CN101040773B - 用于控制关节运动的装置和方法 - Google Patents

用于控制关节运动的装置和方法 Download PDF

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CN101040773B
CN101040773B CN200710089657XA CN200710089657A CN101040773B CN 101040773 B CN101040773 B CN 101040773B CN 200710089657X A CN200710089657X A CN 200710089657XA CN 200710089657 A CN200710089657 A CN 200710089657A CN 101040773 B CN101040773 B CN 101040773B
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M·S·奥尔蒂斯
F·E·谢尔顿四世
J·T·斯皮维
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Ethicon Endo Surgery Inc
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    • A61B34/70—Manipulators specially adapted for use in surgery
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    • 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
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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Abstract

本发明提供了用于控制外科装置工作端的运动的方法和装置。在一种实施方式中，提供了用于运动外科紧固装置的远端上的端部执行器的方法和装置。所述运动可包括端部执行器围绕轴的轴线的旋转运动，端部执行器相对于轴的关节运动和端部执行器的致动，例如闭合、击发和/或切割。在其它实施方式中，提供了单根索致动器，其可在第一位置和第二位置之间运动，在第一位置中其有效地旋转端部执行器而不致动(即闭合和击发)端部执行器，在第二位置中其有效地致动端部执行器而不旋转端部执行器。在其它方面中，提供了用于运动在与内窥镜一起使用的辅助通道的远端上形成的柔性颈的方法和装置。柔性颈的运动可用于控制通过柔性颈延伸的工具的定位。

Description

用于控制关节运动的装置和方法
技术领域
本发明广泛涉及用于控制外科装置工作端的运动的装置和方法。
背景技术
内窥镜外科器械通常优于传统的开放式外科装置，因为使用天然孔口易于缩短术后康复时间并减少并发症。因此，适用于将工具的工作端通过天然孔口精确设置在所需的手术部位的内窥镜外科器械的领域得到极大的发展。这些工具可被用于以多种方式接合和/或治疗组织，以达到诊断或治疗效果。
内窥镜医生需要装置的轴是柔性的，同时还允许工作端能够进行关节运动，以便相对于组织成角度地定向工作端，并且需要装置的轴在一些情况下被致动以便击发或者使工作端运动。由于使用柔性轴以及内窥镜器械的尺寸限制，对于内窥镜装置的工作端的关节运动和致动的控制的集成趋于复杂。一般而言，控制运动都作为纵向平移经过轴传输，这可能与轴的柔性相互干扰。还需要将使工作端进行关节运动和/或致动所需的力降低到所有或者绝大多数医生可操作的水平。降低击发力的一种已知的解决办法是使用电动马达。但是，医生通常优选感受来自工作端的反馈来确保端部执行器的正确操作。在现有马达驱动装置中用户反馈效果不能很好实现。
因此，对于控制内窥镜外科装置工作端的运动而言需要改进的方法和装置。
发明内容
在一种实施方式中，提供了一种外科装置，其具有带近端和远端的细长轴，所述近端具有与其可动地连接的手柄，所述远端具有从其上伸出的柔性颈。手柄和柔性颈可操作地连接，使手柄的运动有效地引起柔性颈在多个平面中进行关节运动。在一些示例性实施方式中，手柄的运动可被柔性颈模仿。装置还可包括在手柄和柔性颈之间延伸并被构造成将运动从手柄传递到柔性颈的致动器。
装置的手柄可具有多种构造，但在一种实施方式中，手柄可适于相对于细长轴的近端进行关节运动。例如，手柄可通过接头，例如球窝接头、铰接接头或者挠曲接头与细长轴的近端连接。装置的致动器还可具有多种构造，在一种实施方式中致动器可以是至少一根沿着细长轴的长度延伸的索。例如，装置可包括多个沿着轴的长度延伸并且彼此围绕致动器的圆周等距离间隔设置的索。索被构造成相对于细长轴滑动并将张力施加到细长轴，引起至少一部分细长轴挠曲和弯曲。手柄和/或索还可任选地包括与其相关联并被构造成将手柄和/或索保持在固定位置中的锁定机构。在示例性实施方式中，当其经过弯曲的腔插入时，细长轴被构造成被动挠曲并弯曲。
细长轴还可具有多种构造，但在一种实施方式中装置可以是外科缝合器的形式，并且细长轴可包括与柔性颈的远端连接并适于接合组织并将至少一个紧固件输送到被接合的组织中的端部执行器。手柄和端部执行器可被连接成使手柄的运动被端部执行器模仿。例如，手柄可通过接头，例如球窝接头、铰接接头或者挠曲接头与细长轴的近端连接，并且柔性颈可在端部执行器上形成或者与其连接，允许端部执行器按比例模仿手柄的运动。装置还可包括在手柄和端部执行器之间延伸并被构造成从手柄向柔性颈传递运动的致动器。例如，致动器可以是多个沿着细长轴的长度延伸的索。索可以彼此围绕致动器的圆周等距离间隔设置。
在另一种实施方式中，装置可以是辅助通道的形式并且细长轴可以是具有适于将工具容纳在其中的内腔的管的形式。从细长轴的远端延伸的柔性颈可被构造成挠曲以定向通过细长管延伸的工具。柔性颈可具有多种构造，但在一种实施方式中，它可以包括多个在其中形成的狭缝，以促进其挠曲。狭缝可被构造成使柔性颈挠曲到所需定向。例如，柔性颈可包括狭缝的远侧区域和狭缝的近侧区域，狭缝可被构造成使施加到柔性颈的张力将引起柔性颈在近侧和远侧区域弯曲。手柄可与细长管的近端连接，并且它可操作地与柔性颈关联，使手柄的运动被柔性颈模仿。手柄还可具有多种构造，在一种实施方式中手柄可包括固定构件和适于相对于固定构件进行关节运动的可动构件。可动构件可通过接头与固定构件连接，例如球窝接头、铰接接头或者挠曲接头。使用时，辅助通道可被构造成可松开放连接到内窥镜。例如，配合元件可在外表面的长度上形成或者沿着其延伸，用于与在适于容纳内窥镜的套筒上形成的辅助配合元件配合。装置还可包括在手柄和柔性颈之间延伸的致动器。致动器可被构造成从手柄向柔性颈传递运动。在一些示例性实施方式中，致动器是至少一根延着细长管的长度延伸的索的形式。在致动器包括多根索时，索优选彼此围绕细长管的圆周等距离间隔设置。使用各种技术使索可沿着细长管延伸。例如，细长管可包括至少一个在其侧壁中形成并沿着其长度延伸的腔，并且索可滑动设置在腔中。装置还可包括定位成与手柄和索中的至少一个接合的锁定机构，以将手柄和索锁定在固定位置中。
