CN1714761A - 采用具有旋转传递装置的不均匀多冲程发射机构的外科钉合器械 - Google Patents
采用具有旋转传递装置的不均匀多冲程发射机构的外科钉合器械 Download PDFInfo
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- 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
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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
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
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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
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
- A61B2017/2913—Handles transmission of forces to actuating rod or piston cams or guiding means
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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
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
- A61B2017/2923—Toothed members, e.g. rack and pinion
Abstract
一种尤其适合于内窥镜操作过程的手术钉合和切割器械，该器械采用一手柄，该手柄可产生单独的闭合和发射动作以致动端部执行器。具体地说，该手柄可产生多发射冲程以便减少发射端部执行器(即钉合和切割)所需要的力的大小。借助驱动楔形件改变与发射触发器相作用的凸轮盘的凸轮凸角的旋转中心、外周长度和深度能够使其优化。具体讲，在具体发射冲程期间的机械优点减轻了在端部执行器处发射所需要的较大的作用力，从而使得在发射触发器处形成更一致的接触力。
Description
相关申请的相互参考
本发明与Frederick E.Shelton IV，Michael Earl Setzer和Douglas B.Hoffman于同一天提交的未审结和共同所有的申请“采用具有旋转传递装置的多冲程发射机构的外科钉合器械”(SURGICAL STAPLINGINSTRUMENT INCORPORATING A MULTISTROKE FIRINGMECHANISM HAVING A ROTARY TRANSMISSION)相关，该申请的全部内容在此引入作为参考。
技术领域
本发明大体涉及能够在向组织施加多行钉的同时切割这些钉线之间组织的外科钉合器，具体而言，本发明涉及与钉合器械相关的改进以及能够通过触发器的多冲程实现发射的这种钉合器械的各种部件形成方法的改进。
背景技术
内窥镜外科器械通常比传统的开放式外科装置更受到偏爱，因为较小切口易于减少术后恢复时间和并发症。因此，适合于通过套管针的套管将远端执行器精确地放置在需要的手术部位的内窥镜外科器械领域有了显著的发展。这些远端执行器可通过多种方式与组织接合，以获得诊断或治疗效果(例如内切割刀、夹紧器、切割器、钉合器、夹具施放器、接触装置、药物/基因治疗输送装置以及使用超声波、RF、激光等的能量装置)。
已知的外科钉合器包括一端部执行器，其同时在组织中形成一个纵向切口，并在切口的相对两侧施加多行钉。端部执行器包括一对协同操作的钳口构件，如果该器械用于内窥镜或腹腔镜应用，则该对钳口能够通过套管通路。其中一个钳口构件容纳一个具有至少两排横向间隔地布置的钉的储钉筒。另一个钳口构件限定了一个砧板，该砧板具有与储钉筒中的钉排对齐的钉形成槽。该器械包括多个往复运动的楔形件，这些楔形件在被向远端驱动时通过储钉筒内的开口并与支撑该钉合器的驱动器接合，以使钉合器朝向砧板发射钉。
美国专利No.5,465,895中披露了适用于内窥镜检查的外科钉合器的一个例子，其有利地提供了不同的关闭和发射动作。由此，临床医生能够在发射之前闭合组织上的钳口构件以定位组织。一旦临床医生已经确定该钳口构件正确地夹紧了组织，临床医生就可接着以单发射冲程发射该外科钉合器，从而切割和钉合组织。切割和钉合同时进行可以避免用分别仅进行切割或钉合的不同手术工具顺序地执行这种动作时引起的复杂操作。
在发射前能够闭合组织的一个具体的优点在于临床医生能够借助内窥镜确认已经找到需要切割的位置，包括在相对的钳口之间已经捕获到足够量的组织。否则，相对的钳口会向一起拉得太近，特别是在其远端夹紧，这样不能有效地在被切割的组织上形成闭合的钉合。在另一种极端情况下，夹住过量组织会引起束缚和不完全的发射。
