CN1868411A - 具有带旋转滑动离合器传动的多冲程击发器的外科缝合器 - Google Patents
具有带旋转滑动离合器传动的多冲程击发器的外科缝合器 Download PDFInfo
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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
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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
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
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Abstract
一种特别适于内窥镜操作的外科缝合和切割器械，包括产生独立的闭合和击发运动以致动端部执行器的手柄。特别的是，该手柄产生多击发冲程以减少用于击发(即，缝合和切割)端部执行器所需力的大小。
Description
相关申请的相互参考
本申请要求由Frederick E.Shelton IV、Michael Earl Setser和Douglas B.Hoffman于2004年6月30日提交的系列号为No.10/881,105和No.10/881,091的两个未审定并共同拥有的美国申请的优先权，这两个申请的发明名称分别为“包含具有旋转传动装置的多冲程击发机构的外科缝合器械”和“包含具有旋转传动装置的不均匀多冲程击发机构的外科缝合器械”，上述两个申请公开的全部内容在此被引入作为参考。
技术领域
本发明总体上涉及能够将数行缝钉施加到组织上并同时切割在这些行列钉线之间的组织的外科缝合器械，尤其涉及关于缝合器械的改进以及对用于形成这种随着扳机的多冲程来完成击发的缝合器械的各种组成元件的方法的改进。
背景技术
由于较小的切口易于减小术后的恢复时间和并发症，所以，内窥镜的外科器械常常比传统的开放式手术装置更受偏爱。因此，适于通过套管针的插管将远端执行器精确地放置在需要手术的部位处的内窥镜手术器械的领域取得了显著的发展。这些远端执行器以多种方式与组织接合以取到得诊断或治疗的效果(例如：内切割器、抓钳、切割器、缝合器、夹具施放器、进入装置、药品/基因的治疗输送装置以及使用超声波、RF、激光等的能量装置)。
已知的外科缝合器包括在组织中形成纵向切口的同时将数行缝钉施加到该切口的相对侧上的端部执行器。该端部执行器包括一对相配合的钳口构件，如果欲将该器械用于内窥镜或腹腔镜的用途，则该钳口构件能够穿过插管通道。其中一个钳口构件容纳具有至少两排横向间隔开的缝钉的缝钉匣。另一个钳口构件限定了砧板，该砧板具有与缝钉匣中的多排缝钉对齐的缝钉成形凹槽。该器械包括数个往复运动的楔状件，当向远侧驱动时，该楔状件穿过缝钉匣中的开口并与支撑缝钉的驱动器接合，以实现朝砧板击发缝钉。
在美国专利No.5,465,895中描述了适于内窥镜用途的外科缝合器的一个示例，该申请有利地提供不同的闭合和击发动作。由此，临床医生能够在组织上闭合钳口构件以在击发前定位组织。一旦临床医生已经确定钳口构件正确地夹紧组织，则临床医生能够用单击发冲程来击发外科缝合器，从而切割并缝合组织。同时切割和缝合避免当先后使用分别仅用于切割或缝合的不同的手术工具来执行这样的操作时可能引起的并发症。
一个击发前能在组织上闭合的特别优点是医生通过内窥镜能够确认已得到用于切割的理想位置，并包括在相对的钳口之间已夹紧足够量的组织。否则，相对的钳口可能过于紧密地靠在一起，特别是在其远端处夹紧，由此，在被切割的组织中不能有效地形成闭合的缝钉。另一个极端是，过量的被夹紧的组织可引起粘结和不完整的击发。
通常，跟随单击发冲程的单闭合冲程是一个进行切割和缝合的方便并有效的方式。然而，在某些情况下，需要多击发冲程。例如，医生能够从钳口尺寸的范围中选择与切割所需的长度相对应的缝钉匣长度。较长的缝钉匣需要较长的击发冲程。因此，与较短的缝钉匣相比，对于这些较长的缝钉匣需要对实现击发的手压式扳机施加较大的力，以切割更多的组织并驱动更多的缝钉。理想的是，力的大小较小并与较短的缝钉匣的力相当，以便不超过一些外科医生的手的力量。另外，一些不熟悉较大缝钉匣的医生可能担心，当需要意料之外的较大的力时已发生粘结或其它故障。
如在美国专利No.5,762,256和No.6,330,965中描述的一种降低用于击发冲程所需的力的方法是允许击发扳机被冲击多次的棘齿机构。然而，可以认为通过棘爪将击发扳机的往复运动直接转换进入整体齿条，这限制了用于在每次击发冲程的过程中击发运动所需量的设计选择。另外，这些已知具有多冲程击发机构的外科缝合器械没有独立的闭合和击发动作的优点。
因此，特别需要一种利用多击发冲程以获得切割和缝合的理想长度的外科缝合器械，并且具有击发冲程行程与为端部执行器产生的纵向击发运动的理想关系。
发明内容
本发明通过提供具有在防止击发构件倒转的同时传递一系列多击发冲程的旋转传动装置的外科缝合和切割器械克服了现有技术的上述以及其它缺陷。因此，需要增加击发力和/或增加击发行程的器械的端部执行器可易于用多冲程击发扳机击发。
