CN103429171A - 具有用于操纵分离的组织的组织拴系件的外科钉仓及其使用方法 - Google Patents
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Abstract
本发明涉及用于操纵分离的组织的切断的端部的外科钉仓和方法。在各种形式中，所述钉仓具有暂时地支撑在钉仓上的至少一种基材，所述至少一种基材被取向成缝合到分离的组织的对应端部。至少一个细长拴系件不可移除地附连到每片基材。一旦基材被缝合到分离的组织的对应片，临床医生便可通过向拴系件施加操纵动作来操纵该片分离的组织。对应凹槽或凹坑可被设置在仓主体上，以在仓主体中暂时地支撑拴系件。
Description
背景技术
技术领域
本发明涉及一种外科器械，并且在各种实施例中涉及被设计成用于切割和缝合组织的外科切割和缝合器械以及用于其的钉仓。
背景技术
外科缝合器已被用于同时在组织中制造纵向切口和将成排的缝合钉施加在切口的相对侧上。此类器械通常包括一对协同工作的钳口构件，如果意图将所述器械用于内窥镜式或腹腔镜式应用，则所述钳口构件能够穿过插管通道。钳口构件之一容纳钉仓，该钉仓具有横向间隔开的至少两行缝钉。另一钳口构件限定具有缝钉成形凹坑的砧座，所述缝钉成形凹坑与支撑在仓中的各排未成形缝钉对齐。
在使用中，临床医生能够在组织上闭合缝合器的钳口构件，以在击发之前将组织定位。一旦临床医生已确定钳口构件正适当地抓持组织，临床医生可接着击发外科缝合器，从而切断和缝合组织。同时进行切割及缝合避免了当利用分别仅用于切割或缝合的不同外科工具依次执行此类动作时可能产生的并发症。
已知多种外科切割和缝合器械，其可以腹腔镜方式和/或结合各种“开放式”外科手术来采用。一些外科缝合和切断器械能够支撑可替换仓，所述可替换仓中支撑有未成形缝钉。此类装置通常采用可回缩的切割构件，所述可回缩的切割构件属于缝合器械并且可与多个仓一起被再利用。在缝钉一个仓中被击发之后，可将切割构件回缩并移除用尽的仓，以使得能够安装新仓，如果需要的话。在切割构件穿过仓朝远侧被驱动时，未成形缝钉从其在仓中的相应凹坑被击发出，从而与砧座的下侧成形接触。此类装置的例子在2006年2月21日公布的名称为“Surgical Stapling InstrumentHaving Separate Distinct Closing and Firing Systems”的美国专利7,000,818中有所公开，该专利的公开内容全文以引用方式并入本文。另一外科切割和缝合器械采用通常被称为“一次性加载单元”或“DLU”的装置。此类装置以“单元”的形式支撑钉仓和新刀，该单元可操作地附接到外科缝合器械。单元被设计成在缝钉已被击发之后丢弃。此类缝合器械的例子在1999年2月2日公布的名称为“Surgical Stapling Apparatus”的美国专利5,865,361中有所公开，该专利的全部公开内容以引用方式并入本文。
在一些情况下，组织层可为相对薄的，可含有高流体含量和/或可具有不均匀的厚度，这可导致缝钉在组织内不适当地成形。为改善该问题，已利用一片“扶壁”材料以在组织被夹持和缝合时支撑组织。此类扶壁材料片通常在第一钳口构件和第二钳口构件被插入手术部位中之前可释放地附接到第一钳口构件和第二钳口构件中的至少一个。该片扶壁材料用于将缝钉所施加的压缩力分布在组织的整个表面区域上，以在组织内形成更均匀的压力分布。2009年8月20日公布的名称为“Surgical End Effector HavingButtress Retention Features”的美国专利公布US2009/0206143A1公开了各种扶壁和扶壁保持构造，并且全文以引用方式并入本文。
在许多外科手术中，并且具体地在许多血管相关的外科手术中，一旦组织被切割和缝合器械分离，两块组织便会从支撑钉仓的端部执行器脱离。在一些涉及例如肠和/或胃的手术中可能不成问题。然而，另一组织类型例如血管具有在被切断之后迅速朝它们的原位置撤回的趋势。例如，在例如肺叶切除的手术中，其中血管一般位于相对有限的胸腔内，一旦血管已拉离，其可能非常难以在需要时再次获得。例如，如果密封或连接有瑕疵并存在出血，则必须尽可能快地再次获得血管以着手修复渗漏的血管。
因此，存在对于解决上述许多挑战的外科钉仓构造的需要。
前述讨论仅为了举例说明本技术领域中目前存在的一些不足之处，而不应看作是对权利要求范围的否定。
发明内容
根据至少一种形式的一般方面，提供了具有仓主体的外科钉仓，所述仓主体中可操作地支撑有多个外科缝钉。基材被暂时地支撑在仓主体的一部分上，并且当支撑在仓主体中的缝钉被缝合到组织中时，所述基材能够被缝合到组织。当仓主体被从组织中撤回时，该基材能够保持附接到组织。至少一个细长拴系件不可移除地联接到基材。