本发明还提供了一种内窥镜系统，其具有构造为围绕内窥镜设置的细长套筒和可与细长套筒运动配合的辅助通道。辅助通道可具有、用于容纳工具的在其近端和远端之间、穿过其间延伸的内腔；在其远侧部分上形成并由多个在其中形成的狭缝产生柔性的柔性部分；和至少一个与其近端连接并可操作地与柔性部分连接的手柄，使手柄被构造成引起柔性部分在至少一个平面中进行关节运动。手柄通过至少一根索可操作地与柔性部分连接，并且手柄可被构造成使索相对于辅助通道轴向运动，引起索将张力施加到辅助通道的柔性部分，使柔性部分在至少一个平面中进行关节运动。在一种实施方式中，装置可包括被构造成引起柔性部分在多个平面中进行关节运动的单个手柄。单个手柄可包括与辅助通道的近端连接的固定构件和被构造成相对于固定构件进行关节运动的可动构件。单个手柄和柔性部分可操作地连接，使单个手柄的运送被柔性部分模仿。在另一种实施方式中，手柄可包括构造成引起柔性部分在第一平面中进行关节运动的第一构件和构造成起柔性部分在第二平面中进行关节运动的第二构件。特别是，手柄可包括与辅助通道连接的固定构件，并且第一和第二构件可旋转地连接到固定构件。装置还包括与第一构件连接并具有至少一个从其上延伸并与柔性部分连接的索的第一卷筒，和与第二构件连接并具有至少一个从其上延伸并与柔性部分连接的索的第二卷筒。第一和第二构件可有效地旋转第一和第二卷筒，从而使索轴向运动，引起柔性部分进行关节运动。
本文中所公开的外科装置还可包括多个其它零件。例如，装置可包括设置在细长轴远端上的光学图像采集单元。光学图像采集单元可适于在内窥镜手术期间采集图像。图像显示屏可设置在装置的近端部分上并适于与光学图像采集单元通信以显示采集的图像。在其它实施方式中，装置的端部执行器可包括可拆卸设置在其中并包含多个用于缝合组织的钉的匣和用于切割被缝合的组织的刀。
在其它方面，提供了一种手术方法，包括将细长轴插入体腔中以将与细长轴远端连接的柔性颈定位在待处理的组织附近，并使与细长轴近端枢转连接的手柄运动，以引起柔性颈模仿手柄的运动。柔性颈可镜像反映手柄的运动，或者柔性颈的运动可直接对应于手柄的运动。在一些示例性实施方式中，运动是成比例的。
在一种示例性实施方式中，与细长轴的远端连接的端部执行器被定位在被紧固的组织附近，与细长轴的近端枢轴连接的手柄运动引起端部执行器成比例地模仿手柄的运动。端部执行器可反射手柄的运动，或者端部执行器的运动可直接对应于手柄的运动。在示例性实施方式中，手柄围绕细长轴的近端可枢转地进行关节运动，引起端部执行器模仿手柄的运动。所述方法还包括将组织接合在端部执行的相对钳口之间，并从端部执行器中将至少一个紧固件驱动到组织中。组织可通过在手柄上形成的平移构件从第一位置运动到第二位置以关闭相对的钳口被接合，并且紧固件可通过旋转在手柄上形成的可旋转构件被击发，以致动设置在端部执行器中的驱动器机构，引起驱动器机构将多个紧固件驱动到组织中。在另一种实施方式中，在使平移构件从第一位置运动到第二位置之前，可旋转构件可被旋转，使端部执行器相对于柔性颈旋转，而不致动驱动器机构。
在再一个方面，细长轴可以是辅助通道的形式，所述辅助通道可滑动配合到在体腔中设置的内窥镜，以便将辅助通道的远端定位在内窥镜的远端附近。工具经过辅助通道中的腔被插入，使工具向远端延伸超过辅助通道的远端，与辅助通道的近端连接的手柄可被运动，引起辅助通道远端上的柔性颈进行关节运动，从而引起工具的工作端沿着所需的位置被定向。手柄可通过手柄相对于辅助通道枢转的关节运动来运动，或者作为替代，可通过旋转手柄上的至少一个可旋转构件来运动。
更具体地说，本发明涉及如下内容：
(1)一种外科装置，包括：
具有近端和远端的细长轴，手柄可动地连接到所述近端，柔性颈从所述远端开始延伸，其中，所述手柄和所述端部执行器联接在一起，从而使所述端部执行器模仿所述手柄的运动。
(2)如第(1)项所述的装置，其中，所述模仿运动是成比例的。
(3)如第(1)项所述的装置，其中，所述手柄能够相对于所述细长轴的所述近端进行关节运动。
(4)如第(3)项所述的装置，其中，所述手柄通过接头联接到所述细长轴的近端，所述接头选自由球窝接头、铰接接头以及柔性接头组成的组中。
(5)如第(1)项所述的装置，其中，所述手柄和所述柔性颈通过在所述手柄和所述柔性颈之间延伸的致动器可操作地相关联，所述致动器能够将运动从所述手柄传递到所述柔性颈。
(6)如第(5)项所述的装置，其中，所述致动器包括至少一根索，所述索沿着所述细长轴的长度延伸并能有效地将力施加到所述柔性颈，从而使所述柔性颈在至少一个运动平面中运动。
(7)如第(6)项所述的装置，其中，所述至少一根索由电活化聚合物材料制成，其中所述手柄的运动能够有效地将能量选择性地输送到所述至少一根索，引起所述至少一根索轴向收缩并径向扩张，从而引起所述柔性颈中的至少一个模仿所述手柄的运动。
(8)如第(6)项所述的装置，其中，所述至少一根索包括沿着所述细长轴的长度延伸的多根索，每根索能有效地将力施加到所述柔性颈，使所述柔性颈在不同的运动平面中运动。
(9)如第(8)项所述的装置，其中，所述多根索围绕所述致动器的圆周彼此等间隔地设置。
(10)如第(8)项所述的装置，其中，所述多根索包括至少三根沿着所述细长轴的长度延伸的索。
(11)如第(8)项所述的装置，其中，所述手柄和所述多根索中的至少一个包括与其相连并被构造成将所述手柄和所述多根索中的至少一个保持在固定位置中的锁定机构。
(12)如第(1)项所述的装置，其中，所述柔性颈包括与其远端连接并适于将至少一个紧固件输送到组织的端部执行器。
(13)如第(1)项所述的装置，其中，所述细长轴包括沿着其长度穿过其中延伸的中央腔，该中央腔适于将工具容纳在其中。
(14)如第(13)项所述的装置，其中，所述细长轴包括在其外表面上形成并沿着其外表面长度延伸的配合元件，用于与在适于容纳内窥镜的套筒上形成的互补配合元件配合。
(15)一种用于再生第(12)项所述装置的方法，包括：
