CN1985768A - 包含具有柔性齿条的多冲程击发机构的外科缝合器械 - Google Patents

包含具有柔性齿条的多冲程击发机构的外科缝合器械 Download PDF

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CN1985768A
CN1985768A CNA200610169956XA CN200610169956A CN1985768A CN 1985768 A CN1985768 A CN 1985768A CN A200610169956X A CNA200610169956X A CN A200610169956XA CN 200610169956 A CN200610169956 A CN 200610169956A CN 1985768 A CN1985768 A CN 1985768A
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firing member
percussion
flexible firing
handle
surgical instruments
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CN1985768B (zh
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弗雷德里克·E·谢尔顿四世
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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
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • 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
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • 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
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2913—Handles transmission of forces to actuating rod or piston cams or guiding means
    • A61B2017/2917—Handles transmission of forces to actuating rod or piston cams or guiding means with flexible part
    • 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
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2923—Toothed members, e.g. rack and pinion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320052—Guides for cutting instruments

Abstract

一种特别适用于内窥镜手术的外科缝合和切割器械，包含能产生独立的闭合和击发运动以致动端部执行器的手柄。特别是，所述手柄产生多个击发冲程以便减小击发(即缝合与切割)端部执行器所需的力的大小。柔性齿条将这些击发冲程传递给在细长轴中往复运动的击发杆，以致动端部执行器。当回缩时柔性齿条有利地收纳到手柄的手枪式握把中，以使手柄长度最小化。

Description

包含具有柔性齿条的多冲程击发机构的外科缝合器械
相关申请的交叉引用
本申请是Jeffrey S.Swayze等人于2005年2月7日提交的序列号为11/052,632、题为“MULTI-STROKE MECHANISM WITH AUTOMATED ENDOF STROKE RETRACTION”的美国专利申请的部分后续申请，而该美国专利申请又是Jeffrey S.Swayze等人的序列号为10/673,930、题为“SURGICAL STAPLING INSTRUMENT INCORPORATING A FIRING MECHANISMHAVING A LINKED RACK TRANSMISSION”的美国专利申请的部分继续申请，该申请的授权专利号为US 6,905,057，这两份申请的内容均通过全文引用而包含于本申请中。
技术领域
本发明总的涉及能够将钉线应用到组织中同时切割那些钉线之间的组织的外科缝合器械，更具体涉及与缝合器械有关的改进，以及用于形成用多冲程触发器实现击发的所述缝合器械的各种元件的方法的改进。
背景技术
