CN1843301B - 具有单枢轴闭合和双枢轴框架底的关节运动轴的外科器械 - Google Patents

具有单枢轴闭合和双枢轴框架底的关节运动轴的外科器械 Download PDF

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CN1843301B
CN1843301B CN2006100725482A CN200610072548A CN1843301B CN 1843301 B CN1843301 B CN 1843301B CN 2006100725482 A CN2006100725482 A CN 2006100725482A CN 200610072548 A CN200610072548 A CN 200610072548A CN 1843301 B CN1843301 B CN 1843301B
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joint motions
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surgical instruments
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CN1843301A (zh
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肯尼思·S·威尔士
查德·P·布德罗克斯
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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
    • 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
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
    • 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
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2933—Transmission of forces to jaw members camming or guiding means
    • A61B2017/2937—Transmission of forces to jaw members camming or guiding means with flexible part
    • 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
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2939—Details of linkages or pivot points
    • A61B2017/294—Connection of actuating rod to jaw, e.g. releasable
    • 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
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2943—Toothed members, e.g. rack and pinion
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T403/00—Joints and connections
    • Y10T403/32—Articulated members
    • Y10T403/32114—Articulated members including static joint
    • Y10T403/32221—Articulate joint comprises pivoted clevis or channel bar

Abstract

一种特别适用于内窥镜使用的外科器械，包括近侧部分，其在患者体外操作，将连接的细长轴和端部执行器定位到患者体内需要进行手术的部位。关节运动接头将端部执行器与细长轴枢转连接，从而在以所需的角度到达组织方面提供进一步的临床弹性。闭合管组件包括单枢轴部分，其跨过关节运动接头向远侧平移，使端部执行器闭合，并通过使多个枢轴框架底包围在其中来越过关节运动轴，以适应闭合套管枢轴中的纵向变化。因此，在定位端部执行器时可获得额外的临床弹性，而不会失去由轴传递的单独闭合和发射运动的能力。