除去并替换可拆卸地设置在端部执行器中的钉仓，制备所述装置以重新使用，所述钉仓容纳有设置在其中的多个紧固件。
(16)一种外科装置，包括：
具有近端和远端的细长轴，并具有限定装置的工作端的柔性颈，所述柔性颈通过在其中形成多个狭缝而具有柔性；
可动地连接到所述细长轴的近端并与所述柔性颈可操作地连接的手柄，所述手柄的运动有效地使所述柔性颈在多个平面中进行关节运动。
(17)如第(16)项所述的装置，其中，所述手柄可操作地通过围绕所述细长轴的圆周间隔设置并在所述手柄和所述柔性颈的远端之间延伸的多根索与所述柔性颈连接，所述多根索能够响应于所述手柄的运动和所述柔性颈的张力相对于所述细长轴的轴线滑动，使所述柔性颈进行关节运动。
(18)如第(17)项所述的装置，还包括定位为与所述手柄和所述多根索中的至少一个接合的锁定机构，以将所述手柄和所述多根索锁定在固定位置，并且由此将所述柔性颈保持在固定位置中。
(19)一种外科装置，包括：
具有近端和远端的柔性细长轴；
围绕所述细长轴的圆周间隔设置并在所述细长轴的近端和远端之间延伸的多根索，所述多根索能够相对于所述细长轴的轴线滑动并将张力施加到所述细长轴，引起至少一部分所述细长轴挠曲和弯曲；和
锁定机构，该锁定机构与所述细长轴连接并被定位成与所述多根索接合，以将所述多根索锁定在固定位置，并由此将所述细长轴保持在固定位置中。
(20)如第(19)项所述的装置，其中，所述细长轴能够在它插入并穿过弯曲的腔时被动地挠曲并弯曲。
(21)一种外科方法，包括：
将细长轴插入到体腔中，以将与所述细长轴的远端连接的柔性颈定位在待处理组织附近；
使与所述细长轴的近端枢转连接的手柄运动，引起所述柔性颈模仿所述手柄的运动。
(22)如第(21)项所述的方法，其中，所述模仿运动是成比例的。
(23)如第(21)项所述的方法，其中，所述柔性颈镜像反映手柄的运动。
(24)如第(21)项所述的方法，其中，所述柔性颈的运动直接对应于所述手柄的运动。
(25)如第(21)项所述的方法，其中，所述手柄围绕所述细长轴的近端枢转地进行关节运动，引起所述柔性颈模仿所述手柄的运动。
(26)如第(21)项所述的方法，还包括将组织接合在与所述柔性颈的远端连接的端部执行器的相对钳口之间，并将至少一个紧固件输送到所述组织。
(27)如第(21)项所述的方法，其中，插入所述细长轴包括将所述细长轴与围绕内窥镜设置的套筒配合，并沿着所述套筒滑动所述细长轴，以便将所述柔性颈定位在所述内窥镜的远端附近。
(28)如第(27)项所述的方法，还包括将工具插入穿过在所述细长轴中形成的中央腔，以便将所述工具的工作端定位在所述柔性颈的远端附近，当所述柔性颈成比例模仿手柄的运动时，使与所述细长轴的近端枢转连接的手柄运动引起工具的工作端运动。
附图说明
通过下列结合附图的详细描述，本发明将更全面地被理解，其中：
图1A是外科缝合和切割装置的一种实施方式的透视图，显示出装置的工作端处于初始位置；
图1B是图1A的外科缝合和切割装置的透视图，显示出装置的工作端处于进行关节运动的位置；
图2是图1A和1B中显示的装置的柔性颈的透视图；
图3A是图1A和1B中显示的装置的远侧部分的透视图，显示与其连接的图2的柔性颈和端部执行器；
图3B是沿着图3A中所示端部执行器的线3B-3B截面的剖视图；
图4A是图1A和1B中显示的装置的近端部分的透视图，显示可动地连接到装置的轴的近端的手柄；
图4B是图4A中显示的装置的近端部分的分解图；
图5是设置在图1A和1B中显示的装置的柔性颈和细长轴之间的连接元件的透视图，显示光学图像采集装置；
图6是图1A和1B中显示的装置的手柄的透视图，显示图像显示屏；
图7是用于内窥镜的辅助通道的透视图；
图8A是图7中显示的装置的柔性颈的透视图；
图8B是图8A中显示的柔性颈的透视图，显示颈沿着第一方向进行关节运动；
图8C是图8A中显示的柔性颈的透视图，显示颈沿着第二方向进行关节运动；
图9A是与所述辅助通道一起通用的柔性颈的另一种实施方式的透视图；
图9B是图9A中显示的柔性颈的透视图，显示颈沿着第一方向进行关节运动；
图9C是图9A中显示的柔性颈的透视图，显示颈沿着第二方向进行关节运动；
图10是用于图7的装置的多根索致动器的透视图；
图11是图7的辅助通道的轴的剖视图；
图12是用于图7的辅助通道的端盖的一种实施方式的透视图；
图13A是图7中显示的细长轴的手柄和近端部分的分解图；
图13B是处于组装结构中的图13A中所示细长轴的手柄和近端部分的剖视图；
图14A是辅助通道的另一种实施方式的透视图；
图14B是图14A中显示的辅助通道的剖视图；
图15A是图14A和14B中显示的装置的手柄组件的侧视图；
图15B是图15A中的手柄组件的分解图；
图16A是锁定机构的一种实施方式的透视图；和
图16B是与图1A和1B的外科缝合和切割装置连接的图16A的锁定机构的透视图。
具体实施方式
现在将描述一些示例性实施方式，为本文中所公开的装置和方法的结构、功能、制造和使用的原理提供全面的理解。这些实施方式的一个或多个例子在附图中示出。本领域普通技术人员将会理解，在本文中特别描述并在附图中示出的装置和方法是非限定性的示例性实施方式，本发明的范围仅仅由权利要求书来限定。结合一种示例性实施方式示出和描述的特征可与另外的实施方式的特征组合。旨在将一些修改和变化都包含在本发明的范围内。
本发明提供了用于控制内窥镜外科装置的方法和装置。一般而言，内窥镜外科装置具有细长轴，所述细长轴具有带柔性颈的远端工作端和具有用于控制远端工作端上的柔性颈的运动的手柄的近端。在一些示例性实施方式中，这可使用例如一个或多根在手柄和柔性颈之间延伸的索实现，使手柄的运动将力施加到一个或多根索上，引起柔性部分挠曲，从而使装置的工作端运动。还提供了各种其它零件，以利于装置的使用。本领域技术人员将会理解，被控制的特定装置以及工作端的特定构造可变化，并且在本文中描述的各种控制技术事实上在需要工作端的任何外科装置中都可使用。
图1A和1B示出了用于控制端部执行器关节运动的技术的一种示例性实施方式，特别是用于引起端部执行器模仿并与手柄同时运动的技术。在该实施方式中，装置是用于将多个线性钉排施加到组织并用于切割被缝合的组织的线性缝合和切割装置10的形式。如图所示，装置10通常包括具有近端12a和远端工作端12b的细长轴12，手柄14与近端12a连接，工作端12b具有与其连接或者在其上形成的端部执行器16(将在下面详细讨论)。在使用时，端部执行器16被构造成模仿手柄14的运动。在手柄14和端部执行器16之间的模仿运动一般可通过使用致动器(未显示)来实现，所述致动器在手柄14和端部执行器16之间延伸，并有效地将力从手柄14传输到端部执行器16。在示例性实施方式中，致动器是可围绕细长轴12的圆周间隔并沿着细长轴12的长度设置的多根索。手柄14围绕轴12的近端12a的运动将力施加到一个或多根索，引起索将力施加到端部执行器16，从而引起端部执行器16模仿手柄14的运动。模仿运动可包括相应的运动，从而使端部执行器16沿着与手柄14相同的方向和朝向(orientation)运动，或者镜像运动，从而使端部执行器16沿着与手柄14相反的方向和朝向运动。模仿运动还可与手柄的运动成比例。
