CN101849846A - 铰接手术装置 - Google Patents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
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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
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/2833—Locking means
- A61B2017/2837—Locking means with a locking ratchet
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2901—Details of shaft
- A61B2017/2905—Details of shaft flexible
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/2909—Handles
- A61B2017/291—Handles the position of the handle being adjustable with respect to the shaft
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- 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
- A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
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- A61B2018/1432—Needle curved
Abstract
一种用于执行手术的手术装置,其一般包括手柄组件、从手柄组件延伸出来的细长部件、可操作地连接到手柄组件的铰接机构和末端执行器。所述细长部件具有铰接段和直部。所述铰接段被配置为相对于直部铰接。所述铰接机构可操作地连接手柄组件和铰接段,使得在手柄组件相对于直部向第一方向移动时,铰接段相对于直部朝第一方向铰接。末端执行器可操作地连接到细长部件的铰接段并包括第一和第二钳口部件。所述手术装置进一步包括被配置为锁定第一和第二钳口部件的相对位置的锁定机构。
Description
相关申请的交叉引用
本公开要求于2008年8月4日提交的申请号为61/085,997的美国临时专利申请的优先权和利益,该申请的全部内容通过引用合并于此。
技术领域
本公开涉及内窥镜手术装置,特别涉及能够多角度铰接的内窥镜手术装置。
背景技术
内窥镜手术是一种最小侵入技术,其用于执行体内手术而不需要大的切口。典型地,内窥镜手术是通过将多个端口通过患者皮肤上的小切口插入而到达手术位置来执行的。端口之一容纳内窥镜,内窥镜是一个类似于摄像机的装置。外科医生通过内窥镜观察手术位置并且借助于将不同的手术装置通过这些端口插入患者体内而执行手术。在内窥镜手术过程中,外科医生可以将不同的手术装置通过这些端口引入。例如,外科医生可以插入手动内窥镜抓握器、解剖器、大剪刀、剪刀以及类似物。这一技术不需要“打开”患者,是一种比传统的手术操作减少了侵入伤害的手术。
为了减少所需的切口数量,单一切口操作和相关的手术装置已经发展了很多年。例如,外科医生可以制造一个切口并且操作手术装置穿过患者身体直到达到期望的手术位置。但是,操纵手术装置通过复杂的人体解剖结构通常是复杂的。鉴于这一困难,需要一种手术装置,其能够多角度操作和运动。
发明内容
本公开涉及一种能够多角度铰接的手术装置。这一手术装置通常包括手柄组件、从手柄组件延伸出的细长部件、可操作地与手柄组件联结的铰接机构以及末端执行器。细长部件具有铰接段(articulating section)和直部。该铰接段被配置为关于直部铰接。铰接机构可操作地与手柄组件和铰接段联结,使得在手柄组件相对于直部朝向第一方向运动时,铰接段相对于直部朝着第一方向铰接。该末端执行器可操作地联结到细长部件的铰接段并且包括第一和第二钳口部件。第一和第二钳口部件被配置为相对于彼此在打开位置和接近位置之间运动。该手术装置进一步包括锁定机构,其被配置为用于固定第一和第二钳口部件的相对位置。该锁定机构包括设置在手柄组件内的第一棘齿组件和第二棘齿组件。第一和第二棘齿组件可以相对于彼此在将第一和第二钳口部件的相对位置锁定的接合位置和将第一和第二钳口部件的相对位置解锁的脱离位置之间运动。
附图说明
在此结合附图描述本公开的手术装置的实施例,其中:
图1是根据本公开的一个实施例的手术装置的后视立体图;
图2是图1的手术装置的侧视图,其中铰接段处于直立位置;
图3是图1的手术装置的侧视图,其中铰接段处于铰接位置;
图4是图1的手术装置的顶视图,其中铰接段处于直立位置;
图5是图1的手术装置的顶视图,其中铰接段处于铰接位置;
图6是图1的手术装置的前视立体图;
图7是图1的手术装置的末端执行器和铰接段的立体截面图,其显示了围绕图1中的区域7所包含的部分并显示了覆盖该手术装置的铰接段的护套(sheath);
图8是图1的手术装置的末端执行器和铰接段的立体截面图,显示了不带有图7中所示的护套的铰接段;
图9是图1的手术装置的手柄组件的剖面透视图,其显示了该手柄组件的内部元件;
图10A是图1的手术装置的分解立体图;
图10B是图1的手术装置的准直管的侧视图;
图10C是图10B中所示的准直管的前视图;
图10D是图1的手术装置的转轮的前视图;
图10E是沿图10D的剖面线10E-10E剖开的图10D中所显示的转轮的截面图;
图11A是图1的手术装置的铰接机构、末端执行器和铰接段的分解立体图;
图11B是图1的手术装置的转矩轴的侧视图;
图11C是在图11B中显示的转矩轴的近端转矩管的侧视图;
图11D是图1的手术装置的转轮、远端管状部件388和近端转矩管456的立体图;
图12是沿图11A的剖面线12-12剖开的图11A中的铰接机构的铰接缆线板和铰接锁定环的立体截面图;
图13是图1的手术装置的铰接段的一部分的前视分解图;
图14是图1的手术装置的铰接段的一部分的后视分解图;
图15是图1的手术装置的铰接段的立体图,显示了铰接缆线经过铰接链环和铰接段的远侧外管;
图16是沿图9中的剖面线16-16剖开的图9中的手柄组件的后视截面图;
图17是图1中的手术装置的侧视截面图;
图18是沿图17中的剖面线18-18剖开的图1中手术装置的后视截面图;
图19是沿图17中的剖面线19-19剖开的图1中的手术装置的后视截面图;
图20是围绕图17中区域20内的图1中的手术装置的末端执行器和铰接段的侧视截面图;
图21是围绕图17中区域21内的图1中的手术装置的手柄组件的一部分的侧视截面图;
图22是沿图21中的剖面线22-22剖开的图1中的手术装置的手柄组件的一部分的后视截面图;
图23是图1中的手术装置在沿其纵轴经历不同旋转阶段的末端执行器和铰接段的立体图;
图24是图1中的手术装置的手柄组件的立体剖面图;
图25是图1中的手术装置的铰接机构的一部分的立体图;
图26是图1中的手术装置的铰接机构的侧视截面图,显示了相对于手柄组件的球向上运动的杯;
图27是图1中的手术装置的末端执行器和铰接段的侧视截面图,显示了铰接段处于铰接位置;
图28是图1中的手术装置的铰接机构的一部分的侧视剖面图,显示了被致动的铰接锁定触发器;
图29是图1中的手术装置的铰接机构的一部分的侧视剖面图,描绘了响应于图28所显示的铰接锁定触发器的致动,铰接缆线向近端移动;
图30是图1中的手术装置的手柄组件的一部分的侧视截面图,显示了被致动的可移动拇指环;
图31是图1中的手术装置的末端执行器和铰接段的一部分的侧视截面图,显示了末端执行器响应于图30中所显示的可移动拇指环的致动向接近位置运动;
图32是根据本公开的另一个实施例的手术装置的立体图,显示了包括剪切刀片的末端执行器;
图33是图32的手术装置的末端执行器和铰接段的一部分的立体图;
图34是图32的手术装置的末端执行器的立体分解图;
图35是图32的手术装置的铰接段和末端执行器的侧视截面图;
图36是根据本公开的进一步的实施例的手术装置的立体图,显示了包括抓钳的末端执行器;
图37是图36的手术装置的末端执行器的立体图;
图38是图36的手术装置的末端执行器的立体分解图;
图39是图36的手术装置的铰接段和末端执行器的侧视截面图;