在本发明的一个方面中，外科器械具有响应纵向击发运动以执行外科手术操作的端部执行器。使用者在击发致动器中引起运动以产生通过击发机构有选择地传递的击发运动。具体地说，旋转传动装置接收来自根据操作者的要求循环运动的击发致动器的击发和返回运动。输入旋转构件对应于其击发和返回方向运动而转动。因此，将那些对应于击发方向的转动通过单向离合器有选择地传送到输出旋转构件，该输出旋转构件接合细长的击发构件以将这种间歇的击发运动传递到端部执行器上。由此可获得多击发冲程以减少在单个冲程装置上每一单堵冲程所需的力。另外，可通过输入和输出旋转构件的适当的尺寸以及通过击发致动器所给出的任何机械优点来选择齿轮减速关系，从而选择在击发致动器处所施加的理想的力并使其实现为在细长击发构件处的纵向行程和力。
在本发明的另一个方面中，外科器械具有切割和缝合组织的端部执行器。特别的是，缝钉施放组件的远侧具有一个砧板，该砧板具有可从与数个缝钉隔开的张开位置运动到邻近数个缝钉的闭合位置的缝钉形成表面。缝钉施放机构具有引起从缝钉施放组件中施放至少一部分缝钉的旋转传动装置。因此，多冲程击发可被用来切割和缝合组织。
(1)本发明涉及一种外科器械，包括：端部执行器，其具有可操作的构造以响应击发运动；连接到端部执行器上的轴，其包括联接到用于运动的端部执行器上的细长击发构件，以纵向传送击发运动；以及在近侧连接到轴上的手柄，其包括：沿击发方向和返回方向可重复地运动的击发致动器；旋转传动装置，包括：输入旋转构件，其被联接在用于对应其击发和返回方向的运动而进行转动的击发致动器上；输出旋转构件，其被接合在用于对应其纵向运动而进行转动的细长的击发构件上；以及单向离合器，其将输入旋转构件的击发转动选择性地传递给输出旋转构件。
(2)根据项目(1)所述的外科器械，进一步包括连接在细长击发构件上的齿条，其中，该齿条通过齿轮接合与由齿轮组组成的凸轮盘联接。
(3)根据项目(2)所述的外科器械，其中，所述旋转传动装置包括齿轮减速组件，该齿轮减速组件使输入旋转构件的间歇旋转与齿条的加速纵向运动相关联。
(4)根据项目(1)所述的外科器械，进一步包括防倒转机构，其具有可操作的构造以防止细长击发构件在击发致动器的击发冲程之间缩回。
(5)根据项目(4)所述的外科器械，其中，所述防倒转机构包括被向近侧偏压成与细长击发构件摩擦接合的摆簧。
(6)根据项目(4)所述的外科器械，进一步包括释放机构，其具有可操作的构造以响应释放致动，从而推动防倒转机构与细长击发构件脱离接合。
(7)根据项目(6)所述的外科器械，其中，所述防倒转机构包括被向近侧偏压成与细长击发构件摩擦接合的摆簧。
(8)根据权利要求1所述的外科器械，其中，所述端部执行器包括一对响应于闭合运动的相对的钳口和响应于击发构件的击发杆，所述轴具有可操作的构造以通过闭合构件将闭合运动传送到端部执行器，所述手柄进一步包括具有可操作的构造以产生闭合运动的闭合机构。
(9)根据项目1所述的外科器械，其中，所述单向离合器包括在输入滚柱构件和输出滚柱构件之间的滚柱式滑动离合器。
(10)根据项目1所述的外科器械，其中，所述击发致动器包括提供往复弧形运动的可枢转联接的杆，该击发致动器包括接合在输入旋转构件上的弧形表面。
(11)根据项目10所述外科器械，其中，所述弧形表面进一步包括弧形齿轮部分，所述输入旋转构件包括接合在其上的齿轮。
(12)根据项目10所述的外科器械，其中，将所述旋转传动装置旋转地安装在手柄壳体内，所述击发致动器包括一孔，该孔的尺寸形成为容纳输入旋转构件并与其沿切线接合，以在往复弧形运动的范围内实现旋转。
(13)根据项目12所述的外科器械，其中，所述弧形表面进一步包括沿在击发致动器中的所述孔的一个表面的弧形齿轮部分，所述输入旋转构件包括与弧形齿轮部分接合的齿轮。
(14)本发明还涉及一种外科器械，包括：手柄；位于手柄远侧的缝钉施放组件，其包括：数个缝钉，以及具有缝钉形成表面的砧板，该缝钉形成表面可从离开所述数个缝钉的打开位置运动至邻近所述数个缝钉的闭合位置；以及缝钉施放机构，其被可操作地联接在缝钉施放组件上，其包括：击发致动器，其可重复地沿击发方向和返回方向移动，旋转传动装置，其包括联接在击发致动器上用于对应于击发和返回方向的运动而旋转的击输入旋转构件、接合在细长击发构件上用于对应纵向运动而旋转的的输出旋转构件以及选择性地将输入旋转构件的击发旋转传送到输出旋转构件上的单向离合器。
(15)本发明还涉及一种外科器械，其包括：端部执行器，该端部执行器具有可操作的构造以响应于击发运动；安装在端部执行器上的轴，其包括连接到用于移动的端部执行器上的细长击发构件，以纵向地传送击发运动；以及近侧轴上的手柄，其包括：击发致动器，其可重复并枢转地沿击发方向和返回方向运动；旋转传动装置，其响应于击发致动器的弧形运动，以选择性地将沿一个方向的间歇的旋转连接在细长击发构件上。
(16)根据项目15所述的外科器械，其中，所述端部执行器进一步包括响应于击发运动的缝合和切割装置。
(17)根据项目16所述的外科器械，其中，所述缝合和切割装置进一步包括一对响应于闭合运动的相对钳口，所述手柄进一步包括用于闭合所述一对相对钳口的部件。
从附图和其说明书中将显而易见本发明的这些和其它目的和优点。
附图说明
包含并构成本说明书的一部分的附图说明了本发明的实施方案，并与上述给出的对发明的总体描述以及下面给出的实施方案的详细描述一起，用来解释本发明的原则。
图1为具有张开端部执行器的外科缝合和切割器械的透视图。
图2为沿图1所示的张开的端部执行器的线2-2的横截面的左侧剖视图。
图3为图1所示的张开的端部执行器的透视图。
