CN101683281A - 电动外科器械 - Google Patents

电动外科器械 Download PDF

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CN101683281A
CN101683281A CN200910175033A CN200910175033A CN101683281A CN 101683281 A CN101683281 A CN 101683281A CN 200910175033 A CN200910175033 A CN 200910175033A CN 200910175033 A CN200910175033 A CN 200910175033A CN 101683281 A CN101683281 A CN 101683281A
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motor
power supply
end effector
surgical instruments
switch
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CN101683281B (zh
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D·C·耶茨
T·W·休特玛
F·E·谢尔顿四世
B·E·斯文斯加德
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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
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00734—Aspects not otherwise provided for battery operated
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—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
    • A61B2017/07214—Stapler heads
    • A61B2017/07278—Stapler heads characterised by its sled or its staple holder
    • 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
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320052—Guides for cutting instruments

Abstract

本发明公开一种电动外科器械，更具体地，公开一种电动的外科切割和紧固器械。在一种实施方式中，该机械包括独立于电池的电荷存储装置，其在特定条件下为电动机提供额外的功率。另外，电动机可包括多个绕组。

Description

电动外科器械
技术领域
本发明涉及一种电动外科器械。
背景技术
在现有技术中，已经利用外科缝合器来同时在组织中形成纵向切口和在该切口相对侧上施加缝合线。这种器械通常包括一对相互配合的钳口构件，该钳口构件在器械被用于内窥镜或者腹腔镜应用时能够通过套管通道。钳口构件中的一个能够容纳具有至少两个侧向间隔开的缝钉排的钉仓。另一个钳口构件限定砧座，砧座具有与钉仓中的缝钉排对准的缝钉成形凹窝。这种器械通常包括多个往复楔形件，当被向远侧驱动时，往复楔形件通过钉仓中的开口并与支撑缝钉的驱动器接合以实现朝向砧座击发缝钉。
适用于内窥镜应用的外科缝合器的一个例子在题为“Surgicalstapling instrument having separate distinct closing and firing systems”、公开号为No.2004/0232196A1的公开美国专利申请中有所描述，该申请的公开内容通过引用结合在此。使用时，医生能够在击发之前将缝合器的钳口构件闭合在组织上来定位组织。一旦医生已经确定钳口构件适当地抓取组织了，医生就能够击发外科缝合器，由此切割并缝合组织。这种同时的切割和缝合避免了当利用仅分别用于切割和缝合的不同外科工具顺次执行这种动作时会引发的并发症。
电动机供能的外科切割和紧固器械(其中电动机为切割器械供能)在现有技术中也是已知的，例如在题为“Motor-driven surgicalcutting and fastening instrument with tactile position feedback”、公开号为No.2007/0175962A1的公开美国专利申请中有所描述，该专利申请通过引用结合在此。在该参考文献中，手柄中的电池用来为电动机供电。
发明内容
在一个总的方面，本发明的实施方式提供一种电动外科器械。该器械可以是内窥镜器械，例如线性内切割器或圆形切割器，或者腹腔镜器械。该器械可以由用于紧固夹紧在端部执行器中的组织的缝钉和/或RF电极构成。
本文公开的多种实施方式与无线电动机供能的器械有关。在一种实施方式中，器械包括独立于电池的电荷存储装置，其在需要时为电动机提供额外的功率。电荷存储装置最初可由电池充电。然后，电池可被取下直到电荷存储装置需要额外的功率。此时，电荷存储装置与电池串联连接以向电动机提供额外的功率。
在另一种实施方式中，电动机可包括至少两个绕组。在一种运行模式，绕组串联连接，在另一种运行模式，绕组并联连接。当绕组串联连接时，电动机可具有高转速低转矩输出。当绕组并联连接时，电动机可具有低转速高转矩输出。这样，例如，电动机可呈现两种运行模式，而不必使器械具有多个电动机。
在又一种实施方式中，器械利用可更换的(有可能是可充电的)电池组来为电动机供电。电池组可包括多节电池单体。第一组电池单体可以串联连接在电池组中，第二组电池单体可串联连接在电池组中，但在电池组内，第一组电池单体并不与第二组电池单体串联连接。而是，器械可包括连接在手柄内的电池单体，例如在电池组安装在或者放置在器械中时将第一组电池单体与第二组电池单体串联连接的电池单体。
(1)一种外科器械，包括：
端部执行器，其包括可动的切割器械；
轴，其远端连接到所述端部执行器；以及
手柄，其连接到所述轴的近端，其中所述手柄包括：
电动机，其用于致动所述切割器械；
电动机控制电路，其用于控制所述电动机，其中，所述电动机控制电路包括：
电源，其连接到所述电动机用于为所述电动机供电；
电荷存储装置；以及
开关电路，其连接到所述电源和所述电荷存储装置，用于(i)将所述电荷存储装置暂时地连接到所述电源以为所述电荷存储装置充电，并且(ii)将所述电荷存储装置选择性地与所述电源串联以为所述电动机提供额外的功率。
(2)如第(1)项所述的外科器械，其中，所述电荷存储装置包括电容器。
(3)如第(2)项所述的外科器械，其中，所述电荷存储装置包括超级电容器。
(4)如第(1)项所述的外科器械，其中，所述电源包括多个串联的电池单体。