通常，单发射冲程之后的单闭合冲程是一种进行切割和钉合的方便有效的方式。不过，在某些情况下，要求多发射冲程。例如，外科医生能够对需要切割的长度从一系列具有对应长度的储钉筒的钳口尺寸中进行选择。较长的储钉筒需要较长的发射冲程，因此，与较短的储钉筒相比，对于那些较长的储钉筒而言，需要施加较大的力才能使手握式的触发器产生发射，以便能够切割更多组织以及驱动更多的钉。希望减小作用力的大小而与较短的储钉筒相当，以便不会超出某些外科医生手部的力量。另外，一些不熟悉较大的储钉筒的外科医生在需要料想不到的大力时可能会担心发生束缚或其它类型的故障。
减小发射冲程所需作用力的一种方法是棘轮机构，它允许发射触发器多次击发，如在美国专利No.5,762,256和No.6,330,965中所描述的。可是，有人认为，通过棘爪将发射触发器的往复运动直接转换到整体齿条(solid rack)限制了在每次发射冲程过程中所需的发射运动量的设计上的选择。另外，这些已知的具有多冲程发射机构的外科钉合器械并不具有独立的闭合和发射运动的优点。
因此，非常需要这样一种外科钉合器械，它使用多发射冲程以获得需要的切割和钉合长度，并且发射冲程行程与对端部执行器产生的纵向发射动作、尤其是与优化用于每一冲程的作用力和行程的纵向发射动作之间具有期望的关系。
发明内容
本发明通过提供一种具有传递一系列多发射冲程的旋转传递装置的外科钉合和切割器械，从而克服了现有技术的上述和其它缺陷。具体地说，认识到这种器械的端部执行器在发射期间需要不同程度的作用力，发射机构的旋转传递装置在某些冲程时与其它冲程相比改变了机械效果，从而对发射进行了优化以满足更一致的作用力的要求。因而不必要求手柄仅仅为了处理其中需要最大作用力的最坏情况而具备过多的发射冲程。
在本发明的另一方面，外科器械具有端部执行器，该端部执行器响应于纵向发射动作来执行手术操作。用户使发射致动器运动以产生发射动作，该发射动作有选择地由发射机构传递。具体地说，凸轮盘在其周缘的至少一部分附近具有多个凸轮凸角，当进行发射动作时，这些凸轮凸角分别由联接到发射致动器的驱动楔形件接合。凸轮盘通过齿轮齿啮合联接到齿条上，从而将这种间歇的旋转动作转换为纵向发射动作。使凸轮凸角的力矩臂和径向间距有利地变化，以便在各个冲程过程中产生需要的作用力。当在端部执行器遇到很大阻力(例如，组织切割，发射杆摩擦，钉成形)的具体冲程过程中，增强机械效果能够使多冲程的数量最小化，从而使每个冲程对外科医生而言具有相似的感觉。
通过附图和对附图的描述，本发明的上述和其它目的和优点会更容易理解。
附图说明
包括在其中并构成说明书的一部分的附图示出了本发明的实施方案，它与上述本发明概述和下面给出的具体实施方式的详细描述一起用于说明本发明的原理。
图1是具有开放的端部执行器的外科钉合和切割器械的透视图。
图2是沿图1中开放的端部执行器的线2-2的横截面的左侧剖视图。
图3是图1中的开放的端部执行器的透视图。
图4是图1中的外科钉合和切割器械的执行部分的分解透视图。
图5是图1中的外科钉合和切割器械的手柄的分解透视图。
图6是图1中的外科钉合和切割器械的手柄在打开状态下的左视图，并且将手柄外壳的左侧部分移开以暴露出包括用于多发射冲程的旋转传递装置的发射机构。
图7是图6中的手柄的右视图，并且将手柄部分的右侧部分移开以暴露出闭合机构和防倒转(anti-backup)特征。
图8是图7中手柄的俯视透视图。
图9是图6中手柄的侧剖视图，其闭合触发器闭合并且略去了发射触发器以暴露出发射驱动楔形件和凸轮盘内的凸轮凸角。
图10是图9中的发射驱动楔形件和凸轮凸角的俯视透视图。
图11是图1中手柄旋转传递发射机构的后侧透视图。
图12是图6中的手柄处于闭合和发射状态的侧剖视图，其中略去了旋转传递发射机构的小空转轮，以暴露出与整体齿条接触的防倒转摆动件。
图13是用于旋转传递发射机构的凸轮盘的侧视图，该旋转传递发射机构采用不均匀的发射冲程，用于优化图1中的外科钉合和切割器械在发射触发器处的发射力。
图14是用于具有均匀发射冲程的多发射冲程器械的发射力与发射行程之间的坐标图。
图15是用于具有不均匀发射冲程的多发射冲程器械的发射力与发射行程之间的坐标图，已经将所述不均匀发射冲程进行了优化以用于在发射触发器处的发射力。
图16显示了用于包括不均匀发射冲程的线性传递发射机构的具有不均匀间隔的齿条齿部分的直齿条，以优化图1中的外科钉合和切割器械在发射触发器处的发射力。
图17显示了用于包括不均匀发射冲程的线性传递发射机构的具有不均匀间隔的齿条齿部分的链接的齿条，以优化图1中的外科钉合和切割器械在发射触发器处的发射力。
图18显示了具有网门锁驱动器(screen door lock drive)的锥形杆线性发射机构，该发射机构包括不均匀的发射冲程，以优化图1中的外科钉合和切割器械在发射触发器处的发射力。
具体实施方案
参见附图，在这些附图中同样的标号表示同样的部件。图1-4描述了能够执行本发明的独特效果的外科钉合和切割器械10。该外科钉合和切割器械10采用一个具有以可枢转的方式连接到细长的沟槽16的砧板14的端部执行器12，从而形成用于夹紧要被切割和钉合的组织的相对的钳口。端部执行器12通过轴18联接到手柄20上。有利地设置由端部执行器12和轴18形成的执行部分22的尺寸，从而通过套管针或小的内窥镜开口插入，以便在由外科医生握住手柄20进行控制的同时进行内窥镜外科手术处理。手柄20有利地包括下述特征：能够允许端部执行器12与发射分开的闭合动作以及能够进行多发射冲程以使端部执行器12进行发射(即切割和钉合)，同时向外科医生指示发射的程度。