图4为图1所示的外科缝合和切割器械的执行部分的分解透视图。
图5为图1所示的外科缝合和切割器械的手柄的分解透视图。
图6为图1所示的外科缝合和切割器械的手柄处于打开状态的左侧剖视图，其中手柄壳体的左侧部分被拆除以露出包括用于多击发冲程的旋转传动装置的击发机构。
图7为图6所示的手柄的右侧剖视图，其中手柄壳体的右侧部分被拆除以露出闭合机构和防倒转装置。
图8为图7所示的手柄的向下透视图。
图9为图6所示的手柄的侧剖视图，其中，闭合扳机闭合并省略击发扳机以露出在凸轮盘中的击发驱动楔状件和凸轮凸角。
图10为图9所示的击发驱动楔状件和凸轮叶的向下透视图。
图11为图1所示的手柄的旋转传动击发机构的后侧透视图。
图12为图6所示的处于闭合和击发状态的手柄的侧剖视图，其中省略了旋转传动击发机构的小惰轮以暴露与整体齿条接触的防倒转摆动件。
图13为图1所示的包含用于外科缝合和切割器械的旋转滑动离合器的可替代的旋转传动击发机构的透视图，其中省略了执行部分、左手柄壳体以及闭合机构。
图14为图13所示的滑动离合器旋转传动击发机构的分解透视图，其省略了执行部分、左手柄壳体以及闭合机构。
图15为图13所示的旋转传动击发机构的滑动离合器组件的详细的右侧剖视图，其中以线示出了左侧正齿轮，该左侧正齿轮当击发扳机释放时脱离接合。
图16为图13所示的旋转传动击发机构的滑动离合器组件的详细的右侧部视图，其示出当致动击发扳机时接合的状态。
图17为处于初始、未击发状态的图13所示的旋转传动击发机构的左侧部视图，其中省略了执行部分、左手柄壳体以及闭合机构。
图18为在第一击发冲程后的图1 3所示的旋转传动击发机构的左侧剖视图，其中省略了执行部分、左手柄壳体以及闭合机构。
图19为随第一击发冲程释放击发扳机后的图13所示的旋转传动击发机构的左侧剖视图，其中省略了执行部分、左手柄壳体以及闭合机构。
图20为图13的旋转传动击发机构的左视图，其处于第二击发冲程后的状态，并省略了执行部分、左手柄壳体以及闭合机构。
具体实施方式
在附图中，相同标号在所给出的附图中均表示相同部件，图1-4示出了能够实施本发明的独特优点的外科缝合和切割器械10。该外科缝合和切割器械10包括端部执行器12，该端部执行器12具有枢转连接到细长通道16上的砧板14，该砧板14形成用于待夹紧切割和缝合组织的相对的钳口。将端部执行器12通过轴18联接到手柄20上。由端部执行器12和轴18形成的执行部分22的尺寸有利地形成为通过套管针或小的腹腔镜开口插入以进行内窥镜的手术处理，并同时通过外科医生抓握手柄20来控制。手柄20有利地包括这样的特征，即，允许击发端部执行器12的独立闭合运动以及启动多击发冲程以实现端部执行器12的击发(即，切割和缝合)，并同时为外科医生显示击发的程度。
为此，将轴18的闭合管24连接在闭合扳机26和砧板14之间以导致端部执行器12的闭合。在闭合管24内，将框架28连接在细长通道16和手柄20之间，以纵向定位并支撑端部执行器12。将旋钮30与框架28联接，并且以相对于绕轴18的纵向轴线作旋转运动的方式将该旋钮和框架可旋转地与手柄20联接。因此，外科医生能通过转动旋钮30来旋转端部执行器12。还可通过旋钮30旋转闭合管24，但闭合管24保持一定程度的相对此处的纵向运动以致使端部执行器12的闭合。在框架28内，将击发杆32定位为用于纵向运动并连接在端部执行器12的砧板14和多冲程击发扳机34之间。闭合扳机26位于手柄20的手枪式握柄36的远侧，而击发扳机34位于手枪式握柄36和闭合扳机26二者的远侧。
在内窥镜手术中，一旦将执行部分22插入病人体内以进入手术部位，医生参照内窥镜或其它诊断成像装置来定位在砧板14和细长通道16之间的组织。通过握紧闭合扳机26和手枪式握柄36，外科医生可重复地夹紧并定位组织。一旦对相对于端部执行器12的组织的定位以及在其中的组织的量满意，医生将闭合扳机26朝向手枪式扳机36完全压下，从而夹紧在端部执行器12中的组织并锁定处于该夹紧(闭合)位置中的闭合扳机26。如果不满意于这样的位置，则外科医生可通过压下释放按钮38(图4)来释放闭合扳机26，其操作在下面被更全面地描述，并从此后重复夹持组织的步骤。
如果夹持是正确的，则外科医生可继续击发外科缝合和切割器械10。具体而言，外科医生握紧击发扳机34和手枪式握柄36，从而压下击发扳机34预定次数。根据最大的手的尺寸、在每次击发冲程的过程中被施加到器械上的力的最大量以及在击发过程中通过击发杆32传送到端部执行器12所需的纵向距离和力来以人机工程学的方式确定必要的击发冲程的次数。正如下述讨论中应当理解的，每个外科医生可选择使击发扳机34在不同角度的运动范围内循环，并因此增加或减少击发冲程的次数。
在图1中，在击发外科缝合和切割器械10后，闭合释放杆40被致动以缩回击发机构。按压闭合释放杆40使在手柄20内的旋转传动装置击发机构42脱开，从而启动弹簧172以将击发杆32从端部执行器12中缩回。
包括E形梁端部执行器的执行部分
能提供多冲程击发运动的手柄20的优点已应用到许多带有如图1-4中所示的这样的端部执行器12的大量器械中。端部执行器12的砧板14响应来自手柄20的通过闭合管24纵向并向远侧传送的闭合运动。细长通道16滑动地与平移和闭合的砧板14接合以形成相对的钳口，而框架28固定地与静止的通道16接合以形成与手柄20的刚性连接。闭合管24从远侧将砧板14接合到在砧板14和细长通道16之间狭缝连接的销上。因此，闭合管24相对于框架28向远侧的运动实现了闭合，而相对于框架28向近侧的运动实现了端部执行器12的张开。