装置10的细长轴12可具有多种构造。例如，其可以是实心或中空的，并且可以由单个元件或者多个节段形成。如图2中所示，细长轴12是中空的，并且由多个相连的节段形成，以允许细长轴12挠曲。轴12的柔性以及相对较小的直径允许轴12可在内窥镜手术中使用，从而使装置经过天然孔口经腔引入。轴的长度还可发生变化，这取决于其期望的应用。
图2还示出了围绕细长轴12的圆周间隔设置并沿着细长轴12的长度延伸的多根索34a、34b、34c、34d形式的致动器22的一种示例性实施方式。索的数目和位置是可以变化的。例如，这些索可以彼此间隔大约120°围绕轴12的圆周设置。每根索34a-d延伸穿过在细长轴12上、其中或周围形成的通道，例如腔。图2示出了延伸穿过在轴12的每个节段的外表面上形成的切除部分的每根索34a-d。因此，每个节段包括四个围绕轴12的圆周的等距离切除部分，将索34a-d彼此等距离保持。切除部分优选具有有效地将索34a-d限制在其中同时允许索34a-d相对于轴12自由滑动的尺寸。
索34a-d的远端可与端部执行器16配合以控制端部执行器16的运动。虽然端部执行器16可具有多种构造，并且本领域已知的各种短端部执行器均可使用，但图3A示出了一种端部执行器的示例性实施方式，其通常包括适于将组织容纳在其间的一对相对设置的第一和第二钳口18、20。第一钳口18适于包含具有设置在其中并被构造成被驱动到组织中的多个钉的钉仓，第二钳口20形成用于使钉变形的砧座。端部执行器16的特定构造和基本操作可以变化，并且本领域已知的各种端部执行器16均可使用。作为非限定性的例子，名称为“Surgical Stapling Instrument Incorporating an E-Beam FiringMechanism”的美国专利No.6978921公开了可用于本发明的端部执行器的一种实施方式，其全部内容均包含于本申请中。
为了允许端部执行器16相对于细长轴12运动，端部执行器16可与细长轴12的远端12b可动接合。例如，端部执行器16可通过枢转或者旋转接头枢转连接到细长轴12的远端12b。作为替代，端部执行器16可包括在其上形成的柔性颈26，如图所示，以允许端部执行器16相对于细长轴12的运动。柔性颈26可与细长轴12的远端12b和/或钳口18、20的近端体形成，或者其可以是在轴12和钳口18、20之间延伸的独立元件。如图13A所示，柔性颈26包括用于将柔性颈26配合到相对的钳口18、20的近端的第一联接件28，和用于将柔性颈26配合到细长轴12远端的第二联接件30。联接件28、30可拆卸的固定配合到柔性颈26和/或钳口18、20以及轴12。联接件28、30还起到容纳端部执行器16的一些元件的作用。例如，第一联接件28可起到将索锚定在其中的作用(将在下面讨论)，它还可以起到容纳用于致动(例如关闭和击发)钳口18、20的齿轮和驱动组件的作用。
为了方便柔性颈26的挠曲，颈26可包括一个或多个在其中形成的狭缝32。狭缝32的数量、位置和尺寸可以变化，以得到需要的柔性。在图3A中显示的实施方式中，柔性颈26包括多排狭缝32，每排围绕柔性颈26径向延伸，并且每排可沿着柔性颈26的长度轴向间隔设置。每排狭缝包括两个围绕颈26的圆周延伸的狭缝，每排狭缝32彼此轴向交错。结果，柔性颈26包括交替的狭缝32。本领域技术人员将理解，狭缝32的具体图式可改变，图3A仅仅示出了用于形成允许柔性颈26挠曲的狭缝32的一种图式。其它示例性狭缝构造将在下面详细讨论。
如上所述，索34a-d可与端部执行器16连接，以允许端部执行器16与手柄14协同运动。索34a-d与端部执行器16的连接位置可基于所需的运动而变化。在所示的实施方式中，索34a-d的远端与柔性颈26的近端连接，特别是它们延伸到第一联接件28中并与其连接。图3B示出了第一联接件28的剖视图，显示分别用于容纳四根索34a、34b、34c、34d的四个膛孔28a、28b、28c、28d。事实上，本领域任何已知技术都可用于将索34a-d连接到联接件28，包括例如机械配合技术(诸如粘合、干涉配合、球窝连接、螺纹等)。使用时，当手柄14将轴向力施加到索34a-d时，索34a-d在柔性颈26的远端的连接将允许索34a-d将张力施加到柔性颈26。该张力将引起颈26沿着由施加到每根索34a-d的张力量指示的方向挠曲(将在下面详细讨论)。
装置10的手柄14可用于控制端部执行器16的运动，特别时使端部执行器16进行关节运动，从而相对于细长轴12的纵向轴线A成角度定向。虽然手柄14可具有多种构造，在一种示例性实施方式中手柄14可动地连接到细长轴12的近端12a，使手柄14的运动可被端部执行器16模仿。虽然各种技术都可用于将手柄14可动地连接到轴12，在图4A-4C所示的实施方式中，在手柄14和细长轴12的近端12a之间形成球窝连接。如图4B中最清楚显示的，细长轴12的近端12a包括在其中形成的窝24，手柄14包括在其远端上形成并构造成可转动安放在窝24中的半球13a。窝24可与细长轴的近端12a一体形成，或者其可通过将中空外壳12c(如图所示)连接到细长轴12的近端12a。半球13a还可与手柄14一体形成，或者其可以是与手柄14连接的独立元件。为了将手柄14可动地配合到轴12，手柄14上的半球13a可使用与手柄14连接(将在下面讨论)的索34a-d限制在窝24中。但是，其它配合技术也可用于将手柄14可动地配合到轴12。例如，球13a可以是球形并且其可捕获在形成于细长轴12的近端12a中的球形窝中，或者配合元件(诸如销)可通过球13a延伸以将球13a限制在窝24中。虽然图4B示出了在手柄14上形成的球13a和在轴12中形成的窝24，球窝连接可颠倒，使球位于轴12上并使窝位于手柄14中。此外，本领域技术人员将会理解，各种其它技术可用于手柄14与细长轴12的近端12a的可动配合。
