CN1961838A - 具有液压驱动端部执行器的外科器械 - Google Patents

具有液压驱动端部执行器的外科器械 Download PDF

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CN1961838A
CN1961838A CNA2006101366542A CN200610136654A CN1961838A CN 1961838 A CN1961838 A CN 1961838A CN A2006101366542 A CNA2006101366542 A CN A2006101366542A CN 200610136654 A CN200610136654 A CN 200610136654A CN 1961838 A CN1961838 A CN 1961838A
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弗雷德里克·E·谢尔顿四世
杰罗姆·R·摩根
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    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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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    • AHUMAN NECESSITIES
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    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B2017/07214Stapler heads
    • A61B2017/07285Stapler heads characterised by its cutter
    • AHUMAN NECESSITIES
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    • A61B2017/2901Details of shaft
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B17/2909Handles
    • A61B2017/2925Pistol grips
    • AHUMAN NECESSITIES
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    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B17/32Surgical cutting instruments
    • A61B2017/320052Guides for cutting instruments

Abstract

一种液压驱动的外科器械。该器械可以包括手柄部分和轴。该轴与手柄部分机械连接。该器械还可以包括端部执行器,该端部执行器沿所述轴的纵向轴线与所述轴机械连接。该端部执行器可以包括外科器具和液压装置。该外科器具的至少一部分可沿横向轴线平移,该横向轴线与轴的纵向轴线基本上垂直。而且,液压装置可以被定位成能够在与轴的横向轴线基本上平行的方向上朝外科器械膨胀。

Description

具有液压驱动端部执行器的外科器械
技术领域
本发明总的涉及外科器械,特别涉及具有液压驱动端部执行器的内窥镜外科器械。
背景技术
内窥镜外科器械通常包括端部执行器和手柄,该端部执行器位于细长轴的远端,该手柄位于该细长轴的近端,以便临床医生对端部执行器进行操作。在使用中,端部执行器通过插管针的插管被送到手术部位。在手术部位处,端部执行器以多种方式接合组织,达到诊断或治疗的效果。与传统的开放式外科器械相比,内窥镜外科器械更受青睐,这是因为内窥镜外科器械需要更小的切口,比传统的开放式手术切口需要更短的术后恢复时间。由于内窥镜手术的这一点以及其他的优点,具有端部执行器的各内窥镜外科器械已经有了显著的发展,所述端部执行器与组织接合,完成多种手术任务。例如,端部执行器已经被开发用作内切割器、抓钳、切割器、缝合器、家具施放器、接入装置、药物/基因治疗传输装置、超声波、RF、或激光能量装置和其他外科器械。