特别参照图4，执行部分22还包括响应来自手柄20的击发运动的组成元件，具体地说是联接在手柄20中的击发机构42和执行部分22之间的纵向运动的击发杆32(图4中未示出)。特别的是，击发杆32(图5中被分解示出)与滑动地设置在框架28中的纵向凹槽48内的击发槽形构件46旋转地接合。击发槽形构件46以直接响应击发杆32的纵向运动而在框架28内纵向运动。在闭合管24中的纵向条缝50可操作地与旋钮30接合(未示出)，以使纵向槽50进一步允许旋钮30在小的纵向条缝52处与框架28接合，从而实现旋转。一突起位于在闭合管24上的条缝50的前面，并且该突起向下弯曲进入在框架28中的小条缝52中以使闭合管24接合到框架28上。闭合管24中的纵向条缝50的长度为足够长，以便允许与旋钮30一起相对的纵向运动，从而分别地完成闭合运动。
将框架槽形构件46的远端连接到与框架28一起运动的击发杆56的近端，以使E形梁60向远侧进入端部执行器12。端部执行器12包括由E形梁60致动的缝钉匣62，该E形梁使将缝钉从缝钉匣62的缝钉孔64中被向上驱动的缝钉与砧板14的缝钉形成凹槽68接触，从而产生所形成的B形缝钉。特别参照图3，缝钉匣主体86还包括近侧开口的垂直槽70，用于沿E形梁60的远端设置的垂直定向切割表面的通道以在被缝合的同时切割组织。
在五个未审定和共同拥有的美国专利申请中详细地描述了图示的端部执行器12，这些申请的每一个公开的全部内容都在此被引入作为参考，这些申请是：(1)由Frederick E.Shelton、Mike Setser和Bruce Weisenburgh于2003年6月20日提交、系列号为No.10/441,424、发明名称为“具有用于防止击发的单独锁定机构的外科缝合器械”；(2)由Frederick E.Shelton、Mike Setser和Brian J.Hemmelgarn于2003年6月20日提交、系列号为No.10/441,632、发明名称为“具有分隔开的不同的闭合和击发系统的外科缝合器械”；(3)由Frederick E.Shelton、Mike Setser和Bruce Weisenburgh于2003年6月20日提交、系列号为No.10/441,565、发明名称为“具有用完的缝钉匣锁定装置的外科缝合器械”；(4)由Frederick E.Shelton、Mike Setser和Bruce Weisenburgh于2003年6月20日提交、系列号为No.10/441,580、发明名称为“具有用于打开的砧板的击发锁定装置的外科缝合器械”；以及(5)由Frederick E.Shelton、MikeSetser和Bruce Weisenburgh于2003年6月20日提交、系列号为No.10/443,617，发明名称为“包含E形梁击发机构的外科缝合器械”。
应当理解的是，尽管此处所示的是非铰接轴18，但是本发明的申请可包括诸如在五个未审定和共同拥有的美国专利申请中描述的能铰接的器械，这些申请的每一个公开的全部内容都在此被引入作为参考，这些申请是：(1)由Frederick E.Shelton、Brian J.Hemmelgarn、Jeff Swayze和Kenneth S.Wales于2003年7月9日提交、系列号为No.10/615,973、发明名称为“包含具有围绕纵向轴线旋转的铰接机构的外科器械”；(2)由Brian J.Hemmelgarn于2003年7月9日提交、系列号为No.10/615,962、发明名称为“包含用于击发杆轨道的铰接接头的外科缝合器械”；(3)由Jeff Swayze于2003年7月9日提交、系列号为No.10/615972、发明名称为“带有横向运动的铰接控制装置的外科器械”；(4)由Frederick E.Shelton、Mike Setser和Bruce Weisenburgh于2003年7月9日提交、系列号为No.10/615,974、发明名称为“包含用于增加在铰接接头周围的挠性的锥形击发杆的外科缝合器械”；以及(5)由JeffSwayze和Joseph Charles Hueil于2003年7月9日申请、系列号为No.10/615,971、发明名称为“具有用于支撑击发杆的铰接接头支撑板的外科缝合器械”。
多冲程击发手柄
在图5-8中，手柄20响应于闭合扳机26和击发扳机34的致动，以分别对执行部分22产生闭合和击发运动。对于闭合运动，闭合扳机26包括上部76，该上部包括三个横向孔，即，前定位销孔78、下后枢转孔80以及中心切口82。将三个杆在手柄壳体88的右半壳体和左半壳体84，86之间横向定向并接合在其间(在图5-6中示出了右半个壳体84，而在图7中示出了左半个壳体86)。特别的是，后杆90穿过闭合扳机26的上部76的后枢转孔80，因此，闭合扳机26绕后杆90枢转。相对于后杆90在远侧定位的前杆92和在前杆92上方的顶部杆94穿过中心切口86，该中心切除部分的形状被形成为通过与在扳机行程的每个极端处的前杆92和顶部杆94接触来限制闭合扳机26的运动。因此，中心切除部分82包括当闭合扳机26向前(向远侧)时其底部表面与前杆92接触的垂直部分，还包括当闭合扳机26在其向前松弛的位置和其近侧致动位置处时其顶部和向前表面分别与顶部杆94接触的上部向近侧倾斜部分。