根据至少一种形式的其它一般方面，提供了一种与外科器械一起使用的外科端部执行器。在各种实施例中，外科端部执行器包括细长通道，所述细长通道可操作地联接到外科器械。具有仓主体的钉仓可操作地支撑在所述细长通道中。仓主体具有由纵向狭槽基本上分成第一平台部分和第二平台部分的平台表面，该狭槽在第一平台部分和第二平台部分之间延伸。仓主体中可操作地支撑有第一组多个未成形缝钉，该第一组多个未成形缝钉对应于第一平台部分。第二组多个未成形缝钉对应于第二平台部分。组织切割构件可操作地支撑在仓主体中，用于在外科器械将切割致动动作施加到组织切割构件时，该组织切割构件在纵向狭槽中轴向行进。砧座被支撑以响应于由外科器械施加到砧座的打开动作和闭合动作可活动地朝向和远离平台表面行进。第一基材被可移除地支撑在第一平台部分上，并且至少一个第一拴系件不可移除地附接到第一基材。第二基材被可移除地支撑在第二平台部分上，并且至少一个第二拴系件不可移除地附接到第二基材。
根据至少一种形式的其它一般方面，提供了一种用于操纵分离的组织的方法。在各种形式中，所述方法包括将一块组织分离成两个单独的组织片段，其中每个组织片段均具有切断的端部。所述方法还包括将第一组织片段和第二组织片段的切断的端部缝合，并在缝合动作期间将至少一个拴系件附连到所述第一组织片段和所述第二组织片段的切断的端部中的至少一个。所述方法还包括通过向拴系件施加操纵动作来操纵所述切断的端部，所述切断的端部具有附连到切断的端部的至少一个拴系件。
附图说明
通过结合附图参考本发明实施例的以下说明，本发明的上述和其它特征和优点及其获取方法将会变得更加明显，并且将更好地理解发明本身，其中：
图1是可与本发明的各种仓和端部执行器实施例一起使用的外科切割和缝合器械的一种形式的侧视图；
图2是本发明的端部执行器实施例的分解视图；
图2A是本发明的另一个端部执行器实施例的分解视图；
图2B是本发明的另一个端部执行器实施例的分解视图；
图3是本发明的钉仓实施例的一部分的分解组件视图；
图4是图3的钉仓的一部分的透视图；
图5是将血管夹持在砧座和其钉仓之间的端部执行器实施例的局部平面图；
图6是图5所示的分开和缝合的血管的透视图；
图7是外科切割和缝合器械的透视图，该外科切割和缝合器械中具有支撑有已被插入套管针插管中的本发明的外科钉仓实施例；
图8是本发明的另一个钉仓实施例的一部分的分解组件视图；
图9是图8的钉仓的一部分的透视图；
图10是本发明的另一个钉仓实施例的一部分的分解组件视图；
图11是图10的钉仓的一部分的透视图；
图12是本发明的另一个钉仓实施例的一部分的分解组件视图；
图13是图12的钉仓的一部分的透视图；
图14是本发明的另一个钉仓实施例的一部分的分解组件视图；
图15是图14的钉仓的一部分的透视图；
图16是本发明的另一个钉仓实施例的一部分的分解组件视图；并且
图17是图16的钉仓的一部分的透视图。
具体实施方式
本申请的申请人也拥有与本申请提交于同一天的名称为“SurgicalFastener Instruments”的美国专利申请（代理人案卷号END6844USNP/100529），并且该文献全文以引用方式并入本文。
现在将描述某些示例性实施例，以提供对本文所公开的装置和方法的结构、功能、制造和用途的总体理解。这些实施例的一个或多个实例在附图中示出。本领域的那些普通技术人员将理解，本文具体描述和在附图中示出的装置和方法为非限制性的示例性实施例，并且本发明的各种实施例的范围仅由权利要求书限定。结合一个示例性实施例示出或描述的特征可与其它实施例的特征进行组合。此类修改形式和变型旨在被包括在本发明的范围内。
本说明书通篇引用的“各种实施例”、“一些实施例”、“一个实施例”或“实施例”等，是指结合所述实施例描述的具体特征、结构或特性包括在至少一个实施例中。因此，本说明书通篇出现的短语“在各种实施例中”、“在一些实施例中”、“在一个实施例中”或“在实施例中”等并不一定全部是指相同的实施例。此外，在一个或多个实施例中，具体特征、结构或特性还可以任何合适的方式组合。因此，在无限制的情况下，结合一个实施例示出或描述的具体特征、结构或特性可全部或部分地与一个或多个其它实施例的特征、结构或特性进行组合。此类修改形式和变型旨在被包括在本发明的范围内。
本文所用术语“近侧”和“远侧”是相对于操纵外科器械柄部部分的临床医生而言的。术语“近侧”是指最靠近临床医生的部分，并且术语“远侧”是指远离临床医生的部分。还应当理解，为简洁和清楚起见，本文可以结合附图使用诸如“竖直”、“水平”、“上”和“下”之类的空间术语。然而，外科器械在许多方向和位置中使用，并且这些术语并非旨在是限制性的和/或绝对的。
本发明提供了各种示例性装置和方法以用于执行腹腔镜式外科手术和微创外科手术。然而，本领域普通技术人员将容易认识到，本文所公开的多种方法和装置可被用于许多外科手术和应用中，包括例如与“开放性”外科手术相关的外科手术和应用。继续参阅本具体实施方式，本领域中的那些普通技术人员将进一步认识到，本文所公开的各种器械可以任何方式插入体内，例如通过自然腔道、通过形成于组织中的切口或穿刺孔等。器械的工作部分或端部执行器部分可被直接插入患者体内，或者可通过具有工作通道的进入装置诸如套管针插入，外科器械的端部执行器及细长轴可通过该工作通道行进。
