准，以确保其放置。
手柄
手术缝合及切割器械10包括一手柄部分22，其与执行部分12的近端连接，以对其进行定位、关节运动、闭合和发射运动。手柄部分22包括一手枪式把手24，临床医生向着它枢转且向近侧拉动闭合触发器26，引起缝钉施加组件20的夹钳或闭合。一发射触发器28设置于闭合触发器26更远的外侧，并可由临床医生枢转地拉动，引起对在缝钉施加组件20中夹钳的组织进行缝合及切割。此后，按下闭合释放按钮30，从释放夹钳的闭合触发器26，并由此释放夹钳的组织的已切割和缝合的末端。手柄部分22还包括一用于与细长轴16的运动偶联的旋转旋钮32，以使轴16和铰接的缝钉施加组件20围绕轴16的纵向轴线旋转。手柄部分22还包括一发射回缩手柄34，以在发生束缚时帮助回缩发射机构(在图1-2中未显示)，从而使缝钉施加组件20此后可张开。
应当理解，这里使用的术语“近侧”和“远侧”以临床医生握持器械的手柄为参照。因此，手术缝合组件20相对于更近侧的手柄部分20位于远侧端。还应理解，为了方便和清楚起见，这里使用的空间术语，例如“垂直”和“水平”与是相对附图而言的。然而，外科器械可以在许多定向和位置使用，这些术语并不意图进行限制和绝对化。
在Swayze和Shelton IV的题为“SURGICAL STAPLINGINSTRUMENT INCORPORATING A MULTISTROKE FIRINGPOSITION INDICATOR AND RETRACTION MECHANISM”的共同未决的共有美国专利申请No.10/674,026中详细描述了一种用于图1-2中的手术缝合及切割器械10的例证性多冲程手柄部分22，其内容在此全部引入作为参考，此处描述另外的特征和变化。尽管多冲程手柄部分22有利地支持能以较大发射力远距离应用，与本发明一致的应用可包括单发射冲程，例如在Frederick E.Shelton IV，Michael E.Setser，and Brian J.Hemmelgarn题为“SURGICAL STAPLINGINSTRUMENT HAVING SEPARATE DISTINCT CLOSING ANDFIRING SYSTEMS”的共同未决的共有美国专利申请No.10/441,632中所描述的，其内容在此全部引入作为参考。
执行部分(使细长轴和缝钉施加组件关节运动)
在图3-5中，执行部分12有利地包括在适于内窥镜和腹腔镜手术的较小直径内的纵向旋转、关节运动，闭合和发射的多种致动运动。缝钉施加组件20(“端部执行器”)具有一对枢轴相对的夹钳，描述为一具有枢轴连接的砧座(anvil)42的细长通道40(图1-2，4-5)。砧座42对细长通道40的闭合和夹钳通过用可旋转地连接于手柄部分22的框架组件44(图3)纵向支撑细长通道40来实现，双枢轴闭合套管组件46在所述手柄部分22的上方沿纵向运动，以分别闭合和打开向砧座42的远离和靠近运动，即使其中如图2所示缝钉施加组件20关节运动也是如此。
特别参照图3，框架组件44包括一单枢轴框架底48，如图3所示，其近端与旋转旋钮32接合，右侧半壳位于其上方。应当理解，闭合套管组件46的近端，具体为闭合直管52，包围框架底48的近端，所述近端进一步穿过其内部到达手柄部分22，以与使闭合套管组件46纵向平移的闭合元件(未显示)接合。一位于闭合直管52近端的圆形唇缘54提供了与所述元件的旋转接合。旋转旋钮32的接合元件穿过直的闭合管52的近侧部分上的纵向狭槽56与在框架底48上近侧地定位的开孔58接合。纵向狭槽56具有足够的长度，以允许闭合套管组件46以由旋转旋钮32设定的旋转角度相对于闭合套管组件46和框架底48闭合纵向平移。
细长轴16通过收纳与手柄部分22的发射元件(未显示)旋转接合的发射杆60来支持发射运动。发射杆60沿着框架底48的纵向中心线进入近侧开62。框架底48的远侧部分沿着其底部包括一与近侧开口62相连通的发射杆狭槽64。发射杆66在发射杆狭槽64中纵向平移，并包括一向上突出的近侧销68，其与发射杆60的远端70接合。
细长轴16通过具有矩形容器腔72(在旋转旋钮32的远侧部分中描绘为横向部分)来支持关节运动。一位于矩形容器腔72中的底部分隔室74具有横向间隔开的左右挡板76、78。一关节运动致动器80在底部分隔室74的上方横向滑动，其位于挡板76、78外侧的横向向下隔开的左右凸缘82、84每个与从旋转旋钮32的相应半壳向外伸出的左右按钮开关86、88横向相通。关节运动致动器80的横向运动使左右凸缘82、84分别更靠近或更远离左右挡板76、78，这与流控关节运动系统94的左右储存囊90、92的运转相反，每个囊90、92分别与左右流体导管或通道96、98远侧连通，该流体导管或通道又分别与左右致动囊100、102连通。后者相对并使致动机构14的T形杆104横向枢转。