内窥镜外科器械必须响应于来自手柄或其他输入装置的输入在端部执行器处产生动作,所述手柄或其他输入装置通过窄的细长轴与端部执行器分离。由于在端部执行器处必要的动作会很复杂并且会包括与细长轴的轴线垂直的方向的动作,这样就产生了相当大的设计难题。现有的一种设计包括驱动带,其通过细长轴或围绕细长轴从器械的手柄延伸到端部执行器。响应于来自手柄的输入,该驱动带朝端部执行器轴向平移。端部执行器沿细长轴的轴线的动作直接由驱动带传输。但是,端部执行器非轴向的动作,例如横向缝合和夹紧动作,必须通过改变轴向驱动动作的方向来传输。其通常通过往复楔形件或其他机械装置实现。这种设计的一个例子在美国申请公开2004/02321961 A1中公开,其公开全部内容通过引用并入本文。
利用如上所述的轴向驱动带设计的外科器械具有许多缺点。例如,在轴向驱动带和轴之间的摩擦会产生明显的能量损耗。该能量损耗在具有关节运动的端部执行器的器械中更加明显,因为轴向驱动带随后必须通过关节运动枢轴平移。机械改向装置由于其低效率导致额外的能量损耗。机械改向装置体积大,加上端部执行器的整体直径,限制了其在小手术环境中的使用。轴向驱动带装置也限制了对端部执行器的操作选择。例如,在具有由往复运动的楔形件驱动的缝钉的缝合器械中,在不击发中间的缝钉的情况下没有办法击发位于更远侧的缝钉,因为楔形滑块必须首先平移通过位于最近侧的缝钉的位置。应当理解,可用于楔形缝合器的缝钉击发模式受到相当大的限制。
众所周知,可以在端部执行器中用轴向导向的液压缸来代替如上所述的轴向驱动带。该液压缸将轴向动作提供到端部执行器中的部件。非轴向动作仍然通过改变轴向动作的方向而获得,所述轴向动作是由液压缸利用往复运动的楔形滑块或其他机械装置提供的。尽管这种设计消除了轴向驱动带和相关的摩擦损耗,但是其没有涉及到关于机械改向装置的其他问题,如端部执行器的大体积、机械改向的低效率以及受限的击发模式。
发明内容
因此,显然需要一种改进的外科器械,其具有能够在更小的手术部位处使用的更小的端部执行器。还极需一种改进的外科器械,其能够更有效地将击发力转移到端部执行器上。另外,还需要一种改进的外科缝合器,其具有更大的击发模式选择范围。
根据本发明的一个实施例,提供一种液压驱动的外科器械。该器械可以包括手柄部分和与该手柄机械连接的轴。该器械还可以包括端部执行器,该端部执行器沿所述轴的纵向轴线与所述轴机械连接。该端部执行器可以包括外科器具和液压装置。该外科器具的至少一部分可沿横向轴线平移,该横向轴线与轴的纵向轴线基本上垂直。而且,液压装置可以被定位成能够在与轴的横向轴线基本上平行的方向上朝外科器械膨胀。
根据本发明的另一个实施例,提供一种用于与外科紧固器械一起使用的端部执行器。该端部执行器可以在第一方向上驱动外科紧固件,并且可以包括外科紧固件仓,该外科紧固件仓包括在第一方向上定向的外科紧固件。该端部执行器还可以包括紧固件液压装置,该紧固件液压装置被定位成能够在第一方向上朝外科紧固件膨胀。
根据本发明的又一个实施例,提供一种外科器械,该器械包括:阀单元;第一外科器具;和第一液压装置。该第一液压装置可以流体连接到所述阀单元上并且被定位成能够朝第一外科器具膨胀。该外科器械还可以包括第二外科器具和第二液压装置。该第二液压装置可以流体连接到所述阀单元上并且被定位成能够朝第二外科器具膨胀。该外科器械还可以包括与阀单元通信的击发模式控制装置。该击发模式控制装置可以设定阀单元,以根据击发模式将加压的液压流体引导到第一和第二液压装置。
本发明还涉及如下方面:
(1)一种液压驱动的外科器械,包括:
手柄部分;
具有纵向轴线的轴,该轴与手柄部分机械连接;
端部执行器,该端部执行器沿所述纵向轴线与所述轴机械连接,该端部执行器包括:
外科器具,该外科器具的至少一部分可沿横向轴线平移,该横向轴线与所述纵向轴线基本上垂直;以及
液压装置,该液压装置被定位成能够在与横向轴线基本上平行的方向上朝外科器具膨胀。
(2)如第(1)项所述的器械,其特征为,所述外科器具选自切割刃、外科紧固件、抓钳、夹具施放器、夹钳和接入装置。
(3)如第(1)项所述的器械,其特征为,所述液压装置选自液压囊和液压缸。
(4)如第(1)项所述的器械,其特征为,所述轴包括关节运动枢轴,端部执行器在所述关节运动枢轴处远离纵向轴线枢转。
(5)如第(1)项所述的器械,其特征为,所述外科器械包括钉仓,该钉仓包括在第一方向上定向的缝钉,所述液压装置被定位成能够在第一方向上朝缝钉膨胀。
(6)如第(5)项所述的器械,其特征为,还包括定位在液压装置和缝钉之间的缝钉驱动器。
(7)如第(1)项所述的器械,其特征为,还包括:第二外科器具,所述第二外科器具的至少一部分可沿第二横向轴线平移;以及第二液压装置,被定位成能够在与第二横向轴线基本上平行的方向上朝第二外科器具膨胀。
(8)一种用于与外科紧固器械一起使用的端部执行器,其特征为,该端部执行器在第一方向上驱动外科紧固件,所述端部执行器包括:
外科紧固件仓,包括在第一方向上定向的外科紧固件;以及
紧固件液压装置,被定位成能够在第一方向上朝外科紧固件膨胀。
(9)如第(8)项所述的端部执行器,其特征为,还包括:
刀片,具有在第一方向上定向的切割刃;
切割液压装置,被定位成能够在第一方向上朝切割刃膨胀。
(10)如第(9)项所述的端部执行器,其特征为,还包括位于切割液压装置和切割刃之间的切割杆。
(11)如第(8)项所述的端部执行器,其特征为,所述外科紧固件为缝钉。
(12)如第(8)项所述的端部执行器,其特征为,所述外科紧固件仓包括在第一方向上定向的多个外科紧固件。
(13)如第(12)项所述的端部执行器,其特征为,所述紧固件液压装置包括与刚性安装板接触的液压囊;
所述刚性安装板限定了多个孔;
所述多个孔中的每个分别与多个外科紧固件之一对应;
所述液压囊仅可膨胀通过刚性安装板的孔。
(14)如第(8)项所述的端部执行器,其特征为,所述紧固件液压装置选自液压囊和液压缸。
(15)如第(8)项所述的端部执行器,其特征为,还包括选自抓钳、夹具施放器和接入装置的外科器具。
(16)一种外科器械,包括:
阀单元;
第一外科器具;
第一液压装置,与所述阀单元流体连接并且被定位成能够朝第一外科器具膨胀;
第二外科器具;
第二液压装置,与所述阀单元流体连接并且被定位成能够朝第二外科器具膨胀;以及
与阀单元通信的击发模式控制装置,所述击发模式控制装置设定阀单元,以根据击发模式将加压的液压流体引导到第一和第二液压装置。
(17)如第(16)项所述的外科器械,其特征为,所述击发模式规定了第一和第二外科器具中的至少一个被驱动。
(18)如第(16)项所述的外科器械,其特征为,所述击发模式规定了在第一外科器具的驱动和第二外科器具的驱动之间的延迟。
(19)如第(16)项所述的外科器械,其特征为,还包括:
第三外科器具;以及
第三液压装置,与所述阀单元流体连接并且被定位成能够朝第三外科器具膨胀。
(20)如第(16)项所述的外科器械,其特征为,所述第一外科器具和第二外科器具选自切割刃、外科紧固件、抓钳、夹具施放器和接入装置。
附图说明
结合到说明书中并构成说明书一部分的描述本发明的具体实施例的附图,与上述本发明的总体描述和以下给出的实施例的详细叙述一起,用于阐述本发明的原理。
图1是根据本发明的各实施例的处于打开位置的外科器械的部分切除后的侧视图;
图2是根据本发明的各实施例的处于上部位置或打开位置的外科器械的端部执行器的沿图1的线2-2的详细的剖面侧视图;
图3是根据本发明的各实施例的处于下部位置或闭合位置的外科器械的端部执行器的沿图1的线2-2的详细的剖面侧视图;
图4是在根据本发明的各实施例的图1的外科缝合和切割器械的远端处的端部执行器的立体图,其中砧座处于上部位置或打开位置,并且大部分圆筒被去除,露出了典型的缝钉驱动器和典型的切割刃;
图5是在根据本发明的各实施例的图1的外科缝合和切割器械的远端处的端部执行器的立体图,其中砧座处于上部位置或打开位置,露出了钉仓和切割刃;
图6是根据本发明的各实施例的图1的外科缝合和切割器械的细长通道的二维俯视图;
图7是在根据本发明的各实施例的细长通道中安装的钉仓的二维俯视图,其中去除了部分钉仓以显示典型的缝钉驱动器;
图8是根据本发明的各实施例的显示了钉仓的图1的外科缝合器械的细长通道的立体图;
图9是根据本发明的各实施例的显示了液压囊之间的横截面关系的剖面图;
图10是根据本发明的各实施例的图1的外科缝合和切割器械的执行部分的分解立体图;
图11是根据本发明的各实施例的用于外科器械的未加压的液压囊缝钉驱动器;
图12显示出用于根据本发明的各实施例的外科器械的膨胀的液压囊缝钉驱动器;
图13显示出用于根据本发明的各实施例的外科器械的液压缸缝钉驱动器;
图14显示出根用于据本发明的各实施例的外科器械的液压缝钉驱动组件;
图15是用于根据本发明的各实施例的外科器械的液压缝钉驱动组件的侧视图;
图16是用于根据本发明的各实施例的外科器械的液压缝钉驱动组件的俯视图;
图17是用于根据本发明的各实施例的外科器械的液压缝钉驱动组件的侧视图;
图18显示出根据本发明的各实施例的具有处于下部位置或闭合位置的关节运动端部执行器的外科缝合和切割器械的远端;
图19是根据本发明的各实施例的液压外科器械的立体图;
图19A是用于根据本发明的各实施例的外科器械的液压系统的示意图;
图20是在根据本发明的各实施例的图1的外科缝合和切割器械的中心线部分处的侧视图,其中处于部分闭合但未夹紧位置端部执行器夹持了组织;
图21是根据本发明的各实施例的处于闭合位置或夹紧位置的图1的外科缝合和切割器械的部分切除后的侧视图;
图22是根据本发明的各实施例的处于闭合位置或夹紧位置的图1的外科缝合和切割器械的远端的中心线部分处的侧视图,其中组织被适当压缩;
图23是根据本发明的各实施例的处于部分击发位置的图1的外科缝合和切割器械的部分切除后的侧视图;
图24是根据本发明的各实施例的处于部分击发位置的图1的外科缝合和切割器械的远端的中心线部分处的侧视图;