参见附图，其中贯穿多个视图的类似的数字代表类似的部件，图1示出了能够实践本发明各种独特的有益效果的外科缝合和切断器械10的一个实施例。外科器械10的各种形式在名称为“Endoscopic Surgical InstrumentWith a Handle That Can Articulate With Respect to the Shaft”的美国专利7,753,904中有所公开，该文献的全部公开内容以引用方式并入本文。因此，无需用以理解本发明的各种实施例和形式的关于该装置的构造和操作的细节将不在本文具体重复。图1中所示的外科器械是马达驱动或“动力式器械”。继续参阅本具体实施方式，技术人员将认识到，在不脱离本发明的实质和范围的情况下，本发明的独特和新型方面也可有效地与采用机械（非动力式）系统的外科缝合和切断器械结合使用，以用于击发缝钉和切割组织。
如在图1中可见，外科器械10的一种形式包括柄部6，该柄部具有可操作地附接到柄部的细长管组件30，该细长管组件能够将致动动作传送到附接到细长管组件30的远端的端部执行器12。端部执行器12包括联接到本发明的各种形式钉仓的槽22，如下文将更详细地论述。砧座24响应于细长管组件30的各个部分施加到砧座的打开动作和闭合动作而相对于槽22被可活动地支撑。
柄部6包括手枪式握把26，可由临床医生将闭合触发器18枢转地拉向手枪式握把，以使砧座24朝向端部执行器12的缝钉槽22夹持或闭合。击发触发器20在闭合触发器18的更外侧。如图2中所示，除了先前提及的槽22和砧座24之外，端部执行器12还可包括刀和滑动件驱动构件32、其中支撑有多个未成形缝钉90的钉仓50、螺旋状螺杆轴36、以及附接到槽结构22的轴承38。砧座24可在近侧枢转点处可枢转地连接到槽22。在一个实施例中，例如，砧座24包括在其近端处横向突出的枢轴销25，该枢轴销可枢转地接合形成于槽22的近端附近的枢转孔23。当由器械10的使用者致动（即拉动）闭合触发器18时，砧座24的耳轴25可在槽22中的枢转孔23内围绕枢转点枢转成夹持或闭合位置。如果端部执行器12的夹持是令人满意的，则操作者可致动击发触发器20，该击发触发器启动柄部6中的马达/传动装置（未示出），该马达/传动装置向螺旋状螺杆轴36施加旋转动作，以使刀/滑动件驱动构件32沿槽22行进，从而切割被夹持在端部执行器12内的组织并驱动未成形缝钉90与砧座24的下侧进行成形接触。如本文所用，针对缝钉的术语“击发”是指涉及以下的动作：将未成形缝钉90驱动出钉仓内它们的相应缝钉凹坑，并使其与砧座的对应部分进行成形接触。然而，继续参阅本具体实施方式，读者将认识到，本发明的独特和新型方面可有利地结合各种其它外科缝合器和外科缝合器器械而被采用，包括能够与所谓的一次性加载单元一起使用的那些外科缝合单元，例如名称为“Surgical Stapler With Universal Articulation and Tissue Pre-Clamp”的美国专利公布2006/0011699A1中所公开的那些装置，该专利的公开内容全文以引用方式并入本文。因此，本发明的各种实施例能够保护的范围不应限于与一种特定类型的外科缝合器械一起使用。
在刀/滑动件驱动构件32已被驱动到钉仓50的远端之后，临床医生释放击发触发器20以使击发触发器20能够返回到打开位置，这将导致向刀/滑动件驱动构件32施加回缩动作，以使其朝近侧移动到起始位置。一旦刀/滑动件驱动构件32已移动到钉仓50外的起始位置，外科医生便可通过柄部上的释放按钮30来解锁闭合触发器18，以允许闭合触发器18移动到打开位置，从而使砧座24枢转打开并释放分离的和缝合的组织。
在图3和4中所示的实施例中，钉仓50包括仓主体51，该仓主体中支撑有多个未成形缝钉90。仓主体51中具有居中设置的狭槽55，该狭槽将仓平台分成第一平台部分53和第二平台部分54。当狭槽55在仓主体51内被纵向驱动时，该狭槽容纳刀/滑动件驱动构件32。本发明的各种实施例包括第一基材60，该第一基材暂时地或可移除地支撑在第一平台部分53上或附接到第一平台部分53。相似地，第二材料70暂时地或可移除地支撑在第二平台部分54上或附接到第二平台部分54。例如，第一基材60和第二基材70可通过粘合剂（天然的和人造的两种）、通过使平台的部分变形而机械地、或者通过使用生物相容的和/或可吸收的紧固件来可移除地分别附接到第一平台部分53和第二平台部分54。在各种实施例中，基材60和70可由可生物吸收的网状材料制成。例如，基材60和70可由Vicryl（或其它可吸收的）缝合线或胶原基材料制成。在其它实施例中，基材60和70可包括由例如牛心包膜、
材料等制成的“扶壁”材料。