将与闭合管24接合的闭合轭形件96纵向滑动地容纳在手柄壳体92内并在其远端处与闭合管24的近端接合，从而将纵向闭合运动传送给闭合管24，并由此传送给用于闭合端部执行器12的砧板14上。这种接合允许闭合管24旋转而闭合轭形件96不旋转。在这种接合的上方，横向销孔100通过前销104与闭合连杆102连接，而闭合连接件102的另一端部通过后销106与闭合扳机26的销孔82联接。
三角衬套120包括分别容纳杆90，92，94的孔122，124，126，并且三角衬套120被夹在凸轮盘130和闭合扳机26的上部76之间。凸轮盘130绕前杆92旋转并包括容纳后杆90和顶部杆94的半圆形槽132。中心孔134容纳前杆92。在凸轮盘130的左侧，在击发扳机34的上端138上的杆孔136容纳顶部杆94。击发扳机34旋转地安装到杆94上，以使凸轮盘130夹在三角衬套120和击发扳机34之间。在击发扳机34中位于杆孔136下方的远侧开口凹槽140被对准以容纳前杆92，从而在击发过程中允许扳机34被向远侧牵拉。闭合扳机26的致动使凸轮连接件102向下摆动与从击发扳机34中向内延伸的驱动锥销184接触，从而导致向远侧局部地牵拉击发扳机34并使击发扳机34分阶段来夹持。
特别参照图5，9和10，凸轮盘130具有在前部周围(当处于所示的未击发状态时)具体地说是沿其左侧的一系列凸轮凸角142-144(图9)，该凸轮叶由击发扳机34分别接合，以便将从顶部到前面(从左侧看时为逆时针)的旋转传送给凸轮盘130。这种旋转通过旋转传动击发机构42的齿轮组150(图5和11)传送，以与小惰轮154接合的在凸轮盘130的右侧下部部分的齿轮部分152开始，因此该小惰轮以相对凸轮盘130增加的速度从顶部旋转到后面(顺时针)。大惰轮156通过惰轮轴158连接在小惰轮154上，并因此沿相同方向和相同速度旋转。将第二小齿轮160啮合到大惰轮156上，并因此以更大的速度从顶部旋转到前面(从左侧看时逆时针)。细齿的大齿轮162通过第二轴164连接在第二小齿轮160上，并因此沿与第二小齿轮160相同方向和相同速度旋转。因此，齿轮组150通过包括双联齿轮减速装置来增强凸轮盘130的运动，以提供额外的纵向击发运动。细齿的大齿轮162在整体齿条170的下侧处与齿轮部分168接合，该整体齿条的远端与击发杆32的近端接合。齿条170具有被纵向滑动地容纳在闭合轭形件96内的远侧部分以及被纵向滑动地容纳在手柄壳体88的右半个壳体84和左半个壳体86之间的近侧部分。
击发扳机34与凸轮叶142-144之间选择性的接合通过致动击发扳机34的多击发冲程进一步地提供纵向行程。为使齿轮组150作好击发准备，凸轮盘130通过连接到在凸轮盘130的下部近侧边缘处的环形槽176内形成的向左突出的整体销174上的齿轮组缩回弹簧172使凸轮盘130朝其未击发位置顺时针方向转动(图9-10)。齿轮组缩回弹簧172具有连接在与手柄壳体88为一体的销178上的另一个端部。击发扳机34的致动使凸轮盘130逆时针方向旋转，以使缩回弹簧172伸长。继续致动击发扳机34使伸长的缩回弹簧172在凸轮盘130旋转时绕其外径缠绕并进入环形槽176中(未示出)。
特别参照图5，9，11，在击发扳机34的上端138的下方和远侧为驱动锥销孔180和近侧销孔190。驱动锥销184和销196分别从击发扳机34中的孔180和190向内延伸。将驱动楔状件182和支座指状件186枢转地安装在驱动锥销184上并通过捕鼠器式弹簧188可操作地连接。在驱动楔状件182和销196之间的相对的拉伸弹簧194沿顺时针方向推动驱动楔状件182、支座指状件186以及弹簧188(图10)。当击发扳机34被致动时(图9)，使支座指状件186与凸轮盘130的中心未凸出的圆周表面接触，以使支座指状件186、弹簧188以及驱动楔状件182沿逆时针方向旋转。支座指状件186的逆时针运动将驱动楔状件182偏压成与凸轮叶142-144击发接合(图9)。
特别参照图12，当驱动楔状件182在击发冲程之间被拉离凸轮叶142-144中的一个时，如果没有防倒转摆杆200的作用而通过齿轮组缩回弹簧172的作用凸轮盘130将趋向于从顶部旋转至后部。防倒转摆200的横向销202，204分别与手柄壳体88的右半个壳体和左半个壳体84，86接合。在销202，204的上方，将防倒转拉伸弹簧206连接到在防倒转摆200远侧的右半个壳体84的整体销208上。特别参照图5，防倒转摆200的下部支脚210与整体齿条170的上表面212形成摩擦接触。当防倒转摆200的下部支脚210通过缩回整体齿条170在近侧被牵拉时，防倒转杆20与整体齿条170进行垂直接合，以增加锁定整体齿条170的摩擦力，这足以克服由齿轮组缩回弹簧172所提供的反驱动力。当整体齿条170被击发扳机34向远侧驱动时，下部支脚210被向远侧推动以减少摩擦并允许击发。通过惰轮轴158以及通过从防倒转拉伸弹簧206的推进来防止下部支脚210向前过多的运动。
在图12中，将释放按钮38绕其后枢转销220，222向上枢转，以将其远侧臂224升高到在防倒转摆200的近侧定向臂226的上方，从而允许用于在击发冲程之间锁定齿条170的下部支脚210向远侧运动。夹具锁定杆230绕其横向枢转销232、234摇摆，以实现提升释放按钮38。特别的是，在夹具锁定杆230的近侧并向上凸起臂236滑动地抵靠在释放按钮38的远侧臂224的下表面上。夹具锁定杆230的远侧凸起锁定臂238在其夹持状态下锁定闭合轭形件96。特别的是，通过拉伸弹簧242使在近侧并向上凸起臂236和远侧凸起锁定臂238之间向下延伸的小突出部分240向近侧推进，该拉伸弹簧还在销244连接在处手柄壳体88的右半个壳体84上。参照图6-7，远侧凸起锁定臂238倚靠在存在于闭合轭形件96的顶部近侧部分上的台阶246上，这允许闭合轭形件96向远侧移动以传送闭合运动。当闭合轭形件96到达其远侧致动活位置(图8，9)时，位于台阶246的远侧并向上开口凹槽的夹具锁定凹槽248容纳远侧凸起锁定臂238。因此，外科医生可在端部执行器保持夹紧的情况下松开闭合扳机26。