(5)如第(4)项所述的外科器械，还包括连接到所述电源的电源选择开关，用于在第一状态时将所有的电源连接到所述电动机，且在第二状态时将一部分电源连接到所述电动机。
(6)如第(1)项所述的外科器械，其中，所述端部执行器包括圆形切割端部执行器。
(7)如第(1)项所述的外科器械，其中，所述端部执行器包括线性切割端部执行器。
(8)如第(1)项所述的外科器械，其中，所述电动机控制电路还包括连接到所述电源的电流控制电路，用于改变从所述电源供应至所述电动机的电流，使得所述电动机具有至少：
用于所述切割器械的切割行程循环的第一部分的第一、低功率运行模式；以及
用于所述切割器械的切割行程循环的第二部分的第二、高功率运行模式。
(9)如第(1)项所述的外科器械，其中：
所述电动机包括至少两个绕组；以及
所述电动机控制电路用于使所述至少两个绕组选择性地串联或者并联。
(10)一种外科器械，包括：
端部执行器，其包括可动的切割器械；
轴，其远端连接到所述端部执行器；以及
手柄，其连接到所述轴的近端，其中所述手柄包括：
电动机，其用于致动所述切割器械，其中所述电动机包括至少两个绕组；
电动机控制电路，其连接到所述电动机并使所述至少两个绕组选择性地串联或者并联。
(11)如第(10)项所述的外科器械，其中，所述手柄还包括连接到所述电动机的电源。
(12)如第(11)项所述的外科器械，其中，所述电源包括多个串联连接的电源。
(13)如第(12)项所述的外科器械，还包括连接到所述电源的电源选择开关，用于在第一状态时将所有电源连接到所述电动机，且在第二状态时将一部分电源连接到所述电动机。
(14)一种外科器械，包括：
端部执行器，其包括可动的切割器械；
轴，其远端连接到所述端部执行器；以及
手柄，其连接到所述轴的近端，其中所述手柄包括：
电动机，其用于致动所述切割器械；
可移除的电池组，用于为所述电动机供电，其中所述电池组包括多节电池单体，其中所述多节电池单体包括多个串联的第一组电池单体和多个串联的第二组电池单体；以及
电池单体连接器，其独立于所述电池组，并在所述电池组安装在所述器械中时将所述多个串联的第一组电池单体与所述多个串联的第二组电池单体串联连接。
(15)如第(14)项所述的外科器械，其中，所述电池组包括多个串联的第三组电池单体，并且所述电池单体连接器在所述电池组安装在所述器械中时将所述第一组电池单体、第二组电池单体与所述多个串联的第三组电池单体串联连接。
(16)如第(14)项所述的外科器械，其中，所述多个串联的第一组电池单体包括三个串联的锂原电池单体，且所述多个串联的第二组电池单体包括三个串联的锂原电池单体。
(17)如第(14)项所述的外科器械，其中，所述手柄还包括：
电荷存储装置；以及
开关电路，其连接到所述电池组和所述电荷存储装置，用于(i)将所述电荷存储装置暂时地连接到所述电池组以为所述电荷存储装置充电，以及(ii)将所述电荷存储装置选择性地与所述电源串联以为所述电动机提供额外的功率。
本发明的这些和其它好处将通过以下描述变得更加清楚。
附图说明
本发明的多种实施方式在这里通过结合以下附图的实施例进行描述，其中：
图1和2是根据本发明的多种实施方式的外科切割和紧固器械的透视图；
图3-5是根据本发明的多种实施方式的器械的端部执行器和轴的分解图；
图6是根据本发明的多种实施方式的端部执行器的侧视图；
图7是根据本发明的多种实施方式的器械的手柄的分解图；
图8和9是根据本发明的多种实施方式的手柄的局部透视图；
图10是根据本发明的多种实施方式的手柄的侧视图；
图11是用于根据本发明的多种实施方式的器械的电路的示意图；
图12-14和17是用于为根据本发明的多种实施方式的器械的电动机供电的电路的示意图；
图15示出了根据本发明的多种实施方式的充电管理电路的框图；
图16是根据本发明的多种实施方式的充电器基座的框图；
图18示出了电池的通常功率曲线；
图19和20是用于根据本发明的多种实施方式的器械中的电路的示意图；
图21和23是根据本发明的多种实施方式的器械的视图；以及
图22和24是根据本发明的多种实施方式的电池组的视图。
具体实施方式
图1和2描绘了根据本发明的多种实施方式的外科切割和紧固器械10。所示的实施方式是内窥镜式器械，并且总体上，这里描述的器械10的实施方式是内窥镜式外科切割和紧固器械。然而，应当注意，根据本发明的其它实施方式，器械可以是非内窥镜式外科切割和紧固器械，例如是腹腔镜式器械。
图1和2中描绘的外科器械10包括手柄6、轴8以及在关节枢轴14处可枢转地连接到轴8的关节式端部执行器12。关节控制器16邻近手柄6设置以实现端部执行器12绕着关节枢轴14的旋转。在所示的实施方式中，端部执行器12被构造为用作夹紧、切割和缝合组织的内切割器，但在其它实施方式中，可以使用不同类型的端部执行器，例如其他类型外科装置用端部执行器，例如抓取器、切割器、缝合器、夹具施放器、接近装置、药物/基因治疗装置、超声、射频(RF)或者激光装置等。在’312专利中可以找到关于RF装置的更多细节。
器械10的手柄6可包括用于致动端部执行器12的闭合扳机18和击发扳机20。可以理解，具有用于不同外科任务的端部执行器的器械可具有不同数量或类型的扳机或者用于操作端部执行器12的其他合适控制器。端部执行器12被显示为通过优选的细长轴8与手柄6分开。在一种实施方式中，医生或者器械10的操作者可通过利用关节控制器16使端部执行器12相对于轴8进行关节运动，如题为“Surgical Instrument Having An Articulating End Effector”、公开号为No.2007/0158385A1的公开美国专利申请中详细描述的，该申请通过引用结合在此。
在该例中，端部执行器12特别包括缝钉通道22和能够可枢转地平移的夹紧构件，例如砧座24，缝钉通道22和夹紧构件保持在确保有效缝合和切割夹紧在端部执行器12中的组织的间隔处。手柄6包括手枪式握把26，闭合扳机18可由医生可枢转地拉向手枪式握把26以引起砧座24朝着端部执行器12的缝钉通道22夹紧或者闭合，由此夹紧定位在砧座24和通道22之间的组织。击发扳机20位于闭合扳机18的更远些的外侧。一旦闭合扳机18如下面进一步描述的锁定在闭合位置，击发扳机20就可以朝手枪式握把26微微旋转，从而使其能够由操作者利用一只手到达。然后操作者可以朝手枪式握把26枢转地拉动击发扳机20，以缝合和切割端部执行器12中的夹紧组织。在其它实施方式中，可以使用除了砧座24之外的不同类型的夹紧构件，例如相对的钳口等。
将会理解，本文使用的术语“近侧”和“远侧”是以抓握器械10的手柄6的医生为参照的。因此，端部执行器12相对于更加近侧的手柄6处于远侧。还可以理解，为了方便和清楚，本文使用的例如“竖直”和“水平”等空间术语是以附图为参照的。然而，外科器械用在很多定向和位置，因此这些术语不能被认为是限制性和绝对的。