图25是根据本发明的各实施例的处于完全击发位置的图1的外科缝合和切割器械的部分切除后的侧视图;以及
图26是根据本发明的各实施例的处于完全击发位置的图1的外科缝合和切割器械的远端的中心线部分处的侧视图。
具体实施方式
在此使用的术语“近侧”和“远侧”是以握持器械手柄的临床医生为参照。例如,参照图1所示的外科器械10,端部执行器12相对于更近侧的手柄部分20位于远侧。为了方便和清楚起见,还应该理解,如“垂直”和“水平”的空间术语在此是相对于附图而言的。但是,外科器械可以在很多方位和位置上使用,这些术语并不意味着限制和绝对化。
如在此使用的,术语“外科器具”指用以接合组织来完成手术工作的一个部件或一套部件。外科器具的例子包括但不限于:内切割器、抓钳、夹具、切割器、缝合器、其他外科紧固件、夹具施放器、探头或接入装置、药物/基因治疗传输装置、如超声波、RF、或激光装置的能量装置等。
如在此使用的,术语“外科紧固件”指在手术设置中使用的任意种类紧固件,其例如包括:缝钉、疝修补器等。如在此使用的,术语“外科紧固件”也可以指用于布置缝钉、疝修补器等的装置。
如在此使用的,术语“流体连接”意味着元件通过适当的管路或其他方式连接在一起以允许其间的加压的流体介质、空气等通过。如在此使用的,“供给管路”、“液压管线”、“回流管路”中使用的术语“管路”指由导管、管件、管道等形成的适当的流动通道,用于从一个部件向另一部件传输加压的液压流体。
如在此使用的,“液压流体”指适合于在液压系统中使用的任意流体。液压流体的非限定性的例子包括油、空气等。在一个非限定性的实施例中,液压流体可以是包括例如甘油、盐水等的生物相容性流体。
参照附图,图1的外科器械10包括手柄部分20和执行部分22。执行部分22包括轴23和端部执行器12。如图1所示的端部执行器12用作包括用于夹紧、缝合和切割的外科器具的内切割器,但是,应当理解的是,本发明的优点可以通过包括可选择的和/或其他附加的外科器具的端部执行器(未示出)来实现。
回到如图1所示的非限定性实施例,器械10的手柄部分20包括手枪式握把24,临床医生向着该手枪式握把24枢转地拉动闭合扳机26,以使砧座18朝向端部执行器12的细长通道16夹紧或闭合。在闭合扳机26的外侧为击发扳机28,其被临床医生枢转地拉动,在端部执行器12中缝合和切割夹紧的组织。
闭合、缝合、和切断组织所需的力可以通过位于端部执行器12中的多个液压装置(图1中未显示)如囊、液压缸等提供。在各实施例中,液压装置可以通过液压管线束306供给加压的液压流体,该液压管线束306例如通过细长轴23从器械10的手柄20延伸至端部执行器12。
图2-5是根据本发明的各实施例的用于执行组织的夹紧、切割和缝合的端部执行器12的示图。端部执行器12可以包括砧座18和用于收纳钉仓37的细长通道16。砧座18可以围绕砧座枢轴14向细长通道16和钉仓37枢转。图2显示了处于打开位置的砧座18,而图3显示了处于枢转或闭合位置的砧座18。
在各实施例中,枢转或驱动砧座18所需的力可以由闭合套管32提供。例如,当临床医生致动闭合扳机26时,闭合套管32可以向远侧朝端部执行器平移,以驱动砧座18进入图3所示的闭合位置。当闭合扳机26被释放时,闭合套管32可以向近侧远离端部执行器12平移。器械10可以包括弹簧或其他能量储存装置,以在闭合套管32回缩时使砧座18回到如图2所示的打开位置。可以通过在例如包括齿轮系统、电动机、液压装置等的本领域公知的任何机械装置,将力从闭合扳机26传输到闭合套管32。
回到图2,端部执行器12可以包括横向的切割刃326。切割刃326可以由位于切割刃326下方的液压切割囊322驱动。切割杆324可以位于切割囊322和切割刃326之间。在各实施例中,切割囊322、切割杆324和切割刃326可以彼此紧固在一起。应当理解的是,在各非限定性实施例中,液压切割囊322可以用例如包括液压缸的任意液压装置替换。响应于临床医生致动击发扳机28,液压切割囊322可以在横向方向上膨胀。这驱动了切割刃326,使其通过细长通道16和钉仓37在横向方向上移动并且切断在砧座18和钉仓以及细长通道16之间的任何组织(未图示),如以下参照图20-26更详细地描述的一样。
再次参照图3,图3是根据各实施例的端部执行器12的剖面图,端部执行器12包括缝钉222和缝钉驱动器220。如图所示,多个缝钉222和缝钉驱动器220位于切割刃326附近。每个缝钉驱动器220可以位于钉仓37中含有的一个或多个缝钉222的下方。缝钉液压囊327可以位于缝钉驱动器220下方。该缝钉液压囊327可以在横向方向上朝缝钉驱动器220膨胀。缝钉液压囊327可以根据临床医生对击发扳机28的驱动而膨胀。缝钉液压囊327的膨胀将缝钉驱动器220和缝钉222推向砧座18中的缝钉形成凹穴(图3中未示出),由此驱动缝钉。