图40是上述显示的手术装置的任一实施例的锁定机构的立体图;
图41是图40中的锁定机构的释放组件的立体图;
图42是图40中的锁定机构在锁定位置的侧视截面图;
图43是图40中的锁定机构在解锁位置的侧视截面图;
图44是根据本公开的另一实施例的手术装置的立体图,显示了具有探针(probe)的末端执行器;
图45是图44中的手术装置的末端执行器和铰接段的一部分的立体图;
图46是图44中的手术装置的末端执行器和铰接段的侧视截面图;
图47是图44中的手术装置的手柄组件的侧视剖面图;
图48是图44中的手术装置的侧视图,显示了在铰接位置的铰接段;
图49是图44中的手术装置的顶视图,显示了在铰接位置的铰接段;
图50是用于结合在上述任一实施例的手术装置中的矫直机构的一个实施例的侧视剖面图;
图51是图50中的矫直机构的前视图;
图52是图50中的矫直机构的前视图,其带有用于将铰接机构固定在中间位置的棘爪;
图53是矫直机构的另一实施例的侧视剖面图,其带有用于结合在上述任一实施例的手术装置中的螺旋弹簧;
图54是矫直机构的一个实施例的侧视截面图,其包括用于结合在上述任一实施例的手术装置中的弹性罩(elastomeric boot);
图55是矫直机构的一个实施例的侧视截面图,其带有用于结合在上述任一实施例的手术装置中的弹性部件;
图56是矫直机构的一个实施例的侧视截面图,其带有用于结合在上述任一实施例的手术装置中的超弹部件;
图57是矫直机构的一个实施例的侧视剖面图,其带有用于结合在上述任一实施例的手术装置中的细长球体;
图58是矫直机构的一个实施例的侧视剖面图,其带有用于结合在上述任一实施例的手术装置中的弹性带;
图59是矫直机构的一个实施例的侧视截面图,其带有用于结合在上述任一实施例的手术装置中的近侧定位弹簧;
图60是矫直机构的一个实施例的侧视截面图,其带有用于结合在上述任一实施例的手术装置中的远侧定位弹簧;以及
图61是矫直机构的一个实施例的侧视截面图,其带有用于结合在上述任一实施例的手术装置中的环和弹簧。
具体实施方式
在此将参考附图对本公开的手术装置的实施例进行详细描述,其中在每个视图中,相似的附图标记代表相同的或相应的元件。在此,术语“远侧”表示手术装置或其部件的远离使用者的部分,而术语“近侧”表示手术装置或其部件的更接近使用者的部分。
图1显示了以附图标记100表示的内窥镜手术装置。手术装置100一般包括手柄组件300和从手柄组件300向远侧延伸出的内窥镜组件200。手柄组件300被配置为相对于内窥镜组件200运动。内窥镜组件200具有细长构型并可操作地与手柄组件300结合。在某些实施例中,手柄组件300可以仅由单手握持和操作。
如图2-6所示,内窥镜组件200包括具有近端212和远端214的细长外管210。细长外管210的近端212被固定于手柄组件300上。在图2所示的实施例中,细长外管210是直的构型并沿所述构型限定了纵轴“X”;但是,细长外管210可以具有弯曲的构型。在某些实施例中,细长外管210完全或部分由基本上刚性或硬的生物相容材料制成,例如聚醚醚酮(PEEK)、钛合金、铝合金、不锈钢、钴铬合金或上述材料的任何组合。
继续参考图2-6,内窥镜组件200进一步包括支撑在细长外管210的远端214上的铰接段230。铰接段230具有近端236和远端238,并且被配置为在手柄组件300相对于细长外管210朝特定方向运动时相对于细长外管210朝同一方向铰接。
当手柄组件300如图2和图4所示定位在中间位置时,细长外管210和铰接段230彼此沿纵向对齐。当手柄组件300相对于细长外管210朝某一方向运动时,铰接段230朝相同的方向铰接。例如,操作者可以相对于细长外管210向上移动手柄组件300以使铰接段230相对于细长外管210向上铰接,如图3所示。除了这一向上运动之外,操作者可以相对于细长外管210横向地移动手柄组件300以使铰接段230相对于细长外管210横向地铰接,如图5所示。尽管附图仅显示了铰接段230的向上和横向运动,但铰接段230具有多角度的运动。不考虑特定运动角度,铰接段230相对于细长外管210的运动反映出(mirror)手柄组件300相对于细长外管210的运动。
参考图6-8,内窥镜组件200进一步包括可操作地联结在铰接段230的远端238上的工具组件或末端执行器260。在特定实施例中,铰接段230包括覆盖铰接段230的至少一部分的护套270。护套270(全部或部分)由任何适合的弹性材料制成。在某些实施例中,护套270由生物相容性聚合物制成。手术装置100的其他实施例不包括护套270。铰接段230附加地包括至少两个铰接链环232、234,其配置为用于可相对于彼此做枢转运动。但是,铰接段230可以包括更多的铰接链环。在图示的实施例中,铰接段230包括十(10)个铰接链环232、234。可以理解,可以给铰接段230提供更多数目的铰接链环232、234以提供更多的铰接角度。不管铰接链环232、234的精确数目是多少,铰接链环232、234允许铰接段230相对于细长外管210铰接。特别地,铰接段230可以从与细长外管210纵向对齐的第一位置移动到不与细长外管210纵向对齐的多种位置。
如上所述,铰接段230可操作地与末端执行器260联结。尽管附图显示了特定种类的末端执行器260,但是可以预想手术装置100可以包括任何适于接合组织的末端执行器。例如,手术装置100的一个实施例包括在公开序列号为2009/0012520、于2008年9月19日提交的美国专利申请中所描述的末端执行器,其全部内容通过引用合并于此。
末端执行器260包括第一钳口部件262和第二钳口部件264,两者彼此枢转地联结。第一和第二钳口部件262、264被配置为从第一或打开位置向第二或接近位置移动。在第一位置,第一和第二钳口部件262、264彼此分隔开,在它们之间可以容纳组织(参见图7和图8)。在第二位置,第一和第二钳口部件262、264彼此接近,并且可以抓住或夹住位于它们之间的任何组织(参见图31)。
第一和第二钳口部件262、264中的每一个包括组织接合表面266、268和壳体276、278。组织接合表面266、268中的每一个包括沿其长度延伸的齿272、274。当第一和第二钳口部件262、264位于接近位置时,齿272、274帮助抓住位于第一和第二钳口部件262、264之间的组织。
在某些实施例中,组织接合表面266、268由电传导材料制成,壳体276、278由电绝缘材料形成。这样,组织接合表面266、268适于接收电手术能量并且将电手术能量传导给被抓握在第一和第二钳口部件262、264之间的组织。第一和第二钳口部件262、264彼此之间电隔离,形成双极布置。这一电布置允许第一和第二钳口部件262、264有效地经组织传递电能量。在双极布置中,电流从一个组织接合表面(266或268)经被抓握的组织传递给另一个组织接合表面(266或268)以形成一个完整回路。在一个可选的实施例中,手术装置100具有单极电布置。在这一实施例中,末端执行器260将电手术能量传递给被抓握在第一和第二钳口部件262、264之间的组织,该电手术能量通过患者身体,直到它到达患者回路电极板(patient return electrode)(未示出)以形成一个完整的电路。该患者回路电极板与手术装置100电力耦合。使用者可以控制施加到组织的电手术能量的密度、频率和持续时间以烧灼、解剖、凝结、干燥、密封和/或仅仅减少或减缓在医学操作中的出血。由第一和第二钳口部件262、264接收的电手术能量由电手术发生器(electrosurgical generator)(未示出)或任何其他适合的电手术能量源产生。在特定的实施例中,手术装置100电力耦合于电手术发生器,所述电手术发生器包括被配置为用于提供DC电压的高电压直流电(HVDC)电源、用于平滑HVDC向DC电平转化的输出滤波器,和联结于HVDC并被配置为将HVDC所产生的DC能量转变成射频能量的射频(RF)输出级。在某些实施例中,手术装置100电力耦合于在申请日为2003年5月8日、专利号为RE40,388的美国专利中所描述的电手术发生器,其全部内容通过引用合并于此。