闭合扳机18可以首先被致动。一旦医生满意了端部执行器12的定位，医生就可以拉回闭合扳机18至其接近手枪式握把26的完全闭合、锁定位置。然后可以致动击发扳机20。击发扳机20在医生移去压力时返回到打开位置(图1和2中所示)，如下文中更加全面地描述的。当被压下时，手柄6上的释放按钮可释放锁定的闭合扳机18。释放按钮可以以各种形式实施，例如图7中所示的滑动释放按钮160或者公开号为No.2007/01755955A1的美国公开专利申请中描述的机构，该申请通过引用结合在此。
图3是根据多种实施方式的端部执行器12的分解视图。如所示的实施方式显示的，除了前面提及的通道22和砧座24之外，端部执行器12可包括切割器械32、滑架33、可拆卸地位于通道22中的钉仓34以及螺旋丝杠36。切割器械32可以是例如刀。砧座24可在连接到通道22近端的枢转点25处可枢转地打开和闭合。砧座24还可以在其近端处包括插入到机械闭合系统(下文中进一步描述)的部件中以打开和闭合砧座24的翼片27。当闭合扳机18被致动，即由器械10的使用者向内拉动时，砧座24可绕着枢转点25枢转至夹紧或者闭合位置。如果端部执行器12的夹紧是令人满意的，则操作者可以致动击发扳机20，如下文中更加详细地解释的，这引起刀32和滑架33沿着通道22纵向行进，由此切割夹紧在端部执行器12内的组织。滑架33沿着通道22的运动导致钉仓34的缝钉被驱动通过切断的组织并抵靠闭合的砧座24，这使缝钉变弯以紧固切断的组织。在多种实施方式中，滑架33可以是钉仓34的一体部件。题为“Surgical stapling instrument incorporating an E-beam firingmechanism”的美国专利6978921提供了关于这种两-行程切割和紧固器械的更多细节，该专利通过引用结合在此。滑架33可以是钉仓34的一部分，使得当刀32在切割操作之后缩回时，滑架33不缩回。
应当注意，尽管这里描述的器械10的实施方式采用缝合切断的组织的端部执行器12，但在其它实施方式中，可以使用用于紧固或者密封切断的组织的不同技术。例如，也可以使用利用RF能量或者粘合剂紧固切断组织的端部执行器。授予Yates等人的题为“Electrosurgical Hemostatic Device”的美国专利No.5709680和授予Yates等人的题为“Electrosurgical Hemostatic Device with Recessedand/or Offset Electrodes”的美国专利No.5688270公开了利用RF能量来密封切断组织的内窥镜式切割器械，上述专利通过引用结合在此。Jerome R.Morgan等人的公开号为No.2007/0102453A1的美国公开专利申请和Frederick E.Shelton，IV等人的公开号为No.2007/0102452A1的美国公开专利申请公开了利用粘合剂来紧固切断的组织的内窥镜式切割器械，上述专利申请通过引用结合在此。因此，尽管本文的说明书提到切割/缝合操作以及下文的类似操作，但应当认识到，这是一种示例性实施方式且并不意味着是限制性的。也可以使用其它组织紧固技术。
图4和5是根据多种实施方式的端部执行器12和轴8的分解视图且图6是其侧视图。如所示实施方式显示的，轴8可包括通过枢转连接件44可枢转连接的近侧闭合管40和远侧闭合管42。远侧闭合管42包括开口45，砧座24上的翼片27插入开口45中以打开和闭合砧座24，如下面进一步描述的。近侧脊管46设置在闭合管40、42内侧。主旋转(或近侧)驱动轴48可设置在近侧脊管46内侧，其通过锥齿轮组件52与次(或远侧)驱动轴50连接。次驱动轴50连接到驱动齿轮54，驱动齿轮54与螺旋丝杠36的近侧驱动齿轮56接合。竖直锥齿轮52b可位于近侧脊管46的远端中的开口57中并在其内枢转。远侧脊管58可用于围绕次驱动轴50和驱动齿轮54、56。主驱动轴48、次驱动轴50和关节组件(例如，锥齿轮组件52a-c)在本文中有时被共同称为“主驱动轴组件”。
定位在缝钉通道22远端处的支承件38接收螺旋驱动丝杠36，允许螺旋驱动丝杠36相对于通道22自由旋转。螺旋丝杠36可与刀32的螺纹开口交接(未示出)，使得轴36的旋转引起刀32向远侧或近侧(取决于旋转方向)平移通过缝钉通道22。因此，当主驱动轴48由击发扳机20的致动而旋转时(如下文中更详细解释的)，锥齿轮组件52a-c引起次驱动轴50旋转，次驱动轴50又因为驱动齿轮54、56的接合引起螺旋丝杠36旋转，这引起刀驱动构件32沿着通道22纵向行进以切割夹紧在端部执行器内的任何组织。滑架33可例如由塑料制成并可具有倾斜的远侧表面。随着滑架33横过通道22，倾斜的前向表面可向上推动或者驱动钉仓中的缝钉通过夹紧的组织并抵靠砧座24。砧座24使缝钉变弯，由此缝合切断的组织。当刀32缩回时，刀32和滑架33脱离接合，由此将滑架33留在通道22的远端。
图7-10示出了电动机驱动的内切割器的一种示例性实施方式。所示的实施方式提供了有关端部执行器中切割器械的展开和加载力的使用者反馈。另外，该实施方式可利用使用者缩回击发扳机20提供的动力来为装置供能(所谓的“动力辅助模式”)。如所示的实施方式显示的，手柄6包括外部的下边件59、60和外部的上边件61、62，它们配合起来总体上形成手柄6的外部。手柄6的手枪式握把部分26中可设置电池64，例如锂离子电池。电池64为设置在手柄6的手枪式握把部分26上部中的电动机65供电。根据多种实施方式，串联的多节电池单体可用来为电动机65供电。
电动机65可以是在没有负载时具有大约为25000转/分钟(RPM)的最大转速的电刷式驱动电动机。在其它实施方式中，电动机65可包括无刷电动机、无引线电动机、同步电动机、步进电动机或者任何其它合适的电动机。电动机64可驱动包括第一锥齿轮68和第二锥齿轮70的90°锥齿轮组件66。锥齿轮组件66可驱动行星齿轮组件72。行星齿轮组件72可包括连接到驱动轴76的小齿轮74。小齿轮74可驱动配合的环形齿轮78，环形齿轮78通过驱动轴82驱动螺旋齿轮鼓80。环84可螺纹连接在螺旋齿轮鼓80上。因此，当电动机65旋转时，引起环84通过居间设置的锥齿轮组件66、行星齿轮组件72和环形齿轮78沿着螺旋齿轮鼓80行进。
手柄6还可以包括与击发扳机20连通的电动机运行传感器110以检测何时击发扳机20已经由操作者朝手柄6的手枪式握把部分26拉动(或者“闭合”)，由此通过端部执行器12致动切割/缝合操作。传感器110可以是比例传感器，例如可变电阻器或者可变电阻。当击发扳机20被向内拉动时，传感器110检测该运动，并发送指示待供应给电动机65的电压(或者功率)的电信号。当传感器110是可变电阻等时，电动机65的旋转可大体与击发扳机20的移动量成比例。也就是说，如果操作者仅稍微拉动或者闭合击发扳机20，则电动机65旋转得相对较慢。当击发扳机20被完全拉动(或者位于完全闭合位置)时，电动机65最高速旋转。换句话说，使用者越剧烈地拉动击发扳机20，施加给电动机65的电压就越大，引起转速越大。