为此，将轴18的闭合管24联接在闭合触发器26和砧板14之间，以致使端部执行器12闭合。在闭合管24内，支架28被联接在细长沟槽16和手柄20之间，以沿纵向定位和支撑端部执行器12。将旋转调节器30联接到支架28，并且这两个元件被可转动地联接到手柄20上，可绕着轴18的纵向轴线进行旋转运动。这样，外科医生能够通过转动旋转调节器30旋转端部执行器12。闭合管24也通过旋转调节器30旋转，但保持相对于旋转调节器30的一定程度的纵向运动，以使得端部执行器12闭合。在支架28内，发射杆32被定位成用于纵向运动，并被联接到端部执行器12的砧板14和多冲程发射触发器34之间。闭合触发器26位于手柄20的手枪式握柄36的远侧，而发射触发器34位于手枪式握柄36和闭合触发器26这二者的远侧。
在内窥镜手术中，一旦将执行部分22插入到患者体内接近手术部位，外科医生就可参考内窥镜或其它诊断用成像装置将组织定位在砧板14和细长沟槽16之间。握住闭合触发器26和手枪式握柄36，外科医生可以反复地夹紧和定位组织。一旦相对于端部执行器12的组织位置和那里的组织数量满足要求，外科医生朝向手枪式握柄36完全压下闭合触发器26，在端部执行器12中夹紧组织并将闭合触发器26锁定在这个夹紧(闭合)位置。如果这个位置不满足要求，外科医生可以通过压下释放按钮38(图4)(将在下面对其操作进行更详细地说明)释放闭合触发器26，，然后重复上述过程夹紧组织。
如果夹紧正确，外科医生可以继续发射外科钉合和切割器械10。具体地说，外科医生夹住发射触发器34和手枪式握柄36，按照预定次数压下发射触发器34。根据以下参量按照人体工程学的方式确定必需的发射冲程数量，即，最大手尺寸、在每次发射冲程期间向器械施加的最大作用力、发射期间需要通过发射杆32向端部执行器12传递的纵向距离和作用力。正如在下面的讨论中将会理解的，每个外科医生可以选择使发射触发器34旋转不同的运动角度范围，并因此增加或减少发射冲程数量。
在图1中，闭合释放按钮38由收缩杆40遮住，该收缩杆在发射钉合和切割器械10时可以向远端旋转越过手柄20顶端，从而露出闭合释放按钮38。在按下闭合释放按钮38而使旋转传递发射机构42在手柄20内脱离接合后，外科医生可以向近端拉动收缩杆40，以辅助从端部执行器12收回发射杆32。
执行部分包括一E形杆(E-Beam)端部执行器
能够提供多冲程发射动作的手柄20的优点可以应用到许多器械中，在图1-4描述了一种这样的端部执行器12。该端部执行器12响应来自手柄20的闭合动作，该闭合动作由闭合管24沿纵向向远端传递。细长沟槽16与砧板14以可枢转的方式接合以形成相对的钳口，该钳口与支架28接合形成与手柄20的刚性连接。闭合管24在砧板14与细长沟槽16之间的枢轴连接的远侧与砧板14连接。因此，闭合管24相对于支架28向远端的运动导致端部执行器12闭合，其相对于支架28向近端的运动导致端部执行器12张开。
特别参考图4，执行部分22还包括响应来自手柄20的发射动作、具体地说是联接手柄20内的发射机构42和执行部分22之间的纵向运动的发射杆32的部件。具体而言，发射杆32(图5中显示了分解图)与支架28中的纵向凹槽48内的发射槽构件46以可旋转的方式接合。发射槽构件46直接响应于发射杆32的纵向运动在支架28内沿纵向运动。闭合管24中的纵向狭槽50可操作地与旋转调节器30联接(未示出)，纵向狭槽50还允许旋转调节器30在支架28中的小纵向狭槽52处与支架28接合以进行旋转。闭合管24内的纵向狭槽50的长度足够长，以便允许与旋转调节器30的相对纵向运动，从而分别实现闭合动作。
发射槽构件46的远端连接到与支架28一起运动的发射杆56的近端，以便将E形杆60伸向远端进入端部执行器12内。端部执行器12包括由E形杆60致动的储钉筒62，该E形杆60使得钉从储钉筒62的钉孔64被驱动而与砧板14的钉形成槽68接触，从而形成“B”形钉。特别参考图3，储钉筒主体86进一步包括一向近端开口的垂直狭槽70，供沿E形杆60的远端设置的垂直方向切割表面通过，以便在被钉住时切割组织。
在五个未审结和共同所有的美国专利申请中描述了所示出的端部执行器12，上述每个申请都全部在此引入作为参考：(1)FrederickE.Shelton，Mike Setser，Bruce Weisenburgh于2003年6月20日提交的序列号为10/441,424的“具有用于防止发射的单个锁定机构的外科钉合器械”；(2)Frederick E.Shelton，Mike Setser，Brian J.Hemmelgarn于2003年6月20日提交的序列号为10/441,632的“具有分开的不同闭合和发射系统的外科钉合器械”；(3)Frederick E.Shelton，MikeSetser，Bruce Weisenburgh于2003年6月20日提交的序列号为10/441,565的“具有用尽的储钉筒锁定机构的外科钉合器械”；(4)Frederick E.Shelton，Mike Setser，Bruce Weisenburgh于2003年6月20日提交的序列号为10/441,580的“具有用于未闭合砧板的发射锁定装置的外科钉合器械”；(5)Frederick E.Shelton，Mike Setser，BruceWeisenburgh于2003年6月20日提交的序列号为10/443,617的“采用E形杆发射机构的外科钉合器械”。