框架组件44通过包括一框架底48的顶部和远端带凹槽的台面106来限制这些流控的致动，在所述框架底的上面有流体通路96、98和致动囊100、102。T形杆104滑动地位于带凹槽的台面106的上、致动囊100、102之间。靠近T形杆104处，一突出的屏障肋108与其对准，用于防止流体通路96、98向内扩张。框架组件44具有一圆形的顶部框架盖(隔离物)110，其在框架底48的上方滑动，防止流体通路96、98和致动囊100、102的垂直膨胀，同时限制T形杆104的任何垂直运动。特别地，框架盖110包括能使其还提供关节运动锁定构件111的结构，下面将作为关节运动锁定机构113的一部分详细描述。
T形杆104的远端(“齿条”)112接合，以使关节运动机构14的铰接的远侧框架构件114的指向近侧的扇形齿轮115枢转。一铰接的闭合管116包围铰接的框架构件114，并具有一与砧座42接合的马蹄形开孔118。在闭合直管52和关节运动的闭合环116之间、关节运动机构14的上方形成一双枢轴连接件，从而可允许纵向闭合运动，即使当关节运动机构14关节运动时也是如此。特别地，闭合直管52上的带有销孔122、124的顶部和底部远侧突出的枢轴翼片118、120分别与关节运动闭合环116上具有销孔130、132的相应的顶部和底部近侧突出的枢轴翼片126、128纵向间隔开。上部双枢轴连接件134具有分别与销孔122、130接合的纵向间隔的向上定向的远侧和后部销136、138，下部双枢轴连接件140具有分别与销孔124、132接合的纵向间隔的向下突出的远侧和后部销142、144。
特别参照图4，为了增强可制造性，关节运动闭合环116显示为包括短管146，其与具有近侧突出的枢轴翼片126、128的连接卡圈148相连。同样地，直闭合管52由与后部连接卡圈152相连的长闭合管150组装而成，所述连接卡圈152包括向远侧突出的枢轴翼片118、120。短闭合管146中的马蹄形开孔118与在横向枢轴销156附近的向上突出的砧座结构154接合，所述枢轴销156与细长通道40中的枢轴凹槽158接合。
图4的示例性方案包括狗骨形连接件160，其近侧销157与框架孔161中的框架底48枢转连接，并且其近侧销159与关节运动框架构件114的近侧下表面162刚性连接，从而在其间提供枢轴支撑。狗骨形连接件160中的底部纵向刀槽163引导发射杆66的关节运动部分。关节运动框架构件114还包括一底部纵向狭槽164，以引导发射杆66的远侧部分。
缝钉施加装置(端部执行器)
参照图4-5，发射杆66远端终止于E-形梁165中，所述E-形梁165包括上部导向销166，其插入砧座42中的砧座狭槽168中，以在缝钉形成和切割期间核实并帮助将砧座42保持为闭合状态。细长通道40和砧座42之间的间隔还可通过E-形梁164使中间销170沿着细长通道40的顶面滑动来保持，同时底应172沿着细长通道40的下表面相对地滑动，由细长通道40中的纵向开口174导向。E形梁164的位于上部导向销166和中间销170之间的远侧切割表面176对夹钳的组织进行切割，同时E形梁通过向远侧移动楔形滑板(sled)180致动可替换的缝钉筒178，使缝钉驱动器182向上突出，使缝钉从在砧座42的缝钉形成下表面形成的缝钉筒主体188中的向上打开的缝钉孔186中弹出。缝钉筒托架192从底部包围缝钉筒178的其它元件，将它们保持在适当的位置。缝钉筒托架192包括一向后打开的狭槽194，其覆盖在细长通道40中的纵向开口174上，从而使中间销170穿过缝钉筒托架192的内部。
缝钉施加组件20在Frederick E.Shelton IV等于2004年9月30日提交的“ARTICULATING SURGICAL STAPLING INSTRUMENTINCORPORATING A TWO-PIECE E-BEAM FIRING MECHANISM”的共同未决的共有美国专利申请No.10/955,042中有详细描述，其内容在此全部引入作为参考。
关节运动锁定机构
在图3-4和6-8中，有利地，包含有一关节运动锁定机构200，以保持缝钉施加组件20处于所需的关节运动角度。关节运动锁定机构200减小了左右致动囊100、102上的负载。特别地，压缩弹簧202(图3)近侧地定位于关节运动锁定构件111的近端204和手柄部分22之间，从而向远侧偏压关节运动锁定构件111。特别参照图4，关节运动锁定构件111远端210处的两个平行的狭槽206、208分别收纳框架底48上向上突出的导向肋212、214。导向肋212、214的纵向长度比平行的狭槽206、208短，使其具有相对纵向冲程范围。因此，特别参照图8，示为从连接锁定元件111向远侧突出的带齿的凹槽216的远侧摩表面的选择性抵接接合与收纳在关节运动框架构件114的顶部近侧凹槽220中的制动板218中的相应锁定扇形齿轮217接合。制动板218中的远侧和近侧孔221、222收纳从顶部近侧凹槽220向上突出的远侧和近侧销223、224。