内窥镜和腹腔镜外科器械通常比传统的开放式外科手术装置更受欢迎，因为其切口较小，缩短了术后康复时间并减少了并发症。腹腔镜和内窥镜外科手术的使用已经相当普遍，并且已经提供了进一步发展这种手术的另外的激励。在腹腔镜手术中，通过小的切口在腹部内进行外科手术。类似地，在内窥镜手术中，通过经过皮肤中的小的进入创口插入的狭窄内窥镜管在身体的任何中空内脏中进行外科手术。
腹腔镜和内窥镜手术通常需要对外科手术区域充气。因此，插入到身体中的任何仪器必须被密封以保证气体不经过切口进入体内或者排出体外。此外，腹腔镜和内窥镜手术常常需要医生在远离切口的器官、组织和/或血管上动作。因此，在这种手术中使用的器械通常是长而窄的，同时可从器械的近端进行功能性控制。
适用于精确地将远端执行器通过套管针的套管设置到需要的外科部位的内窥镜外科器械领域已经得到了显著发展。这些远端执行器以多种方式接合组织，以达到诊断或者治疗效果(例如，内切割器、抓钳、切割器、缝合器、夹具施放器、进入装置、药物/基因治疗输送装置以及采用超声波、RF、激光的能量装置等)。
已知的外科缝合器包括同时在组织中形成纵向切口并将钉线施加到切口的相对侧上的端部执行器。所述端部执行器包括一对协同作用的钳口构件，如果该器械用于内窥镜或者腹腔镜应用，这对钳口能够穿过插管通道。其中一个钳口构件容纳具有至少两排横向间隔设置的钉的钉仓。另一个钳口构件限定了具有与钉仓中的钉排对准的钉形成槽的砧座。所述器械包括多个往复的楔形件，当向远端驱动时，这些楔形件穿过钉仓中的开口并接合支撑钉的驱动器，以使钉向着砧座的击发。
在美国专利US 5,46 5,895中描述了适用于内窥镜应用的外科缝合器的例子，其有利地提供了不同的闭合和击发动作。由此，医生能够将钳口构件闭合在组织上，以便在击发前定位组织。一旦医生已经确定钳口构件正确地夹持组织，则医生可使用单击发冲程击发外科缝合器，从而切割并缝合组织。同时切割和缝合避免了当用仅仅分别进行切割或者缝合的不同外科工具顺序地进行所述动作时可能引起的并发症。
一般而言，在之后进行单击发冲程的单闭合冲程是进行切割和缝合的方便而有效的方式。但是，在一些情况下，可能需要多击发冲程。例如，医生能够选择具有与需要的切割长度相应的钉仓长度的钳口尺寸的范围。更长的钉仓需要更长的击发冲程。因此，为了进行击发，与更短的钉仓相比，这些更长的钉仓需要手挤压式触发器，以施加更大的力，从而切割更多的组织并驱动更多的钉。可能期望力的大小更小，和更短的钉仓需要的力类似，以便不超过一些医生的手部力量。另外，不熟悉更大的钉仓的一些医生在需要不期望的更高的力时可能担心已经发生束缚或者其它故障。
在美国专利US 6,905,057中，用于内窥镜外科缝合和切割器械的多击发冲程手柄通过在每次挤压击发触发器过程中行进击发机构、通过棘爪将这种击发运动机械连接到链接的齿条中来成功地减小了这些击发力。除了减小挤压击发触发器所需的力以外，链接的齿条容纳在手柄的手枪式握把中，与刚性齿条相比有利地缩短了手柄的长度。
因此，非常需要具有多冲程击发机构的外科缝合器械，并且其手柄长度缩短。
发明内容
本发明通过提供有利地在手柄中包括柔性击发构件的外科缝合和切割器械来克服现有技术的上述和其它缺点。手柄沿纵向导引柔性击发构件的远侧部分，以便将击发运动转换到轴击发构件中，该轴击发构件在轴中平移以致动连接在远端的端部执行器。在回缩期间手柄使柔性击发构件的近侧部分相对于纵向轴线偏转，以有利地缩短所需的手柄长度。
更具体地说，本发明涉及如下内容：
(1)一种外科器械，包括：
响应于纵向击发运动来执行外科手术的端部执行器；
在远端与所述端部执行器连接的轴；
由所述轴滑动地容纳的轴击发构件，将击发运动传递到所述端部执行器；以及
在近端与所述轴和击发构件连接的手柄，包括：
具有与轴击发构件的近端连接的远端的柔性击发构件；
通过操作人员往复定位以向远侧平移柔性击发构件的远
侧部分的击发致动器；以及
手柄外壳，包括被定位成导引所述柔性击发构件的远侧部分的桶状部分，并且包括与所述桶状部分连通并定位成在回缩期间导引柔性击发构件的偏转的近侧部分的储存区。
(2)如第(1)项所述的外科器械，其中，所述柔性击发构件包括弹性材料。
(3)如第(2)项所述的外科器械，其中，所述柔性击发构件还包括被对准以用于向下偏转的凹槽部分。
(4)如第(3)项所述的外科器械，其中，所述凹槽部分包括多个横向狭槽，所述横向狭槽垂直经过柔性击发构件的纵向轴线并穿过柔性击发构件的下部。
(5)如第(2)项所述的外科器械，其中，所述柔性击发构件还包括多个沿着顶部纵向对准的凹槽，用于向下偏转。
(6)如第(1)项所述的外科器械，其中，所述柔性击发构件还包括带齿的齿轮齿条部分。
(7)如第(1)项所述的外科器械，其中，所述柔性击发构件还包括纵向对准的多个倾斜凹槽，手柄还包括由击发致动器定位的棘爪机构，以接合所述多个倾斜凹槽中选定的一个，并由此向远侧移动柔性击发构件。
(8)如第(1)项所述的外科器械，其中，所述柔性击发构件包括关节运动的多个连接件。
(9)如第(1)项所述的外科器械，其中，所述柔性击发构件还包括弹簧连接件，所述手柄还包括回缩弹簧，该回缩弹簧在所述储存区中连接到手柄外壳并连接到击发构件上的弹簧连接件，以将柔性击发构件偏压到储存区中。