应当理解，虽然这里示出的是非铰接的轴18，本发明的应用可以包括能够以铰链连接的器械，例如在下面五个未审结和共同所有的美国专利申请中所描述的，将每个申请的全部内容在此引入作为参考：(1)Frederick E.Shelton，Brian J.Hemmelgarn，Jeff Swayze，Kenneth S.Wales于2003年7月9日提交的序列号为10/615,973的“采用具有围绕纵向轴线旋转的铰链机构的外科器械”；(2)Brian J.Hemmelgarn于2003年7月9日提交的序列号为10/615,962的“采用用于发射杆轨道的铰链连接的外科钉合器械”；(3)Jeff Swayze于2003年7月9日提交的序列号为10/615972的“具有横向运动铰链控制的外科器械”(4)Frederick E.Shelton，Mike Setser，Bruce Weisenburgh于2003年7月9日提交的序列号为10/615,974的“采用用于增加铰链连接附近灵活性的锥形发射杆的外科钉合器械”；以及(5)Jeff Swayze，JosephCharles Hueil于2003年7月9日提交的序列号为10/615,971的“具有用于支撑发射杆的铰链连接支撑板的外科钉合器械”。
多冲程发射手柄
在图5-8中，手柄20响应于闭合触发器26和发射触发器34的致动分别向执行部分22产生闭合和发射动作。对于闭合动作，闭合触发器26包括一上部76，该上部76包括三个横向孔：一个在前方定位的销孔78、一个下后方的枢轴孔80和一个中央切口82。三个杆沿横向定位在手柄外壳88的左半壳体86和右半壳体84(图5-6显示出右半壳体84，图7显示出左半壳体86)之间并与左和右半壳体接合。具体地，后侧杆90穿过闭合触发器26的上部80的后侧枢轴孔80，由此闭合触发器26可绕着后侧杆90枢转。相对于后侧杆90在远端定位的前侧杆92和位于前侧杆92上方的顶部杆94穿过中央切口82，该中心切口被形成为通过在触发行程的每一极限位置处接触前侧杆92和顶部杆94而限制闭合触发器26的运动。因此，中央切口82包括一垂直部分和一上部向近侧倾斜的部分，其中所述垂直部分在闭合触发器26向前(远端)时其底面与前侧杆92相接触，所述上部向近侧倾斜的部分当闭合触发器26在其前面松开位置和其近侧致动位置时其顶表面和前表面分别与顶部杆94接触。
与闭合管24接合的闭合轭形件96可沿纵向滑动地容纳在手柄外壳88中，并且该轭形件在其远端与闭合管24的近端接合，从而将纵向闭合运动传递给闭合管24，并传递给砧板14用于闭合端部执行器12。这种接合允许闭合管24旋转而闭合轭形件96并不旋转。在该接合上方，横向销孔100通过前侧销104与闭合连杆102联接。闭合连杆102的另一端通过后侧销106与闭合触发器26的销孔82联接。
三角形垫片120包括用于接收杆90-94的孔122-126，三角形垫片120在闭合触发器26的上部80的左侧。在三角形垫片120的左侧，凸轮盘130可旋转地接收前侧杆92并包括接收后侧杆90和顶部杆94的半圆形槽132。中心孔134接收前侧杆92。在凸轮盘130的左侧，在发射触发器34上端138的杆孔136接收顶部杆94。杆孔136下方的发射触发器内的远端开口凹槽140被对准以接收前侧杆92，从而允许在发射期间向远端拉动发射触发器34。在闭合触发器26致动期间闭合连杆102(图8)和发射触发器34的向下的摩擦接合使得发射触发器34被部分地向远端拉动，从而使发射触发器34处于可被握持状态。
特别参考图5、9和10，凸轮盘130围绕其向前部分(如图示当在其未发射状态下时)、特别是沿着其左侧提供了一系列凸轮凸角142-144(图9)，这些凸轮凸角分别由发射触发器34接合以向凸轮盘130施加从顶部到前部的旋转。这种旋转通过旋转传递发射机构42的齿轮系150(图10)传递，从凸轮盘130的与小空转轮154接合的右侧较低部分附近的齿轮部分152开始，这样相对于凸轮盘130以增加的速度从顶部旋转到后部。较大的空转轮156通过空转轴158连接到小空转轮154，并因而以相同的方向和速率旋转。第二小齿轮160与较大的空转轮156啮合，并因而以较大速率从顶部旋转到前部。一细齿的大齿轮162通过第二轴164连接到第二小齿轮160并因而以与第二小齿轮160相同的方向和速率旋转。因此，齿轮系150通过包括了双齿轮减速特征放大了凸轮盘130的运动，以提供附加的纵向发射动作。细齿的大齿轮162与位于整体齿条170下侧的齿链段168接合，该整体齿条170的远端与发射杆32的近端接合。齿条170的远端部分沿纵向可滑动地装入闭合轭形件96内并且其近端部分沿纵向可滑动地装入手柄外壳88的左半壳体86和右半壳体84之间。
通过起动发射触发器34的多发射冲程，发射触发器34与凸轮凸角142-144的选择性接合可提供进一步的纵向行程。为了使齿轮系150做好发射准备，凸轮盘130由连接到向左凸出的整体销174的齿轮系回缩弹簧172向该盘的未发射位置推压，该整体销174形成在凸轮盘130的近侧下边缘处的环状凹槽176内(图9-10)。齿轮系回缩弹簧172的另一端连接到与手柄外壳88成一体的销178上。