特别参照图5-8，12，除了上述防倒转特征和闭合夹紧特征外，通过击发锁定杆250提供击发锁定特征。如特别在图7和8中所示的，在外科缝合和切割器械10处于初始打开和未击发的状态下，击发锁定杆250响应于通过阻挡整体齿条170的远侧击发运动而缩回的闭合轭形件96。击发锁定杆250包括具有远侧倾斜上表面254的远侧延伸臂252，该倾斜上表面沿整体齿条170的远侧部分与右边缘256对齐。沿整体齿条170的其余远侧部分的凹进的右边缘258允许击发锁定杆250的远侧倾斜上表面254向上转动，从而其通过连接在垂直突起266上的拉力弹簧264推动下绕近侧横向销260、262枢转，将该垂直突起266在近侧垂直地连接在远侧延伸臂252上。将拉伸弹簧264的另一端连接到在垂直突起266后面的手柄壳体88的右半个壳体84中形成的整体销268上。
如图8所示，远侧倾斜表面254挡住通过由跨过闭合轭形件96的近端形成的台阶270向上挤起的整体齿条170的远侧运动，该闭合轭形件96在近侧并向上开口以容纳击发锁定杆250的向下枢转的远侧延伸臂252。在闭合轭形件96向远侧移动以闭合如图12所示的端部执行器12的情况下，通过向下移动远侧延伸臂252以与在更高且更远侧的台阶270的近侧的闭合轭形件96中形成的下部台阶272接合允许整体齿条170的右边缘256通过响应上述的远侧倾斜表面254的上方。击发锁定杆250与下部台阶252之间的接合具有在整体齿条170完全缩回之前防止闭合轭形件96缩回(近侧运动)的好处。因此，击发机构42的初始缩回有利地在松开端部执行器12之前发生，否则可在击发机构42中引起粘结。而且，在下部台阶272和击发锁定杆250之间可存在足够的摩擦接触，以有利地需要两步骤的处理以使外科缝合和切割器械10返回到其打开和缩回状态。特别的是，一旦通过按压释放按钮38使击发机构42缩回，在闭合扳机26上的轻微挤压将易于允许击发锁定杆250升高到其击发锁定位置。随后，当闭合轭形件96被完全缩回时，释放闭合扳机26可继续使击发锁定杆250对齐以与较高的台阶270接合并使端部执行器12打开。
在使用中，医生通过套管针的插管将端部执行器12和轴18定位在手术部位处，并定位作为相对的钳口的砧板14和细长通道16以夹紧被缝合和切割的组织。一旦对端部执行器12的位置满意，将闭合扳机26朝手柄20的手枪式握柄36完全地下压，使闭合连接件102进入闭合轭形件96并然后进入闭合管24以闭合端部执行器12。向远侧移动的闭合轭形件96具有容纳夹具锁定杆230的夹具锁定凹槽248，以夹紧端部执行器12。通过将被联接在击发扳机34上的驱动楔形件182连续地接合在凸轮盘130的凸轮叶142-144上来多次扣动击发扳机34实现击发杆32的击发。通过旋转传动击发机构1 50将这种棘轮的旋转传送以使整体齿条170向远侧前进。随着闭合轭形件96的前进，齿条170能挤压击发锁定杆250使其偏离通道。在击发冲程之间，将防倒转摆100拉成与齿条170垂直锁定接触，从而抵抗通过连接到凸轮盘130上的齿轮组缩回弹簧172施加的缩回力。一旦实现了完整的击发行程，首先下压闭合释放杆40脱离防倒转摆100，从而允许整体齿条170缩回，然后使夹具锁定杆230脱离闭合轭形件96，以便从打开的端部执行器12移除一个障碍物。外科医生挤压闭合轭形件96以允许击发锁定杆250从闭合轭形件96中释放，并释放闭合扳机26，从而允许闭合轭形件96向近侧移动到其使夹紧击发锁定杆250保持锁定整体齿条170使之不能发射之处。随后，可将外科缝合和切割器械10的执行部分22拆掉，例如替换缝钉匣62以做好另一个手术的准备。
滑动离合器旋转传动装置
在图13-14中，用于外科缝合和切割器械310的可替代的旋转传动击发机构300包含将用于使击发致动器(扳机)314进入运整体齿条316和击发杆318中的动的单向接合的旋转滑动离合器组件312。应该理解的是，在图13-14中省略了外科缝合和切割器械310的闭合机构和执行部分的其组成元件，但其操作与上述相类似。
击发扳机314在其上部320处包括与从手柄右侧壳体326向左凸出的销324接合的横向枢转孔322。中空的圆柱形衬套328和的在手柄左侧壳体中对准以与销324接合的内销孔(在图13-14中未示出)枢转地将击发扳机314定位在整体齿条316的左侧和近侧的垂直平面中。
弧形齿轮孔330被横向地限定在销孔322下面的击发扳机314中，并与整体齿条316的底部齿状表面332的下面对准。滑动离合器组件312包括左侧正齿轮342，该左侧正齿轮沿弧形齿轮孔330的底部与曲线形齿轮部分344齿轮啮合。滑动离合器组件312还包括右侧正齿轮346，该右侧正齿轮与整体齿条316的底部齿状表面332齿轮啮合。滑动离合器轴348从手柄右侧壳体326中的插孔350(图14)中伸出，以便在两个正齿轮342、346在滑动离合器轴348上自由旋转的情况下接合在手柄左侧壳体(未示出)中的孔内。可通过在击发扳机314的运动和整体齿条316的纵向平移量之间所需的齿轮齿数比来有利地选择左侧和右侧正齿轮342，346的相对尺寸。