(10)如第(1)项所述的外科器械，还包括通过操作能够将击发致动器连接到柔性击发构件的传动链机构。
(11)如第(10)项所述的外科器械，其中，所述柔性击发构件包括与所述传动链机构连接的关节运动的多个连接件。
(12)如第(11)项所述的外科器械，其中，所述传动链机构还包括单向离合器，该单向离合器接合在击发致动器和关节运动的多个连接件之间，以用于多个击发冲程。
(13)如第(10)项所述的外科器械，还包括接合在手柄外壳和传动链机构之间的回缩螺旋弹簧，用于为柔性击发构件提供回缩偏压。
(14)如第(1)项所述的外科器械，还包括手动击发释放机构，其通过操作能够使所述柔性击发构件回缩。
(15)如第(1)项所述的外科器械，其中，所述纵向击发构件导向件包括容纳在手柄外壳中用于纵向旋转的圆柱形击发套筒，该圆柱形击发套筒包括内径螺纹纵向中心孔，所述柔性击发构件包括容纳在中心孔中的外径螺纹柔性杆、连接在手柄外壳与柔性杆之间的防旋转导向件和在操作上构造为将击发致动器的往复运动转换成圆柱形击发套筒的旋转以使柔性杆向远侧平移的击发传递装置。
(16)如第(15)项所述的外科器械，还包括在操作上构造为在柔性杆击发期间储存反向旋转力的回缩机构。
(17)如第(1)项所述的外科器械，其中，所述储存区包括手枪式握把。
(18)如第(1)项所述的外科器械，其中，所述手柄还包括纵向对准的击发构件导向件，该导向件与轴击发构件的近侧部分对准，击发致动器由操作人员往复定位，以将柔性击发构件的远侧部分向远侧平移到纵向对准的击发构件导向件中。
(19)一种外科器械，包括：
响应于击发运动的执行部分，其径向尺寸适于内镜手术使用，该执行部分包括：
轴；
由所述轴滑动地容纳的轴击发构件，用于传递击发运动；
与所述轴连接的细长通道；
与所述细长通道可枢转地连接的砧座，其响应于来自轴的闭合运动，并包括砧座通道；
连接到击发构件的击发杆，包括纵向容纳在细长通道和砧座之间的向远侧的切割边缘；以及
容纳在细长通道中的钉装置，其可响应地连接到击发杆，以便抵靠砧座形成钉；以及
在近端连接到所述轴和击发构件的手柄，包括：
纵向击发构件导向件，其与轴击发构件的近侧部分对准；
柔性击发构件，具有连接到所述轴击发构件的近端的远端；
击发致动器，由操作人员往复定位，以将柔性击发构件的远端部分向远端平移入所述纵向击发构件导向件中；以及手柄外壳，包括与纵向击发构件导向件的近端连通的储存区，以便在回缩期间容纳柔性击发构件的偏转近侧部分。
(20)如第(18)项所述的外科器械，其中，所述轴还包括所连接的闭合套筒，用于枢转砧座，所述手柄还包括闭合触发器，并且所述纵向对准的击发构件导向件包括由闭合触发器在远侧定位以平移该闭合套筒的闭合轭形件。
通过附图及其说明，本发明的这些和其它目标和优点将会更加清楚。
附图说明
包含在说明书中并构成说明书的一部分的附图示出了本发明的实施方式，并与上面给出的本发明的总体说明以及下面给出的实施方式的详细描述一道，用于解释本发明的原理。
图1是处于初始状态的外科缝合和切割器械的左侧等轴测图，其中闭合和击发触发器被松开并且端部执行器(钉施放组件)张开。
图2是图1的外科缝合和切割器械的分解的右侧等轴测图，其中省略了钉施放组件。
图3是处于夹钳和部分击发状态的图2的外科缝合和切割器械的手柄的右侧等轴测图，其中手柄外壳的右半壳和旋钮被除去，以露出与本发明的各方面一致的柔性击发齿条的第一种形式。
图4是图2的外科缝合和切割器械的柔性击发齿条和闭合轭形件的右后等轴测图。
图5是图2的柔性击发齿条的前左等轴测图。
图6是图2的柔性击发齿条的右后等轴测图。
图7是图2的柔性击发齿条的后部主视图。
图8是备选柔性击发齿条的左前等轴测图，其具有用于图1的外科缝合和切割器械的顶部窗孔。
图9是另一种备选柔性击发齿条的左前等轴测图，其具有用于图1的外科缝合和切割器械的手动回缩的链轮孔。
图10是备选外科缝合和切割器械的右后等轴测图，其中省略了右侧手柄半壳和旋钮，以露出处于初始状态的环链驱动器和链接齿条。
图11是图10的备选外科缝合和切割器械的右侧剖视图，其中省略了右侧手柄半壳和旋钮。
图12是图10的备选外科缝合和切割器械的分解的右后等轴测图，其中省略了钉施放组件。
图13是图10的备选外科缝合和切割器械的手柄的左侧剖视图，其中省略了右侧手柄半壳、闭合轭形件组件的主体、旋钮、闭合管和闭合触发器，以露出向远端行进的闭合轭形件(例如闭合的端部执行器)和处于初始未击发状态的环链驱动器和链接齿条。
图14是环链驱动器已经使链接齿条运动到击发状态后的图13的备选外科缝合和切割器械的部分手柄的左侧剖视图。
图15是图14的部分手柄的击发触发器、环链驱动器、链接齿条和手动回缩机构的左后等轴测图。
图16是图15的击发触发器、环链驱动器和链接齿条的左后等轴测图。
图17是图16的环链驱动器的分解的右后等轴测图，包括与击发触发器连接的棘齿轮。
图18A是沿着通过用于图1的外科缝合和切割器械的处于初始未击发状态的备选柔性螺纹索击发机构的垂直纵向剖面的左侧剖视图。
图18B是沿着通过处于完全击发状态的图18A的备选柔性螺纹索击发机构的垂直纵向剖面的左侧剖视图。