手柄6可包括邻近击发扳机20上部的中间手柄部件104。手柄6还可包括连接在中间手柄部件104和击发扳机20之间的偏压弹簧112。偏压弹簧112可将击发扳机20偏压至其完全打开位置。这样，当操作者释放击发扳机20时，偏压弹簧112将击发扳机20拉至其打开位置，由此解除传感器110的致动，并使电动机65停止旋转。而且，通过偏压弹簧112，任何时候使用者闭合击发扳机20，使用者就会体验对闭合操作的阻力，由此为使用者提供关于电动机65施加的旋转量的反馈。此外，操作者可以停止收回击发扳机20，以由此将力从传感器110移除，并使电动机65停止。这样，使用者可停止端部执行器12的展开，由此向操作者提供能够切割/缝合操作控制的测量。
螺旋齿轮鼓80的远端包括驱动环形齿轮122的远侧驱动轴120，环形齿轮122与小齿轮124配合。小齿轮124连接到主驱动轴组件的主驱动轴48。这样，电动机65的旋转引起主驱动轴组件旋转，这导致端部执行器12致动，如上面所述。
螺纹连接在螺旋齿轮鼓80上的环84可包括设置在开槽臂90的槽88内的柱86。开槽臂90在其相对端94处具有开口92，开口92接收连接在手柄外部边件59、60之间的枢转销96。枢转销96也设置成通过击发扳机20中的开口100和中间手柄部件104的开口102。
另外，手柄6可包括电动机反向传感器130(或者行程结束传感器)和电动机停止(或者行程开始)传感器142。在多种实施方式中，电动机反向传感器130可以是位于螺旋齿轮鼓80远端的限位开关，以便在螺纹连接在螺旋齿轮鼓80上的环84到达螺旋齿轮鼓80远端时使环84接触并使电动机反向传感器130跳闸。在被激活时，电动机反向传感器130向电动机65发送信号以使其旋转方向颠倒，由此在切割操作后撤回端部执行器12的刀32。电动机停止传感器142可以是例如常闭的限位开关。在多种实施方式中，它可以位于螺旋齿轮鼓80近端，使得在环84到达螺旋齿轮鼓80近端时环84使开关142跳闸。
在操作中，当器械10的操作者拉回击发扳机20时，传感器110检测击发扳机20的展开并向电动机65发送信号使电动机65以例如与操作者拉回击发扳机20的剧烈程度成比例的速度正向旋转。电动机65的正向旋转又引起行星齿轮组件72远端的环形齿轮78旋转，由此引起螺旋齿轮鼓80旋转，螺纹连接在螺旋齿轮鼓80上的环84沿着螺旋齿轮鼓80向远侧行进。螺旋齿轮鼓80的旋转还如上面所述的驱动主驱动轴组件，主驱动轴组件又引起端部执行器12中的刀32展开。也就是说，引起刀32和滑架33纵向地经过通道22，由此切割夹紧在端部执行器12中的组织。同样，在使用缝合式端部执行器的实施方式中引起端部执行器的缝合操作。
在端部执行器12的切割/缝合操作完成时，螺旋齿轮鼓80上的环84将已经到达螺旋齿轮鼓80的远端，由此引起电动机反向传感器130跳闸，向电动机65发送信号使电动机65的旋转反向。这又引起刀32缩回，并且还引起螺旋齿轮鼓80上的环84运动回到螺旋齿轮鼓80近端。
中间手柄部件104包括与开槽臂90接合的后方肩部106，如图8和9最佳显示的。中间手柄部件104还具有与击发扳机20接合的前向运动止动件107。如上面解释的，开槽臂90的运动由电动机65的旋转控制。当开槽臂90随着环84从螺旋齿轮鼓80近端行进到远端而逆时针旋转时，中间手柄部件104将逆时针自由旋转。因此，随着使用者向内拉动击发扳机20，击发扳机20将接合中间手柄部件104的前向运动止动件107，引起中间手柄部件104逆时针旋转。然而，由于后方肩部106与开槽臂90接合，中间手柄部件104将只能够以开槽臂所允许那么远地逆时针旋转。这样，如果电动机65出于某种原因要停止旋转，那么开槽臂90将停止旋转，且使用者将不能进一步向内拉动击发扳机20，因为中间手柄部件104由于开槽臂90而不能逆时针自由旋转。
图7-10中也示出了用于通过收回闭合扳机18闭合端部执行器12的砧座24的示例性闭合系统的部件。在所示实施方式中，闭合系统包括通过销251连接到闭合扳机18的轭250，销251通过闭合扳机18和轭250中的对准开口插入。枢转销251插入通过闭合扳机18中的另一开口，该开口与销251插入通过闭合扳机18的位置偏离，闭合扳机18绕着枢转销251枢转。因此，闭合扳机18的旋转引起闭合扳机18的上部逆时针旋转，轭250通过销251连接到闭合扳机18的上部。轭250的远端借助销254连接到第一闭合托架256。第一闭合托架256连接到第二闭合托架258。闭合托架256、258合起来限定一开口，近侧闭合管40的近端(见图4)就座并保持在该开口中，从而闭合托架256、258的纵向运动引起近侧闭合管40的纵向运动。器械10还包括设置在近侧闭合管40内侧的闭合杆260。闭合杆260可包括窗口261，所示实施方式中的手柄外部边件中的一个、例如外部下边件59上的柱263设置在窗口261中以将闭合杆260固定连接到手柄6。这样，近侧闭合管40能够相对于闭合杆260纵向运动。闭合杆260还可包括配合到近侧脊管46中的腔269中并通过帽271(见图4)保持在其中的远侧轴环267。
在操作中，当轭250由于闭合扳机18的收回而旋转时，闭合托架256、258引起近侧闭合管40向远侧移动(即，远离器械10的手柄端)，这引起远侧闭合管42向远侧移动，这引起砧座24绕着枢转点25旋转至夹紧或者闭合位置。当闭合扳机18从锁定位置解锁时，引起近侧闭合管40向近侧滑动，这引起远侧闭合管42向近侧滑动，通过插入远侧闭合管42的窗口45中的翼片27，引起砧座24绕着枢转点25枢转至打开或者未夹紧位置。这样，通过收回和锁定闭合扳机18，操作者可以夹紧砧座24和通道22之间的组织，并可以在切割/缝合操作之后通过将闭合扳机20从锁定位置解锁而放开组织。
电动外科器械的其他结构在题为“Motor-driven surgical cuttingand fastening instrument with tactile position feedback”、公开号为No.2007/0175962A1的公开美国专利申请中有所描述，该申请全部通过引用结合在此。
图11是根据本发明的多种实施方式的电动机控制电路的示意图。在多种实施方式中，电动机控制电路可包括一个或多个集成电路(IC)，例如处理器、存储器、微控制器、时限电路等。在其他实施方式中，电动机控制电路可以不包括任何IC。这种无IC的电动机控制电路是有利的，因为为包括IC的外科器械灭菌常常是困难、复杂且昂贵的。
当操作者在锁定闭合扳机18后最初拉动击发扳机20时，传感器110被激活(或者当传感器110是开关时为闭合)，允许电流流过。如果常开的电动机反向传感器开关130是打开的(意味着还没有到达端部执行器行程的端部)，电流将流向单极、双掷继电器132。当电动机反向传感器130没有闭合时，继电器132的线圈134将不通电，因此继电器132将处于其断电状态。