具有三个倾斜外部凹槽362、364、366的内凸轮360与左侧正齿轮342的右表面一起旋转运动为。将该内凸轮360容纳在右侧正齿轮346中的中心孔372的内部。在中心孔372和各个倾斜外部凹槽362，364，366之间为滚柱380、382、384。如图15-16所示，该组件用作斜面式滚柱离合器(roller-ramp clutch)(也叫作：过速离合器、单向离合器和空程离合器)。在图15中，当使击发扳机314向远侧时(从右侧看时逆时针(CCW))，左侧正齿轮342通过滑动离合器轴348被保持在壳体内的适当位置中，而左侧正齿轮342从顶部旋转到后部(CCW)。内凸轮360与左侧正齿轮342一起旋转。因此，滚柱380、382、384易于保留在其各自的倾斜外部凹槽的更宽敞的部分内(即，顺时针(CW))，并且不将这种运动传送到右侧正齿轮346上以及整体齿条316上。
参照图13-14，可选的旋转传动击发机构300包含在滑动离合器机构312的远侧操作的防倒转机构400。尤其是，摆状件402具有绕摆轴404的左侧部分旋转的枢转孔403，该摆轴404被容纳在手柄右侧壳体326的轴孔406中和在手柄左侧壳体中的对应轴孔中(未示出)。摆状件402的支座408绕摆轴404旋转到顶部表面409的远侧与其脱离接合或者在近侧垂直地对准成与顶部表面409摩擦接合。摆状件402具有关于摆轴404与支座408相对的上部410，该上部410受到防倒转弹簧412向前弹性地推进，该防倒转弹簧412被接合到穿过上部410的近侧销414上和容纳在手柄右侧壳体326中的销孔418和手柄左侧壳体中的对应销孔(未示出)之间的远侧销416上。因此，将摆支座408推入以锁定整体齿条316。在击发过程中通过整体齿条316的向前运动克服防倒转弹簧412。
与本发明一致的申请可使用其它防倒转机构，例如在2003年9月29日提交的、系列号为NO.10/673,929、名称为“带有包含防倒转机构的多冲程击发的外科缝合器械”的未审定且共同拥有的专利申请中所描述的，上述申请公开的全部内容在此被引入作为参考。
通过同时脱开防倒转机构400和滑动离合器组件312的接合可缩回可选的旋转传动击发机构300，从而允许通过在整体齿条316中的近侧弹簧孔502和从手柄右侧壳体326中伸出的最近侧销504之间连接的缩回弹簧500将整体齿条316向近侧推进。防倒转机构400的手动脱离可通过操作者下压缩回按钮510来实现(图14，17)，该缩回按钮绕缩回按钮510的下后部枢转装置514向下部枢转前臂512。该前臂512又绕其中心枢转装置524向下牵拉摇杆构件522的后臂520，这使其远侧并向上凸起的臂526向上和向后旋转，从而向后牵拉被连接到穿过摆状件402的上部410的近侧销414上的缩回连杆528，由此使摆动件支脚408向远侧旋转以脱离与整体齿条316的上部表面409的接合。因此应当理解的是，当防倒转机构400处于其锁定位置时，这些组成元件的相对运动使缩回按钮510上升。
一般来说，整体齿条316的近侧运动以及滑动离合器组件312的右侧正齿轮346应当足以使滚柱380、382、384脱离接合，即使击发扳机314处于局部致动的位置中，其中，左侧正齿轮342仍然啮合在沿其弧形齿轮孔330的底部的曲线形齿轮部分344上。应当理解的是，有些申请可进一步包括迫使滚柱380、382、384脱离与右侧正齿轮346的接合，以确保脱离(即，迫使三个凸轮销进入倾斜凹槽362，364，366中)的缩回件。
在使用中，可选的旋转传动击发机构300实现如图17-20依次所示的多冲程击发。在图17中，整体齿条316在近侧被完全缩回，并且击发扳机314略微地被拉回到滑动离合器组件312将要接合的准备位置。在图18中，在第一次冲程后将击发扳机314向近侧牵拉。滑动离合器组件312向远侧旋转驱动整体齿条316的对应量，从而拉伸缩回弹簧500。在弹簧(未示出)的作用下，当释放击发扳机314并允许其向远侧旋转时，滑动离合器组件312脱离接合，并且防倒转机构400通过摆支座408的向后运动来锁定整体齿条316。在图19中，击发扳机314正在开始第二次冲程，以使滑动离合器组件312再次接合，从而将击发扳机314的击发运动传送到从其在图18中左侧处的整体齿条316的远侧运动中。当摆支座408相对防倒转弹簧412向远侧旋转时，这种击发运动使防倒转机构400脱离接合。
尽管已经通过几个实施方案的描述对本发明进行了说明，并且已相当详细地描述了所示的实施方案，但是申请人的目的并不是限制或以任何方式限定所附权利要求的范围到这样的细节中。对于本领域普通技术人员来说，本发明的其它优点和改进是显而易见的。
应当理解的是，在此参考医生抓握器械的手柄而使用术语“近侧”和“远侧”。因此，端部执行器12位于相对于更近的手柄20的远侧。应当进一步理解的是，出于方便和清楚，在附图中使用诸如“垂直”和“水平”的空间术语。然而，外科器械被用在许多方向和位置上，并且这些术语也不意味着限制性和绝对的。
根据内窥镜的操作和设备来讨论本发明。但是，此处使用的诸如“内窥镜的”术语不应被解释为将本发明限定到仅仅与内窥镜管(即，套管针)结合使用的外科缝合和切割器械。相反，可以认为本发明可用于在局限在进入小切口的任何处理中，包括但不限于腹腔镜操作以及开放式操作。
例如，尽管外科缝合和切割器械10在此处被描述为有利地具有独立且明显的闭合致动和击发致动，但应当理解的是，与本发明一致的申请可包括将单个使用者的致动转换为闭合和击发器械的击发运动的手柄。