如图3和4中可见，例如基材60和70的各种实施例各自具有附接到基材60和70的至少一个细长拴系件。具体地，第一细长拴系件62可完全围绕第一基材60延伸，并且通过例如粘合剂（天然的和人造的两种）、通过使平台的部分变形而机械地、或者通过使用生物相容得和/或可吸收的紧固件附接到该第一基材。在其它实施例中，第一细长拴系件62附接到第一基材的单个部分（例如拐角、侧边、端部、顶部或底部表面），使得其从该单个部分延伸。同样，第二细长拴系件72通过相同或相似的材料和/或方法附接到第二基材70。在图3和4中所示的实施例中，第一细长拴系件62和第二细长拴系件72分别以各种长度提供。在一个实施例中，例如，第一拴系件62和第二拴系件72可各自具有约为仓50的长度“L”的至少两倍的长度。参见图2。然而，第一拴系件62和第二拴系件72可各自具有更短或更长的长度，如下文将更详细地论述。在另一实施例中，细长拴系件62或72之一短于另一细长拴系件62或72。尽管图2示出了拴系件62和72分别附接到第一基材60和第二基材70的远端，但是在其它实施例中，拴系件62、72也可分别附接到第一基材60和第二基材70的近端，或者在其它实施例中，一个拴系件62或72可附接到其对应的基材60、70的远端，并且另一拴系件62或72可附接到其对应基材的近端。参见例如图2A。在其它实施例中，拴系件62、72可附接到它们的对应基材60、70的两端，如图2B中所示。在其它实施例中，拴系件62、72可附接到其相应基材60、70的每个拐角。
图5和图6示出了钉仓50用于切割和缝合血管80的一种用途。如图5中可见，端部执行器12相对于血管80被定位成使得血管80的待切割和缝合的部分被容纳在砧座24和钉仓50的平台52之间。接着（通过牵拉闭合触发器18并将其锁定在定位上而）使砧座24闭合。接着可按压击发触发器20以击发缝钉90并将血管切割成两个血管端82、84。在击发之后，第一基材60被捕获于缝钉90的冠部和第一血管端82之间。同样，第二基材70被捕获于缝钉90的冠部和第二血管端84之间。见图6。在完成切割和缝合动作且砧座24移动到打开位置以从端部执行器12释放分开的血管端82、84之后，可从手术部位撤回端部执行器12。在该实施例中，拴系件62、72未在前附接到仓主体51且保持从其相应的第一基材60和第二基材70悬挂。因此，临床医生需要取回或识别分开的血管端82、84，临床医生可找到对应的拴系件62、72或者使用单独的器械（例如抓紧器、手术钳等）来使血管端更靠近。此类构造尤其是在用于切割可能需要在缝合之后进一步操纵的组织时呈现出相对于现有切割和缝合装置以及方法的巨大改良。
如图7中所示，端部执行器12和细长轴组件30的尺寸可被设定成穿过已被插入患者体内的套管针组件900而插入。此类套管针组件在本领域中是已知的，因此本文将不再详细讨论其构造和操作。例如，授予Frederick等人的名称为“Method For Using a Trocar For Penetration and SkinIncision”的美国专利6,017,356公开了各种套管针组件，该文献全文以引用方式并入本文。然而，读者应当理解，在不脱离本发明的实质和范围的情况下，本发明的各种实施例可有效地结合多种不同的套管针、插管等构造一起使用。因此，本发明的各种实施例及其等效结构不应以任何方式被限制为与本文以举例方式所述的具体类型的套管针一起使用。
在结合提供通往患者体内的手术部位的进入通道的套管针、插管等一起使用时，第一拴系件62和第二拴系件72可分别设置有能够使拴系件62、72延伸到套管针900之外从而能够容易地获取所述拴系件的长度。在此类构造中，例如如果一条缝钉线附接到待切除组织的一部分，则可利用拴系件来朝套管针插管902牵拉组织以使组织通过该插管离开。见图7。此类独特且新型的构造也可在套管针已移除但拴系件延伸出体腔中的开口时采用。因此，即使在移除套管针之后也可使用拴系件从体腔外操纵缝合的组织。
图8和图9示出了另一个仓实施例150，除下述不同之外，该仓基本上与上述仓50相同。在该实施例中，例如仓150具有被狭槽155分成第一平台部分153和第二平台部分154的仓平台152。第一基材60以上述各种方式暂时地附接到第一平台部分153或被可移除地支撑在该第一平台部分上，并且第二基材70以上述各种方式暂时地附接到或可移除地附接到第二平台部分154或者支撑在第二平台部分154上。然而，在该实施例中，其中能够暂时地容纳有第一拴系件62的至少一部分的第一凹槽或凹坑156被设置在第一平台部分153中。相似地，第二凹槽或凹坑157形成于第二平台部分154中，用于在第二平台部分中暂时地容纳第二拴系件72的至少一部分。参见图9。第一凹槽或凹坑156的尺寸相对于第一拴系件62可被设定成使得该第一拴系件可被按压在所述第一凹槽或凹坑中，以在端部执行器12被引入手术部位时将所述第一拴系件保持在凹槽156内，然后在第一基材60已附连到组织且端部执行器12被从手术部位撤回之后将所述第一拴系件拉出第一凹槽156。同样，第二凹槽157的尺寸相对于第二拴系件72可被设定成使得该第二拴系件可被按压在所述第二凹槽中，以在端部执行器12被引入手术部位时将所述第二拴系件保持在凹槽157内，然后在第二基材70已附连到组织且端部执行器12被从手术部位撤回之后将所述第二拴系件拉出第二凹槽157。在其它实施例中，第一拴系件62可通过生物相容的粘合剂、凝胶等暂时地被保持在第一凹槽156内，并且第二拴系件72可通过生物相容的粘合剂、凝胶等暂时地被保持在第二凹槽157内。