图18C是沿着通过自动击发回缩后的图18B的备选柔性螺纹索击发机构的垂直纵向剖面的左侧剖视图。
图18D是沿着通过图18A的备选柔性螺纹索击发机构的垂直纵向剖面的前侧剖视图。
具体实施方式
在图1中，外科缝合和切割器械10包括端部执行器的多冲程击发，在解释性方案中该端部执行器为钉施放装置12。上部钳口(砧座)14可围绕其与可置换钉仓17接合的细长(钉)通道16的下部钳口15的枢转连接点重复地张开和闭合。钉施放组件12在近侧与细长轴18连接，形成执行部分19。当钉施放组件12闭合时，执行部分19呈现适于通过从外部连接并受到控制的手柄21经套管针插入的小的横截面积。在图2中，包含在手柄21中的柔性击发齿条22有利地将击发运动传递到执行部分19中，但其可回缩以使手柄21长度缩短。
在图1-3中，手柄21具有安装在其手柄外壳23上的用户控制器，例如围绕轴18的纵向轴线旋转细长轴18和钉施放组件12的旋钮24。在手枪式握把27的前面围绕横向穿过手柄外壳23接合的闭合触发器销28枢转的闭合触发器26被压缩，以闭合钉施放组件12。在闭合触发器26前面枢转的多冲程击发触发器30引起钉施放组件12同时切割并缝合夹钳于其中的组织。由于采用多击发冲程以减小由医生的手施加的每个冲程所需的力的大小，在轴31(图3)上旋转的右侧和左侧指示轮32、33(前者在图3中示出)旋转提供击发进程的指示。例如，整个击发行程需要三个整个击发冲程，因而指示轮32、33每个冲程旋转到每个回转的三分之一。如果需要，手动击发释放杆34允许在整个击发行程之前回缩，并在回缩倾向中存在束缚或者失败时允许辅助回缩。手动击发释放杆34通过螺旋弹簧35(图3)垂直向下偏压。当闭合触发器26被夹钳并且没有发生可防止松开闭合触发器26的部分击发时，闭合释放按钮36向外凸出。
在图3中，细长轴18具有作为其外部结构的纵向往复运动的闭合管38，其围绕砧座14枢转以响应于手柄21的闭合触发器26的近端压缩而影响闭合。细长通道18通过内置到闭合管38中的框架40与手柄21连接。框架40与手柄21可旋转地结合，使旋钮24的扭转引起执行部分19的旋转。旋钮24的每个半壳包括向内的突起41，其进入闭合管38中各自的更长的侧开口42中并向内突出，以与框架40接合，确定执行部分19的旋转位置。更长的开口42的纵向长度足够长，以允许闭合管38的纵向闭合运动。
闭合触发器26的上部44通过闭合连接件48向前推动闭合轭形件组件46。闭合连接件48通过闭合轭形件销50在其远端与闭合轭形件组件46枢转连接，并在其近端与闭合连接件销52枢转连接。闭合触发器26被闭合触发器张力弹簧54促动到张开位置，该闭合触发器张力弹簧54在近端与闭合触发器26的上部44以及由右侧和左侧半壳56、58形成的手柄外壳23连接。右侧和左侧半壳56、58分别包括闭合轭形件导柱59，该闭合轭形件导柱59在闭合轭形件组件46的两侧中形成的相应的水平细长矩形窗孔60中滑动，当闭合轭形件组件46定位在近侧并且砧座14张开时，柱59位于相应的窗孔60中的远侧位置处，当闭合轭形件组件46定位在远侧并且砧座14闭合时，柱59位于窗孔60中的近侧位置处。
闭合触发器26的上部44包括具有后切口64的近侧顶部62。闭合释放按钮36和枢转锁定臂66通过中央侧向枢轴68连接。压缩弹簧70向近侧(从右侧观察为围绕中央侧向枢轴68的顺时针方向)偏压闭合释放按钮36。随着当闭合触发器26被释放时上部44返回，枢转锁定臂66置于被拉近闭合释放按钮36的近侧顶部62上。当闭合触发器26到达其完全压下位置时，应当理解，后切口64位于枢转锁定臂66下方，该枢转锁定臂66在压缩弹簧70的促动下落入到后切口64中并抵靠后切口64锁定。随着击发构件的回缩，闭合释放按钮36的手动压缩使枢转锁定臂66向上旋转，松开闭合触发器26。
一旦闭合触发器26向近端夹钳，击发杆72响应于被拉向手枪式握把27的多冲程击发触发器30从手柄21向远侧运动，并且击发行程的大小在右侧和左侧指示导轮32、33上对医生来说是可视的。击发触发器30围绕侧向穿过并右侧和左侧半壳56、58并与之接合的击发触发器销74枢转。
柔性击发齿条22最初通过被限制在手柄21的手枪式握把27中的张力/压缩组合弹簧76被回缩、促动以保持在该位置，并且其固定末端78与外壳23连接，运动末端80与钢带84的向下挠曲的近侧回缩末端82连接，所述钢带84可模制在柔性击发齿条22中(图6-7)。作为替代，钢带84可位于柔性击发齿条22的前端85下并连接到其上(图3)。作为另一种替代，柔性击发齿条22上向近侧伸出的钩86(图4-5)可用作回缩弹簧(未显示)的连接件。在图5-6中，柔性击发齿条22的前端85包括与击发杆72的近端接合的凹形连接插座87。带齿的齿条部分88(图2-5)沿着柔性击发齿条22的左侧边缘向上。
在图4-6中，除了通过选择材料将一定程度的向下的柔性包含在柔性击发齿条22中以外，穿过底部部分的多个横向狭槽90提供了更紧密的转弯半径，允许向下弯曲到手枪式握把27中，从而使手柄21的纵向长度最小化。然而，当通过向远侧行进到闭合轭形件组件46中拉直以通过执行部分19中的击发杆72传输极大的击发力时，柔性击发齿条22在其上部形成具有足够刚性的齿条结构，并且很容易回缩到手枪式握把27中。应理解的是，张力/压缩组合弹簧76增加了可获得的击发冲程的大小，同时将单个弹簧的最小长度实质上减小了一半以上。