图4示出了处于未击发位置的器械10的端部执行器12的立体图,其中部分钉仓37被去除,以露出细长通道16的结构,如凹槽212、214,并且露出钉仓37的部件,如缝钉驱动器220。如图所示,切割刃326位于其未击发位置,位于缝钉驱动器220的中央。图4也显示了位于砧座18的近端的组织挡块244。在各实施例中,组织挡块244防止组织与砧座枢轴14的部件接触,避免端部执行器12阻塞。
图5是处于打开位置的端部执行器12的立体图,其中钉仓37安装在细长通道16中。在砧座18的下表面200排列有多个缝钉形成凹穴202,与钉仓37的上表面206中的多个缝钉孔204相对应。如图3所示,每个孔204可以与钉仓37内的直接位于孔204下方的单个缝钉222对应。位于钉仓37中间的狭槽49可以封闭切割刃326(图5中未示出)。钉仓37可以压入配合到细长通道16中。例如,钉仓37的延伸部分208、210接合细长通道16的凹槽212、214(如图4所示)。
在各实施例中,端部执行器12中含有的缝钉222可以根据一个或多个缝钉区域而被驱动,其中每个缝钉区域能够被单独击发或驱动。图6-8示出了含有六个缝钉区域的非限定性划分区域的实施例,其中每个缝钉区域包括一个液压装置和一个用于驱动多个缝合的缝钉驱动器。例如,右侧远端缝钉区域包括右侧远端缝钉囊332(如图6所示)和右侧远端缝钉驱动器370(如图7所示)。应当理解的是,本发明的各非限定性实施例根据应用可以包括多于或少于六个的缝钉区域,并且每个区域根据需要包括或多或少的缝钉。还应当理解的是,根据本发明的各实施例的单独的缝钉区域可以包括多个缝钉囊和/或缝钉驱动器。
回到图6,示出了细长通道16的俯视图,该细长通道16包括六个液压缝钉囊328、330、332、334、336和338。每个囊可以与六个缝钉区域之一对应。缝钉囊328、330、332、334、336、338和切割囊322(在图10中位于切割杆324下方)可以分别通过液压管线束306中含有的对应的液压管线340、342、344、346、348、350、352具有加压的液压流体。因此,在各实施例中,囊328、330、334、336、338和322中的每个可以单独地或根据击发模式来驱动相关的外科器具。
图7是细长通道16和钉仓37的俯视图,其中钉仓37的上表面206被去除以显示缝钉驱动器370、372、374、376、378、380。每个缝钉驱动器可与六个缝钉区域之一对应。并且,每个缝钉驱动器370、372、374、376、378、380位于对应于相同的缝钉区域的缝钉囊328、330、332、334、336、338(如图10所示)的上方。例如,右侧远端缝钉囊332位于右侧远端缝钉驱动器370的上方。应当理解的是,不需要每个缝钉袭328、330、332、334、336、338仅对应于一个缝钉驱动器。例如,在一个非限定性实施例中,可以为每一单独的缝钉222提供一个缝钉驱动器220。
图8示出了细长通道16的分解立体图,其具有实现如图6和图7所示的缝钉布置的钉仓37。钉仓37可以包括缝钉凹槽354、356、358、360、362、364。每个缝钉凹槽可以容纳缝钉222(图8中未示出)和缝钉驱动器370、372、374、376、378(图8中未示出)之一。当钉仓37安装到细长通道16中时,每个缝钉凹槽,包括缝钉222和上述的缝钉驱动器,可以与至少一个缝钉囊328、330、332、334、336、338对准。当缝钉囊328、330、332、334、336、338膨胀时,它们可以延伸到缝钉凹槽354、356、358、360、362、364中,对缝钉驱动器370、372、374、376、378产生横向力,驱动缝钉222。图8还示出钉仓37可以包括用于收纳如图10所示的液压管线340、342、344、346、348、350、352的通道366。通道366防止各液压管线被夹压在钉仓37和细长通道16之间。
图9是端部执行器12的截面图,显示了根据各个实施例的囊328、334、322、338和334的结构。如图所示,囊328位于缝钉驱动器370的下方。膨胀的囊328产生将要施加到驱动器370上的横向力,可以驱动缝钉222。图9中所示的其他缝钉囊334、338和334可以相同的方式操作。切割囊322膨胀时也可以产生横向力。该横向力可以使切割杆324横向升高,推动切割刃326横向通过端部执行器12中的任何组织(未示出)。
图10是外科缝合和切割器械10的执行部分22的分解图。如图所示,钉仓37包括:钉仓主体216;缝钉驱动器370、372、374、376、378、380;切割刃326;和缝钉222。钉仓主体216在组装后容纳缝钉驱动器370、372、374、376、378、380和缝钉222。当执行部分22被组装时,如图所示,切割囊322、切割杆324和切割刃326可以沿着细长通道16定位。缝钉囊328、330、332、334、336、338也可以沿着细长通道16定位,并且可以用于例如根据上述的区域布置驱动缝钉222。钉仓37可以被放置于细长通道16中,从而切割囊322、切割杆324和切割刃326与通道49对准,并且从而多排缝钉222和驱动器370、372、374、376、378、380与囊328、330、332、334、336、338对准。