参考图9和图10,手柄组件300被配置为机电地联结于电手术发生器(未示出)并包括除其他以外用于容纳至少铰接机构330的某些部件的壳体340。如图10A所示,壳体340包括第一半340a和第二半340b,两者构造为相互连接。在一些实施例中,第一和第二半340a、340b可以由聚合物(或其他任何适合的材料)制成。第一和第二半340a、340b共同形成用于容纳铰接机构330的球331的杯332。杯332设置在手柄组件300的远端部分344(图9)上。手柄组件300进一步包括设置在其近端部分342(图9)上的可移动拇指环301。可移动拇指环301可操作地连接到末端执行器260(图7)并被配置为相对于壳体340向上和向下运动。在不同的实施例中,可移动拇指环301枢转地固定在壳体340上。相对于壳体340运动可移动拇指环301引起末端执行器260在打开位置和接近位置之间移动,如下面所详述的。可移动拇指环301限定了尺寸设计为容纳使用者手指的孔346。孔346设置在可移动拇指环301的近端部分358上。可移动拇指环301的至少远端部分360设置在壳体340内。
手柄组件300进一步包括手指环302,其限定了一个尺寸设计为容纳使用者手指的开口348。手指环302相对于壳体340保持固定。手指环302包括纵向腔352(图10A),其用于保持杆(post)350,所述杆350适于促进手术装置100和电手术发生器(未示出)之间的机电联结。杆350部分地设置在手指环302内,其全部或部分地由电传导材料制成。在一个实施例中,电热绝缘护套(未示出)包绕杆350的处于手指环302外的部分。这一绝缘护套可以保护使用者,防止在手术装置100的操作过程中电流通过杆350传导给使用者。杆350的处于手指环302内的部分机电联结于由导电材料制成的电连接器356。电连接器356延伸通过手指环302并进入壳体340的内部。电连接器356的处于壳体340内部的部分与由导电材料制成的准直管207机电配合地布置。准直管207围绕致动缆线205的一部分(图10A)。在某些实施例中,致动缆线205由导电材料制成。在这些实施例中,经过准直管207传导的电流可以到达致动缆线205。
致动缆线205的近端250(图10A)可操作地连接到可移动拇指环301的远端部分360。在特定的实施例中,可移动拇指环301的远端部分360限定了纵向凹槽362,所述纵向凹槽362相对于致动缆线205横向排列。纵向凹槽362的尺寸设计为容纳销364。销364具有与致动缆线205纵向对齐的孔366。纵向孔366适于容纳致动缆线205的近端250。套圈(ferrule)368围绕内轴205的近端250并将致动缆线205的近端250保持在销364的纵向孔366内。销364进而将致动缆线205的近端250连接到可移动拇指环301的远端部分360。准直管207被卷曲连接到销364远侧的致动缆线205上。因此,套圈368和准直管207将销364夹在中间,保持致动缆线205和销364之间的轴向关系。相应地,当销364移动时,致动缆线205也移动。但是,致动缆线205能相对于销364轴向旋转。
如图10B和图10C所示,准直管207不具有圆形的外截面形状。替代地,准直管207具有一个或多个平的侧面。准直管207的至少一个侧面可以是圆形轮廓。准直管207的非圆形外截面部分对应于内部通道399的内截面部分,内部通道399延伸通过转轮303的近端细长部分386(图10A、图10D和图10E)。因此,当转轮303旋转时,准直管207也旋转并且,由于准直管207被卷曲连接于致动缆线205,所以致动缆线205也将旋转。
可移动拇指环301被配置为相对于壳体340移动以致动末端执行器260。在各种实施例中,可移动拇指环301可以朝向和远离手指环302枢转。当操作者朝手指环302移动可移动拇指环301时,致动缆线205在近侧方向平移。作为这一近侧平移的结果,末端执行器260的第一和第二钳口部件262、264从打开位置(图20)运动到接近位置(图31)。另一方面,将可移动拇指环301远离手指环301推进了致动缆线205在远侧平移。响应于这种远侧平移,末端执行器260的第一和第二钳口部件262、264从接近位置(图31)运动到打开位置(图20)。
手柄组件300也包括安装在准直管207上的转轮303。转轮303被配置为相对于壳体340旋转。转轮303的某些部分伸出壳体340,以允许操作者能接触到转轮303。转轮303的其他部分被固定在壳体340内。壳体340包括第一内壁370和第二内壁372,两者相互隔开。第一和第二内壁370、372限定了它们之间的间隙374(图10A)。间隙374尺寸设计为适于容纳转轮303的至少一部分并且布置为与壳体340的第一半340a的第一槽376(图10A)以及壳体340的第二半340b的第二槽378(图10A)连通。转轮303的至少某些部分通过第一和第二槽376、378伸出壳体340,因此提供到达转轮303的入口。第一和第二内壁370、372中的每一个限定了用于容纳转轮303的一部分的凹槽382和384(图10A)。特别地,内壁370的凹槽382支撑转轮303的近侧细长部分386。近侧细长部分386从转轮303向近侧延伸并围绕准直管207的至少一部分(参见图9)。第二内壁372的凹槽384支撑可释放地连接到转轮303的远端的远侧管状部件388。
参考图11B和图11C,转矩轴499具有近端部分495和远端部分497,并且在操作过程中,将旋转转矩从转轮303(图11A)传递给末端执行器260(图8)。转矩轴499的远端部分497可操作地连接到联结部件222,同时转矩轴499的近端部分495联结于转轮303(图21)。转矩轴499包括近侧转矩管456、近侧转矩线圈468、远侧转矩管492和远侧转矩线圈494。转矩轴499的每个部件都相互连接。在特定的实施例中,包括转矩轴499的全部部件被焊接在一起,并且远侧转矩线圈494被焊接到联结部件222。在某些实施例中,近侧转矩线圈468和远侧转矩线圈494都是由ASAHI INTECCCO.,LTD所售的三层转矩线圈或等同物制成。转矩线圈的不同层具有相反的卷绕方向,这样线圈可以在任一方向被旋转而不会松开。如图11C所示,近侧转矩管456的近端包括菱形压花式样部分457。
参考图11D,旋转转轮303使得近侧转矩管456朝同一方向旋转。转矩和所导致的旋转接着经转矩轴499的其他部件传递给联结部件222,从而旋转末端执行器260(参见图23)。转轮303包括多个设置在其周边的波浪形(undulation)380和四个远侧延伸部件381。波浪形380符合人体工程学地被配置为容纳使用者的手指和方便使用者旋转转轮303。近侧转矩管456以菱形压花式样部分457的至少一部分接触四个远侧延伸部件381的内表面而安装在四个远侧延伸部件381内。远侧管状部件388被设置在四个远侧延伸部件381之上。远侧管状部件388限定了一个其尺寸设计为适于容纳四个远侧延伸部件381的纵向开口390并且包括围绕其远端设置的凸缘392。远侧管状部件388的纵向开口390接触四个远侧延伸部件381的外表面。纵向开口390的内径被这样设置:使得当远侧管状部件388被放置在四个延伸部件381和近侧转矩管456之上时,四个延伸部件381被压进菱形压花式样部分457,产生压配合。
继续参考图9和图10,铰接机构330包括设置在转轮303远侧的铰接锁定触发器304,所述铰接锁定触发器304被配置为锁定铰接段230(图2)相对于细长外管210的位置。铰接锁定触发器304可操作地联结于铰接缆线板311并能够相对于壳体340运动。在几个实施例中,铰接锁定触发器304可以相对于壳体340在第一或解锁位置和第二或锁定位置之间枢转。当操作者将铰接锁定触发器304从解锁位置朝锁定位置移动时,铰接缆线板311相对于壳体340向近侧移动以锁定铰接段230相对于细长外管210的位置,如下面所详细讨论的。在描述的实施例中,铰接锁定触发器304限定了制动凹口(detent recess)398,所述制动凹口398设置在近侧表面上并且适于容纳铰接缆线板311的制动装置(detent)394。当铰接锁定触发器304设置在锁定位置时,铰接缆线板311的制动装置394接合制动凹口398。铰接锁定触发器304也包括定位于壳体340内的至少一个突出物(tab)396。在某些实施例中,铰接锁定触发器304包括设置在铰接锁定触发器304相反两侧的两个突出物396。
参考图11和图12,铰接机构330包括部分地围绕铰接缆线板311的铰接锁定环400。铰接锁定环400限定了一个尺寸设计为适于容纳铰接缆线板311的开口404(图11A)并且包括多个从其中向近侧延伸的锁定指402。锁定指402沿铰接锁定环400的周边设置,其(全部或部分)可以由弹性材料制成。铰接锁定环400设置在壳体340(图9)的杯332的内部并且包括彼此径向相对的两个横向槽406(图11A)。每个横向槽406适于容纳球331的延伸部件408。在某些实施例中,球331包括彼此径向相对的两个延伸部件408。每个延伸部件408从球331向近侧延伸。当球331的延伸部件408接合铰接锁定环400的槽406时,球331相对于铰接锁定环400的旋转被阻止,或至少被阻碍。球331进一步包括搭扣配合制动装置(snap-fit detent)410,或其他任何的适于帮助稳固球331和铰接锁定环400之间的接合的装置、机构或工具。搭扣配合制动装置410被配置为稳定地接合沿铰接锁定环400的内表面以及指402之间设置的接合壁412。