使用时，手柄14可进行关节运动或者相对于轴12枢转运动，引起端部执行器16模仿手柄14的运动。这可通过将索34a-d的近端与手柄14连接来实现。索34a-d与手柄14的连接位置可基于所需的运动而变化。在所示的实施方式中，索(在图4A中仅仅显示了三根索34a，34b和34c)从细长轴12延伸穿过中空外壳12c，并从在中空外壳12c中形成的槽或者开口中穿出。然后索34a-d围绕手柄14上的球13a延伸并与围绕球13a的手柄14上的远端面连接。实际上任何本领域已知的技术都可用于将索34a-d与手柄14连接，包括例如机械配合技术，诸如粘结，过盈配合，螺纹等。如图4A所示，手柄14包括在其中形成的开口，索34a-d的近端(未示出)可具有在其上形成并被捕获在开口中的球或者其它元件。图4A还显示，索(在图4A中仅仅显示了三根索34a，34b和34c)可保持围绕手柄14的周向间隔。这可允许手柄14的运动被端部执行器16镜像(将在下面详细讨论)。作为替代，索34a-d可在它们与手柄14连接之前交叉，以引起端部执行器16沿着与手柄14相同的方向运动。例如，相对设置的索34a和34c可彼此交叉并与手柄14的相对侧连接，并且相对设置的索34b和34d可同样彼此交叉并可与手柄14的相对侧连接。索34a-d可在任何位置交叉，诸如在轴12的近端12a上的中空外壳12c中。
图4A和4B还显示，手柄14还可包括其它零件，以利于装置的使用。例如，手柄14可包括有效地关闭端部执行器16上的钳口18、20的平移构件38，和有效的选择性旋转并致动端部执行器16的可旋转构件40。平移和可旋转构件38、40在由Mark Ortiz等人提交的题为“Surgical Fastener And Cutter With Single Cable Actuator”的专利申请中详细描述，申请日与本申请相同，其内容通过引用而全文包含于本申请中。在另外的实施方式中，手柄14可包括触发器、旋钮等，用于旋转和/或致动端部执行器16。
仍参照图1B，在使用时，手柄14可相对于细长轴12的近端12a枢转或者成角度定向，以使端部执行器16进行模仿运动。特别是，手柄14围绕细长轴12沿着第一方向枢转，将力施加到一个或多根索34a-d上以轴向拉动索。结果，致动的索将张力施加到柔性颈26，引起颈26挠曲。为了防止细长轴12相应于由手柄14施加到索34a-d的张力挠曲，柔性颈26可具有比细长轴12更大的柔性。这可例如通过使用如前所述的交替狭缝32实现，或者在其它实施方式中材料可不同，或者细长轴可包括稳定元件，诸如穿过其中延伸的杆，使细长轴比柔性颈更具刚性。
手柄14的运动方向可被端部执行器16沿着相同方向(即相应运动)或相反方向(即镜像运动)模仿，从而允许用户精确控制端部执行器16的位置。在示例性实施方式中，端部执行器16运动的特定量可与手柄14的运动量成比例。也就是说，端部执行器16的运动量可直接与手柄14的运动量相等，或者其可相对于手柄14的运动量成比例增加或减少。在一些实施方式中，使端部执行器16的运动量相对于手柄14的运动量增加是理想的。结果，仅仅需要手柄14的小运动来允许端部执行器16大运动量。虽然各种技术可用于实现端部执行器16运动的成比例倍增或增加，力倍增机构的一种示例性实施方式是与索连接的偏心凸轮，当张力被手柄14施加到索34a-d时所述偏心凸轮可增加索34a-d的机械优点，或是力或者是位移。
本领域技术人员将会理解，虽然手柄和装置的工作端之间的运动在理论上可成比例，但在实践中，由于力经过细长轴被传递时可能发生力的一些损失。因此，在本文中使用的成比例运动试图包括其中手柄和工作端被构造成按比例量运动、但在装置的实际运转过程中可发生一些力的丢失的应用。
本文中公开的各种装置还可包括各种其它零件，以方便其使用。例如，图1A的装置10可包括设置在细长轴12上并被构造成在内窥镜手术期间采集图像的光学图像采集单元。虽然该单元的位置可以变化，在一种实施方式中光学图像采集单元可设置在第二联接件30上。特别是，图5示出了斜面形外壳42，从联接件30的外表面突出，其中容纳有光学图像采集单元。在外壳42的远侧面上形成有视窗44，以允许所述单元采集端部执行边16及周围与手术部位的图像来自光学图像采集单元的图像可被传输到外置图像显示屏，或者作为替代，装置10可包括设置在装置的近端部分上或者与其连接的图像显示屏。图6示出了从手柄14向外突出的图像显示屏46的一种实施方式。
如前所述，本文中公开的用于控制内窥镜外科装置的工作端的各种技术可与各种医学装置结合使用。图7示出了具有用于控制其工作端的运动的医学装置的另一种实施方式。在该实施方式中，医学装置是用于内窥镜的辅助通道100的形式。辅助通道100是可与内窥镜配合并沿着其滑动的外置装置，允许其它工具诸如抓钳，切割器等穿过其中引入并定位在内窥镜的观察端附近。虽然辅助通道100实际上可具有各种构造、形状和尺寸在图7所示的实施方式中，辅助通道100包括细长管或轴102，其具有在其近端和远端102a、102b之间延伸、用于将工具容纳在其间的内腔。辅助通道100还可包括在其上形成的配合元件，用于将辅助通道100直接配合在内窥镜、或者设置在内窥镜周围的套筒、或者其它装置上。虽然实际上任何配合技术均可使用，但在所示的实施方式中，辅助通道100上的配合元件是沿着细长轴102的长度延伸的导轨104的形式。导轨104被构造成容纳在内窥镜或者围绕内窥镜设置的装置(例如套筒)上形成的互补轨道中。本领域技术人员将会理解，各种其它技术都可用于将辅助通道直接或间接配合配合在内窥镜上。
为了控制辅助通道100的工作端的运动，装置100可包括类似于前面描述的那些零件。特别是，装置100可以包括在细长轴102的远端102a上形成或者与其连接的柔性颈108、在细长轴102的近端102a上形成或者与其连接的手柄106，以及在手柄106和柔性颈108之间延伸的致动器。在该实施方式中，致动器被构造成从手柄106将力传输到柔性颈108，使手柄106的运动被柔性颈108模仿，从而允许穿过辅助通道100延伸的工具被定位在所需的角度朝向。
柔性颈108可具有各种构造，并且其可以使与细长轴12连接的独立元件，或者其可以与细长轴102整体形成，如图7所示。颈108可使用各种技术产生柔性。例如，颈108可由一个或多个可彼此相对运动的节段形成，和/或其可由柔性材料形成。在图8A所示的示例性实施方式中，颈108包括在其中形成并被构造成提供颈108的最大柔性的多个狭缝112。虽然狭缝112的尺寸、数量和朝向可变化以获得需要的结果，在所示的实施方式中柔性颈108包括四列狭缝(仅仅显示了三列狭缝，由箭头112a、112b、112c指示)。每列沿着柔性颈108的长度轴向延伸，并且每列包括围绕颈108的圆周轴向间隔设置的四排狭缝。每列狭缝112还轴向彼此交错，以允许狭缝112叠置。使用时，当张力被施加到致动器时，狭缝112将允许颈108弯曲或者采取弯曲构造，使颈108相对于细长轴102的剩余部分进行关节运动，如图8A和8C所示。