上述实施例示出了靠在缝钉囊327或缝钉囊328、330、332、334、336、338上的缝钉222,各缝钉驱动器220位于缝钉之间。但是,应当理解的是,在各实施例中,缝钉可以通过使用其他机构液压驱动。例如,图11-12示出了直接位于缝钉囊504上的缝钉222(例如没有缝钉驱动器)。例如,响应于临床医生对击发扳机28的致动,液压管线506可以将加压的液压流体提供到囊504。当加压的液压流体被提供至缝钉囊时,如图12所示,缝钉囊会横向膨胀。缝钉囊504的横向运动可以朝缝钉形成凹穴202推动缝钉222,从而驱动缝钉222。可以例如通过沿细长通道16放置缝钉囊504,将如图11-12所示的组件结合到端部执行器12中。应当理解的是,在各实施例中,每个个囊504可以驱动一个或多个缝钉222。
图13示出了另一个非限定性实施例,显示了含有缝钉驱动液压缸510的辅助机构。该液压缸510可以包括活塞512。缝钉222可以位于活塞512上。在活塞512和缝钉222之间可以有也可以没有缝钉驱动器(图13中未示出)。液压管线514可以提供加压的液压流体,使活塞512伸出。相应地,活塞512可以驱动缝钉222与上述的缝钉形成凹穴202接触。在各实施例中,液压缸510可以驱动一个或多个缝钉222。应当理解的是,可以通过沿细长通道16放置一个或多个液压缸510而将如图13所示的组件结合到端部执行器12中。
图14示出了根据本发明的各实施例的用于液压驱动缝钉的另一个非限定性典型实施例的分解图。如图所示,缝钉222靠在缝钉驱动器517上,该缝钉驱动器517靠在安装板516上。如图所示,导轨518围绕着安装板516。当提供了加压的液压流体时,囊522可以横向膨胀。这可以使得安装板516沿导轨518横向膨胀,驱动缝钉222。导轨518可以确保安装板516在横向方向上膨胀。在一个非限定性实施例中,缝钉222可以直接靠在安装板516上(例如没有驱动器517)。应当理解的是,可以通过沿细长通道16放置一个或多个囊522、导轨518和安装板516将如图14所示的组件结合到端部执行器12中。
图15-17示出了根据各实施例的用于液压驱动缝钉的又一非限定性典型实施例。图15示出了与刚性安装板526配合的液压囊524。安装板526可以包括一系列孔528。每个孔可以与一个或多个缝钉相对应。当加压的液压流体被施加到囊524时,囊524可以横向膨胀通过安装板526中的孔528。如图17所示,囊524延伸通过孔528的部分可以对一个或多个缝钉222提供横向驱动力。
如图18所示,在各实施例中,器械10可以包括关节运动端部执行器12。该端部执行器12可以在关节运动枢轴368处远离细长轴23的轴线枢转。由此可见,液压管线束306容易地穿过关节运动枢轴368。
图19示出了根据各实施例的装备有液压系统321的器械10的实施例。在击发扳机28和/或闭合扳机26被驱动时,液压泵302可以产生加压的液压流体。液压泵302可以是适合于加压液压流体的任何种类的装置,例如包括液压缸、囊等。在各实施例中,例如可以包括辅助泵(未示出),以响应于闭合扳机26的致动驱动砧座18。由液压泵302产生的加压的液压流体可以被提供到阀单元304,该阀单元304通过液压管线束306将流体提供到位于端部执行器12中的各个囊和/或液压缸(图19中未示出)。阀单元304可以包括适合于控制和引导液压流体流动的任何种类的阀。在各非限定性实施例中,阀单元可以包括电致动阀,例如响应于电信号的压电阀或电活化聚合物(EAP)阀。
在图19A中示意性地示出了可以用于控制端部执行器12的液压系统321的一个实施例。在该非限定性实施例中,泵302为包括流体储存器432的传统液压泵组件。在一个实施例中,泵302由支撑在手柄内的电池434供电。在另一非限定性实施例中,泵302可以由向下述控制电路318供电的相同的电池320供电。应当理解的是,泵302也可以通过其它方式供电,例如通过交流供电。在一个非限定性实施例中,泵302可以是由从一个或多个扳机26、28获得的机械力供能的液压囊或液压缸。参见图19A,泵302可以通过具有传统止回阀438的供给管路436而与储存器432流体连接。