如图11A所示,铰接锁定环400部分地围绕铰接缆线板311。铰接缆线板311具有细长部分414和缆线接合部分416。铰接缆线板311的细长部分414具有近端418和远端420并且限定了近端418处的开口422和延伸通过其中的钻孔424。开口422通向钻孔424,开口422的尺寸设计为适于容纳近侧转矩管456(图12)。钻孔424也尺寸设计为适于容纳环形轮轴310的细长部分458(图10A)。
继续参考图12,铰接缆线板311的缆线接合部分416联结于细长部分414的远端420并且限定了内腔426。在某些实施例中,缆线接合部分416具有截头圆锥形状。内腔426与钻孔424连通。另外,缆线接合部分416包括连接到细长部分414的近侧部分428和限定了多个沟槽432的远侧部分430。沟槽432沿缆线接合部分416的远侧部分430的周边设置,每个沟槽被构造为容纳一条铰接缆线240(图11A)和套圈或卷筒(crimp)242(图11A)。
参考图12,铰接机构330包括一根或多根可操作地联结于铰接缆线板311的铰接缆线240。在图示的实施例中,四条铰接缆线240可操作地连接到铰接缆线板311。套圈242将四个铰接缆线240的每一个保持在铰接缆线板311内。特别地,套圈242设置在铰接缆线板311的沟槽432内,沟槽432围绕和容纳铰接缆线240的一部分,因此保持铰接缆线240与铰接缆线板311连接。
参考图13-15,铰接缆线240可操作地联结于铰接段230(也参见图20)。铰接段230包括多个铰接链环232、234(也参见图11A)、远侧外管220和联结部件222。在特定的实施例中,联结部件22是关节联结器。每个铰接链环232、234都限定了至少一个适于容纳铰接缆线240(图15)的钻孔224和适于容纳远侧转矩管492(图20)的中心开口226。在图示的实施例中,每个铰接链环232、234包括四个围绕中心开口226设置的钻孔224。铰接链环232、234进一步包括从那里向远侧延伸的延伸部件228和用于容纳延伸部件228的凹槽244(图14)。凹槽244设置在每个铰接链环232、234的近侧表面246上。铰接链环232、234的近侧表面246中的每一个具有成形轮廓。近侧表面246的该成形轮廓被配置为与铰接链环232、234的远侧表面248的成形轮廓相配合。尽管近侧表面246和远侧表面248相互配合,但这两个表面246、248的成形轮廓提供给铰接链环232、234相对于彼此运动的一定的运动度。另外,铰接链环232、234虽然基本上相同,但它们相对于彼此具有不同的定向。在某些实施例中,铰接链环232相对于铰接链环234以90度定位,如图13所示。
继续参考图13-15,远侧外管220具有成形为配合铰接链环232或234的远侧表面248的近侧表面254,从而允许相邻的铰接链环232或234相对于远侧外管220移动。凹槽282被限定在近侧表面254上,每个凹槽282被配置为容纳铰接链环232、234的延伸部件228。远侧外管220的近侧表面254进一步限定了一个或多个尺寸设计为容纳铰接缆线240的孔258。在图示的实施例中,远侧外管220具有四个孔258。但是,可以预想的是远侧外管22可以具有更多或更少的孔258。此外,远侧外管220限定了适于容纳联结部件222的至少一部分的中间开口256和至少一个用于将铰接缆线240的一部分保持在远侧外管220内的沟槽284。在某些实施例中,远侧外管220包括四个围绕远侧外管220的内表面设置的沟槽284。另外,远侧外管220包括两个设置在每个沟槽284的相反两侧的保持壁286以便将铰接缆线240保持在沟槽284内(也参见图15)。
继续参考图13-15,联结部件222包括两个在其间限定一定空间的腿288和近侧突起292。联结部件222的每个腿288包括贯通孔(transverseopening)298和沿其内表面设置的纵向轨道202。联结部件222的近侧突起292限定了适于容纳密封件或环带294的环形凹槽296。在图示的实施例中,环带或密封件294基本上呈C形。当环带294放置在凹槽296内并且近侧突起292放置在远侧外管220的内部时,环带294有助于将联结部件222固定到远侧外管220。当突起292被放置在远侧外管220内时,部分环带294经远侧外管220的圆周槽221伸出,将联结部件222固定于远侧外管220。远侧外管220可以具有一个或多个圆周槽221。在图示的实施例中,远侧外管220具有四个沿其周边设置的圆周槽221。
参考图16,铰接缆线240可操作地联结于铰接锁定触发器304。在某些实施例中,铰接锁定触发器304包括两个设置在铰接锁定触发器304相对两侧上的突出物396,如上所述。铰接锁定触发器304可以相对于壳体340在锁定位置和解锁位置之间移动,如下面所详细讨论的。当铰接锁定触发器304设置在锁定位置时,铰接机构330(图9)固定铰接缆线240的位置,因此阻止或至少妨碍铰接段230相对于纵轴“X”的铰接(参见图2)。反之,当铰接锁定触发器304设置在解锁位置(图16)时,铰接机构330(图9)允许铰接段230相对于纵轴“X ”铰接(参见图2)。在解锁位置,铰接锁定触发器304的突出物396安置在壳体340的内部肋322上,因此将铰接锁定触发器304保持在解锁位置。
如图17-19所示,手术装置100的一个实施例包括四(4)条铰接缆线240A、240B、240C和240D。每个铰接缆线240A、240B、240C、240D从铰接缆线板311向铰接段230延伸。当延伸穿过手术装置100时,铰接缆线240A、240B、240C、240D将它们的位置改变了180度(参见图18和图19),允许铰接段230与手柄组件300做相同方向的铰接。
参考图20,铰接段230可操作地联结到末端执行器260。致动缆线205延伸穿过铰接段230并连接到末端执行器260。远侧转矩线圈494围绕延伸穿过铰接段230的致动缆线205的一部分。在一个实施例中,远侧转矩线圈494是ASAHI INTECC CO.,LTD所售的SUS304或SUS316等级不锈钢转矩线圈。致动缆线205的远端252可操作地联结到末端执行器260。在某些实施例中,联接器(coupling)436将致动缆线205的远端252与末端执行器260相连接(也参见图11A)。联接器436限定了尺寸设计为适于容纳销440的贯通孔(transverse hole)438。在这些实施例中,销440穿过孔438和第一和第二钳口部件262、264的凸轮槽442、444,由此枢转地将致动缆线205联结到末端执行器260。第一钳口部件262具有设置在其近侧部分265上的凸轮槽444。凸轮槽444限定了一个相对于致动缆线205的倾斜角。第二钳口部件264具有设置在其近侧部分263上的凸轮槽442。凸轮槽442限定了一个相对于致动缆线205的角度。销440可滑动地设置在凸轮槽442、442内。由此,第一和第二钳口部件262、264在致动缆线205的纵向平移时在打开位置和接近位置之间运动。如下面将详细讨论的,操作者可以通过朝手指环302方向移动可移动拇指环301(参见图17)而将第一和第二钳口部件262、264从打开位置移动到接近位置。随着可移动拇指环301朝手指环302方向移动,致动缆线205向近侧平移从而向近侧方向推进销440。当销440被向近侧推进时,销440沿凸轮槽442、440滑动,引起第一和第二钳口部件262、264朝彼此移动。
继续参考图20,第一和第二钳口部件262、264彼此枢轴地联结。在特定的实施例中,枢转销446使第一和第二钳口部件262、264相互枢转地连接。第一钳口部件262限定了尺寸设计为适于容纳枢转销446的开口448(图11A)。第二钳口部件264限定了尺寸设计为适于容纳枢转销446的开口450(图11A)。如图13和图14所示,联结部件222具有一对配置为容纳枢转销446的贯通孔298(图20)。在末端执行器260的致动过程中,纵向轨道202接合枢转销446并引导枢转销446的平移。