特别参考图5、9、11，在发射触发器34上端128的下方和远端侧是驱动楔形件销孔180。驱动楔形件182由驱动楔形件销184保持靠在发射触发器34的左侧，在驱动楔形件182和驱动楔形件销184之间设置有支座指状件(standoff finger)186，该指状件186与凸轮盘130中心的未凸起的圆周表面接触。在向近端和向上指向的支座指状件186与向下和向近端指向的驱动楔形件182之间的捕鼠器型的弹簧188推动驱动楔形件182向上与凸轮凸角142-144接合。
在驱动楔形件销孔180下方，驱动楔形件182还具有下侧近端销孔190，发射触发器34包括一下侧销孔192。反向拉簧194被连接在下侧销孔192内的向右延伸的销196和销孔190之间，以向下推压驱动楔形件182，从而当发射触发器34在冲程间歇向远端行进时(见图10，其中发射触发器34被隐藏)防止驱动楔形件182向上旋转过远。
特别参考图12，当驱动楔形件182在发射冲程之间从凸轮凸角142-144中的一个凸角中拉出时，如果没有防倒转杆200的作用，凸轮盘130将通过齿轮系回缩弹簧172的作用趋向于从顶部向后部旋转。防倒转摆动件200的横向销202、204分别与手柄外壳88的右半壳体84和左半壳体86接合。在销202、204上方，防倒转拉簧206连接到防倒转摆动件200远端的右半壳体88的整体销208上。特别参考图5，防倒转摆动件200的下部支脚210与整体齿条170的上表面212摩擦接触。当防倒转摆动件200的下部支脚210由于收回整体齿条170而向近端拉回时，防倒转杆200与整体齿条接近垂直接合，这增加了摩擦力，从而锁定整体齿条170，这足以克服由齿轮系回缩弹簧172提供的向后驱动力。当整体齿条170由发射触发器34向远端驱动时，下部支脚210被向远端推动，从而减小摩擦并允许发射。通过空转轴158和通过防倒转拉簧206的推压来防止下部支脚210的过度向前运动。
在图12中，释放按钮38绕其后侧枢销220、222向上枢转，从而使其远端臂224在防倒转摆动件200的近端定向臂226上方升起，以便允许下部支脚210的远端运动在发射冲程之间锁定齿条170。夹紧锁定杆230绕其横向枢销232、234摆动，从而使释放按钮38抬起。具体地说，夹紧锁定杆230的向近端和向上凸出的臂236与释放按钮38的远端臂224的下表面可滑动地抵接。夹紧锁定杆230的向远端凸出的锁定臂238在它夹紧的情况下锁定闭合轭形件96。尤其是，在向近端向上凸出的臂236和向远端凸出的锁定臂238之间向下延伸的凸起240在近端由拉簧242推压，上述拉簧242在销244处也被连接到手柄外壳88的右半壳体84上。参考图6-7，远端凸出锁臂238放置在位于闭合轭形件96的顶部近端部分处的梯台246上，允许闭合轭形件96被向远端移动以传递闭合运动。当闭合轭形件96到达它的远端致动位置时(图8、9)，梯台246的向远端向上开口的凹槽的夹紧锁定凹口248容纳向远端凸出的锁定臂238。因此，外科医生可以在端部执行器12保持夹紧的情况下释放闭合触发器26。
参考图5-8、12，除了上述防倒转特征和闭合夹紧特征，发射闭锁特征由发射闭锁杆250提供。尤其是如图7和图8所示，在外科钉合和切割器械10处于其初始开放和未发射状态的条件下，发射闭锁杆250响应于通过阻挡整体齿条170的远端发射动作被收回的闭合轭形件96。发射闭锁杆250包括向远端延伸的臂252，该延伸臂具有向远端倾斜的上表面254，该上表面沿整体齿条170的近端部分与右边缘256对齐。沿整体齿条170其余远端部分的凹陷右边缘258允许发射闭锁杆250的向远端倾斜的上表面254向上转动，绕其近端横向销260、262枢转，上述近端横向销被连接到垂直凸起266的拉簧264推动，而上述垂直凸起266在近端垂直地连接到向远端延伸的臂252上。将拉簧264的另一端连接到整体销268，该整体销268在位于垂直凸起266后面的手柄外壳88的右半壳体84中形成。
如图8所示，向远端倾斜表面254通过由梯台270向上挤起整体齿条170来阻挡该齿条的远端运动，上述梯台270横跨闭合轭形件96的近端形成，在近端向上敞开以支撑发射闭锁杆250向下枢转的向远端延伸的臂252。如图12所示，伴随着闭合轭形件96向远端运动以闭合端部执行器12，允许整体齿条170的右边缘256在远端倾斜表面254上通过，通过向下运动向远端延伸臂252以接合下方梯台272，远端倾斜表面254在那里做出响应，其中上述下方梯台272在邻近更高和更远端梯台270的闭合轭形件96中形成。发射闭锁杆250和下方梯台272的接合具有在整体齿条170被收回之前防止闭合轭形件96缩回(近端运动)的优点。因此，在端部执行器12松开之前启动发射机构42的缩回，否则可能会导致在发射机构42中的束缚。此外，下方梯台272和发射闭锁杆250之间可以存在充分的摩擦接触，从而需要两步式程序将钉合和切割器械10恢复到其打开和缩回状态。尤其是，一旦已经通过按下释放按钮38将发射机构42收回，在闭合触发器26上的轻微挤压就很容易使发射闭锁杆250抬升到它的发射闭锁位置。此后，当闭合轭形件96被全部收回时，闭合触发器26的释放可以和使发射闭锁杆250对准以与较高梯台270接合一起进行，由此打开端部执行器12。
应当进一步理解的是，齿条170可以有利地为连杆的形式，上述连杆允许靠近发射机构42的部分被弯曲入手柄中，从而允许更紧凑的设计。Jeffrey S.Swayze，Frederick E.Shelton IV在2003年9月29日提交的序列号为No.10/673,930的共同所有专利申请“采用具有链接的齿条的发射机构的外科钉合器械”中更详细地描述了这种链接的齿条(linked rack)。