另外，尽管对手动致动手柄进行了说明，但是电动或具有动力的手柄可从包含有这里所描述的连接齿条而受益，这允许实现手柄的尺寸的减少或其它益处。例如，尽管将连接齿条部分地装载到手枪式握柄中是方便的，但应当理解的是，在连杆之间的枢转连接允许将连杆平行于通过手柄的轴和圆筒限定的直线部分地装载。
应当进一步理解的是，齿条170可有利地由允许将要弯曲的击发机构42的近侧部分进入手柄中的连杆形成，以考虑更紧凑的设计。在下述共同拥有的申请中更详细地描述了这种连接齿条，该申请是由Jeffrey S.Swayze和Frederick E.Shelton IV在2003年9月29日提交的、系列号为No.10/673,930、名称为“包含具有连接齿条传动装置的击发机构的外科缝合器械”，上述申请的全部内容在此被引入作为参考。
Claims (10)
1.一种外科器械，包括：
端部执行器，其具有可操作的构造以响应击发运动；
连接到端部执行器上的轴，其包括联接到用于运动的端部执行器上的细长击发构件，以纵向传送击发运动；以及
在近侧连接到轴上的手柄，其包括：
沿击发方向和返回方向可重复地运动的击发致动器；
旋转传动装置，包括：
输入旋转构件，其被联接在用于对应其击发和返回方向的运动而进行转动的击发致动器上；
输出旋转构件，其被接合在用于对应其纵向运动而进行转动的细长的击发构件上；以及
单向离合器，其将输入旋转构件的击发转动选择性地传递给输出旋转构件。
2.根据权利要求1所述的外科器械，进一步包括连接在细长击发构件上的齿条，其中，该齿条通过齿轮接合与由齿轮组组成的凸轮盘联接。
3.根据权利要求2所述的外科器械，其特征在于，所述旋转传动装置包括齿轮减速组件，该齿轮减速组件使输入旋转构件的间歇旋转与齿条的加速纵向运动相关联。
4.根据权利要求1所述的外科器械，进一步包括防倒转机构，其具有可操作的构造以防止细长击发构件在击发致动器的击发冲程之间缩回。
5.根据权利要求4所述的外科器械，其特征在于，所述防倒转机构包括被向近侧偏压成与细长击发构件摩擦接合的摆簧。
6.根据权利要求4所述的外科器械，进一步包括释放机构，其具有可操作的构造以响应释放致动，从而推动防倒转机构与细长击发构件脱离接合。
7.根据权利要求6所述的外科器械，其特征在于，所述防倒转机构包括被向近侧偏压成与细长击发构件摩擦接合的摆簧。
8.根据权利要求1所述的外科器械，其特征在于，所述端部执行器包括一对响应于闭合运动的相对的钳口和响应于击发构件的击发杆，所述轴具有可操作的构造以通过闭合构件将闭合运动传送到端部执行器，所述手柄进一步包括具有可操作的构造以产生闭合运动的闭合机构。
9.根据权利要求1所述的外科器械，其特征在于，所述单向离合器包括在输入滚柱构件和输出滚柱构件之间的滚柱式滑动离合器。
10.根据权利要求1所述的外科器械，其特征在于，所述击发致动器包括提供往复弧形运动的可枢转联接的杆，该击发致动器包括接合在输入旋转构件上的弧形表面。
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Also Published As
| Publication number | Publication date |
|---|---|
| AU2005203436B2 (en) | 2011-12-01 |
| RU2005127845A (ru) | 2007-03-20 |
| CA2517547C (en) | 2013-11-19 |
| JP2006075597A (ja) | 2006-03-23 |
| BRPI0504413B1 (pt) | 2016-07-19 |
| JP4818665B2 (ja) | 2011-11-16 |
| KR20060051039A (ko) | 2006-05-19 |
| AU2005203436A1 (en) | 2006-03-23 |
| CA2517547A1 (en) | 2006-03-07 |
| BRPI0504413A (pt) | 2006-04-18 |
| US7128254B2 (en) | 2006-10-31 |
| US20060049230A1 (en) | 2006-03-09 |
| DE602005005123D1 (de) | 2008-04-17 |
| EP1632187B1 (en) | 2008-03-05 |
| CN100579471C (zh) | 2010-01-13 |
| EP1632187A1 (en) | 2006-03-08 |
| PL1632187T3 (pl) | 2008-08-29 |
| ATE387887T1 (de) | 2008-03-15 |
| DE602005005123T2 (de) | 2009-03-19 |
| RU2408306C2 (ru) | 2011-01-10 |
| KR101169914B1 (ko) | 2012-08-06 |
| MXPA05009496A (es) | 2006-03-09 |
| BRPI0504413B8 (pt) | 2021-06-22 |
| ES2300954T3 (es) | 2008-06-16 |
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