图20显示了(剖视图)固定在铰接段230的远侧外管220内的铰接缆线240。铰接缆线240穿过铰接链环232、234的钻孔224(图13)直到触及远侧外管220。在某些实施例中,套圈或卷筒452被连接到每根铰接缆线240的远端454(也参见图11和图15)。套圈452(以剖视图显示)有助于将铰接缆线240的远端454保持在远侧外管220内。如上所述,远侧外管220可操作地连接到铰接链环234。铰接链环232、234操作地彼此连接。这一连接允许铰接段230相对于纵轴“X”铰接(图2)。可以预想的是铰接段230的运动程度与铰接链环232、234的数量成正比。铰接段230包括最近侧链环496。最近侧铰接链环496基本与铰接链环232、234相同。但是,最近侧铰接链环496包括向近侧伸出的伸展部(extension)498。伸展部498适于被固定地容纳在内窥镜组件200的远端214内。
参考图21,致动缆线205可操作地连接到可移动拇指环301。准直管207围绕致动缆线205的从可移动拇指环301延伸到转轮303的一部分。手柄组件300进一步包括近侧转矩管456,近侧转矩管456围绕致动缆线205的从转轮303延伸到铰接缆线板311的一部分(也参考图11A)。近侧转矩管456部分地设置在环形轮轴310内。环形轮轴310部分地设置在铰接缆线板311内,并且包括细长部分458和缆线保持部分460。环形轮轴310的细长部分458至少部分地设置在铰接缆线板311的细长部分414内并限定了尺寸设计为适于容纳致动缆线205和近侧转矩管456的钻孔462。缆线保持部分460包括多个成形为容纳铰接缆线240的凹口464(图11A)和通向细长部分458的钻孔462的腔466。另一个近侧转矩线圈468部分地设置在腔466内并围绕致动缆线205的从细长部分458向环形轮轴310的缆线保持部分460延伸的一部分(也参见图11A)。在特定的实施例中,近侧转矩线圈468由弹性材料制成。在几个实施例中,近侧转矩线圈468(全部或部分地)由形状记忆材料,例如镍钛合金制成。在某些实施例中,近侧转矩线圈468(全部或部分地)由ASAHI INTECC CO.,LTD所售的不锈钢转矩线圈制成。缆线保持部分460进一步包括覆盖腔466的弹性壁476。弹性壁476具有允许近侧转矩线圈468穿过弹性壁476的裂隙(slit)478(图11A)。铰接锁定环400围绕环状轮轴310的至少一部分。如上所述,铰接锁定环400包括多个锁定指402。每个锁定指402包括用于接合杯332的内表面472的棘爪470。如下面所解释的,杯332的内表面472限定了多个空腔474(图26),所述空腔474的每一个适于接纳一个棘爪470。当棘爪474被放置在空腔474内时,末端执行器260(图11A)保持在中间位置。
在可选的实施例中,朝第一方向旋转转轮303引起致动缆线205朝相同方向旋转,如箭头“A”所示。在致动缆线205朝第一方向旋转时,末端执行器260朝同一方向旋转,如箭头“B”所示。例如,转轮303相对于壳体340的顺时针旋转引起末端执行器260也朝顺时针方向旋转。
参考图24和图25,铰接缆线240通过套圈242被连接到铰接缆线板311。套圈242设置在铰接缆线板311的沟槽432内(图25)。因此,铰接缆线240从铰接缆线板311的沟槽432向远侧延伸。沟槽432与沿缆线保持部分460的周边限定的开口480(图25)对齐。每个开口480通向缆线保持部分460的凹口464(图25)。相应地,每个铰接缆线240穿过沟槽432、开口480和凹口464。在特定的实施例中,凹口464具有三角形轮廓。铰接缆线240也穿过球331和内窥镜组件200,如图24所示。
继续参考图24,球331包括从其向远侧延伸的远侧管482。远侧管482限定了钻孔484,钻孔484的尺寸设计为适于容纳细长外管210的一部分和内窥镜组件200的细长内管486的一部分。细长外管210限定了构造为容纳细长内管486的钻孔488(图11A)。细长内管486依次限定了适于容纳致动缆线205、铰接缆线240和远侧转矩管492的钻孔490。远侧转矩管492围绕致动缆线205的从球331延伸到内窥镜组件200的远端214的部分(参见图20)。
参考图26和图27,手术装置100允许操作者仅用一只手使铰接段230相对于纵轴“X”铰接(图2)。在使用时,操作者用单手抓住手柄组件300。例如,操作者可以将拇指放在可移动拇指环301内(图9),其他手指放在手指环302内(图9)。一旦操作者已经抓住手柄组件300,操作者移动手腕使手柄组件300相对于细长外管210和球331铰接。操作者可以使手柄组件在任何方向上铰接。例如,图26显示了手柄组件300相对于细长外管210向上铰接(也参见图3)。但是,手柄组件300可以如图5所示向下或横向铰接。不考虑铰接方向,相对于细长外管210铰接手柄组件300会引起铰接段230的铰接,如图3和图5所示。铰接段230反映了手柄组件300的运动,并能够相对于细长外管210做与手柄组件300相同方向的铰接。
例如,当操作者相对于细长外管210向上铰接手柄组件300时,一条铰接缆线240D向近侧移动,同时另一条铰接缆线240C向远侧移动。结果,铰接缆线240D绷紧,而铰接缆线240C松弛。特别地,铰接缆线板311在手柄组件300的铰接作用下与手柄组件300一起运动,而球331相对于细长外管210保持静止。由于铰接缆线板311被连接到铰接缆线240,所以移动铰接缆线板311会引起铰接缆线240移动。当铰接缆线板311相对于球331向上倾斜时,铰接缆线240C向远侧运动,同时铰接缆线240D向近侧运动,如图26所示。
如图27所示,一条铰接缆线240D的近侧运动和铰接缆线240C的远侧运动的组合引起铰接段230相对于纵轴“X”向上铰接(图2)。如上所述,铰接缆线240C、240D沿细长外管210改变位置(参见图18和图19)。尽管在细长外管210的近端212(图2)处铰接缆线240C位于铰接缆线240D的上方,但是铰接缆线240C、240D在沿细长外管210的某一点处交换位置。结果,在细长外管210的远端214(图2)处和在铰接段230内(图27),铰接缆线240C位于铰接缆线240D的下方。因此,铰接缆线240C的远侧平移允许铰接缆线240C松弛,由此松开了铰接段230的下部。反之,铰接缆线240D的近侧平移使得铰接缆线240D绷紧,压缩铰接段230的上部。作为压缩铰接段230上部的结果,铰接段230相对于纵轴“X”向上铰接(图2)。操作者同样可以通过使手柄组件300相对于纵轴“X”移动而使铰接段230做向下或横向的铰接(图2)。在手柄组件300相对于纵轴“X”运动时,铰接段230做与手柄组件300方向相同的铰接。
参考图28和图29,操作者可以通过致动铰接锁定触发器304来固定铰接段230的位置。为了致动铰接锁定触发器304,操作者朝转轮303移动铰接锁定触发器304,如图28所示。在铰接锁定触发器304的致动下,制动凹口398接合铰接缆线板311的棘爪394,向近侧方向推进铰接缆线板311。随着铰接缆线板311向近侧移动,缆线接合部分416朝向杯332的内表面472向外推动铰接锁定环400的指402。当指402向外弯曲时,指402的棘爪470摩擦地接合杯332的内表面472,由此锁定手柄组件300相对于细长外管210和球331的位置。另外,铰接缆线板311的近侧平移引起所有的铰接缆线240向近侧运动。这一近侧运动的结果是全部的铰接缆线240被绷紧,同时将铰接链环232、234压在一起。因此,被压缩的铰接链环232、234固定铰接段230(图27)相对于细长外管210的位置。
参考图30和图31,操作者可以通过致动可移动拇指环301而在打开位置(图27)和接近位置(图31)之间移动第一和第二钳口部件262、264。为了致动末端执行器260,操作者朝手指环302移动可移动拇指环301,如图30所示。由于可移动拇指环301的远端部分360可操作地连接到致动缆线205,所以致动可移动拇指环301引起铰接缆线205的近侧平移。当致动缆线205向近侧移动时,连接末端执行器260和致动缆线205的联结部件436向近侧推进销440。销440沿凸轮槽442、444的近侧运动促使第一和第二钳口部件262、264朝彼此移动。操作者可以在末端执行器260处于打开位置时,首先将组织放置在第一和第二钳口部件262、264之间,然后移动第一和第二钳口部件262、264到接近位置从而夹住组织。
图32和图33示出了除末端执行器1260外与图1-4所示的实施例基本相同的手术装置100的实施例。末端执行器1260包括配置为机械地或机电地切割组织的第一和第二剪切刀片1262、1264。第一和第二剪切刀片1262、1264相互电绝缘并且适于在打开位置和接近位置之间移动。