图10和图11示出了另一个仓实施例250，除下述不同之外，该仓基本上与上述仓50相同。在该实施例中，例如仓250具有被细长狭槽255分成第一平台部分253和第二平台部分254的仓平台252。第一基材60暂时地附接到或可移除地附接到第一平台部分253或者支撑在第一平台部分253上。同样，第二基材70以上述各种方式暂时地附接到或可移除地附接到第二平台部分254或者支撑在第二平台部分254上。然而，在该实施例中，其中能够暂时地容纳有第一拴系件62的至少一部分的第一凹槽、凹坑、区或区域257被设置在仓前缘部分256中。相似地，第二凹槽、凹坑、区或区域258或凹坑形成于仓前缘部分256中，用于在仓前缘部分中暂时地容纳第二拴系件72的至少一部分。参见图11。第一凹槽或凹坑257的尺寸相对于第一拴系件62可被设定成使得该第一拴系件可被按压在所述第一凹槽或凹坑257中，以在端部执行器12被引入手术部位时将所述第一拴系件保持在凹槽257内，然后在第一基材60已附连到组织且端部执行器12被从手术部位撤回之后将所述第一拴系件拉出第一凹槽257。同样，第二凹槽258的尺寸相对于第二拴系件72可被设定成使得该第二拴系件可被按压在所述第二凹槽258中，以在端部执行器12被引入手术部位时将所述第二拴系件保持在凹槽258内，然后在第二基材70已附连到组织且端部执行器12被从手术部位撤回之后将所述第二拴系件拉出第二凹槽258。在其它实施例中，第一拴系件62可通过粘合剂或摩擦暂时地被保持在第一凹槽257内，并且第二拴系件72可通过粘合剂或摩擦暂时地被保持在第二凹槽258内。
图12和图13示出了另一个仓实施例350，除下述不同之外，该仓基本上与上述仓50相同。在该实施例中，例如仓350具有仓主体351，该仓主体具有被细长狭槽355分成第一平台部分353和第二平台部分354的仓平台352。第一基材60暂时地附接到或可移除地附接到第一平台部分353或者支撑在第一平台部分353上。同样，第二基材70以上述各种方式暂时地附接到或可移除地附接到第二平台部分354或者支撑在第二平台部分354上。然而，在该实施例中，其中能够暂时地容纳有第一拴系件62的至少一部分的第一凹槽、凹坑、区或区域358被设置在仓前缘部分356的侧面357中。相似地，第二凹槽、凹坑、区或区域359形成于仓前缘部分356的侧面357中，用于在仓前缘部分356的侧面357中暂时地容纳第二拴系件72的至少一部分。参见图13。第一凹槽或凹坑358的尺寸相对于第一拴系件62可被设定成使得该第一拴系件可被按压在所述第一凹槽或凹坑358中，以在端部执行器12被引入手术部位时将所述第一拴系件保持在凹槽358内，然后在第一基材60已附连到组织且端部执行器12被从手术部位撤回之后将所述第一拴系件拉出第一凹槽358。同样，第二凹槽359的尺寸相对于第二拴系件72可被设定成使得该第二拴系件可被按压在所述第二凹槽359中，以在端部执行器12被引入手术部位时将所述第二拴系件保持在第二凹槽359内，然后在第二基材70已附连到组织且端部执行器12被从手术部位撤回之后将所述第二拴系件拉出第二凹槽359。在其它实施例中，第一拴系件62可通过粘合剂或摩擦暂时地被保持在第一凹槽358内，并且第二拴系件72可通过粘合剂或摩擦暂时地被保持在第二凹槽359内。
图14和图15示出了另一个仓实施例450，除下述不同之外，该仓基本上与上述仓50相同。在该实施例中，例如仓450具有仓主体451，该仓主体具有被细长狭槽455分成第一平台部分453和第二平台部分454的仓平台452。第一基材60暂时地附接到或可移除地附接到第一平台部分453或者支撑在第一平台部分453上。同样，第二基材70以上述各种方式暂时地附接到或可移除地附接到第二平台部分454或者支撑在第二平台部分454上。然而，在该实施例中，其中能够暂时地容纳有第一拴系件62的至少一部分的第一凹槽、凹坑、区或区域457被设置在仓450的前缘部分456中。相似地，第二凹槽、凹坑、区或区域458形成于前缘部分456中，用于在前缘部分中暂时地容纳第二拴系件72的至少一部分。参见图15。第一凹槽或凹坑457的尺寸相对于第一拴系件62可被设定成使得该第一拴系件可被按压在所述第一凹槽或凹坑457中，以在端部执行器12被引入手术部位时将所述第一拴系件保持在凹槽457内，然后在第一基材60已附连到组织且端部执行器12被从手术部位撤回之后将所述第一拴系件拉出第一凹槽453。同样，第二凹槽458的尺寸相对于第二拴系件72可被设定成使得该第二拴系件可被按压在所述第二凹槽458中，以在端部执行器12被引入手术部位时将所述第二拴系件保持在第二凹槽458内，然后在第二基材70已附连到组织且端部执行器12被从手术部位撤回之后将所述第二拴系件拉出第二凹槽458。在其它实施例中，第一拴系件62可通过粘合剂或摩擦暂时地被保持在第一凹槽457内，并且第二拴系件72可通过粘合剂或摩擦暂时地被保持在第二凹槽458内。