在图3中，远端小正齿轮91与带齿的齿条部分88接合，从而在击发过程中围绕远侧齿轮轴92转动，该远侧齿轮轴92的横向末端在手柄半壳56、58中的插座内转动。近侧双齿轮93具有左侧大正齿轮94，其通过远侧小正齿轮91在轴31上转动。共轴的右侧小棘轮95在与手动击发释放杆34连接的套节96中转动。夹箍弹簧97促动套节96内的棘爪98与棘齿轮95接触，从而使手动击发释放杆34的致动反向驱动双齿轮93、小正齿轮91和柔性击发齿条22，同时解锁凸轮表面99解锁防倒退机构100。
特别参考图2-3，防倒退机构100防止张力/压缩组合弹簧76在击发冲程之间使柔性击发齿条22回缩。连接滑动管101具有近侧开口的圆柱形腔102，其形状适于容纳柔性击发齿条22的前端85，并具有更窄的远侧开口103，其允许击发杆72通过以传输击发运动。一对在近侧设置在连接滑动管101上的横向凹槽104分别与一对闭合轭形件导柱59接合，该对闭合轭形件导柱59已进入闭合轭形件组件46中作为连接滑动管101的基底。击发杆72向近端延伸出框架40的近端并通过防倒退板106的锁定孔105。通孔105的尺寸被设置为当垂直对准时滑动容纳击发杆72，但当倾斜时造成束缚。下部翼片连接件107从框架40的近端下凸缘向近端延伸，延伸经过防倒退板106的下边缘上的窗孔108。该下部翼片连接件107拉动防倒退板106的下部使其靠近框架40，当击发杆72向远侧行进时使防倒退板106垂直，并且当击发杆72试图回缩时允许使顶部后部倾斜成束缚状态。防倒退压缩弹簧110在远端由框架40的近端限制并在远端抵接防倒退板106的顶部部分，从而将防倒退板106偏压成锁定状态。
与防倒退压缩弹簧110的向后偏压相反，防倒退凸轮管112滑动包围连接滑动管101并抵接防倒退板106。与防倒退凸轮管112连接的向近侧突出的防倒退轭形件114在闭合轭形件组件46的顶部上方延伸。
为了使刀在整个击发冲程结束时回缩，柔性击发齿条22的近端116包括柄脚118(图4-5)，当远端116行进到在闭合轭形件组件46中形成的齿条通道120中时该柄脚向上突出。柄脚118被对准以致动防倒退释放杆124上的底部近侧凸轮122。作为替代或者另外的，手动释放击发杆34的致动使套节96上的凸轮表面99向远侧运动，从而使防倒退释放杆124上的底部近侧凸轮122向远侧运动，以进行释放。在右侧和左侧半壳56、58中形成的结构限制防倒退释放杆124的运动。在右侧和左侧半壳56、58之间分别形成的销插座126和圆形销128被容纳穿过纵向细长窗孔130，窗孔130形成于在底部近侧凸轮122远侧的防倒退释放杆124中，从而允许纵向平移以及围绕环形销128的旋转。在右侧半壳56中，向近侧张开的通道132包括与向上并向远侧倾斜的部分连通的近侧水平部分，该倾斜部分容纳防倒退释放杆124的近端附近的右后部销134，从而当防倒退释放杆124到达其平移的最远侧部分时施加向上的旋转。在靠近防倒退释放杆124的右侧半壳56中形成的闭锁结构136一旦被组装就可防止防倒退释放杆124向近侧运动，从而将右后部销134保持在向近侧张开的通道132中。
应理解，闭合轭形件组件46的齿条通道120用作稳定柔性击发齿条22的远侧部分的纵向对准的击发构件导向件。在不包括不同的端部执行器闭合机构的应用中，纵向对准的击发构件导向件可作为固定管道包含在手柄外壳23中。
向远侧并向下促动防倒退释放杆124的远端138，使右前部销140落入在右侧半壳56中形成的向远侧张开的阶式结构142中，通过钩在防倒退释放杆124的右前部销140和纵向细长窗孔130之间的左侧钩146上的压缩弹簧144促动形成该结合。压缩弹簧144的另一端与钩148连接，该钩148形成于左侧半壳58中的更处于近侧并且更低的位置，刚好位于闭合轭形件组件46上方。压缩弹簧144由此向下并向后拉动防倒退释放杆124的远端138，导致当向远侧行进时右前部销140锁定在向远侧张开的阶式结构142中。
一旦松开，防倒退释放杆124保持向前垂直地保持防倒退板106，从而允许柔性击发齿条22回缩。在松开端部执行器12、闭合轭形件组件46随后回缩时，闭合轭形件组件46上的向上突出的复位柄脚150与防倒退释放杆124的底部远侧凸轮152接触，将右前部销140从向远侧张开的阶式结构142处提升出来，从而使防倒退压缩弹簧110可将防倒退凸轮管112和防倒退释放杆124推动到它们的回缩位置。为了实现柔性击发齿条22向远侧的运动，击发触发器30围绕与外壳23连接的击发触发器销74枢转。当击发触发器30被向着手枪式握把27压缩时，击发触发器30的上部160围绕击发触发器销74向远侧运动，拉伸设置在近侧的击发触发器张力弹簧162，该弹簧162在近侧连接在与击发触发器30的上部160的弹簧销163和外壳23之间。