在另外的实施方式中，狭缝可被定位成允许颈挠曲到预定位置中。作为非限定性的例子，图9A示出了在其中形成有狭缝112’的两个区域的柔性颈108’的另一种实施方式。特别是，柔性颈108’包括狭缝的远侧区域112a’和狭缝的近端区域112b’。每个区域112a’、112b’可包括定位在任何位置的任何数目的狭缝，以沿着一个或多个所需方向提供所需的柔性程度。如图9A所示，狭缝的远侧和近侧区域112a’、112b’分别包括两排在柔性颈108’的相对侧上形成并沿着其长度延伸的狭缝。使用时，当张力被施加到柔性颈108’时(将在下面详细讨论)，颈108’将在远侧和远近侧区域112a’，112b’两个区域都挠曲，从而相对于细长轴102’的剩余部分进行关节运动。如图9B所示，挠曲可首先在颈108’的远侧区域112a’中发生。进一步施加到108’的张力然后可引起近端区域112b’中发生挠曲，如图9C所示。在另外的实施方式中，狭缝定位和/或狭缝的尺寸可被构造成在挠曲在远侧区域112a’中发生之前，引起挠曲在近端区域112b’中发生，或者作为替代，狭缝可被构造成引起近侧和远侧区域112b’、112a’中同时发生。本领域技术人员将会理解，狭缝的数量、位置、尺寸和形状可调节，以得到所需的结果。用于形成狭缝的切口的具体构造也是可变的。例如，狭缝的宽度和长度可从细长轴的外表面到细长轴的那表面保持一致，或者作为替代，宽度和长度可增加或者减小，使狭缝逐渐变细或者其它变化。作为非限定性的例子，逐渐变细的构造可通过形成具有三角形构造的狭缝来形成，其中狭缝的长度和宽度从细长轴的外表面到内表面减小。
如上所述，致动器被构造成将张力施加到柔性颈108上，引起颈108进行关节运动。致动器可具有多种构造，但在一种示例性实施方式中致动器类似于前述致动器，并包括一个或多个在手柄106和柔性颈108的远端之间延伸的索，使手柄106和柔性颈108在操作上相关联。每根索可被构造成将张力施加到柔性颈108，引起颈108在运动平面中进行关节运动。因此，在装置100仅仅包括一根索时，柔性颈108可在单个运动平面中进行关节运动。每个附加的索可允许颈108在不同的运动平面中进行关节运动。当提供多根索时，颈108可在多个运动平面中进行关节运动。此外，索可同时被施加张力，能够允许柔性颈108进行360°的关节运动。
虽然索的数目可以变化，但装置100可仅仅包括一根索，在图7所示的实施方式中，装置100包括四根索(仅仅显示了三根索110a、110b、110c)。索110a、110b、110c、110d在图10中更详细显示。如上所述，索110a-d沿着手柄106和柔性颈108之间的细长轴102的长度延伸。索110a-d的具体位置可以变化，但在示例性实施方式中索110a-d围绕细长轴102的圆周沿径向间隔设置，并且它们在柔性颈108的最远端和手柄106之间延伸。索110a-d可通过细长轴102的内部或者沿着细长轴102外部延伸，或者它们可穿过在细长轴102的侧壁中形成的腔或者通道延伸。图11示出了细长轴102的剖视图，显示在其中形成的四个腔103a、103b、103c、103d。腔103a-d优选具有允许索116a-d在其中滑动的尺寸，并且它们围绕细长轴102周向间隔设置。腔103a-d在细长轴102的近端102a和远端102b之间延伸，允许索110a-d在手柄106和柔性颈108的最远端之间延伸。
索110a-d的远端可使用各种技术与柔性颈108的最远端配合，但是在图12中显示的一种实施方式中，柔性颈108包括与其最远端连接或者在其上形成的端盖114。虽然端盖114的构造可基于致动器的构造而变化，在所示的实施方式中端盖114包括在其中形成并围绕端盖114的圆周间隔设置的四个膛孔114a、114b、114c、114d，使膛孔114a-d与细长轴102中的腔103a-d对准。每个膛孔114a-d被构造成容纳其中一根索110a-d。各种配合技术都可用于将索110a-d保持在膛孔114a-d中。例如，图10示出了在每根索110a-d的末端上形成的球，用于将索110a-d的末端保持在端盖114中的膛孔114a-d中。端盖114还可包括在其中形成的中央腔116，用于将工具容纳在其中。腔116还可用于方便经过辅助通道100插入的工具定位。
索110a-d的近端可与连接到轴102的近端的手柄106配合。虽然手柄106可具有多种构造，在前面图7中显示的一种示例性实施方式中，手柄106可以是与细长轴102的近端102a可动地连接的操纵杆形式，特别是被构造成相对于细长轴102的近端进行关节运动。手柄106的关节运动可允许手柄106的运动被柔性颈108模仿(将在下面探讨)。
虽然关节运动可使用多种类型的连接头实现，但在所示的实施方式中，在手柄106和细长轴102之间形成球窝连接。特别是，如图13A和13B中更详细显示的那样，细长轴102的近端102a包括在其上形成并在其近端中限定一个窝118的外壳103。手柄106包括可动地设置在窝118中的球120，并且操纵杆从球120向近端延伸，从而允许手柄106相对于细长轴102进行关节运动。销或其它机构可被用于将球120可动地保持在窝118中。本领域技术人员将会理解，手柄可具有各种其它形状，并且各种其它技术都可用于将手柄106可动地连接到细长轴102。
如上所述，索110a-d的近端被构造成与手柄106配合。因此，手柄106可包括用于配合到索110a-d的零件。虽然具体配合零件可基于致动器的构造而变化，在示例性实施方式中，手柄106上的操纵杆122包括在其上形成的四个腿124a、124b、124c、124d。腿124a-d围绕操纵杆122的圆周间隔设置，使它们大致与索对准，并且每个腿124a-d被构造成与其中一个索110a-d的终端配合。如前所述，索110a-d的远端说明的球窝连接可用于使索110a-d与腿配合，或者作为替代，可使用任何其它已知的配合技术。
仍参照图7，在使用时，手柄106可相对于细长轴102的近端102a枢转或者成角度定向，以便柔性颈108进行模仿运动，从而定位穿过柔性颈108延伸的工具。如图7和13B所示，手柄106上的操纵杆可包括穿过其中形成并与细长轴102中的腔102c对准的腔107，允许工具通过装置100引入。在其它实施方式中，手柄106可以从细长轴102的近端102a偏置，使手柄106与索连接，但不影响直接接触细长轴102中的腔102c。