特别参照图6，细长轴16描绘为处于铰接位置，其中闭合套管组件46从框架组件44周围被去除，因而没有细长通道40和砧座42。关节运动致动器80显示为横向运动到左侧以压缩右侧近侧储存90和膨胀的远侧右致动100，使T形杆104运动到所示的位置。因此，如图所示，关节运动致动器80的横向运动使远侧框架114围绕单枢轴框架底48顺时针关节运动。有利地，关节运动致动器80还自动与关节运动锁定机构200接合和脱离接合。特别地，沿着关节运动致动器80的近端上表面的齿棘表面225收纳从铰接闭合元件111的近端204向上突起的锁定销226。锁定销226在齿棘表面225根部中的接合提供了足够的关节运动锁定构件111向远侧的运动，用于将锁定扇形齿轮217在制动板218中锁定接合。操作人员使压缩构件272进行的横向运动，向近侧推动锁定销226，由此使关节运动锁定构件111与制动板218脱离接合。当操作人员释放关节运动致动器80时，锁定销226被压缩弹202推动到棘表面225中的相邻棘中，使锁定机构111锁定，并由此缝钉施加组件20，通过将近侧左右储存90、92限制和扩张为膨胀的形状，将关节运动机构14限制在所需的关节运动位置。
关节运动锁定机构200在Dale R.Schulze和Kenneth S.Wales等于1996年3月10日提交的题为“SURGICAL INSTRUMENT”的共有美国专利US5673841A中有详细描述，其内容在此全部引入作为参考。
作为选择或者另外，可在平行的流体236、238中设置一孔口，以控制近端致动100、102和远端储存90、92之间的流速。在图16、18中，流体流路258、264的尺寸可设置为提供改变关节运动的角度的阻力，起孔的作用，或者它们可包括流体流速限制结构。
在图10中，一种替代的外科器械2004的关节运动机构2002的锁定机构2000通常是未锁定的，并由于支撑负载通过发射横向运动的T形杆2006来致动。一狭槽2008定位于框架底2010中，以收纳并引导从T形杆2006向下伸出的肋2012。如果端部执行器2016支撑负载，则与肋2012正交连接的细长纵向部分2014偏转。例如，当端部执行器2016受到如箭头2018所示向右的力，例如，其近侧扇形齿轮2020作用于T形杆2006的齿条2022上，提供非正交的后驱动力(backdriving force)，如箭头2024所示。因此，细长纵向部分2014弯曲，将肋2012斜置到狭槽2008中。这种斜置产生了相对的束缚力，如箭头2026、2028所示，该力将T形杆2006锁定并阻止进一步的关节运动。当关节运动囊的致动使横向运动的T形杆2006解锁时，则产生释放。此后，肋2016可帮助引导T形杆2006。
在图11中，显示了另一种用于外科器械2102的关节运动锁定机构2100，其通常由与端部执行器2106的齿轮齿2104和T形杆2110的齿条齿2108成20度压力角的近侧力向量来解锁和致动。当端部执行器2106支撑负载时(如非垂直箭头2112表示)压力角的纵向向量(以箭头2114表示)使T形杆2110向近侧运动。该纵向力向量施加到位于T形杆2110的齿条2120后面的刚性弹簧2118上。当弹簧2118随着T形杆2110向近侧移动而偏转时，从齿条2120向近侧突出的锁定齿2126开始接合，同时在底部框架2124上近侧横向对准的锁定元件2122与从齿条2120向近侧突出的锁定齿2126接合。当通过除去端部执行器2106的支撑负载并通过弹簧2118的推动使T形杆2110向远侧运动，使近侧力向量减小或消除时，锁定齿2126和锁定元件2122脱离接合。
双枢轴闭合套管和单枢轴框架底的结合