在图2-4中，在每次通过侧棘爪机构170压下击发触发器期间击发触发器30的上部160(图2-3)接合柔性击发齿条22，当击发触发器30被释放时，该侧棘爪机构170也脱离接合。特别是，由沿着柔性击发齿条22间隔设置的多个向近侧并向右的斜面174形成的倾斜右侧轨道172通过侧棘爪滑动组件176顺序结合。具体地说，棘爪滑块178具有右侧和左侧下部导向件180，所述导向件分别在位于齿条通道120下方的闭合轭形件组件46的主体183中形成的左侧轨道182和闭合轭形件导轨186中的右侧轨道184中滑动，该闭合轭形件导轨186与齿条通道120平行且与齿条通道盖188连接，所述齿条通道盖188封闭在棘爪滑动组件176的行程远侧的闭合轭形件组件46的主体183中的齿条通道120的向右张开的部分。压缩弹簧190连接在闭合轭形件导轨186上的顶部近侧位置上的钩192和棘爪滑块178的远端右侧上的钩193之间，该压缩弹簧190使被向近侧拉动的棘爪滑块178保持与击发触发器30的上部160接触。
棘爪块194安放在围绕垂直后部销196枢转的棘爪滑块178上，该垂直后部销196穿过棘爪块194的左侧近端角和棘爪滑块178。弹出块凹槽198形成于棘爪块194的顶面的远端部分上，以容纳通过垂直销202枢转销接在其中的弹出块200，所述垂直销202的底部尖端延伸到棘爪滑块178的顶面上的棘爪弹簧凹槽204中。棘爪弹簧凹槽204中的棘爪弹簧206延伸到垂直前部销202右侧，促动棘爪块194逆时针旋转(从上面观察时)成与倾斜右侧轨道172接合。弹出块凹槽198中的小螺旋弹簧208促动弹出块200顺时针旋转(从上面观察时)，小螺旋弹簧208的近端在齿条通道120上方与在闭合轭形件组件46中形成的成形凸缘210接触。
应理解，棘爪弹簧206比小螺旋弹簧208更强的机械优点指的是棘爪块194易于向着与顺时针旋转的弹出块200接合。当击发触发器30完全被压下并开始被释放时，当棘爪滑块178回缩时弹出块200遇到成形凸缘210中的脊212(图4)，迫使弹出块200顺时针旋转(从上面观察时)，由此使棘爪块194从与柔性击发齿条22的接合中弹出。弹出块凹槽198的形状使弹出块200的顺时针旋转停止成与成形凸缘210垂直，在整个回缩期间保持这种脱离，从而消除了齿合噪声(ratcheting noise)。柔性击发齿条22的材料选择可进一步减轻齿合噪声。
在图8中，具有沿着顶面的右部纵向对准的矩形顶窗孔240的备选柔性击发齿条22a降低了刚性，增加了向下的柔性，以便装载到外科缝合和切割器械10的手枪式握把27中(图1)。
在图9中，另一种备选柔性击发齿条22b包括顶部窗孔240，并且另外包括底部减薄部分250(而不是侧槽90)，以增强向下的柔性。
在图10-17中，除链接齿条22c的替代外，备选外科缝合和切割器械10’与上面描述的图1-4的相同，类似于在前面参考的US 6,905,057中描述的，代替柔性击发齿条22、22a-22b。另外，与前面描述的侧棘爪机构170不同的是，链驱动器170a击发链接齿条22c。
应理解，在本文中通过引用而并入的任何专利、出版物或者其它公开的材料(全部或者部分)仅仅限于所并入的材料不与在本公开文本中阐释的已有定义、陈述或者其它公开的材料相矛盾的程度。这样，必要时，在本文中明确阐明的公开内容取代任何通过引用而并入本文中的矛盾的材料。通过引用而并入本文中但与在本文中阐释的已有定义、陈述或者其它公开材料矛盾的任何材料或其部分将仅仅包含到不引起所并入的材料与已有公开的材料之间的矛盾的程度。
特别参考图12，链接齿条22c包括远侧长连接件300，其在闭合轭形件组件46a的齿条通道120中往复运动，后者的不同在于，主体183与右侧齿条通道盖188a连接，该右侧齿条通道盖188a包括与右侧半壳56的右侧闭合轭形件导柱59接合的凹槽60a。在远侧长连接件300近侧的多个更小的齿条连接件301-305具有圆形的相邻端部，允许当位于齿条通道120中时连接件301-305向下旋转，并且还提供带齿的齿条部分88a的相应部分。每个连接件300-305都通过相应的一对长销312与环状脚踏车形传动链310接合，所述长销312经过传动链310的相应链节316穿过连接枢转孔314。其它链节316通过短连接销312a销接在一起。
下部近侧滚轮318在手柄外壳23的邻近闭合释放按钮36和右侧半壳56的后部中的轴320上旋转。远侧滚轮322在齿条通道盖188a的回缩位置近侧的轴324上旋转。传动链310在每个环形端围绕这些滚轮318、322旋转。轴326在传动链310内径过下部近侧滚轮318上方，从而使围绕轴326旋转的回缩偏压正齿轮328接合并在传动链310中形成大约90度角。螺旋弹簧329具有与回缩偏压正齿轮328连接的内端和与右侧半壳56连接的外端，并且卷绕成使传动链310的顺时针(从右侧观察)击发张紧螺旋弹簧329，从而为链驱动器170a提供回缩偏压。