参考图34和图35,尽管联结部件222将铰接段230连接到末端执行器1260,但是末端执行器1260另外包括马蹄形联结件1500。马蹄形联结件1500被连接到致动缆线205并且包括两个从其向远侧伸出的腿1538、1540。在第一和第二腿1538、1540之间限定了尺寸设计为适于容纳第一和第二剪切刀片1262、1264的近侧部分1572、1574的空间。每个腿1538、1540限定了适于容纳销1580的孔1548、1550。销1580也被配置为可滑动地容纳在第一和第二剪切刀片1262、1264的凸轮槽1442、1444内。凸轮槽1442沿剪切刀片1262的近侧部分1572限定,而凸轮槽1444沿剪切刀片1264的近侧部分1574限定。由电绝缘材料制作的圆盘1600将剪切刀片1262、1264彼此电隔离。如图34所示,圆盘1600设置在第一和第二剪切刀片1262、1264之间,并限定了配置为容纳销1580的孔1602。
图37和图38图示了手术装置100的另一个实施例。这一实施例的结构和操作与图1-5所示的实施例基本相同。手术装置100的这一实施例包括配置为抓住组织的末端执行器2260。末端执行器2260包括配置为抓住组织的第一和第二抓钳2262、2264。虽然这一实施例的附图显示了没有杆350的手术装置100(图10A),但是手术装置100的这一实施例可以包括用于将末端执行器2226电力联结到发电机的杆350。第一和第二抓钳2262、2264被配置为在打开位置和接近位置之间移动。第一和第二抓钳2262、2264中的每一个都包括组织接合表面2266、2268。组织接合表面2266、2268都包括多个用于接合组织的齿2272、2274。
参考图38和图39,第一和第二抓钳2262、2664通过枢转销446彼此枢转地连接。末端执行器2260通过联结器436和销440可操作地联结于致动缆线205。第一和第二抓钳2262、2264中的每一个都包括适于可滑动地容纳销440的凸轮槽2442、2444。这种连接使得第一和第二抓钳2262、2264在致动缆线205向近侧移动时移动到接近位置。
参考图40-43,手术装置100的任一实施例可以包括用于固定第一和第二钳口部件262、264之间的相对位置的锁定机构3000。如上所述,可移动拇指环301可操作地联结于第一和第二钳口部件262、264。在操作中,可移动拇指环301朝手指环301的枢转引起第一和第二钳口部件262、264从打开位置移动到接近位置(参见图30和图31)。因此,保持可移动拇指环301接近手指环302将使第一和第二钳口部件262、264保持在接近位置。在使用中,锁定机构3000可以保持拇指环301接近手指环302以将第一和第二钳口部件262、264固定在接近位置。在某些实施例中,锁定机构3000包括连接到可移动拇指环301的第一棘齿组件3002。特别地,第一棘齿组件3002被连接到可移动拇指环的设置在手柄组件300内部的部分的侧壁。第一棘齿组件3002包括弯曲柱形物3004和从弯曲柱形物3004向近侧延伸的多个齿3006。每个齿3006相对于可移动拇指环301向上成角度。
锁定机构3000进一步包括例如弹簧的偏置部件3008,其固定于可移动拇指环301的设置在手柄组件300内的部分并可操作地联结于释放组件3010。偏置部件3008朝远侧方向偏置释放组件3010。在图示的实施例中,偏置部件3008是扭转弹簧。但是,可以想到偏置部件3008可以是任何适于向远侧偏置释放组件3010的装置或工具。
释放组件3010包括适于容纳手指的触发器3012、从触发器3012向近侧延伸的细长部分3014、配置为牢固地接合第一棘齿组件3002的第二棘齿组件3016和从细长部分3014的下部伸出的引导棒3018。
引导棒3018具有凸轮表面3020和设置在其近端3024处的横向销3022。凸轮表面3020被配置为可滑动地接合手柄组件300(图42和图43)上的突起3026、3028以引导释放组件3010平移通过手柄组件300。横向销3022被配置为接合设置在手柄组件300内的机械止挡3030,以便阻止、或至少妨碍释放组件3010进一步向近侧前进。
如上所述,释放组件3010也包括被配置为接合第一棘齿组件3002的第二棘齿组件3016。第二棘齿组件3016包括从细长部分3014向近侧延伸的壁3032和沿壁3032的近端3038设置的弯曲柱形物3034。多个齿3036从弯曲柱形物3034的至少一部分向远侧伸出。齿3036适于牢固地接合第一棘齿组件3002的齿3006。在某些实施例中,齿3036相对于可移动拇指环301向下成角度。当第二棘齿组件3016的齿3036接合第一棘齿组件3002的齿3006时,可移动拇指环301的位置相对于手指环302固定(参见图42)。
在操作中,操作者可以使用锁定机构3000来固定第一和第二钳口部件262、264的相对位置(图31)。最初,操作者朝手指环302移动可移动拇指环301以朝接近位置移动第一和第二钳口部件262、264(图31)。随着可移动拇指环301朝手指环302移动,第一棘齿组件3002的齿3006接合第二棘齿组件3016的齿3036。齿3006和齿3036的定位阻止或至少妨碍可移动拇指环301从手指环302移开,而且允许可移动拇指环301进一步向手指环302移动。结果,锁定机构3000固定了可移动拇指环301和手指环302之间的相对位置,如图42所示。由于可移动拇指环301可操作地连接到第一和第二钳口部件262、264(图31),所以当锁定机构300固定可移动拇指环301和手指环302之间的相对位置时,第一和第二钳口部件262、264之间的相对位置也被固定。一旦锁定机构300已经锁定了可移动拇指环301的位置,操作者可以进一步朝手指环302推进可移动拇指环301,直到第一和第二钳口部件262、264(图31)到达接近位置。
为了释放可移动拇指环301,操作者向近侧按压触发器3012以克服偏置部件3008的力量。当触发器3012向近侧移动时,第二棘齿组件3016的齿3036向近侧移动并脱离第一棘齿组件3002的齿3002。结果,可移动拇指环301在偏置部件3008的作用下从手指环302移开,由此朝打开位置移动第一和第二钳口部件262、264,如图43所示(也参见图20)。
图44-46示出了手术装置100的另一个实施例。手术装置100的这一实施例的操作和结构基本上与上述的实施例相同。在这一实施例中,手术装置100包括末端执行器4260,末端执行器4260包括电极组件4262。电极组件4262包括至少一个适于传导和施加电手术能量给组织的探针或电极4264。在图示的实施例中,电极组件4262具有一个钩状的探针4264。但是,探针4264可以具有任何适合形状或构形。不管其形状如何,探针4264电连接到手术装置100的致动缆线205,如图46所示。
继续参考图44-46,手术装置100的这一实施例包括支撑在手柄组件300上的电开关4700。电开关4700被配置为将手术装置100设定为多个操作模式,例如切割、结合和/或凝结中的一个。更特别地,电开关4700适于改变能量的波形和/或总量,所述能量从电手术能量源被传送到电极组件4262。在几个实施例中,电开关4700具有两个离散的位置。在第一离散位置,电开关4700设定手术装置100传送“切割波形”输出给电极组件4262,而在第二离散位置,电开关4700设定手术装置100传送“凝结波形”输出给电极组件4262。可以预想的是,电开关4700也可以包括一些能够由操作者感知的触觉反馈测量和/或一些由电开关4700产生的可听反馈测量(例如,“喀哒(click)”声)。
除了电开关4700,手术装置100还包括配置为被机械地或电连接到如发生器的电手术能量源上的电接口或插销4800。插销4800包括多个插脚(prong)4802,它们适于将插销4800机械地和电联结于电手术能量源。电缆4804将插销4800与手柄组件300电连接。
参考图47,手术装置100的这一实施例包括容纳电缆4804的一部分的固定手柄4301。电缆4804内包含多根配置为从电手术能量源(未示出)传输电手术能量的电线4806。电线4806电连接到电开关4700。