为了控制柔性颈108的运动并由此控制穿过其中定位的工具，手柄106围绕细长轴102的近端102a枢转或者进行关节运动。例如，手柄106沿着第一方向的运动将引起手柄106上的腿124a-d将力施加到一个或多根索110a-d上，以轴向拉动索。结果，致动的索将张力施加到柔性颈108，引起颈108挠曲。为了防止细长轴102响应于由手柄106施加到索110a-d的张力而挠曲，柔性颈108可具有比细长轴102更大的柔性。例如，这可采用如前所述的狭缝来实现，或者在其它实施方式中轴102可包括穿过其中延伸的稳定元件，诸如杆，使轴102比柔性颈108更具刚性。手柄106的运动方向将被柔性颈108以相同方向(即相应的运动)或者以相反方向(即镜像)模仿，从而控制穿过柔性颈108延伸的工具的位置。在示例性实施方式中，柔性颈108的具体运动量可与手柄106的运动量成比例。也就是说，柔性颈108的运动量可与手柄106的运动量直接相等，或者其可相对于手柄106的运动量成比例增加或减少。在一些实施方式中，理想的是柔性颈108的运动量可相对于手柄106的运动量增加。结果，仅仅需要手柄106的小运动量来使柔性颈108进行更大量运动。虽然各种技术可用于实现柔性颈108运动的成比例倍增或者增加，力倍增机构的一种示例性实施方式是与索连接的偏心凸轮，当张力被手柄106施加到索110a-d时该凸轮可增加索110a-d的机械优点，或是力或者是位移。
如前所述，虽然手柄和装置的工作端之间的运动在理论上可成比例，但在实践中，由于力经过细长轴被传递时可能发生力的一些损失。因此，在本文中使用的成比例运动试图包括其中手柄和工作端被构造成按比例量运动、但在装置的实际运转过程中可发生一些力的丢失的应用。
虽然图1A和7示出了其中工作端模仿手柄运动的装置，但手柄可具有能有效使装置的工作端进行关节运动而不会使装置的工作端模仿手柄的运动的多种其它构造。图14A和14B示出了具有手柄204的装置200的另一种实施方式，所述手柄包括有效的使柔性颈206沿着一个或多个运动平面相对于装置的细长轴202进行关节运动的可旋转构件。一般而言，装置200的细长轴202与前述细长轴102非常相似，并且它通常包括与其远端连接或者在其上形成的柔性颈206。四根索致动器(未显示)延伸穿过手柄106和柔性颈206之间的细长轴。轴102和索致动器类似于前面参照装置100描述的轴102和索致动器110a-d，因此将不再对它们进行详细描述。
装置200的手柄204在图15A和15B中更详细显示。一般而言，手柄204包括一个或多个可旋转设置在其中的卷筒。每个卷筒被构造成配合到其中一个索致动器并对其进行控制。因此，每个卷筒的转动将卷绕或释放索，从而引起柔性颈108挠曲并沿着特定方向致动。虽然卷筒的数目可基于索致动器而变化，在图15A和15B所示的实施方式中，手柄204包括四个卷筒208a、208b、210a、210b。前面的两个卷筒208a、208b彼此连接，并且后面的两个卷筒210a、210b彼此连接。第一索212a与第一卷筒208a连接并卷绕其上，第二索212b与第二卷筒208b连接并卷绕于其上。第一和第二索212a、212b被定位在细长轴202的相对侧并上并沿着其延伸。结果，施加到第一索212a上的张力将引起柔性颈206在第一运动平面中沿着一个方向进行关节运动，施加到第二索212b上的张力将引起柔性颈206在第二运动平面中沿着相反方向进行关节运动。为了允许张力仅仅被施加到索212a、212b中的一个，第一和第二索212a、212b沿着相反方向围绕第一和第二卷筒208a、208b卷绕。因此，第一和第二卷筒208a、208b的旋转将卷绕索212a\212b中的一个并向且施加张力，同时使索212a、212b中的另一个打开并解除张力。第三和第四索212c、212d同样围绕第三和第四卷筒210a、210b卷绕，第三和第四卷筒210a、210b的旋转将使索212c、212d中的一个卷绕并将张力施加于其上，同时打开索212c、212d中的另一个并解除张力。第三和第四索212c、212d可沿着轴202在与第一和第二索212a、212b径向错开的位置延伸，使第三和第四索212c、212d引起柔性颈沿着不同的第二运动平面进行关节运动。例如，第三和第四索212c、212d可与第一和第二索212a、212b错开大约90°，使索212a-d都围绕细长轴202的圆周大致间隔相等的距离。本领域技术人员将会理解，手柄204可包括任意数量的卷筒和索，以沿着需要的平面数进行关节运动。
为了控制卷筒208a、208b、210a、210b，装置可包括一个或多个夹持构件。如图15A和15B所示，第一旋钮214与第一和第二卷筒208a、208b连接，第二旋钮216与第三和第四卷筒210a、210b连接。旋钮214、216可与卷筒208a、208b、210a、210b整体形成，或者它们可通过穿过卷筒208a、208b、210a、210b延伸的轴与卷筒208a、208b、210a、210b连接。在所示的实施方式中，第一旋钮214直接在第一卷筒208a上形成或者与其连接，第二旋钮216可通过从穿过第一和第二卷筒208a、208b的旋钮216延伸并连接到第三和第四卷筒210a、210b的轴218与第三和第四卷筒210a、210b连接。换言之，第一和第二卷筒208a、208b围绕轴218旋转设置。
在一些示例性实施方式中，卷筒和旋钮也可具有不同尺寸。在图15A和15B中所示的实施方式中，第一和第二卷筒208a、208b以及第一旋钮214具有比第三和第四卷筒210a、210b和第二旋钮216的直径大的直径。虽然不是必须的，所述构造是有利地，因为它将索212a-d间隔开，防止了索212a-d彼此接触。
使用时，工具经过细长轴202被定位，并且旋钮214、216可旋转，使柔性颈206在轴202上进行关节运动，从而根据需要定位工具。如图14A和14B所示，手柄204可包括穿过其中延伸并与细长轴202中的腔对准的腔205，允许工具穿过手柄204和轴202。在另外的实施方式中，手柄204可与细长轴202错开，以提供细长轴202中腔的直接进口。一旦工具经过轴202被定位，旋钮214、216可旋转，使柔性颈206在细长轴202的远端上进行关节运动。特别是，第一旋钮214可沿着第一方向(例如沿着顺时针方向)旋转，以将张力施加到一个索(例如第二索212a)，同时释放或者打开另一个索(例如第二索212b)。结果，施加到第一索212a的张力将沿着近端方向拉动柔性颈206的最远端，引起柔性颈206挠曲并由此沿着第一方向进行关节运动。第一旋钮214沿着相反方向的旋转(例如逆时针方向)的旋转，将打开第一索212a同时卷绕第二索212b。柔性颈206将恢复到其初始的线性构造。第一旋钮214的进一步旋转将继续卷绕第二索212b，同时打开第一索212a，从而引起柔性颈206挠曲并在相同的运动平面中沿着相反方向进行关节运动。第二旋钮216可同样旋转，使柔性颈在不同运动平面中进行关节运动。旋钮214、216还可任选地同时旋转，使柔性颈206在与第一和第二运动平面不同的另外的运动平面中进行关节运动。