Description

具有单枢轴闭合和双枢轴框架底的关节运动轴的外科器械
相关申请的交叉参考
本发明要求Kenneth Wales和Chad Boudreaux于2005年2月18日申请的题为“SURGICAL INSTRUMENT INCORPORATING AFLUID TRANSFER CONTROLLED ARTICULATION MECHANISM”的共有美国专利申请的优先权，其内容在此全部引用作为参考。
技术领域
本发明总的通常涉及外科器械，其适用于将端部执行器(例如，末端切割器，抓钳，切割器，缝合器、夹钳施放器、接触装置、药物/基因治疗传送装置，以及采用超声波、RF、激光等的能量装置)以内窥镜检查的方式插入到手术部位，更具体地说，本发明涉及带有关节运动轴的这种外科器械。
背景技术
内窥镜外科器械通常比传统的开放手术装置更优越，是由于较小的切口减少了术后康复时间和并发症。因此，适于将远侧端部执行器经套管针插管精确放置到所需的手术部位的各种内窥镜外科器械得到了极大的发展。这些远侧端部执行器以多种方式与组织接合，实现诊断或治疗的效果(例如，末端切割器、抓钳、切割器、缝合器、夹钳施放器、接触装置、药物/基因治疗传送装置，以及采用超声波、RF、激光等的能量装置)。
端部执行器的定位受到套管针的约束。通常，这些内窥镜外科器械包括位于端部执行器和由临床医生操纵的手柄部分之间的长杆。该长杆可插入到所需的深度并围绕杆的纵向轴线旋转，由此将端部执行器定位到某种程度。例如，通过另一个套管针正确放置套管针并使用抓钳，这种定位的量常常就足够了。手术缝合以及切割器械(例如在美国专利No.5,465,895中描述的器械)是一成功地通过插入和旋转来定位端部执行器的内窥镜外科器械的例子。
最近，Shelton IV等于2003年5月20日申请的题为“SURGICALSTAMPLING INSTRUMENT INCORPORATING AN E-BEAMFIRING MECHANISM”的美国专利No.10/443,617公开了一种用于切割组织并致动缝钉的改进的“E形梁”发射杆，其全部内容在此引入作为参考。该装置的一些其它优点包括确保将端部执行器的钳夹间隔开，或者更具体地说，将缝钉施加组件间隔开，即使夹钳了比最佳缝合形成略多或略少的组织也是如此。而且，E形梁发射杆与端部执行器和缝钉筒以能进行几种有益的锁定的方式接合。
这些手术缝合及切割器械包括具有引导进行发射的发射杆的框架的轴。一闭合管在框架和发射杆上面滑动，以缝钉施加组件的钳夹的闭合。因此，提供了单独的闭合和发射能力，增加了临床弹性。外科医生可反复闭合和重新定位组织，直到对其放置满意为止。
根据手术的性质，可能需要进一步调节内窥镜外科器械的端部执行器的定位.具体地说，通常需要将端部执行器在相对于器械的轴的纵向轴线为横向的轴线上定位.端部执行器相对于器械的轴的横向运动通常称为“关节运动”(articulation).这通常可通过将枢轴(或关节)接头设置于与缝钉施加组件近侧伸出的轴中来实现.这使得外科医生可在远处将缝钉施加组件关节运到任一侧，以更好的放置缝合线，并更容易进行组织操纵和定向.在一些情况下，例如在器官的后面这种关节运动定位使临床医生能够更容易地接合组织.另外，有利地，关节运动定位可使内窥镜定位于端部执行器的后面，而不受器械轴的阻碍.
通过将对关节运动的控制与对闭合端部执行器以夹钳组织和在内窥镜检查器械的很小直径范围内发射端部执行器(即缝合及切除)的控制一体化，来使手术缝合及切割器械进行关节运动的方法显得非常复杂。通常，当纵向平移时，这三种控制运动都通过轴来传送。例如，在Frederick E.Shelton IV等的题为“SURGICAL INSTRUMENTINCORPORATING AN ARTICULATION MECHANISM HAVINGROTATION ABOUT THE LONGITUDINAL AXIS”的共同未决和共有美国专利申请No.10/615,973中，作为纵向运动的替代，其采用旋转运动来传送关节运动，其内容在此通过引入作为参考。
因此，非常需要一种用于手术缝合和切割的器械，其具有一轴，该轴包括单独的闭合管，该闭合管单独打开和闭合夹钳，而且能够进行关节运动。
发明内容