参照图3-4和7，有利地，执行部分12包括纵向平移的双枢轴闭合套管组件46，其包围一单枢轴框架底48。下面将进一步详细描述这些机构和其它操作。特别参照图7，关节运动机构14显示为处于铰接状态，其中闭合套管组件46向近侧回缩到砧座打开状态。随着砧座42的打开，关节运动控制器18的致动引起铰接的闭合环116分别围绕上部和下部双枢轴闭合连接件134、140的向上指向的远侧销136和向下指向的远端销142枢转。框架底48围绕单销(图示为将框架底48与近侧框架构件114连接的近侧销157)枢转。当砧座42打开时，框架底48的近侧销147与闭合套管组件46的上部和下部双枢轴连接件134、140的最远侧位置对准。当砧座42打开时，该定位很容易使缝钉施加组件20进行枢转及旋转。当闭合套管组件46向远侧运动以使闭合的砧座42枢转时，随着枢轴连接件134、140的推动，闭合直管52围绕框架底48向远侧运动，并且铰接的闭合环116沿着铰接的远侧框架构件114的轴线向远侧运动。当装置被铰接时(未显示)，连接件134、140上的双枢轴销136、138以及142、144在它们被推向远端闭合位置有利于与闭合直管52和铰接的闭合环116的接合。当有效运行时，在远侧闭合位置，框架底枢轴销(“近侧销”)147与近侧枢轴销138、144在完全关节运动时垂直对准，或者落在远端销136、142和近端销138、144之间的任一点上。
实心发射杆支撑件
在图8中，图7中的关节运动机构14被部分分解并从底部看去，显示实心壁发射杆支撑设计(狗骨状连接件160)，其提供了常规挠性支撑板所不具备的优点。支撑板用于填平间隙，并通过单框架底枢轴关节运动接头1801，引导和支撑发射杆66。挠性发射杆是公知的，但结合实心壁发射杆，例如图4、8、9中显示的那些发射杆，提供了独特的优点。下面参见图8，框架底48包括一沿着框架底48的底部延伸的框架小刀槽1802，一沿着关节运动的远端框架元件114的底部延伸的远侧小刀槽164，用于将发射杆66(未显示)滑动地收纳于其中。框架底48如上所述，并包括一带有远侧框架构件114的导向单枢轴连接件157。可旋转地连接在近侧销末端157上并可移动地连接在远侧销末端159上的固定壁狗骨形连接件160包括左右横向导向件1818、1820，在其间限定了一导向狭槽1822，用于滑动地通过发射杆66(图4)。
因此，为了填平框架底48和远侧框架构件114之间的间隙，固定壁枢轴狗骨形连接件160与框架底48枢转连接，并与框架构件114滑动地连接。枢转狗骨形160的近侧销157枢转地收纳于框架底48中的腔1824中，使狗骨连接件160能够围绕穴1824枢转。一远侧销159从枢转狗骨连接件160向上伸出，并滑动地容纳于远端框架114中的狭槽1826中。缝钉施加组件20相对纵向轴线成例如45度角关节运动，使腔1824中的枢转狗骨形连接件116在其近端销157处枢转，并且远端销157在其远端1814滑进狭槽1826中，使发射杆66弯曲成两个间隔开的角，它们的角度是缝钉施加组件20的角度的一半。与以前参照的将发射杆66弯曲成45度角的挠性支撑板不同，固定壁枢转狗骨形连接件160将发射杆66弯曲成两个间隔的角，例如每个22.5度。将一或多个挠性发射杆66弯曲成该角度的一半，将发射杆66中的弯曲应力分割成传统的关节运动支撑件中的一半。发射杆66中的弯曲应力的减小降低了发射杆中的永久弯曲或位置固定的可能性，降低了发射阻塞的可能性，确保了较小的发射杆回缩力，并为发射系统提供了更平稳的操作。
在图9中，外科器械1900包括双闭合枢轴。单框架枢轴关节运动接头1902显示了一种作为替代的实心壁支撑板机构1904，其可替代下部双枢轴连接件140和狗骨连接件1812。左右发射杆支架1906、1908从闭合套管组件1912的下部双枢轴连接件1904向上伸出。在框架底1916中提供间隙1914，从当闭套管组件向远侧运动闭合砧座42(在图9中未显示)以及向近侧运动打开砧座42时，使发射杆1906、1908能够运动。如上所述的枢转狗骨形连接件1812，作为替代的下部双枢轴连接件1910还可弯曲并支撑发射杆66(在图9中未显示)，形成两个间隔开的弯曲角，其中的每个达到缝钉施加组件20的弯曲角的一半。
横向构件导向机构
继续参照图9，框架底1916上的左右向上的凸缘1918、1920包括近侧和远侧横向销导向件1922、1924，它们横向穿过T形杆1926中的孔，帮助在关节运动机构1928中减小束缚。作为另一例子，在图7中，有利地，T形杆104包括一燕尾横向导向件1930，其可在T形杆104中形成的燕尾状通道1932中横向滑动。作为另一例子，在图12中，一从框架底1936上的突出肋1934容纳于在T形杆1940中形成的矩形狭槽1938中。为了进一步便于无束缚地横向平移，近侧和远侧横向轴承轨道每个都包括多个球轴承1946、1948。作为另一个例子，在图13中，与T形杆1964中的T形杆纵向沟槽1958-1962相对应，在框架底1956中形成多个框架横向沟槽1950-1954。滑动滚子1966-1970被捕获于每对纵向沟槽1950/1958、1952/1960、1954/1962中。这些决不意味着对防止T形杆1940意外的倾斜或旋转的横向导向构件的穷尽列举。