如图11所示，电路还可包括并联的电阻元件144和开关146，该并联元件与继电器132串联。电阻元件144和开关146也连接到电源64。开关146可由响应于切割器械位置传感器150的控制电路148控制。根据多种实施方式，控制电路148在切割器械32(i)非常靠近其行程开始处和(ii)非常靠近其行程末端时使开关146打开。例如，当切割器械位置传感器150确定切割器械32(i)距其行程开始点0.001英寸和(ii)距其行程结束处0.001英寸时，控制电路可使开关打开。在开关146打开的情况下，电流流经电阻元件144、然后经过继电器132、继电器138、电动机运行传感器开关110到电动机65。流经电阻元件144的电流使传输到电动机65的电流大小减小，由此减小由电动机65传输的功率。因此，当切割器械32(i)非常靠近其行程开始和(ii)非常靠近其行程结束时，由电动机65传输的功率降低。反之，一旦切割器械132运动到距其行程开始点或者结束点足够远，控制电路148可闭合开关146，由此使电阻元件144短路，由此增加到达电动机65的电流，由此增加由电动机传输的功率。
根据多种实施方式，电路还包括共同限定互锁电路137的锁定传感器开关136a-d，在断电时，来自继电器132的电流流经互锁电路137以启动电动机65的电运行。每个锁定传感器开关136a-d能够分别响应于相应条件的存在或缺失保持开关打开状态(即，不导电)或者开关闭合状态(即，导电)。当器械10被击发时，任何所述相应条件的存在可造成不满意的切割和缝合操作和/或对器械10的损害。锁定传感器开关136a-d可响应的条件包括例如：(a)通道22中缺失钉仓34，(b)通道22中存在用过的(例如，之前击发过的)钉仓34和(c)砧座24相对于通道22的打开位置(或者要不然不充分闭合)。锁定传感器开关136a-d可响应的其他条件(例如部件磨损)可基于器械10产生的击发操作的累积数来推知。因此，在多种实施方式中，如果存在任意这些条件，相应的锁定传感器开关136a-d保持开关打开状态，由此防止启动电动机65的操作所需的电流通过。在多种实施方式中，仅在所有条件都矫正后，锁定传感器开关136a-d才允许电流通过。将会理解，上面描述的条件仅作为示例提供，且可以提供用于响应有害于器械10操作的其它条件的另外的锁定传感器开关。同样将会理解，对于其中一个或多个上述条件可能不存在或者不关注的实施方式来说，锁定传感器开关的数量可以少于所描述的。
如图11所示，锁定传感器开关136a可利用常开开关结构来实施，使得当钉仓34处于相当于由通道22适当接收的位置时保持开关闭合状态。当钉仓34未装配于通道22中时或者装配不适当(例如，不对准)时，锁定传感器开关136a保持开关打开状态。锁定传感器开关136b可利用常开开关结构来实施，使得只有在通道22中存在未用过的钉仓34(即，在未击发位置具有滑架33的钉仓34)时才保持开关闭合状态。通道22中存在用过的钉仓34引起锁定传感器开关136b保持开关打开状态。锁定传感器开关136c可利用常开开关结构来实施，使得当砧座24相对于通道22处于闭合位置时保持开关闭合状态。锁定传感器开关136c可以根据时间延迟特征来控制，其中，只在砧座24处于闭合位置一个预定时段后才保持开关闭合状态。
锁定传感器开关136d可利用常闭开关结构来实施，使得只在由器械10产生的击发累积数小于预定数时才保持开关闭合状态。锁定传感器开关136d可以与计数器139连接，计数器139用于保持表示器械10执行的击发操作的累积数的计数，将该计数与预定数进行比较，并基于比较控制锁定传感器开关136d的开关状态。尽管图11中显示是单独部件，但将会理解，计数器139可与锁定传感器开关136d一体以形成共同装置。优选地，计数器139可实施为电子装置，其基于向其提供的离散电信号具有用于增加保持的计数的输入。将会理解，可以使用能够基于机械输入(例如，击发扳机20的收回)保持计数的机械计数器来替代。当实施为电子装置时，电路中出现的每击发操作一次转换一次的任何离散信号可用于计数器139输入。例如如图11所示的，可以利用由行程结束传感器130的致动产生的离散电信号。计数器139可控制锁定传感器开关136d的开关状态，使得当保持的计数小于计数器139中存储的预定数时保持开关闭合状态。当保持的计数等于预定数时，计数器139导致锁定传感器开关136d保持开关打开状态，由此防止电流通过。将会理解，计数器139存储的预定数可根据需要选择性地调整。根据多种实施方式，计数器139可与集成到器械10用于向使用者指示保持的计数或者预定数和保持的计数之间的差的外部显示器(未示出)、例如LCD显示器连接。
根据多种实施方式，互锁电路137可包括器械10的使用者可看到的一个或多个指示器，用于显示至少一个锁定传感器开关136a-d的状态。关于这种指示器的更多细节可在题为“Electronic lockoutsand surgical instrument including same”、公开号为No.2007/0175956的公开美国专利申请中找到，该申请全部通过引用结合在此。该申请还包括用于锁定传感器开关136a-d的示例性安装布置和构型。
在所示的实施方式中，当锁定传感器开关136a-d全体保持开关闭合状态时，单极单掷继电器138通电。当继电器138通电时，电流流经继电器138、经过电动机运行开关传感器110，并通过双极双掷继电器140流到电动机65，由此为电动机65供电，允许其沿正向方向旋转。根据多种实施方式，由于一旦通电，继电器138的输出将保持继电器138处于通电状态直到继电器132被通电，互锁电路137将不起作用以防止电动机65一起动就操作，即使一个或多个锁定传感器开关136a-d随后保持开关打开状态。然而，在其他实施方式中，连接互锁电路137和继电器138是必须的或者是期望的，以便为了维持电动机65一起动就操作，必须使一个或多个锁定传感器开关136a-d保持开关关闭状态。
电动机沿正向方向的旋转引起环84向远侧移动，由此使多种实施方式中的电动机停止传感器开关142解除致动。因为开关142是常闭的，与开关142连接的螺线管142可以通电。螺线管141可以是传统的推式螺线管，这种推式螺线管在通电时引起柱塞(未示出)轴向延伸。可操作柱塞的延伸以将闭合扳机18保持在收回位置，由此防止砧座24在击发操作正在进行(即，在开关142未致动)时打开。在螺线管141断电后，柱塞缩回从而使闭合扳机18的手动释放成为可能。
当端部执行器12到达其行程端部时，电动机反向传感器130将被激活，由此使开关130闭合并为继电器132通电。这引起继电器132呈现其通电状态(图11中未示出)，这引起电流绕过互锁电路137和电动机运行传感器开关110，并反而引起电流流过常闭的双极双掷继电器140，不过是以通过继电器140引起电动机65颠倒旋转方向的方式回到电动机65。由于电动机停止传感器开关142是常闭的，因此电流将流回继电器132以保持其通电直到开关142打开。当刀32完全缩回时，电动机停止传感器开关142被激活，引起开关142打开，由此除去电动机65的功率并使螺线管141断电。
在其他实施方式中，可以使用其他替换方式来限制在切割行程循环过程的特定时段供应至电动机65的电流。其他实施方式描述在序列号为No.12/235782的美国专利申请中，该申请整体通过引用结合在此。