在一个实施例中,与泵302的排出口431连接的排出管路440管接到歧管442,该歧管442对于连接到其上的每个袭都具有指定的供给管路。例如,在如图19A所示的实施例中,供给管路444与囊328连接,并且具有控制阀460,用以控制加压流体流通过管路444流到囊328。供给管路446与囊330连接,并且具有控制阀462。供给管路448与囊332连接,并且具有控制阀464。供给管路450与囊334连接,并且具有控制阀466。供给管路452与囊336连接,并且具有控制阀468。供给管路454与囊338连接,并且具有控制阀470。供给管路456与切割囊322连接,并且具有控制阀472。提供有回流阀478以允许流体从囊回流到歧管442中,并且通过与歧管442和储存器432连接的回流管路459。如图19A所示,回流管路459可以具有回流阀478。阀460、462、464、466、468、470、472、474、478构成了如上所述附图标记为304的阀单元。
阀单元304可以响应于从输入按钮(如按钮308、310、312、314和/或316)接收的输入由控制电路318控制。电池320可以向控制电路318和按钮308、310、312、314、316供电。控制电路318可以是能够响应于来自按钮308、310、312、314、316的输入产生用于设定阀单元304的信号的任何种类的电路。在一个非限定性实施例中,控制电路318可以包括微处理器和含有随机存储器(RAM)、只读存储器(ROM)等的其他相关部件。在另一个非限定性实施例中,控制电路318可以包括各逻辑电路元件。
控制电路318可以响应于输入按钮308、310、312、314、316来控制阀。在一个非限定性实施例中,每个输入按钮308、310、312、314、316可以与端部执行器12中含有的特定外科器具或部分外科器具相对应。例如,按钮308可以与切割器相对应,而按钮310、312、314、316可以分别与缝钉的一个区域(图2中未示出)相对应。选择与外科器具相对应的按钮310、312、314、316可以使得控制电路318设定阀单元304,从而在击发扳机28被压下时具有相应功能的液压装置被击发,驱动相应的外科器具。也可以选择多个按钮,以产生包括多于一个的器具的击发模式。在其他的非限定性实施例中,每个输入按钮308、310、312、314、316可以代表一个预定的击发顺序和/或模式。例如,选择一个按钮308、310、312、314、316可以使得控制电路318设定阀单元304,从而在击发扳机28被压下时,与特定外科器具相应的液压装置被击发。应当理解的是,各实施例可以具有比所示实施例更多或更少的输入按钮。
在各非限定性实施例中,控制电路318可以设定阀单元304,以便将延迟引入到端部执行器12所含有的一个或多个外科器具中。例如,可以驱动一个切割器具,然后在驱动缝钉器具的一个或多个区域之前延迟预定的时间。延迟可以根据任何适当的方法完成。在一个非限定性实施例中,控制电路318可以设定阀单元304,为在液压泵302和端部执行器12的第一外科器具之间的液压流体开通路径。当击发扳机28被驱动时,泵302可以产生加压的液压流体,该流体驱动第一外科器具。当第一外科器具被驱动时,控制电路318可以例如通过利用如图19A所示的传感器405进行检测(例如通过检测击发扳机28的位置)。当第一外科器具被驱动时,控制电路318可以开启计数预定延迟时间的定时器。在预定延迟时间的截止处,控制电路318可以设定阀单元304,向第二外科器具提供加压的液压流体。在击发扳机28的致动下产生的液压力可以有效地驱动第二外科器具;或者在各实施例中,可以使用液压泵302来产生辅助液压力。
在使用中,如图1、图2和图20-26一样使用外科缝合和切割器械10。在图1-2中,器械10在其起始位置具有压入配合到细长通道16的远端中的未被驱动的充分装载的钉仓37。两个扳机26、28向前,并且端部执行器12打开,在通过插管或其他开口将端部执行器12插入体腔后通常是如此。如图20所示,随后临床医生操纵器械10,从而使将要被缝合和切割的组织248定位在钉仓37和砧座18之间。
然后,参照图21-22,临床医生向近侧移动闭合扳机26,直到闭合扳机26直接位于手枪式握把24附近,将手柄部分20锁定到闭合和夹紧位置。端部执行器12中回缩的切割刃326不会妨碍端部执行器12选择性的打开和闭合,而是沿细长通道16,定位于钉仓37的狭槽49中。响应于闭合扳机26的致动,砧座18可以被驱动以沿砧座枢轴14枢转。
参照图23-24,当夹紧组织后,临床医生向近侧移动击发扳机28,例如通过液压泵302使液压流体加压。当器械进行切割时,液压力可以使切割囊322膨胀,迫使切割杆324通过狭槽49并与切割组织248的切割刃326接触。当器械进行缝合时,液压力可以使一个或多个缝钉袭328、330、332、334、336、338(图24中未示出)膨胀,向驱动缝钉222的驱动器220上施加垂直力。参照图25-26,临床医生继续移动击发扳机28,直到击发扳机28靠近闭合扳机26和手枪式握把24。由此,全部缝钉222的端部由于与砧座18接合而弯曲。通过释放击发扳机28以及通过随后压下释放按钮30,同时挤压闭合扳机26打开端部执行器12,来结束上述过程。