在其它实施方式中，本文中公开的各种装置可包括用于将手柄和/或致动器锁定在固定位置以将装置的工作端保持在所需的关节运动或者角度朝向的锁定机构。虽然锁定机构可具有各种构造，在一种示例性实施方式中锁定机构可以是夹具的形式，其有效地夹钳在索上从而防止索的运动，以便沿着需要的朝向锁定工作端。夹具可具有各种形状和尺寸，并且它可被定位在装置上的各种位置。图16A和16B示出了夹具300的一种示例性实施方式，其围绕图1A和1B的外科紧固和切割装置10上的中空外壳12c设置。夹具300一般为环形并可被构造成与邻近开口的中空外壳12c滑动或者旋转配合，索(在图16B中仅仅显示了索34a、34b、34c)可穿过所述开口延伸。在初始位置，夹具300与开口间隔设置，允许索34a-d穿过其中自由运动。一旦装置的工作端、例如端部执行器16沿着所需的方向进行关节运动，夹具300可沿着中空外壳12c轴向运动，直到其在开口上方延伸并与延伸穿过其中的索34a-d接合。当夹具300处于锁定位置中时，夹具300将由此防止索34a-d的运动。为了使夹具300轴向运动并将夹具300锁定在外壳12c中，夹具300可包括在其上形成并被构造成与在外壳12c上形成的相应配合元件接合的配合元件。如图16A和16B所示，夹具包括在其中形成的螺纹302，其被构造成与在外壳12c上形成的相应螺纹(未显示)配合。结果，夹具300围绕外壳12c的旋转将引起夹具300在初始位置和锁定位置之间运动。本领域技术人员将会理解各种其它配合技术也可使用。例如，手柄可包括在其上形成并被构造成将手柄锁定在固定的关节运动位置中的锁定元件。
在其它实施方式中，索可用于被动地允许细长轴经过体腔进行关节运动，并且在需要时夹具300或者其它锁定机构可用于将装置的工作端锁定在位置中。在这类的构造中，手柄可仅仅用于方便装置的夹持。
在其它实施方式中，在本文中公开的用于使装置的工作端进行关节运动的索致动器可由电活化聚合物材料制成。电活性聚合物(EAP)(也被称为人造肌肉)是响应于电场或者化学场表现出压电、热电或者电致特性的材料。特别是，EAP是一组掺杂的导电聚合物，当施加电压时其形状发生改变。导电聚合物可以是配对形成离子流体或者凝胶和电极，来自流体/凝胶进入或流出导电聚合物的离子流可诱导聚合物形状发生改变。典型地，取决于使用的特定聚合物和离子流或者凝胶施加大约1V到4kV范围内的电压，需要特别注意的是当供给能量时，EAP不改变体积，它们仅仅沿着一个方向膨胀并沿着相反方向收缩。因此，前面在本文中公开的索致动器可被EAP致动器取代，并且手柄可被构造成能激活能源，以选择性地将能量输送到一个或多根索。在示例性实施方式中，手柄的运动可被构造成控制能源的量以及索接收的能源。结果，手柄的运动仍可被装置的工作端模仿，为用户提供对工作端位置的相同的精确控制。能源可以是内部源(例如电池)，或者也可以是外部源。在其它实施方式中，EAP索致动器可补充通过手柄的运动施加到索上的轴向力，从而相对于手柄成比例增加工作端的运动量。
在其它方面中，索致动器可由形状记忆材料制成，例如镍钛诺。所述构造允许张力被施加到索，使端部执行器进行关节运动，还允许索回复到最初的线性构造，而不需要操作手柄。
在又一种实施方式中，本文中公开的各种装置，包括其部分，可被设计成在一次使用后被抛弃，或者它们可被设置成多次使用。在任何一种情况下，在至少一个使用之后，装置可被再生以便再次使用。再生可包括任何装置的拆分，然后清洁或者替换特定部件并随后组装的步骤组合。作为例子，图1A和1B中所示的外科缝合和切割装置可在装置已经在医学手术中使用后再生。装置可以拆分，并且任意数目的特定部件可在任何组合中选择性地被替换或者被除去。例如，对于外科缝合和切割装置而言，设置在端部执行器中并含有多个紧固件的钉仓可通过将新的紧固件仓增加到端部执行器中来替换。当清洁和/或替换特定部件时，装置可在再生车间或者通过外科团队在外科手术之前立即被重新组装用于随后的使用。本领域技术人员将会理解，装置的再生可利用各种用于组装、清洁/替换和重组技术。所述技术的使用和产生的再生装置都属于本申请的范围。
基于上述实施方式，本领域技术人员将会理解本发明的其它特征和优点。因此，除非由所附的权利要求书特别指明，本发明不由已经特别显示并描述的来限定。在本文中引用的所有出版物和参考文献都通过全文引用而明确地包含在本申请中。

Claims (10)

1.一种外科装置，包括：
具有近端和远端的细长轴，手柄可动地连接到所述细长轴的近端，柔性颈从所述细长轴的远端开始延伸，端部执行器通过所述柔性颈从远侧连接到所述细长轴，其中，所述手柄和所述柔性颈可操作地联接在一起，使所述柔性颈模仿所述手柄的运动，所述手柄上形成的可旋转构件能够致动设置在所述端部执行器中的驱动器机构，引起所述驱动器机构将紧固件驱动到组织中。
2.根据权利要求1所述的装置，其中，所述模仿运动是成比例的。
3.根据权利要求1所述的装置，其中，所述手柄能够相对于所述细长轴的所述近端进行关节运动。
4.根据权利要求3所述的装置，其中，所述手柄通过接头联接到所述细长轴的近端，所述接头选自由球窝接头、铰接接头以及柔性接头组成的组中。
5.根据权利要求1所述的装置，其中，所述手柄和所述柔性颈通过在所述手柄和所述柔性颈之间延伸的致动器可操作地相关联，所述致动器能够将运动从所述手柄传递到所述柔性颈。
6.根据权利要求5所述的装置，其中，所述致动器包括至少一根索，所述索沿着所述细长轴的长度延伸并能有效地将力施加到所述柔性颈，从而使所述柔性颈在至少一个运动平面中运动。
7.根据权利要求6所述的装置，其中，所述至少一根索由电活化聚合物材料制成，其中所述手柄的运动能够有效地将能量选择性地输送到所述至少一根索，引起所述至少一根索轴向收缩并径向扩张，从而引起所述柔性颈中的至少一个模仿所述手柄的运动。
8.根据权利要求6所述的装置，其中，所述至少一根索包括沿着所述细长轴的长度延伸的多根索，每根索能有效地将力施加到所述柔性颈，使所述柔性颈在不同的运动平面中运动。
9.根据权利要求8所述的装置，其中，所述多根索围绕所述致动器的圆周彼此等间隔地设置。
10.根据权利要求8所述的装置，其中，所述多根索包括至少三根沿着所述细长轴的长度延伸的索。
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