击发触发器30a具有在每次击发压缩期间通过击发触发器棘轮组件330连接的上部160a。特别是，与击发触发器轴74径向等距的弧形齿轮齿332接合在棘轮轴336上自由转动的触发器正齿轮334。与触发器正齿轮334的右侧连接的盘338也在棘轮轴336上自由旋转并向棘齿轮342提供棘爪340，该棘齿轮342被连接成与棘轮轴336一起旋转。正齿轮344也被连接成与棘轮轴336一起旋转，并被定位在传动链310之下，以接合链驱动器310并限制其运动成急转向形状。棘齿轮342(图11)的形状设置成使击发触发器棘轮组件330将弧形齿轮齿332的顺时针旋转(CW)(从右侧观察)和触发器正齿轮334的逆时针旋转(CCW)转变成棘轮轴336和正齿轮334的CCW旋转，以及传动链310的CCW旋转。用模制聚合物形成盘338和棘爪340对于有限运转寿命的外科缝合和切割器械来说比较经济并能降低齿合噪声。
在使用时，外科缝合和切割器械10’在图10-11中最初是松开和未击发的。一旦被夹钳，击发触发器30a被多次压下，使链接齿条22c通过链驱动器170a从回缩位置(图13)运动到远侧击发位置(图14-15。)。特别是，击发触发器棘轮组件330允许击发触发器30a向远侧行进传动链310的顶部，这使回缩螺旋弹簧329卷绕。在整个击发冲程之后，通过与防倒退释放杆124接触的位于最近侧连接件305上的柄脚118使防倒退机构100松开。击发触发器棘轮组件330允许传动链310沿着回缩方向旋转而不与击发触发器30a连接。作为替代，可致动手动回缩释放杆34，使防倒退释放杆124运动到被释放位置，并反向驱动通过接合齿条部分88a的齿回缩链接齿条22c的齿轮93、91。
在图18A-18D中，用于另外的备选外科缝合和切割器械10”的柔性螺纹索击发机构400有利地具有一个击发行程长度，该长度不必具有更长的手柄。在图18A中，远侧和近侧手柄基础结构402、404围绕圆柱形击发套筒406，该击发套筒406具有中心孔408，该中心孔408包括沿着远端412的内径(ID)螺纹部分410，该远端412包括最初抵接在远侧手柄基础结构402上的直径增大的远侧头部414。圆柱形击发套筒406的中央部分416具有恒定的半径，以便经过远侧和近侧手柄基础结构402、404反复滑动很小的量。圆柱形击发套筒406的近侧套节端部418具有略微增大的半径，其在近侧最初与近侧手柄基础结构404间隔设置并可运动成与其抵接。压缩弹簧420包围圆柱形击发套筒406的中央部分416，接触远侧手柄基础结构402的近侧表面，和向后的锥齿轮422的远侧表面(该锥齿轮422包围圆柱形击发套筒406的中央部分416并与之连接)，为圆柱形击发套筒406提供向近侧的偏压。
柔性杆424穿过中心孔408并包括接合圆柱形击发套筒406的ID螺纹部分410的外径(OD)螺纹426。索连接器428在其近端连接到柔性杆424，在其远端连接击发杆72。防旋转销430从索连接器428横向延伸以沿着被搁置在手柄(未显示)上的销导向件432纵向滑动，同时防止柔性杆424的旋转。用于减小摩擦的索鞘433可覆盖柔性杆424的在能够到达ID螺纹部分410的部分近侧的部分。
左侧锥齿轮434通过单向离合器(例如棘轮)连接到击发触发器(未显示)，以沿着第一方向转动向后的横向锥齿轮422以及圆柱形击发套筒406。给定螺纹410、426旋转的相应方向，柔性杆424从圆柱形击发套筒406向远侧平移，使索连接器428和击发杆72向远侧运动。沿着圆柱形击发套筒406的第一方向的旋转卷绕回缩螺旋弹簧436，该螺旋弹簧围绕近侧套节末端418的远侧部分并具有与之连接的内端，还具有搁置在手柄外壳(未显示)的外端437(图18D)。当击发触发器未与左侧锥齿轮434连接时，在击发冲程之间，通过棘轮机构438阻止回缩螺旋弹簧436沿着相反的第二方向转动圆柱形击发套筒406。特别是，靠近回缩螺旋弹簧436在近侧形成包围近端套节末端418的中央部分的棘齿轮440。最近侧横向表面442具有减小的半径。棘爪444搁置到手柄(未显示)上。如图18A所示，随着圆柱形击发套筒406回缩，棘爪444接合棘齿轮440，防止其沿着第二方向旋转。
在图18B中，当柔性杆424接近整个远侧行程时，与柔性杆424连接的索限位器446充分向远侧行进，以接触圆柱形击发套筒406的近侧表面，从而向远侧平移圆柱形击发套筒406并压缩压缩弹簧420。直径增大的远侧头部414接触围绕搁置在外壳(未显示)上的枢转连接器452枢转的摇杆闩锁450的向远侧倾斜的近侧边缘448。应理解，摇杆闩锁450被向内偏压并由此使倾斜的近侧制动片448旋转，以纵向捕获圆柱形击发套筒406的直径增大的远侧头部414的近侧边缘。圆柱形击发套筒406的远端平移使棘齿轮440运动并从棘爪444下面脱离，从而允许回缩螺旋弹簧436沿着第二方向旋转圆柱形击发套筒406，这又使柔性杆424回缩。在图18C中，索连接器428已经充分回缩，以接触摇杆闩锁450的向近侧倾斜的释放臂454，从而使倾斜的近侧制动片448旋转并与圆柱形击发套筒406的直径增大的远端414脱离接合，并允许压缩弹簧420向近侧促动圆柱形击发套筒406，使机构400复位到图18A中的状态。