双枢轴框架底和单枢轴闭合机构的结合
在图14-15中，一种替代的框架底和闭合机构2200包括具有双枢轴框架组件2204的外科器械2202。特别地，框架底2206通过双枢轴框架狗骨形件2210与远端框架构件2208连接，所述双枢轴框架狗骨连接件2210具有一与框架底2206中的近侧腔2214枢转接合的近侧枢轴销2212和一与远侧框架构件2208的远侧腔2218接合的远侧枢轴销2216。一导向狭槽2220设置于狗骨件2210的下侧，以在其中引导发射杆66(在图14-15中未显示)。小刀槽2222设置在远侧框架构件2208中。如图所示，闭合环2230以45度角的关节运动使远侧框架构件2208以45度角关节运动，并使框架狗骨件2210以该角度的一半关节运动。因此，发射杆66受到间隔的两个浅的半弯曲，并达到上述列举的优点。
最外侧闭合套管组件2224的不同点在于，框架组件2204的双枢轴设计中仅一个枢轴提供其纵向闭合运动。如图所示，一闭合管轴2226远端具有一U形夹(clevis)2228。U形夹2228与闭合环2230枢转接合。闭合环2230具有一在远端形成的近侧齿轮2232，并且销2234与U形夹2228的上柄脚2236枢转接合，下臂2238与U形夹2228的下柄脚2240接合。U形夹2228中的孔2242收纳横向导向销2243，并且T形杆2244可滑动地连接于其中，以接合闭合环2230的近侧齿轮2232。因此，这种替代机构2200使用与前面描述机构相反的单/双枢轴的替代构想。也就是说，这种替代的闭合机构具有单枢轴，而替代的框架底具有双枢轴，这与前面描述的具有单枢轴框架底的双枢轴闭合机构不同。
横向运动的关节运动机构
在图16-19中，示意性显示了一横向运动的关节运动机构230，以显示用于使端部执行器232关节运动的横向运动。横向运动是至少一个元件向着或离开手术装置234的纵向轴线的运动。这种运动通常与纵向轴线成直角，其为将机构230等分的水平线，而且不涉及旋转运动或纵向运动。横向运动关节运动机构可以由流体致动，如图16-19所示，也可机械地致动，如图20-23所示。
横向运动流体关节运动机构
横向运动关节运动机构230在图16-19中示意地显示，包括一流体控制系统235，其具有在其中纵向延伸的平行的左右流体囊236、238，其通过流体242的运动而移动横向构件或T形杆240。所有方向都以纵向轴线为参照。参见图16和17的未铰接视图，远端定位的端部执行器232绕销244枢转，并在其近端具有一个扇形齿轮246。枢轴销244与框架(未显示)相连。在T形杆240远端的一齿条248可操作地与扇形齿轮246接合。T形杆240和齿条248可沿着轴线A-A横向运动。长的左右流体囊236、238的远侧部分相对于可横向运动的T形杆240横向平放，并横向限制于闭合套管250中，并在垂直方向上由下方的框架252和上方的隔离物254限制。左致动流体囊236充满流体242，并具有左远侧致动囊256、左侧流体通路258和左侧近端储存囊260。右致动流体囊238含有流体242，并具有右侧远侧致动囊262、右侧流体通路264和右侧近端储存囊268。一固定分隔器270从框架252伸出，并将囊260、268和流体通路258、264分开。固定分隔器270和闭合套管250限制了流体通路258、264，并防止囊236、238的流体通路部分258、264的扩张。在关节运动控制机构230中包括一可横向运动的“C”形压缩构件272，用于近端储存囊260、268中的一的压缩和端部执行器232的关节运动。此外，也可包括其它元件，例如穿过框架252中的发射杆狭槽276的发射杆274(图17，19)。
如图2和18-19中所示，C形压缩构件272向左侧的横向运动压缩右侧近端储存囊260，迫使流体进入右侧流体通路258和右侧远端致动囊256中。当右侧远端致动囊256使T形杆240向左侧横向运动时，左侧远端致动囊262被压缩，并且端部执行器232向右侧关节运动(从如图所示的顶部观察为顺时针)。左侧远端致动囊262的压缩导致流体通过左侧固定流体通路264向近侧流动，并进入左侧近端储存囊266中。特别地，C形压缩构件272的连接的右侧壁280向左侧运动，引起右侧近端储存囊260的压缩。当流体流进膨胀的左侧近端储存囊266中时，C形压缩构件272的连接的左侧壁278向左的相应运动为来自压缩的左侧储存囊262的流体提供了空间。