图16和图17示出了另一个仓实施例550，除下述不同之外，该仓基本上与上述仓50相同。在该实施例中，例如仓550具有仓主体551，该仓主体具有被细长狭槽555分成第一平台部分553和第二平台部分554的仓平台552。第一基材60暂时地附接到或可移除地附接到第一平台部分553或者支撑在第一平台部分553上。同样，第二基材70以上述各种方式暂时地附接到或可移除地附接到第二平台部分554或者支撑在第二平台部分554上。然而，在该实施例中，其中能够暂时地容纳有第一拴系件62的至少一部分的第一凹槽、凹坑、区或区域（未示出）被设置在仓550的第一横向侧部556中。相似地，第二凹槽、凹坑、区或区域558形成于仓550的第二横向侧部557中，用于在第二横向侧部中暂时地容纳第二拴系件72的至少一部分。参见图17。第一凹槽或凹坑的尺寸相对于第一拴系件62可被设定成使得该第一拴系件可被按压在所述第一凹槽或凹坑中，以在端部执行器12被引入手术部位时将所述第一拴系件保持在该凹槽内，然后在第一基材60已附连到组织且端部执行器12被从手术部位撤回之后将所述第一拴系件拉出第一凹槽。同样，第二凹槽558的尺寸相对于第二拴系件72可被设定成使得该第二拴系件可被按压在所述第二凹槽558中，以在端部执行器12被引入手术部位时将所述第二拴系件保持在第二凹槽558内，然后在第二基材70已附连到组织且端部执行器12被从手术部位撤回之后将所述第二拴系件拉出第二凹槽558。在其它实施例中，第一拴系件62可通过粘合剂或摩擦暂时地被保持在第一凹槽内，并且第二拴系件72可通过粘合剂或摩擦暂时地被保持在第二凹槽558内。在该实施例中，足够量的间隙被设置在槽的直立的侧壁23、25（图2）和仓550的第一横向侧部和第二横向侧部之间，以为第一拴系件和第二拴系件提供足够的间隙，以在基材60、70已被缝合到切断的组织部分且端部执行器12被从手术部位撤回之后将所述第一拴系件和第二拴系件拉出仓550中的它们的相应凹槽或换句话讲使它们从仓550的横向侧脱离。
上述实施例各自采用第一基材60和第二基材70。然而，其中对于能够期望操纵分离的/缝合的组织的仅一部分的那些应用而言，可采用仅一种基材。因此，本发明的各种实施例包括至少一种基材，所述至少一种基材被暂时地附接到端部执行器12的仓或其它部分或换句话讲被可移除地支撑在端部执行器12的仓或其它部分上，并且所述基材具有附接到基材的至少一个细长拴系件。
可将本发明所公开的装置设计为单次使用后即进行处理，或者可将它们设计为可多次使用。然而，在任一种情况下，所述装置均可进行修复，以在至少一次使用后再利用。修复可包括如下步骤的任何组合：拆卸该装置、随后清洁或替换特定部件、以及后续的组装。具体地，所述装置可被拆卸，并且可以任何组合选择性地替换或移除该装置的任何数目的特定部件或部分。清洁和/或替换特定部分后，该装置可以在修复设施处重新组装以供后续使用，或者在即将进行外科手术之前由外科手术团队重新组装。本领域的技术人员将会知道，装置的修复可利用多种用于拆卸、清洁/替换和重新组装的技术。此类技术的使用以及所得的修复的装置全部在本发明的范围内。
优选地，将在手术前处理本文所述的发明。首先，获取新的或用过的装置，并在必要时进行清洁。接着对装置进行消毒。在一种消毒技术中，将该装置置于闭合且密封的容器，例如塑性袋或TYVEK袋中。接着将容器和器械置于能够穿透该容器的辐射区，例如γ辐射、x-射线或高能电子。辐射将器械上和容器中的细菌杀死。接着将灭菌后的器械保存在无菌容器中。该密封的容器将器械保持无菌，直到在医疗设施中打开该容器。
以引用方式全文或部分并入本文的任何专利、公布或其它公开材料均仅在所并入的材料不与本发明所述的现有定义、陈述或其它公开材料相冲突的范围内并入本文。因此，在必要的程度下，本文所明确阐述的公开内容将取代以引用方式并入本文的任何相冲突的材料。如果据述以引用方式并入本文但与本文所述的现有定义、陈述或其它公开材料相冲突的任何材料或其部分，仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。
尽管已经将本发明作为示例性设计进行了描述，但还可以在本公开的实质和范围内对本发明进行修改。因此本专利申请旨在涵盖采用本发明一般原理的任何变型、用途或适应型式。此外，本专利申请旨在涵盖本发明所属领域中出自已知或惯有实践范围内的背离本公开的型式。
Claims (20)
1.一种用于操纵分离的组织的方法，包括：
将一块组织分离成两个单独的组织片段，每个所述组织片段均具有切断的端部；
缝合所述第一组织片段和第二组织片段的切断的端部；