在图47所示的实施例中,电开关4700包括配置为在第一位置和第二位置之间移动的按钮4702和第一和第二传感器4704、4706。可以预想的是,传感器4704、4706可以是压力传感器。按钮4702包括向下朝第一和第二传感器4704、4706延伸的第一和第二插脚4708、4710。如图47中所示,当按钮4702被设置在中间位置时,第一和第二插脚4708、4710不接触第一和第二传感器4704、4706。但是,按钮4702可以在第一和第二位置之间被移动。在第一位置,第一插脚4708接触并将压力施加到第一传感器4704。作为响应,第一传感器4704将此压力转变为信号,该信号经电线4806被传送给电手术发生器(未示出)。接着,电手术发生器传输相应量的电手术能量(例如RF能量)或合适的波形输出给电极组件4262。同样,按钮4702结合第一和第二传感器4704、4706允许操作者控制电联结于手术装置100的电手术发生器(未示出)的能量大小和/或波形输出。例如,当按钮4702被放置在第一位置时,“切割形式”波形被选择。反之,当按钮4702被放置在第二位置时,第二插脚4710接触并将压力施加到第二传感器4706。接着,第二传感器4706将此压力转变为信号,该信号经电线4806被传送给电手术发生器(未示出)。响应于此信号,电手术发生器将“切割形式”波形输出传输给电极组件4262。相应地,操作者可以借助于简单地在第一和第二位置之间移动按钮4702来选择期望的治疗效果。可以预想的是,当按钮470处于中间位置时,手术装置100可以被无效(即,断电)。
手柄组件300进一步包括使电开关4700和内杆4205电连接的电线4808。内杆4205由导电材料制成并且将电极组件4262电联结于连接到手术装置100的电手术发生器(未示出)。
继续参考图47,手术装置100的这一实施例也包括可操作地连接到内窥镜组件200的铰接段230的铰接机构330。铰接段230被配置为在手柄组件300相对于细长外管210朝特定方向移动时,其相对于细长外管210朝相同方向铰接,如图48和图49所示。
参考图50-51,手术装置100的任一实施例可以包括矫直机构(straightening mechanism)5000,其用于在铰接后使铰接段230(图2)返回到与细长外管210(图2)纵向对齐。矫直机构5000包括连接到球331的第一组磁体5002和连接到杯332的第二组磁体5004。可以预想的是磁体5002、5004可以是稀土磁体5002。磁体5002、5004也可以是永久磁体或电磁体。在磁体5002、5004是永久磁体的实施例中,磁体5002、5004定位为使得磁体5002、5004的相反磁极彼此面对,这样引发吸引力。磁体5002沿球331的周边设置,而磁体5004沿杯331的内表面设置(参见图51)。当铰接段230与细长外管210纵向对齐时,磁体5002与磁体5004径向对齐。磁体5002相对于磁体5004的位置和定向引发两者之间的吸引力。磁体5002、5004之间的吸引力保持杯332与球331对齐。如上所述,当球331与杯332对齐时,铰接段230与细长外管210纵向对齐(参见图2)。如果杯332相对于球331移动以铰接铰接段230,则磁体5002、5002之间的吸引力将球331拉回与杯332对齐,如图2所示。如图51所示,在某些实施例中,球331包括连接到每个磁体5002上的棘爪5008。反过来,杯332包括适于牢固地容纳棘爪5008的凹陷5006。棘爪5008与凹陷5006的接合有助于球331固定在中间位置。
参考图53,手术装置100的任一实施例可以包括矫直机构6000,其用于在铰接后使铰接段230(图2)返回到与细长外管210(图2)纵向对齐。矫直机构6000包括设置在球331内的圆锥形螺旋弹簧6002。圆锥形螺旋弹簧6002具有连接到缆线保持部分460的近端6004和连接到致动缆线205的远端6006。当手柄组件300相对于细长外管210被铰接时(图3),圆锥形螺旋弹簧6002的一侧受到张力作用,而圆锥形螺旋弹簧6002的另一侧被压缩,产生了一个推进手柄组件300返回其中间位置(参见图2)的力矩。如上所述,当手柄组件300在其中间位置时,铰接段230与细长外管210纵向对齐。可以预想的是,圆锥形螺旋弹簧6002可以是预受张力的以便增加力矩。
参考图54,手术装置100的任一实施例可以包括矫直机构7000,其用于在铰接后使铰接段230(图2)返回到与细长外管210(图2)纵向对齐。矫直机构7000包括覆盖球331的弹性罩7002。可以预期的是,弹性罩7002可以由弹性材料或其他任何适合的材料制成。弹性罩7002具有连接到杯332的近端部分7004和连接到细长外管210的邻近球331定位的部分上的远端部分7006。在操作中,当杯332相对于球331运动时,弹性罩7002的一侧伸展并且处于张力作用下,产生了一个推进球331返回其中间位置(参见图2)的力矩。
参考图55,手术装置100的任一实施例可以包括矫直机构8000,其用于在铰接后使铰接段230(图2)返回到与细长外管210(图2)纵向对齐。矫直机构8000包括从球331向近侧延伸的突出部件8002和连接到突出部件8002的近端8006的弹性部件8004。弹性部件8004具有连接到突出部件8002的远端8010和连接到铰接缆线板311(图21)的近端8012。壳体8008包围突出部件8002和至少一部分弹性部件8004。在操作中,当球331相对于杯332(图21)移动时,弹性部件8004伸展(如剖视图所示)。结果,在弹性部件8004上建立张力。这一张力产生了偏置球331返回其中间位置(参见图2)的恢复力矩。
参考图56,手术装置100的任一实施例可以包括矫直机构9000,其用于在铰接后使铰接段230(图2)返回到与细长外管210(图2)纵向对齐。矫直机构9000包括由具有超弹性能的材料制成的管或杆9002。可以想到的是,管9002基本上是弹性的。在某些实施例中,管9002全部或部分由形状记忆材料,如镍钛记忆合金制成。管9002具有近端9004和远端9006。杆9002的近端9004连接到近侧转矩管456,而杆9002的远端9006固定于球331。当球331相对于杯332铰接时,管9002铰接并且产生使球331朝其中间位置偏置(参见图2)的力矩。在某些实施例中,管9002对应于图24所示的近侧转矩线圈468。
参考图57,手术装置100的任一实施例可以包括矫直机构500,其用于在铰接后使铰接段230(图2)返回到与细长外管210(图2)纵向对齐。在矫直机构500中,球331包括从其向近侧延伸的细长部分502。当球331相对于杯332移动时,细长部分502扩张杯332。结果,杯332向细长部分502施加力并且将球331推进到其中间位置(参见图2)。
参考图58,手术装置100的任一实施例可以包括矫直机构600,其用于在铰接后使铰接段230(图2)返回到与细长外管210(图2)纵向对齐。矫直机构600包括多个配置为将球331偏置到其中间位置(参见图2)的弹性带602。每个弹性带602具有近端606和远端604。每个弹性带602的近端606都与铰接缆线板311的细长部分414相连接。每个弹性带的远端604都连接到球331的远侧部分。在操作中,当球331相对于杯332(图21)移动时,至少一个弹性带602朝中间位置(参见图2)拉伸和偏置球331。在某些实施例中,矫直机构600包括三条弹性带602,但是可以想到的是,矫直机构600可以包括更多或更少的弹性带602。
参考图59,手术装置100的任一实施例可以包括矫直机构700,其用于在铰接后使铰接段230(图2)返回到与细长外管210(图2)纵向对齐。矫直机构700包括从杯332的内表面朝径向和内部延伸的环形壁702和设置在邻近球331的近侧部分708的环704。此外,矫直机构700包括多个设置在环形壁702和环704之间的弹簧706。弹簧706被配置为在球331相对于杯332移动时,朝球331的中间位置(参见图2)偏置球331。在操作中,当球331相对于杯332移动时,一些弹簧706压缩,而另一些弹簧706拉伸。弹簧706的延长和压缩的联合作用推进球331返回其中间位置(图2)。
参考图60,手术装置100的任一实施例可以包括矫直机构800,其用于在铰接后使铰接段230(图2)返回到与细长外管210(图2)纵向对齐。矫直机构800包括环804,其处于杯332的远侧并且围绕球331的一部分设置。此外,矫直机构800包括多个设置在环804和杯332的远端802之间的弹簧806。弹簧806被配置为在球331相对于杯332移动时将球331偏置到其中间位置(参见图2)。在操作中,当球331相对于杯332移动时,某些弹簧806压缩,而其他弹簧806拉伸。弹簧806的延长和压缩的联合作用推进球331返回其中间位置(图2)。