这种用于关节运动机构230的流体控制系统235至少提供了多种好处。首先，致动囊256、262靠近关节运动接头或机构230的定向使其可在器械234中采用长的囊236、238和更长的T形杆240。作为流体驱动系统，流体控制系统235输出力的增加可以两种方式来实现。第一，对于T形杆240上固定的流体面积而言，可增大作用于固定面积上的流体压强。第二，对于固定的流体压强而言，可增加T形杆240上的流体接触面积。第一种方法导致更紧凑的设计和更高的系统压力。第二种方法导致更大的设计和更低的系统压力。为了降低成本，简化设计，减小系统应力，并降低囊破裂的风险，该示例性方案示出了长的远端致动囊256、262，其位于靠近器械的细长轴中的关节运动机构230的有利位置。囊256、262的这种设置使囊256、262可以很长，并且以较低的输入压强得到较高的关节运动输出力。
因此，可简单地通过增大T形杆240上的远侧囊256、262的压力接触面积，使关节运动机构230的输出力增加(输入力相同)。压力接触面积的增加受到高度和长度的限制。由于传统的内窥镜外科器械的直径以某一直径固定，以穿过注入口，这限制了高度的变化。压力接触面积的长度变化具有最大影响，并能使装置的横向输出力被有利地调节(通过改变长度)，以符合系统需要的任何输出力。
在横向运动装置中使用的流体可以是可压缩的，也可以是不可压缩的。如这里所指，术语“流体”包括液体、气体、凝胶、微粒子以及任何可在压力梯度之间流动的其它材料。尽管可使用任何流体，特别优选使用杀菌溶液，如盐水、矿物油或者硅树脂。
横向运动机械的关节运动机构
尽管上面描述的流体机构引起横向运动和关节运动，机械机构可实现与流体囊206、208产生的类似的横向运动。在图20-21中，一种替代横向运动关节运动机构300采用机械控制系统，特别是纵向运动构件，来进行外科器械301的横向运动和关节运动。在该示例性方案中，特别参照图20，一横向运动滑动杆302具有至少一对成角度的左右凸轮表面304、306，它们从其上在细长纵向轴308的相对两侧横向延伸。在该示例性方案中，还包括另一对近端左右成角度的凸轮表面310、312。一个右侧纵向运动连接件314包括相应的向内定向的远侧和近侧反倾斜表面316、318，它们与远侧和近侧右侧凸轮表面306、312对准并与其滑动接合，从而运动连接件312的向远侧的纵向运动引起滑动杆302向左横向运动。应理解，这种倾斜接触可倒转，从而向远侧的运动分别引起向右的运动。
应当理解，弹性偏压元件(未显示)可包括于滑动杆302上，以向右推动滑动杆302使其与右侧纵向运动连接件314接合，从而右侧纵向运动连接件314的相反的近侧运动引起滑动杆302向左运动。作为选择，在该示例性方案中，左侧纵向运动连接件320包括相应的向内定向的远侧和近侧反倾斜表面322、324，它们与远侧和近侧凸轮表面304、310对准并与其滑动接合，后者向远侧倾斜，前者向近侧倾斜，从而左侧纵向运动的连接件320的纵向远侧运动引起滑动杆302向右横向运动。应理解，这种倾斜接触可倒转，从而向近侧的运动引起向左的运动。应当理解，右侧和左侧纵向运动连接件314、320和滑动杆302支撑于细长轴326中，使得前者可进行纵向运动，后者可进行横向运动。
滑动杆302的远端，图示为一个承窝球328，收纳于近侧对准的V形凸轮槽330中，并靠近端部执行器334的枢轴销332。因此，在图21中，右侧纵向运动连接件314的向近侧的运动和左侧纵向移动连接件320的向远侧运动导致滑动杆302相应于承窝球328的向右运动而向右运动。因此，V字形凸轮槽330被向右驱动，使其最远端336为向左枢转。作为选择，滑动杆302的横向运动可通过上面参照图16-19中描述的齿条和齿轮的接合转换成端部执行器334的关节运动。因此，采用纵向移动的机械系统可用于为外科器械301提供横向铰接关节运动。
可旋转的连接件
在图22和23中，另一种替代的关节运动机构400采用可旋转的连接件402来移动横向元件，图示为横向运动滑动杆404，以使外科器械406关节运动。横向运动的滑动杆404可操作地与如上所述图16和20中的端部执行器(未显示)近端的旋转齿轮或者带凸轮的沟槽接合。可旋转的连接件402可定位于滑动杆404的下方，其中至少一个臂408可旋转地横向从其延伸到纵向轴线，以与滑动杆中的承窝410接合。滑动杆404垂直地限制于顶部隔离物412和底部框架414之间，后者具有纵向沟槽416，其收纳可旋转的连接件402，并使臂408旋转。隔离物412和框架414由管状套管418包围。旋转连接件402的旋转使臂408做弧形运动，由此使滑动杆404沿着旋转的方向横向运动。
具有相对的纵向弯曲挠性构件的关节运动机构