在所述缝合期间，将至少一个拴系件附连到所述第一组织片段和第二组织片段的切断的端部中的至少一个；以及
通过向所述拴系件施加操纵动作来操纵所述切断的端部，所述切断的端部具有附连到切断的端部的所述至少一个拴系件。
2.根据权利要求1所述的方法，其中所述附连包括：
在所述缝合期间，将第一基材附连到所述切断的端部之一，所述第一基材具有联接到第一基材的至少一个所述拴系件；以及
在所述缝合期间，将第二基材附连到所述切断的端部中的另一个，所述第二基材具有联接到第二基材的至少一个另一所述拴系件。
3.根据权利要求1所述的方法，其中所述分离包括：
将外科切割和缝合器械的端部执行器插入患者体内的开口中，所述端部执行器包括：
钉仓，所述钉仓具有主体部分，所述主体部分中支撑有多个未成形缝钉；
组织切割构件；和
砧座，所述砧座被支撑以响应于由所述外科器械施加到砧座的打开动作和闭合动作可活动地朝向和远离所述钉仓上的平台表面行进；和
至少一种基材，所述至少一种基材被暂时地支撑在所述平台表面上，并且具有不可移除地联接到至少一种基材的至少一个细长拴系件，并且其中所述分离还包括：
将待切断的所述组织夹持在所述砧座和所述钉仓之间；以及
向所述组织切割构件施加驱动动作以分离所述组织。
4.根据权利要求3所述的方法，其中所述附连包括将所述至少一种基材缝合到所述组织的切断的端部之一。
5.根据权利要求3所述的方法，其中所述插入包括将所述端部执行器插入所述患者体内的开口中，使得仍然能够从所述患者的体外触及所述至少一个拴系件中的至少一个的一部分，并且其中所述操纵包括向所述患者体外保留的至少一个拴系件的每个部分施加牵拉动作。
6.根据权利要求2所述的方法，其中所述第一基材和第二基材以及每个所述细长拴系件是由可生物吸收的材料制成的。
7.根据权利要求2所述的方法，其中所述第一基材和第二基材包括可生物吸收的扶壁材料。
8.根据权利要求3所述的方法，其中所述基材通过可生物吸收的粘合剂而被可移除地保持在所述平台表面上。
9.根据权利要求3所述的方法，其中所述至少一个细长拴系件被可移除地支撑在所述仓主体的对应部分上。
10.根据权利要求9所述的方法，其中每个所述细长拴系件均被可移除地支撑在设置在所述仓主体部分中的对应凹槽内。
11.根据权利要求10所述的方法，其中所述至少一个所述对应凹槽被设置在所述仓主体的横向侧部中。
12.根据权利要求11所述的方法，其中所述至少一个对应凹槽被设置在所述仓主体部分的前缘部分中。
13.一种外科钉仓，包括：
仓主体，所述仓主体中可操作地支撑有多个外科缝钉，所述仓主体包括：
平台表面以及第一横向侧和第二横向侧；和
狭槽，所述狭槽被居中地设置在仓主体中，从而将所述平台表面分成第一平台部分和第二平台部分；
第一基材区段，所述第一基材区段被可移除地保持在所述第一平台部分上，所述第一基材具有不可移除地附连到第一基材的至少一个第一拴系件；和
第二基材区段，所述第二基材区段被可移除地保持在所述第二平台部分上，所述第二基材具有不可移除地附连到第二基材的至少一个第二拴系件。
14.根据权利要求13所述的外科钉仓，其中所述第一基材和所述第二基材包括网状材料。
15.根据权利要求13所述的外科钉仓，其中所述仓主体具有主体长度，并且其中所述至少一个细长拴系件中的至少一个具有至少与所述主体长度一样长的拴系件长度。
16.根据权利要求13所述的外科钉仓，其中所述第一拴系件被可移除地支撑在所述仓主体的对应的第一部分上，并且其中所述第二拴系件被可移除地支撑在所述仓主体的对应的第二部分上。
17.根据权利要求16所述的外科钉仓，其中每个所述第一拴系件均被可移除地支撑在对应的第一凹槽内，所述第一凹槽被设置在所述仓主体部分的所述第一部分中，并且其中所述第二拴系件被可移除地支撑在对应的第二凹槽内，所述第二凹槽被设置在所述仓主体的所述第二部分中。
18.根据权利要求17所述的外科钉仓，其中所述第一凹槽被设置在所述仓主体的第一横向侧部中，并且其中所述第二凹槽被设置在所述仓主体的第二横向侧部中。
19.根据权利要求13所述的外科钉仓，其中所述第一拴系件和第二拴系件的部分被可移除地支撑在所述仓主体部分的前缘部分中的至少一个凹槽中。
20.一种与外科器械一起使用的外科端部执行器，所述外科端部执行器包括：
细长通道，所述细长通道可操作地联接到所述外科器械；
钉仓，所述钉仓具有可操作地支撑在所述细长通道中的仓主体，所述仓主体具有由纵向狭槽基本上分成第一平台部分和第二平台部分的平台表面，所述狭槽在第一平台部分和第二平台部分之间延伸，所述仓主体中可操作地支撑有对应于所述第一平台部分的第一组多个未成形缝钉和对应于所述第二平台部分的第二组多个未成形缝钉；
组织切割构件，所述组织切割构件可操作地支撑在所述仓主体中，用于在由所述外科器械将切割致动动作施加到组织切割构件时，所述组织切割构件在所述纵向狭槽中轴向行进；
砧座，所述砧座被支撑以响应于由所述外科器械施加到砧座的打开动作和闭合动作可活动地朝向和远离所述平台表面行进；