可包括右侧锥齿轮456，其为手动击发释放机构458的一部分，该手动击发释放机构458用于释放棘轮机构438(例如，向远侧移动圆柱形击发套筒406，移位棘爪444)并使圆柱形击发套筒旋转以回缩柔性杆424。右侧锥齿轮456可包括枢轴偏压件(未显示)，无论如图18A中被回缩或者如图18B中被延伸，枢轴偏压件通常保持右侧锥齿轮456不与向后的横向锥齿轮422接触，但当手动击发回缩杆(在图18A-18D中未显示)被致动时，其向远侧充分平移右侧锥齿轮456，以进行接合。
虽然已经通过描述一些实施方式对本发明进行了解释，并且已经相当详细地描述了示例性实施方式，但是，申请人并不是想以任何方式将所附的权利要求书的范围限定得如此详细。其它优点和修改对本领域技术人员来说是可以想到的。
例如，虽然多击发冲程的典型附加击发行程显示了包含在手柄中的柔性击发构件的特别优点，应理解，本发明的各个方面可应用到单击发冲程器械。
作为另一个例子，虽然由手枪式握把提供的横腔示出了回缩柔性击发构件的一个位置，与本发明一致的应用不需要包括手枪式握把。例如，柔性击发构件可围绕180度的弯曲部分行进，并且回缩的端部与远端几乎平行。
作为再一个例子，虽然为了清楚起见解释了手动致动的击发触发器，遥控致动的手柄可得益于包含在与由夹具或者机机器人控制器定位和/或保持的手柄等同的近侧部分中的柔性击发构件。

Claims (10)

1、一种外科器械，包括：
响应于纵向击发运动来执行外科手术的端部执行器；
在远端与所述端部执行器连接的轴；
由所述轴滑动地容纳的轴击发构件，将击发运动传递到所述端部执行器；以及
在近端与所述轴和击发构件连接的手柄，包括：
具有与轴击发构件的近端连接的远端的柔性击发构件；
通过操作人员往复定位以向远侧平移柔性击发构件的远侧部分的击发致动器；以及
手柄外壳，包括被定位成导引所述柔性击发构件的远侧部分的桶状部分，并且包括与所述桶状部分连通并定位成在回缩期间导引柔性击发构件的偏转的近侧部分的储存区。
2、根据权利要求1所述的外科器械，其中，所述柔性击发构件包括弹性材料。
3、根据权利要求2所述的外科器械，其中，所述柔性击发构件还包括被对准以用于向下偏转的凹槽部分。
4、根据权利要求3所述的外科器械，其中，所述凹槽部分包括多个横向狭槽，所述横向狭槽垂直经过柔性击发构件的纵向轴线并穿过柔性击发构件的下部。
5、根据权利要求2所述的外科器械，其中，所述柔性击发构件还包括多个沿着顶部纵向对准的凹槽，用于向下偏转。
6、根据权利要求1所述的外科器械，其中，所述柔性击发构件还包括带齿的齿轮齿条部分。
7、根据权利要求1所述的外科器械，其中，所述柔性击发构件还包括纵向对准的多个倾斜凹槽，手柄还包括由击发致动器定位的棘爪机构，以接合所述多个倾斜凹槽中选定的一个，并由此向远侧移动柔性击发构件。
8、根据权利要求1所述的外科器械，其中，所述柔性击发构件包括关节运动的多个连接件。
9、根据权利要求1所述的外科器械，其中，所述柔性击发构件还包括弹簧连接件，所述手柄还包括回缩弹簧，该回缩弹簧在所述储存区中连接到手柄外壳并连接到击发构件上的弹簧连接件，以将柔性击发构件偏压到储存区中。
10、根据权利要求1所述的外科器械，还包括通过操作能够将击发致动器连接到柔性击发构件的传动链机构。
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CN101507643B (zh) * 2008-02-14 2012-10-10 伊西康内外科公司 带有可联锁击发系统的外科缝合器械
CN104622528A (zh) * 2013-11-08 2015-05-20 柯惠Lp公司 具有腕关节式机构的医疗设备接合器
CN110505845A (zh) * 2017-04-07 2019-11-26 列克星敦医疗公司 手术手柄组合件
CN110505845B (zh) * 2017-04-07 2020-11-13 列克星敦医疗公司 手术手柄组合件
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AU2006252103A1 (en) 2007-07-12
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JP5377827B2 (ja) 2013-12-25
US7303108B2 (en) 2007-12-04
EP1800610B1 (en) 2016-07-20
BRPI0605374A (pt) 2007-10-16
MX2007000032A (es) 2008-11-26
BRPI0605374B8 (pt) 2023-02-23
CN1985768B (zh) 2011-09-28
JP2007167666A (ja) 2007-07-05
CA2571935C (en) 2014-07-22
BRPI0605374B1 (pt) 2018-05-15
EP1800610A1 (en) 2007-06-27
AU2006252103B2 (en) 2012-03-08
PL1800610T3 (pl) 2017-01-31

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