在图24中，外科器械500具有沿着细长轴504的纵向轴线对准的滑动构件502，可在左侧纵向弯曲构件506和右侧纵向弯曲构件508之间横向运动，并在垂直方向上由框架和隔离物(未显示)限制。每个纵向弯曲构件506、508分别具有一个固定的远侧附属装置510、512和可纵向平移的近端连接件514、516。每个左右挠性构件518、520在对着滑竿502的位置向内弯曲成弓形，向内横向弯曲的量与它们的每个近端连接件514、516向远端的纵向运动相关。在图24中显示的未关节运动状态，近端连接件514、516位于不同的位置，因而滑动构件502的向远端突出的尖端522位于相对于端部执行器528的一个枢轴销526向近侧打开的V字形凸轮沟槽524的中央。在图25中，左侧近端连接件514向远侧行进，并且右侧近端连接件向近侧回缩，导致滑动杆502横向平移到右侧，从而导致向远侧突出的尖端522顶着V-字形凸轮槽524的右侧部分偏心，结果端部执行器528围绕枢轴销526向左关节运动。
电磁横向关节运动控制机构
在图26中，外科器械600具有一个远侧连接的端部执行器602，其通过滑动杆608的横向运动相对于细长轴606围绕枢轴销604选择性地弧形关节运动。特别地，滑动杆608的远侧承窝610与V字形凸轮槽612接合，其靠近枢轴销604打开。滑动杆608由框架和隔离物(未显示)沿垂直方向限定于细长轴606中。与滑动杆608的相对的横侧上向内定向的左右压缩弹簧614、616靠近细长轴606的远端618。这些弹簧614、616提供了在滑动杆608上的中心偏压，从而提供了在端部执行器602上的中心偏压。滑动杆608两相对侧上的左右电磁体620、622选择性地致动，以对固定在滑动杆608上或与之成整体的铁靶624吸引，从而选择性地使滑动杆608横向移位，并使端部执行器关节运动，如图27所示。为了简化起见，显示了纵向对准的线圈，尽管应当理解，可将一个或多个电磁体对准来产生与滑动杆608垂直的磁场，例如多个线圈(未显示)沿着滑动杆608的纵向长度对准，其中每个线圈的纵向轴线与滑动杆608的横向运动轴线对准。
尽管通过对多个实施例的描述对本发明进行了示例，尽管这些示例性的实施例描述得非常详细，但申请人并不意图将所附的权利要求书的范围限制或以任何方式限定于此细节。其它优点和变化对本领域技术人员来说是显而易见的。
例如，可包含单流体传送方法，其中单流体致动膨胀和压缩来进行关节运动，或者通过未与手柄流体或者气动连通的弹性相对构件来辅助。例如，与这种设计相一致的应用可包括仅仅一个与T形杆连接的囊，从而当由抽出流体而压缩时，使其能推动T形杆。

Claims (10)

1.一种外科器械，包括：
端部执行器，其具有近侧凸轮表面；
细长轴，其包括限定了一与纵向轴线对准的横向凹槽的框架；
关节运动接头，其将端部执行器枢转地连接到细长轴的远端上；
位于横向凹槽中的滑动杆，其具有与端部执行器的近侧凸轮表面接合的远端；
横向引导机构，其将滑动杆与框架接合，用于滑动杆的横向运动和纵向对准的运动；以及
手柄部分，其与细长轴的近端连接，并被可操作地构造成能产生关节运动，以使滑动杆横向运动。
2.如权利要求1所述的外科器械，其特征为，端部执行器的近侧凸轮表面包括指向近侧的凸轮凹槽，用于收纳滑动杆的远端。
3.如权利要求1所述的外科器械，其特征为，端部执行器的近侧凸轮表面包括一扇形齿轮，并且滑动杆的远端包括一齿条。
4.如权利要求3所述的外科器械，其特征为，横向引导机构包括一在框架中横向形成的通道和一收纳于该通道中的肋，该横向引导机构垂直地连接到滑动杆上，该滑动杆还包括将所述肋连接到齿条上的挠性纵向部分，其中，对端部执行器的操纵引起扇形齿轮的向回驱动，该驱动使纵向部分挠曲，从而使肋束缚地接合于通道中。
5.如权利要求1所述的外科器械，其特征为，横向引导机构包括：
左支承面和右支承面，其经过细长通道中的横向凹槽而横向间隔开；
滑动杆中的至少一个横向通孔，其与所述左支承面和右支承面对准；以及
至少一个滑动销，其收纳于滑动杆的横向通孔中并连接到每个支承面上。
6.如权利要求1所述的外科器械，其特征为，所述横向引导机构包括：
一形成于横向凹槽的附近的框架上的横向通道；以及
一连接到所述滑动杆上并滑动地收纳于横向通道中的横向肋。
7.如权利要求1所述的外科器械，其特征为，横向引导机构包括：
一形成于框架附近的滑动杆上的横向通道；以及
一横向肋，其连接到延伸到横向凹槽中的框架表面上并滑动地收纳于滑动杆的横向通道中。
8.如权利要求1所述的外科器械，其特征为，横向引导机构包括：
一形成于框架附近的滑动杆上的横向通道；
一形成于横向凹槽和滑动杆横向通道附近的框架上的相应的横向通道；以及
一支承构件，其收纳于由滑动杆横向通道和框架横向通道限定的横向导向凹槽中。
9.如权利要求8所述的外科器械，其特征为，支承构件包括至少一个球面轴承。