第一基材，所述第一基材被可移除地支撑在所述第一平台部分上；
至少一个第一拴系件，所述至少一个第一拴系件不可移除地附接到所述第一基材；
第二基材，所述第二基材被可移除地支撑在所述第二平台部分上；和
至少一个第二拴系件，所述至少一个第二拴系件不可移除地附接到所述第二基材。
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- 2012-03-13 CN CN201280013169.XA patent/CN103429171B/zh not_active Expired - Fee Related
- 2012-03-13 BR BR112013023739-2A patent/BR112013023739B1/pt not_active IP Right Cessation
- 2012-03-13 WO PCT/US2012/028914 patent/WO2012125628A1/en active Application Filing
- 2012-03-13 EP EP12711724.0A patent/EP2685908B1/en active Active
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Cited By (10)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN106132318A (zh) * | 2014-03-28 | 2016-11-16 | 奥林巴斯株式会社 | 手术用器具 |
| CN106132318B (zh) * | 2014-03-28 | 2018-11-06 | 奥林巴斯株式会社 | 手术用器具 |
| CN108135602A (zh) * | 2015-07-30 | 2018-06-08 | 伊西康有限责任公司 | 包括用于确保外科器械的正确顺序操作的系统的外科器械 |
| CN108135602B (zh) * | 2015-07-30 | 2021-04-23 | 伊西康有限责任公司 | 包括用于确保外科器械的正确顺序操作的系统的外科器械 |
| CN108024812A (zh) * | 2015-09-24 | 2018-05-11 | 伊西康有限责任公司 | 用于系紧平直钉线的装置和方法 |
| CN108135599A (zh) * | 2015-09-24 | 2018-06-08 | 伊西康有限责任公司 | 用于利用套管针通道形成钉线的设备和方法 |
| CN108135599B (zh) * | 2015-09-24 | 2020-12-18 | 伊西康有限责任公司 | 用于利用套管针通道形成钉线的设备和方法 |
| CN108024812B (zh) * | 2015-09-24 | 2021-02-02 | 伊西康有限责任公司 | 用于系紧平直钉线的装置和方法 |
| CN108289671A (zh) * | 2015-09-30 | 2018-07-17 | 伊西康有限责任公司 | 具有中间支撑结构的可压缩附属物 |
| CN108289671B (zh) * | 2015-09-30 | 2021-07-30 | 伊西康有限责任公司 | 具有中间支撑结构的可压缩附属物 |
Also Published As
| Publication number | Publication date |
|---|---|
| BR112013023739A2 (pt) | 2016-12-13 |
| AU2012230052A1 (en) | 2013-09-12 |
| US8540131B2 (en) | 2013-09-24 |
| CN103429171B (zh) | 2016-04-06 |
| BR112013023739B1 (pt) | 2020-12-08 |
| US20120234900A1 (en) | 2012-09-20 |
| EP2685908A1 (en) | 2014-01-22 |
| AU2012230052B2 (en) | 2016-05-19 |
| RU2013145904A (ru) | 2015-04-20 |
| JP2014515639A (ja) | 2014-07-03 |
| WO2012125628A1 (en) | 2012-09-20 |
| JP6017466B2 (ja) | 2016-11-02 |
| EP2685908B1 (en) | 2018-01-03 |
| CA2828786A1 (en) | 2012-09-20 |
| CA2828786C (en) | 2018-11-20 |
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