在一些实例中，为流向电动机65的电流提供瞬时增加以增加输出转矩是有利的。图19示出了根据多种实施方式用于向电动机65提供瞬时增加的电路的一种实施方式。除了图19的电路另外包括连接到电源64的电荷存储装置1000之外，该电路与图11中所示的电路类似。电荷存储装置1000可以是能够储存电荷的任何装置，例如电容器。例如，电荷存储装置1000可包括超级电容器(有时被称作超级电容)。当电动机65首先接通，例如当开关110由于击发扳机20的收回而闭合时，可闭合开关S 1使得电池64能够如上所述的为电动机65供电。另外，开关S3也可以仅闭合一小段时间(“充电时段”)以通过电阻R1为电荷存储装置1000充电。例如，根据多种实施方式，开关S3可闭合一到十个RC时间常数，其中R是电阻R1的电阻值且C是电荷存储装置1000的电容值。
在正常操作条件期间可以不使用电荷存储装置1000中的电荷，但如果在过程中有医生需要来自电动机65的额外输出转矩的时间时，电荷存储装置1000可以与电池64串联。这例如可以通过打开开关S1并闭合开关S2来完成(在充电时段之后S3保持打开)。当开关S2闭合时，电荷存储装置1000可与电池64串联，由此向电动机65供应额外的电流。
可以多种方式检测电荷存储装置1000的需求条件。例如，可以有与击发扳机20连接的可变电阻或者弹簧。当击发扳机收回超过特定点或者具有阈值水平以上的力时，电荷存储装置1000可与电池64串联。附加地或者作为替换方式，手柄6可包括医生可以致动以将电荷存储装置1000与电池64串联的外部开关(未示出)。
电荷存储装置1000可以与或不与上面结合图11描述的电流限制装置一起使用。
在器械10使用过程中的一些时候，使电动机65高速运行但输出相对较低的转矩是有利的。在另一些时候，使电动机65低速运行但具有较高转矩输出是希望的。根据多种实施方式，这种功能可以利用如图20所示的具有多个(例如两个或更多)绕组的电动机65来实现。在所示的实施方式中，电动机具有两个绕组。第一绕组1200可具有绕组半部(或部分)1201和1202。第二绕组1204可具有绕组半部(或部分)1206和1208。该实施例中的电动机65可以是具有双极驱动电路1210的6或8引线电动机(例如，见图11和12)。当希望高速低转矩模式时，两组绕组可以串联连接。在该模式，如图20所示，开关S1和S4闭合，且开关S2、S3、S5和S6打开。当希望低速高转矩模式时，两组绕组可以并联连接。在该模式，开关S1和S4打开，且开关S2、S3、S5和S6闭合。两个模式之间转换的能力在不需要另外的移动零件的情况下有效地形成了双速传动。这也允许同一电动机产生高速和高转矩，虽然不是同时。该结构的好处在于其避免使用多个电动机。另外，由于电动机65能够在并联模式产生额外的转矩且在串联模式产生额外的速度，因此有可能消除一些传动装置。另外，可以采用另外的绕组使得可以实现更多操作模式。例如，可以有用于串联和并联绕组连接的多种组合的绕组。同样，一些绕组可以用于感测电动机状态等。
根据多种实施方式，手柄6可包括外部的电动机模式选择开关1220，如图21所示。通过使用开关1220，器械10的操作者可以选择电动机65处于高速低转矩模式或者处于低速高转矩模式。也可以使用其他转换电路来使电动机65在操作模式之间进行转换，例如基于传感器输入而自动转换电动机模式的转换电路。
在电动外科器械，例如上面描述的一个电动内窥镜器械中或者电动圆形切割器械中，电动机可由串联连接的多节电池单体供电。此外，在某些情况下，希望利用电池单体总数的一部分为电动机供电。例如，如图12所示，电动机65可由包括串联连接的6节电池单体310的电池组299供电。电池单体310可以是例如3伏锂电池单体，例如CR 123A电池单体，但在其他实施方式中，可以使用不同类型的电池单体(包括具有不同电压等级和/或不同化学性质的电池单体)。如果将6个3伏的电池单体310串联来为电动机65供电，则可用来供给电动机65的总电压是18伏。电池310可包括可充电或者不可充电电池单体。
在该实施方式中，在最高负荷下，电动机65的输入电压可下降到大约9至10伏。在这种操作条件，电池组299向电动机65传输最大功率。因此，如图12所示，电路可包括选择性地允许电动机65通过(1)所有电池单体310或者(2)部分电池单体310供电的开关312。如图12所示，通过合适选择，开关312可允许电动机65由全部的6节电池单体或者电池单体中的4节供电。这样，开关312可用来为电动机65供应18伏(当使用全部的6节电池单体310时)或者12伏(例如利用第二电池单体的4节)电。在多种实施方式中，用来为电动机65供电的部分中的电池单体数的设计选择可基于操作在用于最高负荷时的最大输出时电动机65需要的电压来进行。
开关312可以是例如机电开关，例如微动开关。在其他实施方式中，开关312可以用固态开关、例如晶体管来实施。诸如按钮开关的第二开关314可用来控制是否向电动机65供电。同样，正向/反向开关316可用来控制电动机65沿正向方向还是沿反向旋转。正向/反向开关316可用双极双掷开关、例如图11中所示的继电器140来实施。
在操作中，器械10的使用者可通过利用控制开关312位置的一些类型的开关控制，例如位置依赖开关(未示出)，例如切换开关、机械摇杆开关或者凸轮来选择希望的功率水平。然后使用者可以激活第二开关314以将选择的电池单体310连接到电动机65。另外，图12中显示的电路可用来为其他类型的电动外科器械的电动机供电，例如圆形切割器和/或腹腔镜器械。关于圆形切割器的更多细节可在公开号为No.2006/0047307A1和公开号为No.2007/0262116A1的公开美国专利申请中找到，该专利申请通过引用结合在此。
在其他实施方式中，如图13中所示，主要电源340，例如电池单体，例如CR2或者CR123A电池单体可用来为多个辅助蓄电装置342充电。主要功率源340可包括一个或多个串联连接的电池单体，其在所示的实施方式中优选为可更换的。辅助蓄电装置342可包括例如可再充电的电池单体和/或超级电容(也被称为“超级电容器”或者“电化学双层电容器”(EDLC))。超级电容器是与通常的电解电容器相比具有非常高的能量密度的电化学电容器，通常处于比高容量电解电容器大几千倍的量级上。
主要功率源340可为辅助蓄电装置342充电。一旦充分地充电，主要功率源340就可移除且辅助蓄电装置342就可在过程或手术期间用来为电动机65供电。在各种情况下，蓄电装置342可用大约15到30分钟来充电。与传统的电池相比，超级电容器具有可极快充电和放电的特性。另外，鉴于电池仅在有限数量的充电/放电循环是良好的，超级电容常常可重复充电/放电，有时数千万个循环。对于利用超级电容器作为辅助蓄电装置342的实施方式，超级电容器可包括碳纳米管、导电聚合物(例如，聚并苯)，或者碳气凝胶。
如图14所示，可采用充电管理电路344来确定辅助蓄电装置342何时被充分充电。充电管理电路344可包括指示器，例如一个或多个LED，LCD显示器等，其被致动以在辅助蓄电装置342充分充电时警告器械10的使用者。