本发明通过提供一种外科器械，其包括一具有框架底的轴，所述框架底经双枢轴连接件与端部执行器枢轴连接，克服了现有技术的上述及其它缺点。端部执行器又包括一枢转上部钳夹或砧座，它们枢转以响应于在框架上滑动的闭合管的纵向运动而闭合和夹钳组织。为了纵向平移以引起关节接头上的这种闭合，框架底本身具有双枢轴接头。
在本发明的一个方面，一种外科器械，包括一近侧部分，其在患者的体外操纵，以将相连的细长轴和端部执行器定位于患者体内需要手术的部位。一闭合管包括一枢轴接头，其越过关节运动接头，以向远侧平移来闭合端部执行器，并越过铰接轴。一关节运动接头枢转地将端部执行器与细长轴连接，从而以所需的角度达到组织，提供进一步的临床弹性。为了容纳闭合管的纵向运动枢转接头，双枢轴框架底具有一连接件，其分别在其近侧和远侧枢转地连接到与手柄部分相连的近侧框架部分上和与端部执行器相连的远侧框架部分上。因此，在端部执行器定位方面获得了另外的临床弹性，而不会失去由轴来传递单独闭合和发射运动的能力。
在本发明的另个一方面，外科器械包括一关节运动端部执行器，其对夹钳于闭合砧座和细长通道或包含有缝钉筒的下部钳夹之间的组织进行切割和缝合。一双枢轴框架底包括一连接件，其有助于使在外科器械的细长轴中往复的发射杆关节运动。
(1)本发明涉及一种外科器械，包括：
细长轴，它包括框架组件和围绕该框架组件而设置的关节运动闭合套管；
端部执行器，它包括下部钳夹和枢转连接的上部钳夹；
关节运动接头，它包括与端部执行器的下部钳夹连接的远侧框架底部分、近侧框架底部分和与远侧框架底部分枢转连接并与近侧框架底部分枢转连接的框架连接件；以及
手柄部分，其连接到细长轴的近端上，并被可操作地构造成能将闭合运动与关节运动闭合套管纵向联接。
其中，关节运动闭合套管包括关节运动部分，该关节运动部分被定位成横跨并包围至少部分框架连接件，并且与上部钳夹远侧地接合，以执行上部钳夹的枢转。
(2)如项目(1)所述的外科器械，其中，关节运动闭合套管组件还包括与砧座接合的远侧闭合管部分和与手柄部分联接的近侧闭合管部分，该关节运动闭合套管的关节运动部分包括在远侧和近侧闭合管部分的每一个之中形成的上部和下部相对的并枢转销接的柄脚。
(3)如项目(1)所述的外科器械，其中，远侧和近侧框架底部分的每一个都具有U形夹，所述U形夹相对设置，所述框架连接件包括横向突出的圆柱形销和分别枢转地收纳于相对的U形夹中的远侧和近侧端部。
(4)如项目(3)所述的外科器械，其中，框架连接件包括与横向突出的圆柱形销横向相对的小刀槽开口。
(5)如项目(1)所述的外科器械，还包括在细长轴中受引导并由手柄部分使其纵向往复运动的发射杆以及收纳在响应于发射杆的向远侧的运动的端部执行器中的缝钉筒，其中，枢转连接的上部钳夹包括具有缝钉形成表面的砧座。
(6)如项目(5)所述的外科器械，其中，框架连接件包括定位成横向引导发射杆的小刀槽。
(7)如项目(1)所述的外科器械，其中，框架连接件包括狗骨形连接件，该狗骨形连接件包括变细的中间部分。
(8)如项目(1)所述的外科器械，其中，框架连接件包括弹性材料。
(9)如项目(1)所述的外科器械，其中，框架连接件包括刚性材料。
(10)如项目(1)所述的外科器械，其中，手柄部分还包括闭合触发器，其可操作地连接到关节运动闭合套管上，以执行其闭合运动，并且手柄部分还包括一发射触发器，其可操作地连接到发射杆上，以执行其向远侧的发射运动。
(11)如项目(1)所述的外科器械，其中，细长轴和端部执行器的横截面大小设置成能穿过插管到达患者体内的手术部位。
(12)本发明还一种外科器械，包括：
细长轴，包括框架组件和围绕并纵向滑动地收纳的关节运动闭合套管；
缝钉施加组件，包括细长通道，接合于细长通道中的缝钉筒，和一枢转地连接到细长通道上并为缝钉筒提供缝钉形成表面的砧座；
关节运动接头，它包括与端部执行器的细长通道连接的远侧框架底部分、近侧框架部分和与远侧框架底部分枢转连接并与近侧框架底部分枢转连接的框架连接件；以及
手柄部分，其连接到细长轴的近端上，并被可操作地构造成能将闭合运动与关节运动闭合套管纵向联接。
其中，关节运动闭合套管包括关节运动部分，该关节运动部分被定位成横跨并包围至少部分框架连接件，并且与上部钳夹远侧地接合，以执行上部钳夹的枢转。
(13)如项目(12)所述的外科器械，其中，远侧和近侧框架底部分具有相对的U形夹、包括横向突出的圆柱形销的框架连接件以及分别枢转地收纳于相对的U形夹中的远侧和近侧端部。
(14)如项目(13)所述的外科器械，其中，框架连接件包括与横向突出的圆柱形销横向相对的小刀槽开口。
(15)如项目(12)所述的外科器械，还包括在细长轴中受引导并由手柄部分使其纵向往复运动的发射杆以及收纳在响应于发射杆的向远侧的运动的端部执行器中的缝钉筒.