10.如权利要求8所述的外科器械，其特征为，支承构件包括一圆柱形轴承。
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US20070027468A1 (en) 2005-08-01 2007-02-01 Wales Kenneth S Surgical instrument with an articulating shaft locking mechanism
US7481824B2 (en) 2005-12-30 2009-01-27 Ethicon Endo-Surgery, Inc. Surgical instrument with bending articulation controlled articulation pivot joint

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CN101254125B (zh) * 2007-02-28 2012-12-05 伊西康内外科公司 具有驱动钉驱动器的多个堆叠的楔形凸轮的外科缝合装置
CN101801283B (zh) * 2007-09-21 2012-07-18 Tyco医疗健康集团 手术器械
CN105324086A (zh) * 2013-04-16 2016-02-10 伊西康内外科公司 动力外科缝合器
CN105324086B (zh) * 2013-04-16 2018-02-02 伊西康内外科公司 动力外科缝合器
CN104337554A (zh) * 2013-08-09 2015-02-11 瑞奇外科器械(中国)有限公司 双向行程控制开关、弯转行程控制装置和外科手术器械
CN104337554B (zh) * 2013-08-09 2016-12-28 瑞奇外科器械(中国)有限公司 双向行程控制开关、弯转行程控制装置和外科手术器械
US10603063B2 (en) 2014-12-30 2020-03-31 Suzhou Touchstone International Medical Science Co., Ltd. Suturing and cutting apparatus for endoscopic surgery
WO2016107584A1 (zh) * 2014-12-30 2016-07-07 苏州天臣国际医疗科技有限公司 腔镜外科手术用缝切装置
CN107405149A (zh) * 2015-02-27 2017-11-28 伊西康有限责任公司 模块化缝合组件
CN110099627A (zh) * 2016-12-21 2019-08-06 爱惜康有限责任公司 击发构件销角度
CN110099627B (zh) * 2016-12-21 2022-08-09 爱惜康有限责任公司 击发构件销角度
CN110325122A (zh) * 2017-02-28 2019-10-11 波士顿科学国际有限公司 铰接针
CN110325122B (zh) * 2017-02-28 2024-03-19 波士顿科学国际有限公司 铰接针
CN113288268A (zh) * 2021-05-25 2021-08-24 常州安康医疗器械有限公司 一种可交错缝合的腔镜吻合器

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CA2542082A1 (en) 2006-10-07
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AU2006201220A1 (en) 2006-10-26
US20060226196A1 (en) 2006-10-12
EP1709912A2 (en) 2006-10-11
CA2542082C (en) 2014-12-23
CN100508899C (zh) 2009-07-08
US7654431B2 (en) 2010-02-02
AU2006201220B2 (en) 2012-04-05
EP1709912A3 (en) 2007-01-03
JP5000181B2 (ja) 2012-08-15
JP2006289089A (ja) 2006-10-26
RU2006111323A (ru) 2007-10-27
KR20060107393A (ko) 2006-10-13

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