主要功率源340、辅助蓄电装置342以及充电管理电路可以是器械10的手柄6的手枪式握把26中的电池组的一部分，或者是在器械10的其他部分中。电池组可从手枪式握把26拆卸，在该情形中，在器械10用于外科手术时，电池组可由例如帮助手术的巡回护士无菌地插入手枪式握把26中(或者根据其他实施方式插入器械中的其他位置)。在插入电池组后，护士可将可更换的主要功率源340放入电池组中，从而在使用器械10之前的一段时间例如30分钟，为辅助蓄电装置342进行充电。当辅助蓄电装置342充满电时，充电管理电路344可指示电池组可进行使用了。此时，可移除可更换的主要功率源340。在操作过程中，器械10的使用者然后可例如通过致动开关314来致动电动机65，由此辅助蓄电装置342为电动机65供电。因此，不是利用多节一次性电池来为电动机65供电，而是在该实施方式中可利用一节一次性电池(如主要功率源340)，且辅助蓄电装置342是可以再度使用的。然而，在替代的实施方式中，应当注意，辅助蓄电装置342可以是不可充电的和/或是不可再度使用的。辅助蓄电装置342可结合上述结合图12描述的电池选择开关312使用。
充电管理电路344也可以包括指示辅助蓄电装置342中还剩多少电荷的指示器(例如，LED或者LCD显示器)。这样，外科医生(或者器械10的使用者)可看出经过涉及器械10的程序的过程还剩多少电荷。
如图15中所示，充电管理电路344可包括电荷计345用于测量辅助蓄电装置342上的电荷。充电管理电路344还可包括例如闪存或者ROM存储器的非易失性存储器346和一个或多个处理器348。处理器348可连接到存储器346以控制存储器。另外，处理器348可连接到充电计345以读取充电计345的读数或者以其他方式控制充电计345。另外，处理器348可控制充电管理电路344的LED或者其他输出装置。处理器348可将器械10的参数存储在存储器346中。这些参数可包括由各种传感器感测的可安置或采用在器械10中的器械的操作参数，例如击发次数、涉及的力的水平、端部执行器12的相对钳口之间的压缩间隙的距离、关节运动的量等等。另外，存储在存储器346中的参数可包括充电管理电路344可读取和储存的器械10的各个部件的ID值。具有这种ID的部件是可更换的部件，例如钉仓34。ID可以是例如充电管理电路344借助RFID应答器350读取的RFID。RFID应答器350可读取来自器械的包括RFID标签的部件、例如钉仓34的RFID。ID值可被读取、存储在存储器346中，并通过处理器348与存储在存储器346中的可接受的ID值列表或者与充电管理电路相关联的其他存储相比较，以确定例如与读取的ID值相关联的可移除的/可更换的部件是可信的和/或合适的。根据各种实施方式，如果处理器348确定与读取的ID值相关联的可移除的/可更换的部件是不可信的，则充电管理电路344可防止器械10使用电池组，例如通过打开可防止向电动机65传递来自电池组的功率的开关(未示出)。根据各种实施方式，处理器348可评估以确定部件是否可信和/或合适的参数包括：数据编码；部件机型/类型；制造商；区域信息；和之前的错误编码。
充电管理电路344还可以包括i/o接口352用于与如下面描述的其他装置连接。这样，存储在存储器346中的参数可以下载到其他装置中。i/o接口352可以例如是有线或无线接口。
如前已提及的，电池组可包括辅助蓄电装置342、充电管理电路344和/或正向/反向开关316。根据各种实施方式，如图16所示，电池组299可连接到为电池组中的辅助蓄电装置342充电的充电器基座362(还有别的)。充电器基座362可通过在电池组安装在器械10中的同时将充电器基座362无菌地连接到电池组299而与电池组299连接。在电池组可移除的其他实施方式中，充电器基座362可通过将电池组299从器械10移除并将其连接到充电器基座362而与电池组299连接。对于这种实施方式，在充电器基座362为辅助蓄电装置342充分充电时，电池组299可无菌地安装在器械10中。
如图16所示，充电器基座362可包括用于为辅助蓄电装置342充电的电源364。充电器基座362的电源364可以例如是电池(或者一些串联的电池)，或者将例如来自供电网的AC电转换成DC的AC/DC转换器，或者用于为辅助蓄电装置342充电的任何其他合适电源。充电器基座362还可包括指示器装置，例如LED、LCD显示器等来显示辅助蓄电装置342的电荷状态。
另外，如图16所示，充电器基座362可包括一个或多个处理器366、一个或多个存储单元368和i/o接口370、372。通过第一i/o接口370，充电器基座362可与电池组299连接(经由电池组的i/o接口352)。这样，例如存储在电池组299的存储器346中的数据可下载到充电器基座362的存储器368中。这样，处理器366可评估从充电管理电路344下载的用于可移除/可更换部件的ID值，来确定部件的可信度和合适度。从充电管理电路344下载的操作参数也可存储在存储器348中，并然后可经由第二i/o接口被下载到其他的计算机装置用于评估和分析，例如通过执行涉及器械10的操作的医院系统，通过外科医生的办公室，通过器械的分配商，通过器械的制造商等。
充电器基座362还可包括充电计374用于测量辅助蓄电装置342上的电荷。充电计347可与处理器366连接，使得处理器366可实时地确定为确保高执行性而使用的电池组299的适当性。
在另一种实施方式中，如图17所示，电池电路可包括功率调节器320来控制由节电器310供应给电动机65的功率。功率调节器320也可以是电池组299的一部分，或者是单独的部件。如上面提及的，电动机65可是电刷电动机。电刷电动机的速度通常与施加的输入电压成比例。功率调节器320可为电动机65提供高度调节的输出电压，从而电动机65将以恒定的(或大致恒定)速度运行。根据各种实施方式，功率调节器320可包括开关模式的功率转换器，例如图17的实施例中所示的升降压转换器。这种升降压转换器可包括例如FET的电源开关322、整流器32、感应器326和电容器328。当电源开关合上时，输入电压源(例如电源310)直接连接到感应器326，感应器326在该状态储存能量。在该状态，电容器328向输出负荷(例如电动机65)供应能量。当电源开关320处于断开状态时，感应器326连接到输出负荷(例如电动机65)和电容器328，因此能量从感应器326传递到电容器328和负荷65。控制电路330可控制电源开关322。控制电路330可采用数字和/或模拟控制环路。另外，在其他实施方式中，控制电路330可借助通信链路，例如串行或并行数字数据总线，从主控制器(未示出)接收控制信息。用于功率调节器320输出的电压设定点可设置为例如开路电压的一半，在该点可以利用来自电源的最大可用功率。
在其他实施方式中，可以采用不同的功率转换器拓扑结构，包括线性或者开关模式的功率转换器。可以采用包括回扫、正向、降压、升压和SEPIC的其他开关模式拓扑结构。用于功率调节器320的设定点电压可根据正在用来为电动机65供电的电池单体的多少来变化。另外，功率调节器320可与图13所示的辅助蓄电装置342一起使用。此外，正向/反向开关316可结合到功率调节器320中，但在图17中显示的是单独的。