(16)如项目(15)所述的外科器械，其中，框架连接件包括定位成横向引导发射杆的小刀槽。
(17)如项目(12)所述的外科器械，其中，框架连接件包括狗骨形连接件，该狗骨形连接件包括变细的中间部分。
(18)如项目(12)所述的外科器械，其中，框架连接件包括弹性材料。
(19)如项目(12)所述的外科器械，其中，框架连接件包括刚性材料。
(20)如项目(12)所述的外科器械，其中，手柄部分还包括闭合触发器，其可操作地连接到关节运动闭合套管上，以执行其闭合运动，并且手柄部分还包括一发射触发器，其可操作地连接到发射杆上，以执行其向远侧的发射运动。
(21)如项目(12)所述的外科器械，其中，细长轴和端部执行器的横截面大小设置成能穿过插管到达患者体内的手术部位。
(22)本发明还一种外科器械，包括：
细长轴，它包括框架组件和关节运动套管；
端部执行器，它包括致动构件；
关节运动接头，它包括与端部执行器的下部钳夹连接的远侧框架底部分、近侧框架部分和与远侧框架底部分枢转连接并与近侧框架底部分枢转连接的框架连接件；以及
手柄部分，其连接到细长轴的近端上，并被可操作地构造成能将闭合运动与关节运动闭合套管纵向联接。
其中，关节运动闭合套管包括关节运动部分，该关节运动部分被定位成横跨并包围至少部分框架连接件，并且与上部钳夹远侧地接合，以执行上部钳夹的枢转。
通过附图及其描述，本发明的这些和其它目的和优点将更加明显。
附图简述
包含于并构成说明书的一部分的附图，与上面给出的本发明的总的描述以及下面给出的实施例的详细描述一起示出了本发明的实施例，用于解释本发明的原理，其中：
图1是手术缝合及切割器械的前俯视透视图，其具有开口的端部执行器，或者缝钉施加组件，并且其中去除了缝钉筒。
图2是图1中的手术缝合及切割器械的前俯视透视图，其中关节运动机构由流体致动控制器所致动。
图3是图1的手术缝合及切割器械的细长轴和关节运动机构的分解透视图。
图4是图1的手术缝合及切割器械的执行部分的远侧部分的分解透视图，包括缝钉施加组件和关节运动机构。
图5是图1及图4的缝钉施加组件的俯视透视图，其中去除了缝钉筒的侧面半部，以暴露由发射运动所驱动的组成元件。
图6是图1的外科器械的执行部分的前方透视图，其中去除了双枢轴闭合套管组件和端部执行器，以显示通过流控关节运动机构而进行关节运动的单枢轴框架底。
图7是图1的外科器械的一种作为选择的关节接头的透视详示图，显示出具有单枢轴框架底的位于近侧位置处的双枢轴闭合套管。
图8是图7的作为替代的关节接头的底部右侧分解透视图，包括双枢轴固定壁狗骨形连接件和具有用于横向运动构件(T形杆)的导轨的框架底。
图9是图1的外科器械的另一作为选择的关节接头的顶部左侧分解透视图，包括一结合于下部双枢轴连接件中的作为替代的坚固壁支撑板机构，以支撑发射杆，并包括受导轨引导的横向运动构件(T形杆)。
图10是用于图1的外科器械的一种作为选择的关节运动锁定机构的顶部示意图，其中去除了闭合的套管组件，以暴露用于自动的关节运动锁定接合和脱离接合的支撑负载(backloading)的脱离接合T形杆。
图11是用于图1的外科器械的另一种作为选择的关节运动锁定机构的顶部示意图，T形杆具有由弹簧偏置的齿条，其具有由于端部执行器的支撑负载而接合的锁定结构。