不均匀发射冲程
发射触发器34和位于整体齿条170上游的旋转传递发射机构150的相互作用提供了进一步优化多发射冲程的机会。参考图13，凸轮盘330促进不均匀发射冲程，从而使得对于可能遇到增大的阻力的特定冲程机械优势会增加，而同时对应于具有较少机械优势的其它冲程则减小了所需的发射冲程数。此外，向外科医生提供了更加一致的触觉反馈，这样当此次发射比起前一次发射需要更大的发射力时，避免了束缚已经发生或整个行程已经完成的错误感觉。
借助与驱动楔形物182的操作关系，使发射触发器34和三个凸轮凸角342-344绕与包括凸轮凸角的凸轮盘330不同的旋转中心相互作用；从而，可以实现对凸轮盘330借助发射触发器34的致动而旋转的方式加强控制。凸轮凸角342-344的间隔、它们的深度(如它们分别从前侧销92开始的半径距离R1-R3所示)和它们的总体形状允许冲程距离和机械优势产生期望的变化。
如图14-15所述，由于负载的变化，发射所需要的作用力为随纵向发射行程变化的函数。在图14中，发射行程距离已经被分成距离相等的3次发射冲程。在第一次发射期间，作用力在冲程的第一部分期间向上增大，然后在缓慢增加的情况下变得基本恒定。在第二冲程和进入第三冲程期间，所需作用力的这种缓慢增加继续进行，当接近整个发射行程时力开始逐渐下降。这种所需作用力的变化涉及多种因素，诸如被切割组织的数量，被驱动的钉和在发射机构150和执行部分22中遇到的机械摩擦。在第二冲程期间，外科医生经历了做功(举例来说，经过一段距离的力)的最高水平，与之相关的面积2大于邻接的面积1和面积3。如果对于预期的外科医生群体所需的作用力太大，那么对于这种均匀发射旋转传递发射机构150可能需要附加的冲程。
在图15中，不均匀的发射冲程被用于有利地改变冲程间发射行程的纵向大小，如在D* 1处的第一冲程末端和在D* 2处的第二冲程所示，其中D* 1大于图14的D1，D* 2小于图14的D2。在每一冲程期间外科医生所需做功的数值基本上相同，这样易于避免超出一些外科医生的握力。此外，在发射每一冲程的平均作用力似乎更加恒定的情况下，外科医生基本上不会误解这种触觉反馈。尤其是，尽管没有描述，但是应当理解，在冲程2期间不得不行进更短的纵向距离意味着使用增强的机械优势减少在发射触发器处感觉到的用于发射的瞬时力。
已经描述了示例性的旋转传递发射机构42得益于不均匀发射冲程以优化行程所需的作用力；但是，应当理解，将发射触发器运动转换成纵向发射运动的线性联接方法也可以从不均匀发射冲程中受益。在图16中描述了直齿条400，所示的直齿条400具有不均匀间隔的齿条齿部分402、404、406。具体地说，在远端齿条齿部分402中，所示的三个齿具有较小的纵向长度。在中间齿条齿部分404中，所示的三个齿具有适中的纵向长度。在近端齿条齿部分406中，所示的三个齿具有延长的纵向长度。因此，当在近端齿条齿部分406而不是在远端齿条齿部分402接触齿时，从枢轴连接件410到发射触发器414的顶部412向前向下推动的棘爪408易于在随后的冲程中接合给定齿。因此，根据每一部分402、404、406的齿条齿的长度，在棘爪408接合直齿条400时，机械优势和外科医生手握紧的程度在发生变化。
在图17中，不均匀发射冲程被应用于链接齿条发射机构430，诸如在Jeffrey S.Swayze和Frederick E.Shelton IV申请的序列号为No.10/673,930的共同所有和未审结的美国专利申请“采用具有链接齿条传递装置的发射机构的外科钉合器械”中更加详细描述的那样。在这种情况下，在形成为链接齿条444的三个连杆438、440、442上的倾斜狭槽432、434、436的长度有变化。
在图18中，网门锁驱动器(screen door lock drive)500将不均匀发射冲程和锥形发射杆502结合在一起，上述发射杆502由网门锁型折线板504接合，折线板504围绕位于发射触发器510顶部508的枢轴连接件506被向下向前推动。折线板504具有连接枢轴连接件506和向下的臂514的向远端凸出的臂512，其中向下的臂514包括用于容纳锥形杆502的孔516。当发射触发器510的顶部508向远端运动以便发射时，凸出臂512向远端运动。锥形杆502和孔516的摩擦接触使向下的臂514向上向前旋转网门折线板504，导致孔516不再沿锥形杆502滑动，而是代之以结合和接合，从而推动锥形杆502向远端发射该器械。因此，锥形杆502的直径决定了在结合发生前折线板504必须向上向前旋转多少。
因此，在图16-18中的发射触发器与发射齿条的直线部分的棘爪型接合的每一种版本中，改变齿的间隔导致不均匀的冲程并且避免了当需要更大的作用力时发射机构在更接近于其最松弛的位置接合发射触发器。作为替代，在发射触发器已经被带到更接近器械的手枪式握柄之前延迟接合，确保在给定冲程中所做的功(一段距离上的力)与其它冲程类似。此外，在发射触发器靠近通常容易获得较大握力的手枪式握柄的条件下施加作用力。而且，发射触发器的上部相对齿条的纵向远端运动的弧线形相对运动也根据棘爪与齿条何时接合而变化。