电池可通常被模拟为理想电压源和源电阻。对于理想模型，当源和负荷电阻匹配时，传递给负荷最大功率。图18示出了电池的典型功率曲线。当电池电路打开时，电池两端的电压很高(在其开路值)且从电池吸取的电流为零。从电池传递的功率也为零。随着从电池吸取的电流越多，电池两端的电压越小。由电池传递的功率是电流和电压的乘积。在小于开路电压的电压水平周围，功率达到其峰值。如图18所示，由于化学性质或者正温度系数(PTC)，或者由于电池保护装置，对于大多数电池化学性质来说，在更高电流处电压/功率具有剧烈的下降。
尤其是在过程中利用电池(或多节电池)来为电动机65供电的实施方式来说，控制电路330可监控输出电压并控制调节器320的设定点，从而电池运行在功率曲线的“左”或者功率增加侧。如果电池达到了峰值功率水平，则控制电路330可改变(例如降低)调节器的设定点，从而需要来自电池的更少总功率。电动机65然后可减速。这样，来自电池组的需求很少超过可用的功率峰值(即使会超过的话)，从而可以避免过程中功率不足的情况。
另外，根据其他实施方式，从电池吸取的功率可以按电池中的化学反应需要时间来恢复的方式来优化，以此来优化电流和电池可用的功率。在脉冲负荷中，电池通常在朝向脉冲结尾的脉冲的开始处提供更多的功率。这缘于多个因素，包括：(1)PTC可能在脉冲过程中改变其电阻；(2)电池的温度可能改变；以及(3)由于阴极的电解液正被耗尽而使电化学感应速率发生变化且新鲜电解液的扩散速率限制了反应速率。根据各种设施方式，控制电路330可以控制转换器320，使得其从电池吸取更少的电流以允许电池在再次脉冲之前恢复。
如上面提及的，根据各种实施方式，电池组299可包括多节电池单体310。图22示出了具有6节电池单体310的实施方式。电池单体310可以例如是锂一次电池。根据各种实施方式，电池组299可只具有内部连接的电池的一部分。例如，如图22所示，电池单体310a连接到电池310b，电池单体310c连接到电池单体310d，且电池单体310e连接到电池单体310f。然而，电池单体310b并不在电池组中内部连接到单体310c，且电池单体310d并不在电池组中内部连接到电池单体310e。这种实施方式中的器械10的手柄6可包括仅在电池组299物理地插入器械10中时将电池单体310串联连接的电池单体连接器1300。例如，连接器1300可包括正输出端1302、将电池单体310b串联至电池单体310c的连接器1304、将电池单体310d连接至单体310e的连接器1306以及负输出端1308。
图23示出了器械10的一种实施方式，其中可更换、可移除的电池组299安置于器械10的手柄6中。如图23所示，电池单体连接器1300可集成到手柄6中，使得在电池组299插入手柄6中时，电池单体连接器1300形成必要的电池单体连接。
当然，在其它实施方式中，可以使用具有不同数量内部单体和不同数量的内部连接单体的电池组。例如，图24示出了具有6节单体310a-f的实施方式，其中两组3节单体(单体310a-c和单体310d-f)连接在一起。
这里公开的装置可设计成在一次使用后丢弃，或者可设计成多次使用。然而，在任一种情况下，装置可在至少一次使用后修复以备再次使用。修复可包括装置的拆卸、接着清洗或更换特定部件和随后的重新组装这些步骤的任意组合。特别地，该装置可以被拆卸，任何数量的特定部件或零件可以有选择地以任意组合被更换或去除。在清洗和/或替换特定部件之后，该装置可在修复设备中或在即将进行手术程序之前由手术队进行重新组装以便以后使用。本领域普通技术人员将会理解对该装置的修复可利用用于拆卸、清洗/替换、和重新组装的各种技术。这些技术的使用以及产生的修复好的装置也全都在本申请的保护范围内。
优选地，本文中公开的本发明将在外科手术前被处理。首先，获取新的或者使用过的器械并在需要的情况下对其进行清洁。该器械然后进行灭菌。在一种灭菌工艺中，器械被放置在闭合且密封的容器中，诸如用一片TYVEK(高密度聚乙烯合成纸袋)覆盖的热成形塑料壳。容器和器械然后被放置在可穿透容器的辐射场中，诸如γ射线、x射线或者高能电子。辐射杀死器械上以及容器中的细菌。灭菌后的器械然后可被储存在无菌容器中。密封的容器保持器械处于无菌状态，直到其在医学设施中被打开。
优选使装置被灭菌。这可以通过本领域技术人员已知的多种方式，包括β或者γ射线、环氧乙烷、蒸汽和其它方法来完成。
尽管已经通过若干实施方式示出了本发明且所示的实施方式已经描述得相当详细了，但申请人并不意于将权利要求的范围局限于这样的细节。本领域的技术人员可以想到其它优点和变型。本发明的各种实施方式表现出对现有的需要在单个钉仓中使用不同尺寸的缝钉以实现具有不同成形(最终)高度的缝钉的端部执行器的巨大进步。
相应地，本发明针对内窥镜式手术和设备进行了讨论。然而，这里使用的术语例如“内窥镜式”不应当被解释为将本发明限制于仅结合内窥镜管(即，套管针)使用的外科缝合和切割器械。相反，相信本发明可以应用于接近受限的任何手术，包括但不限于腹腔镜式手术以及开放式手术。而且，本发明的各种钉仓实施方式的独特和新颖方面可在结合其它形式的缝合设备使用时找到应用，同样不脱离本发明的精神和范围。

Claims (10)

1.一种外科器械，包括：
端部执行器，其包括可动的切割器械；
轴，其远端连接到所述端部执行器；以及
手柄，其连接到所述轴的近端，其中所述手柄包括：
电动机，其用于致动所述切割器械；
电动机控制电路，其用于控制所述电动机，其中，所述电动机控制电路包括：
电源，其连接到所述电动机用于为所述电动机供电；
电荷存储装置；以及
开关电路，其连接到所述电源和所述电荷存储装置，用于(i)将所述电荷存储装置暂时地连接到所述电源以为所述电荷存储装置充电，并且(ii)将所述电荷存储装置选择性地与所述电源串联以为所述电动机提供额外的功率。
2.如权利要求1所述的外科器械，其中，所述电荷存储装置包括电容器。
3.如权利要求2所述的外科器械，其中，所述电荷存储装置包括超级电容器。
4.如权利要求1所述的外科器械，其中，所述电源包括多个串联的电池单体。
5.如权利要求4所述的外科器械，还包括连接到所述电源的电源选择开关，用于在第一状态时将所有的电源连接到所述电动机，且在第二状态时将一部分电源连接到所述电动机。
6.如权利要求1所述的外科器械，其中，所述端部执行器包括圆形切割端部执行器。
7.如权利要求1所述的外科器械，其中，所述端部执行器包括线性切割端部执行器。
8.如权利要求1所述的外科器械，其中，所述电动机控制电路还包括连接到所述电源的电流控制电路，用于改变从所述电源供应至所述电动机的电流，使得所述电动机具有至少：
用于所述切割器械的切割行程循环的第一部分的第一低功率运行模式；以及
用于所述切割器械的切割行程循环的第二部分的第二高功率运行模式。
9.如权利要求1所述的外科器械，其中：
所述电动机包括至少两个绕组；以及
所述电动机控制电路用于使所述至少两个绕组选择性地串联或者并联。
10.一种外科器械，包括：
端部执行器，其包括可动的切割器械；
轴，其远端连接到所述端部执行器；以及
手柄，其连接到所述轴的近端，其中所述手柄包括：
电动机，其用于致动所述切割器械，其中所述电动机包括至少两个绕组；
电动机控制电路，其连接到所述电动机并使所述至少两个绕组选择性地串联或者并联。
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