图12是用于图1的外科器械的一种作为选择的T形杆和带有横向导向件的框架底。
图13是用于图1的外科器械的另一种作为选择的T形杆和带有横向导向件的框架底。
图14是用于图1的外科器械的一种作为选择的关节运动机构的左侧顶部分解透视图，包括一双枢轴框架组件和一单枢轴闭合套管组件。
图15是图14的作为选择的关节运动机构的左侧底部透视图。
图16是一可选择的执行部分的前透视图，该执行部分具有多个用于图1的手术缝合及切割器械的枢轴闭合套管组件。
发明详述
关节运动轴概述
参照附图，其中在所有附图中，相同的附图标记表示相同的元件，图1描绘了一种外科器械，在该示例性方案中具体为手术缝合和切割器械10，能够实现本发明的独特优点。具体地说，手术缝合和切割装置10的大小设置为能够以如图1所示的非关节运动状态，通过套管针插管通道插入到患者(未显示)体内的手术部位，以进行外科手术。一旦执行部分12通过插管通道插入，如图2中所示，就可通过关节运动控制器18遥控使执行部分12的细长轴16的远侧部分中结合有的关节运动机构14进行关节运动。在示例性方案中描述为缝钉施加组件20的端部执行器与铰接机构14远侧相连。因此，远程使关节运动机构14关节运动使缝钉施加组件20从细长轴16的纵向轴线关节运动。这种成角度的定位可具有根据切割和缝合所需的角度来接近组织的优点，避免了在接近组织时其它器官和组织所造成的障碍，和/或使内窥镜能够定位于后面并与缝钉施加组件20对准，以确保其放置。
手柄
手术缝合及切割器械10包括一手柄部分22，其与执行部分12的近端连接，以对其进行定位、关节运动、闭合和发射运动.手柄部分22包括一手枪式把手24，临床医生向着它枢转且向近侧拉动闭合触发器26，引起缝钉施加组件20的夹钳或闭合.一发射触发器28设置于闭合触发器26更远的外侧，并可由临床医生枢转地拉动，引起对在缝钉施加组件20中夹钳的组织进行缝合及切割.此后，按下闭合释放按钮30，从释放夹钳的闭合触发器26，并由此释放夹钳的组织的已切割和缝合的末端.手柄部分22还包括一用于与细长轴16的运动偶联的旋转旋钮32，以使轴16和铰接的缝钉施加组件20围绕轴16的纵向轴线旋转.手柄部分22还包括一发射回缩手柄34，以在发生束缚时帮助回缩发射机构(在图1-2中未显示)，从而使缝钉施加组件20此后可张开.
应当理解，这里使用的术语“近侧”和“远侧”以临床医生握持器械的手柄为参照。因此，手术缝合组件20相对于更近侧的手柄部分20位于远侧端。还应理解，为了方便和清楚起见，这里使用的空间术语，例如“垂直”和“水平”与是相对附图而言的。然而，外科器械可以在许多定向和位置使用，这些术语并不意图进行限制和绝对化。