在使用中，外科医生通过套管针的套管将端部执行器12和轴18定位在手术位置，在相对钳口夹住要被钉合和切割的组织时定位砧板14和细长沟槽16。一旦端部执行器12的位置满足要求，即可朝着手柄20的手枪式握柄36完全压下闭合触发器26，导致闭合连杆102使闭合轭形件96和闭合管24前进，从而闭合端部执行器12。向远端运动的闭合轭形件96设有容纳夹紧锁定杆230的夹紧锁定凹口248，以便夹紧端部执行器12。驱动楔形件182被联接到发射触发器34上，通过将驱动楔形件182顺序地接合到位于凸轮盘330上的凸轮凸角342-344上，多次击打发射触发器34来实现发射杆32的发射。通过旋转传递发射机构150将传递这种棘轮旋转，以便使整体齿条170向远端前进。在使闭合轭形件96前进的条件下，齿条170能够压下发射闭锁杆250，使其不挡操作。在发射冲程之间，防倒转摆动件100被拉成与齿条170成垂直锁定接触，抵抗连接到凸轮传动装置330的齿轮系回动弹簧172施加的回缩力。一旦完成整个发射行程，首先按下释放按钮38释放防倒转摆动件200，允许收回整体齿条170，接着使夹紧锁定杆230与闭合轭形件96脱离接合，以便消除打开端部执行器12的一个障碍。外科医生挤压闭合轭形件96以允许发射闭锁杆250从闭合轭形件96中释放，并释放闭合触发器26，从而允许闭合轭形件96向近端运动到它可以支撑发射闭锁杆250以便锁定整体齿条170，使其不能发射。此后，外科钉合和切割仪器10的执行部分22可以被除去，诸如为另一个手术作准备而替换储钉筒62。
尽管已通过若干实施方案描述了本发明，并且尽管已经相当详细地描述了示例性实施方案，但是不意味着申请人打算以任何方式用这些详细描述来限制所附的权利要求的保护的范围。其它优点和变型对于本领域的技术人员来说是显而易见的。
应当理解的是，此处所用术语“近侧”和“远侧”以临床医生握持器械手柄作为参考。因此，端部执行器12相对于在近侧的手柄20位于远侧。还应当理解，为了简便和清晰起见，对于附图使用了诸如“垂直”和“水平”这样的空间术语。但是，可在各种方向和位置使用外科仪器，这些术语并不是限定和绝对性的。
本发明是就内窥镜操作和设备进行说明的。但是，这里使用的诸如“内窥镜”这样的术语不应当理解为将本发明限制为仅与内窥镜套管(即套管针)相结合使用的外科钉合和切割器械。相反地，应当认为本发明可以用于任何接触限制为微创的操作，包括但不限于内窥镜操作以及开放性操作。
例如，虽然在这里将外科钉合和切割器械10描述为有利地具有单独的和不同的闭合和发射致动，它给医务工作者提供了灵活性。但是，应当理解，这些与本发明一致的应用中可以包括这样的手柄，该手柄将单用户致动转换为闭合和发射该器械的发射动作。
另外，虽然这里示出的是手动致动手柄，但电动和其它动力驱动的手柄也可以得益于采用一个如上所述的链接齿条，以允许减小手柄的尺寸或带来其它优点。例如，虽然部分地将链接齿条收纳到手枪式握手中是方便的，但应当理解，在连杆之间的这种枢轴连接允许以平行于由轴和手柄筒限定的平直部分的方式收纳连杆。
Claims (3)
1.一种外科器械，其包括：
可操作地设置以响应发射动作的端部执行器；
连接到端部执行器上的轴，该轴包括一个联接到端部执行器上的细长的发射构件，用于运动以沿轴向传递发射动作；以及
从近端连接到所述轴的手柄，该手柄包括：
凸轮构件，该凸轮构件包括多个凸轮凸角，至少一个凸轮凸角的形状与相邻的凸轮凸角不同；
发射致动器，可沿发射方向和返回方向反复地运动，并被可操作地设置为在每个发射冲程期间与对应的凸轮凸角相互作用，以及
发射机构，其响应于来自凸轮盘的间歇动作以便向执行部分产生纵向发射动作。
2.如权利要求1所述的外科器械，其特征在于，凸轮构件包括一个凸轮盘，该凸轮盘包括在至少一部分周缘周围的多个凸轮凸角，至少一个凸轮凸角与相邻的凸轮凸角在形状上不同。
3.如权利要求2所述的外科器械，其特征在于，所述手柄进一步包括一个联接到发射致动器的楔形件，其被可操作地设置为在每次发射致动器沿发射方向的运动期间顺序地与凸轮盘的多个凸轮凸角中的相对应的一个接合。
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- 2005-06-22 CA CA2510844A patent/CA2510844C/en not_active Expired - Fee Related
- 2005-06-29 RU RU2005120369/14A patent/RU2434593C2/ru not_active IP Right Cessation
- 2005-06-29 AT AT05254066T patent/ATE392188T1/de not_active IP Right Cessation
- 2005-06-29 PL PL05254066T patent/PL1611856T3/pl unknown
- 2005-06-29 DE DE602005006049T patent/DE602005006049T2/de active Active
- 2005-06-29 ES ES05254066T patent/ES2303196T3/es active Active
- 2005-06-29 EP EP05254066A patent/EP1611856B1/en active Active
- 2005-06-29 JP JP2005190315A patent/JP4799929B2/ja active Active
- 2005-06-29 MX MXPA05007124A patent/MXPA05007124A/es active IP Right Grant