尽管通过一些实施例的描述阐述了本发明,并且相当详细地描述了说明性的实施例,但并不意味着申请人将后附的权利要求的范围严格地或以任何方式限定为这样的具体实施例。本领域技术人员可以容易地理解其他的优点和修改。
例如,尽管如上所述的实施例对于内窥镜使用的手术切断和缝合器械10具有优点,类似的实施例也可以被用到其它临床过程中。普遍接受的是,内窥镜操作比腹腔镜操作更普遍。因此,本发明在内窥镜有关的过程和装置方面进行了描述。但是,在此使用的术语“内窥镜”不应该被解释为把本发明限定于仅仅与内窥镜管(即插管)相关的外科器械。相反地,认为本发明可以用于在进入被限定到很小的切口的情况下的任何手术中,该过程包括但不限于腹腔镜手术,以及开放手术。
对于又一实施例,尽管在此所述的说明性的手柄部分20响应于来自临床医生的输入而被液压操纵,但对于通过其它(例如,气动的、电动机械的、超声的、机械的等)方式供能的手柄部分的一些或全部功能,适用于本发明。而且,这些功能的每个的控制可以手动地在手柄部分上实现,或者通过遥控(例如,无线遥控,自动遥控控制台等)实现。
通过引用而全部或者部分并入本文中的任何专利、公开出版物或者其它公开的材料,仅限于不会与在本申请中公开的定义、陈述或者其它公开的材料相矛盾的部分。如此一来,必要时这里明显阐述的公开内容替代任何通过引用而并入本文中的相矛盾的材料。被声称通过引用并入本文中但是与本发明公开的定义、陈述或者其它公开的材料矛盾的任何材料或其部分将只并入不会使得所并入的材料与本发明公开的材料相矛盾的部分。

Claims (7)

1、一种液压驱动的外科器械,包括:
手柄部分;
具有纵向轴线的轴,该轴与手柄部分机械连接;
端部执行器,该端部执行器沿所述纵向轴线与所述轴机械连接,该端部执行器包括:
外科器具,该外科器具的至少一部分可沿横向轴线平移,该
横向轴线与所述纵向轴线基本上垂直;以及
液压装置,该液压装置被定位成能够在与横向轴线基本上平
行的方向上朝外科器具膨胀。
2、如权利要求1所述的器械,其特征为,所述外科器具选自切割刃、外科紧固件、抓钳、夹具施放器、夹钳和接入装置。
3、如权利要求1所述的器械,其特征为,所述液压装置选自液压囊和液压缸。
4、如权利要求1所述的器械,其特征为,所述轴包括关节运动枢轴,端部执行器在所述关节运动枢轴处远离纵向轴线枢转。
5、如权利要求1所述的器械,其特征为,所述外科器械包括钉仓,该钉仓包括在第一方向上定向的缝钉,所述液压装置被定位成能够在第一方向上朝缝钉膨胀。
6、如权利要求5所述的器械,其特征为,还包括定位在液压装置和缝钉之间的缝钉驱动器。
7、如权利要求1所述的器械,其特征为,还包括:第二外科器具,所述第二外科器具的至少一部分可沿第二横向轴线平移;以及第二液压装置,被定位成能够在与第二横向轴线基本上平行的方向上朝第二外科器具膨胀。
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CN107257663B (zh) * 2014-12-18 2020-07-28 伊西康有限责任公司 用于能够关节运动的外科器械的驱动布置结构
CN109688949A (zh) * 2016-07-13 2019-04-26 伊西康有限责任公司 用于液压辅助断裂肝实质的装置
CN109688949B (zh) * 2016-07-13 2022-01-25 伊西康有限责任公司 用于液压辅助断裂肝实质的装置
CN110650691A (zh) * 2017-01-31 2020-01-03 特兰森特里克斯手术公司 用于微创手术的液压器械驱动系统
CN110650691B (zh) * 2017-01-31 2023-11-10 阿森塞斯(美国)手术公司 用于微创手术的液压器械驱动系统
CN112741712A (zh) * 2019-10-31 2021-05-04 杭州启明医疗器械股份有限公司 通过液压方式驱动的介入器械输送系统
WO2021083295A1 (zh) * 2019-10-31 2021-05-06 杭州启明医疗器械股份有限公司 利用液压方式驱动的介入器械输送系统
CN112741712B (zh) * 2019-10-31 2022-11-08 杭州启明医疗器械股份有限公司 通过液压方式驱动的介入器械输送系统

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US20070102473A1 (en) 2007-05-10

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