在Swayze和Shelton IV的题为“SURGICAL STAPLINGINSTRUMENT INCORPORATING A MULTISTROKE FIRINGPOSITION INDICATOR AND RETRACTION MECHANISM”的共同未决的共有美国专利申请No.10/674,026中详细描述了一种用于图1-2中的手术缝合及切割器械10的例证性多冲程手柄部分22，其内容在此全部引入作为参考，此处描述另外的特征和变化。尽管多冲程手柄部分22有利地支持能以较大发射力远距离应用，与本发明一致的应用可包括单发射冲程，例如在Frederick E.Shelton IV，Michael E.Setser，and Brian J.Hemmelgarn题为“SURGICAL STAPLINGINSTRUMENT HAVING SEpARATE DISTINCT CLOSING ANDFIRING SYSTEMS”的共同未决的共有美国专利申请No.10/441,632中所描述的，其内容在此全部引入作为参考。
执行部分(使细长轴和缝钉施加组件关节运动)
在图3-5中，执行部分12有利地包括在适于内窥镜和腹腔镜手术的较小直径内的纵向旋转、关节运动，闭合和发射的多种致动运动。缝钉施加组件20(“端部执行器”)具有一对枢轴相对的夹钳，描述为一具有枢轴连接的砧座(anvil)42的细长通道40(图1-2，4-5)。砧座42对细长通道40的闭合和夹钳通过用可旋转地连接于手柄部分22的框架组件44(图3)纵向支撑细长通道40来实现，双枢轴闭合套管组件46在所述手柄部分22的上方沿纵向运动，以分别闭合和打开向砧座42的远离和靠近运动，即使其中如图2所示缝钉施加组件20关节运动也是如此。
特别参照图3，框架组件44包括一单枢轴框架底48，如图3所示，其近端与旋转旋钮32接合，右侧半壳位于其上方。应当理解，闭合套管组件46的近端，具体为闭合直管52，包围框架底48的近端，所述近端进一步穿过其内部到达手柄部分22，以与使闭合套管组件46纵向平移的闭合元件(未显示)接合。一位于闭合直管52近端的圆形唇缘54提供了与所述元件的旋转接合。旋转旋钮32的接合元件穿过直的闭合管52的近侧部分上的纵向狭槽56与在框架底48上近侧地定位的开孔58接合。纵向狭槽56具有足够的长度，以允许闭合套管组件46以由旋转旋钮32设定的旋转角度相对于闭合套管组件46和框架底48闭合纵向平移。
细长轴16通过收纳与手柄部分22的发射元件(未显示)旋转接合的发射杆60来支持发射运动。发射杆60沿着框架底48的纵向中心线进入近侧开口62。框架底48的远侧部分沿着其底部包括一与近侧开口62相连通的发射杆狭槽64。发射杆66在发射杆狭槽64中纵向平移，并包括一向上突出的近侧销68，其与发射杆60的远端70接合。
细长轴16通过具有矩形容器腔72(在旋转旋钮32的远侧部分中描绘为横向部分)来支持关节运动.一位于矩形容器腔72中的底部分隔室74具有横向间隔开的左右挡板76、78.一关节运动致动器80在底部分隔室74的上方横向滑动，其位于挡板76、78外侧的横向向下隔开的左右凸缘82、84每个与从旋转旋钮32的相应半壳向外伸出的左右按钮开关86、88横向相通.关节运动致动器80的横向运动使左右凸缘82、84分别更靠近或更远离左右挡板76、78，这与流控关节运动系统94的左右储存囊90、92的运转相反，每个囊90、92分别与左右流体导管或通道96、98远侧连通，该流体导管或通道又分别与左右致动囊100、102连通.后者相对并使致动机构14的T形杆104横向枢转.