参考图61,手术装置100的任一实施例可以包括矫直机构900,其用于在铰接后使铰接段230(图2)返回到与细长外管210(图2)纵向对齐。矫直机构900包括从杯332的内表面朝径向和内部延伸的环形壁902和邻近球331的近侧部分908定位的环904。环904限定了一个环形槽910,其被配置为可滑动地容纳球331的近侧部分908。此外,矫直机构900包括多个设置在环形壁902和环904之间的弹簧906。弹簧906被配置为在球331相对于杯332移动时将球331偏置到其中间位置(参见图2)。在操作中,当球331相对于杯332移动时,弹簧906延长,引发弹簧906内部的张力。在此张力的作用下,弹簧906推进球331返回其中间位置(图2)。
在本公开的手术装置的实施例上作各种改变都可以理解。因此,上述说明应当不解释为限制性的,而仅作为实施例的范例。本领域技术人员会在本公开的范围和精神内预想其他的改变。
Claims (20)
1.一种用于执行手术的手术装置,包括:
手柄组件;
从所述手柄组件延伸出来的细长部件,所述细长部件具有铰接段和直部,其中所述铰接段被配置为相对于所述直部铰接;
铰接机构,其可操作地与所述手柄组件和所述铰接段连接,使得在所述手柄组件相对于所述直部向第一方向移动时,所述铰接段相对于所述直部朝所述第一方向铰接;
可操作地连接到所述细长部件的铰接段的末端执行器,所述末端执行器具有第一和第二钳口部件,其中所述第一和第二钳口部件被配置为相对于彼此在打开位置和接近位置之间运动;和
配置为用于固定所述第一和第二钳口部件的相对位置的锁定机构,所述锁定机构包括设置在所述手柄组件内的第一棘齿组件和第二棘齿组件,所述第一和第二棘齿组件相对于彼此在锁定所述第一和第二钳口部件的相对位置的接合位置和将所述第一和第二钳口部件的相对位置解锁的脱离位置之间可移动。
2.根据权利要求1所述的手术装置,其中所述铰接机构包括配置为固定所述铰接段相对于所述直部的位置的铰接锁定系统。
3.根据权利要求1所述的手术装置,其中所述铰接段包括用于促进所述铰接段相对于所述直部铰接的多个铰接链环。
4.根据权利要求3所述的手术装置,其中所述铰接机构包括穿过所述铰接链环的多根铰接缆线。
5.根据权利要求1所述的手术装置,其中所述手柄组件包括拇指环,其可操作地连接到所述末端执行器使得所述拇指环的致动引起所述末端执行器的致动。
6.根据权利要求1所述的手术装置,其中所述锁定机构包括配置为将所述第一棘齿组件从所述第二棘齿组件脱离的释放组件。
7.根据权利要求6所述的手术装置,其中所述锁定机构包括用于将所述释放组件朝远侧方向偏置的偏置部件。
8.根据权利要求6所述的手术装置,其中所述锁定机构的释放组件包括触发器,所述释放组件被配置为在所述触发器朝近侧方向移动时将所述第一棘齿组件从所述第二棘齿组件脱离。
9.根据权利要求1所述的手术装置,其中所述第二棘齿组件被配置为沿所述手柄组件纵向移动。
10.根据权利要求1所述的手术装置,其中所述末端执行器被配置为给组织传送电手术能量。
11.一种用于执行手术的手术装置,包括:
手柄组件;
从所述手柄组件延伸出来的细长部件,所述细长部件具有铰接段和实质刚性部分,其中所述铰接段被配置为相对于所述实质刚性部分铰接;
可操作地连接所述手柄组件和所述铰接段的铰接机构,其中所述手柄组件相对于所述实质刚性部分向第一方向的移动引起所述铰接段相对于所述实质刚性部分朝第一方向铰接;和
可操作地连接到所述细长部件的铰接段的末端执行器,所述末端执行器具有第一和第二钳口部件,其中所述第一和第二钳口部件被配置为相对于彼此在打开位置和接近位置之间运动;和
配置为固定所述第一和第二钳口部件的相对位置的锁定机构,所述锁定机构包括设置在所述手柄组件内的第一棘齿组件和第二棘齿组件,所述第一和第二棘齿组件相对于彼此在锁定所述第一和第二钳口部件的相对位置的接合位置和将所述第一和第二钳口部件的相对位置解锁的脱离位置之间可移动。
12.根据权利要求11所述的手术装置,其中所述铰接机构包括配置为固定所述铰接段相对于所述直部的位置的铰接锁定系统。
13.根据权利要求11所述的手术装置,其中所述铰接段包括用于促进所述铰接段相对于所述直部铰接的多个铰接链环。
14.根据权利要求13所述的手术装置,其中所述铰接机构包括穿过所述铰接链环的多根铰接缆线。
15.根据权利要求11所述的手术装置,其中所述手柄组件包括拇指环,其可操作地连接到所述末端执行器使得所述拇指环的致动引起所述末端执行器的致动。
16.根据权利要求11所述的手术装置,其中所述锁定机构包括配置为将所述第一棘齿组件从所述第二棘齿组件脱离的释放组件。
17.根据权利要求16所述的手术装置,其中所述锁定机构包括将所述释放组件朝远侧方向偏置的偏置部件。
18.根据权利要求16所述的手术装置,其中所述锁定机构的释放组件包括触发器,所述释放组件被配置为在所述触发器朝近侧方向移动时将所述第一棘齿组件从所述第二棘齿组件脱离。
19.根据权利要求18所述的手术装置,其中所述第二棘齿组件被配置为沿手柄组件纵向移动。
20.根据权利要求11所述的手术装置,其中所述末端执行器被配置为给组织传送电手术能量。
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- 2009-08-03 AU AU2009203208A patent/AU2009203208B2/en not_active Ceased
- 2009-08-03 JP JP2009181091A patent/JP2010036039A/ja active Pending
- 2009-08-04 CN CN200910173384.6A patent/CN101849846B/zh active Active
- 2009-08-04 EP EP09251932.1A patent/EP2151204B1/en not_active Not-in-force
Cited By (7)
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CN102670280A (zh) * | 2011-02-25 | 2012-09-19 | 厄比电子医学有限责任公司 | 具有改善的操作性能的手术器械 |
CN102670280B (zh) * | 2011-02-25 | 2015-09-16 | 厄比电子医学有限责任公司 | 具有改善的操作性能的手术器械 |
CN108472055A (zh) * | 2015-10-20 | 2018-08-31 | 卢门迪公司 | 用于执行微创手术的医疗器械 |
CN108472055B (zh) * | 2015-10-20 | 2022-04-15 | 卢门迪公司 | 用于执行微创手术的医疗器械 |
US11376031B2 (en) | 2015-10-20 | 2022-07-05 | Lumendi Ltd. | Medical instruments for performing minimally-invasive procedures |
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US11504104B2 (en) | 2015-10-20 | 2022-11-22 | Lumendi Ltd. | Medical instruments for performing minimally-invasive procedures |
Also Published As
Publication number | Publication date |
---|---|
US20100030018A1 (en) | 2010-02-04 |
AU2009203208B2 (en) | 2014-05-29 |
AU2009203208A1 (en) | 2010-02-18 |
CA2674520C (en) | 2016-10-18 |
JP2010036039A (ja) | 2010-02-18 |
EP2151204B1 (en) | 2019-06-19 |
CN101849846B (zh) | 2013-06-19 |
EP2151204A1 (en) | 2010-02-10 |
CA2674520A1 (en) | 2010-02-04 |
US8801752B2 (en) | 2014-08-12 |
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