- 2005-06-29 BR BRPI0503624A patent/BRPI0503624B8/pt active IP Right Grant
- 2005-06-30 KR KR1020050057675A patent/KR101141030B1/ko active IP Right Grant
- 2005-06-30 CN CNB200510080744XA patent/CN100484481C/zh active Active
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| Publication number | Priority date | Publication date | Assignee | Title |
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| CN101095621B (zh) * | 2006-06-27 | 2011-11-09 | 伊西康内外科公司 | 手动驱动外科切割和紧固器械 |
| CN101317781B (zh) * | 2007-06-04 | 2012-03-28 | 伊西康内外科公司 | 具有多速率方向切换机构的外科器械 |
| CN102438532A (zh) * | 2009-04-22 | 2012-05-02 | 伊兹拉普有限公司 | 人类工程学旋转装钉器 |
| CN102438532B (zh) * | 2009-04-22 | 2014-07-09 | 伊兹拉普有限公司 | 人类工程学旋转装钉器 |
| CN103826550A (zh) * | 2011-08-08 | 2014-05-28 | 瑞福克斯集团公司 | 用于在眼部组织形成切口的装置及方法 |
| CN103826550B (zh) * | 2011-08-08 | 2016-12-14 | 瑞福克斯集团公司 | 用于在眼部组织形成切口的装置 |
| CN102949220A (zh) * | 2011-08-24 | 2013-03-06 | 苏州天臣国际医疗科技有限公司 | 外科缝合器的操作机构 |
| CN102949220B (zh) * | 2011-08-24 | 2014-10-29 | 苏州天臣国际医疗科技有限公司 | 外科缝合器的操作机构 |
| CN110799124A (zh) * | 2017-06-28 | 2020-02-14 | 爱惜康有限责任公司 | 具有关节运动系统比率的外科器械 |
| US10806631B2 (en) | 2017-08-23 | 2020-10-20 | Refocus Group, Inc. | Surgical tool for forming incisions in ocular tissue with tip providing visibility and related apparatus and method |
Also Published As
| Publication number | Publication date |
|---|---|
| JP4799929B2 (ja) | 2011-10-26 |
| BRPI0503624B8 (pt) | 2021-06-22 |
| EP1611856A1 (en) | 2006-01-04 |
| RU2434593C2 (ru) | 2011-11-27 |
| KR20060048751A (ko) | 2006-05-18 |
| DE602005006049D1 (de) | 2008-05-29 |
| AU2005202480B2 (en) | 2012-02-02 |
| US20060000867A1 (en) | 2006-01-05 |
| ATE392188T1 (de) | 2008-05-15 |
| EP1611856B1 (en) | 2008-04-16 |
| AU2005202480A1 (en) | 2006-01-19 |
| CA2510844A1 (en) | 2005-12-30 |
| BRPI0503624B1 (pt) | 2016-06-14 |
| DE602005006049T2 (de) | 2009-05-07 |
| BRPI0503624A (pt) | 2006-02-07 |
| JP2006015150A (ja) | 2006-01-19 |
| PL1611856T3 (pl) | 2008-08-29 |
| MXPA05007124A (es) | 2006-02-08 |
| ES2303196T3 (es) | 2008-08-01 |
| CN100484481C (zh) | 2009-05-06 |
| RU2005120369A (ru) | 2007-01-10 |
| US7059508B2 (en) | 2006-06-13 |
| KR101141030B1 (ko) | 2012-07-12 |
| CA2510844C (en) | 2013-01-22 |
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