框架组件44通过包括一框架底48的顶部和远端带凹槽的台面106来限制这些流控的致动，在所述框架底的上面有流体通路96、98和致动囊100、102。T形杆104滑动地位于带凹槽的台面106的上、致动囊100、102之间。靠近T形杆104处，一突出的屏障肋108与其对准，用于防止流体通路96、98向内扩张。框架组件44具有一圆形的顶部框架盖(隔离物)110，其在框架底48的上方滑动，防止流体通路96、98和致动囊100、102的垂直膨胀，同时限制T形杆104的任何垂直运动。特别地，框架盖110包括能使其还提供关节运动锁定构件111的结构，下面将作为关节运动锁定机构113的一部分详细描述。
T形杆104的远端(“齿条”)112接合，以使关节运动机构14的铰接的远侧框架构件114的指向近侧的扇形齿轮115枢转。一铰接的闭合管116包围铰接的框架构件114，并具有一与砧座42接合的马蹄形开孔118。在闭合直管52和关节运动的闭合环116之间、关节运动机构14的上方形成一双枢轴连接件，从而可允许纵向闭合运动，即使当关节运动机构14关节运动时也是如此。特别地，闭合直管52上的带有销孔122、124的顶部和底部远侧突出的枢轴翼片118、120分别与关节运动闭合环116上具有销孔130、132的相应的顶部和底部近侧突出的枢轴翼片126、128纵向间隔开。上部双枢轴连接件134具有分别与销孔122、130接合的纵向间隔的向上定向的远侧和后部销136、138，下部双枢轴连接件140具有分别与销孔124、132接合的纵向间隔的向下突出的远侧和后部销142、144。
特别参照图4，为了增强可制造性，关节运动闭合环116显示为包括短管146，其与具有近侧突出的枢轴翼片126、128的连接卡圈148相连。同样地，直闭合管52由与后部连接卡圈152相连的长闭合管150组装而成，所述连接卡圈152包括向远侧突出的枢轴翼片118、120。短闭合管146中的马蹄形开孔118与在横向枢轴销156附近的向上突出的砧座结构154接合，所述枢轴销156与细长通道40中的枢轴凹槽158接合。
图4的示例性方案包括狗骨形连接件160，其近侧销157与框架孔161中的框架底48枢转连接，并且其近侧销159与关节运动框架构件114的近侧下表面162刚性连接，从而在其间提供枢轴支撑。狗骨形连接件160中的底部纵向刀槽163引导发射杆66的关节运动部分。关节运动框架构件114还包括一底部纵向狭槽164，以引导发射杆66的远侧部分。
缝钉施加装置(端部执行器)
参照图4-5，发射杆66远端终止于E-形梁165中，所述E-形梁165包括上部导向销166，其插入砧座42中的砧座狭槽168中，以在缝钉形成和切割期间核实并帮助将砧座42保持为闭合状态.细长通道40和砧座42之间的间隔还可通过E-形梁164使中间销170沿着细长通道40的顶面滑动来保持，同时底应172沿着细长通道40的下表面相对地滑动，由细长通道40中的纵向开口174导向.E形梁164的位于上部导向销166和中间销170之间的远侧切割表面176对夹钳的组织进行切割，同时E形梁通过向远侧移动楔形滑板(sled)180致动可替换的缝钉筒178，使缝钉驱动器182向上突出，使缝钉从在砧座42的缝钉形成下表面形成的缝钉筒主体188中的向上打开的缝钉孔186中弹出.缝钉筒托架192从底部包围缝钉筒178的其它元件，将它们保持在适当的位置.缝钉筒托架192包括一向后打开的狭槽194，其覆盖在细长通道40中的纵向开口174上，从而使中间销170穿过缝钉筒托架192的内部.
缝钉施加组件20在Frederick E.Shelton IV等于2004年9月30日提交的“ARTICULATING SURGICAL STAPLING INSTRUMENTINCORPORATING A TWO-PIECE E-BEAM FIRING MECHANISM”的共同未决的共有美国专利申请No.10/955,042中有详细描述，其内容在此全部引入作为参考。
关节运动锁定机构
在图3-4和6-8中，有利地，包含有一关节运动锁定机构200，以保持缝钉施加组件20处于所需的关节运动角度。关节运动锁定机构200减小了左右致动囊100、102上的负载。特别地，压缩弹簧202(图3)近侧地定位于关节运动锁定构件111的近端204和手柄部分22之间，从而向远侧偏压关节运动锁定构件111。特别参照图4，关节运动锁定构件111远端210处的两个平行的狭槽206、208分别收纳框架底48上向上突出的导向肋212、214。导向肋212、214的纵向长度比平行的狭槽206、208短，使其具有相对纵向冲程范围。因此，特别参照图8，示为从连接锁定元件111向远侧突出的带齿的凹槽216的远侧摩擦表面的选择性抵接接合与收纳在关节运动框架构件114的顶部近侧凹槽220中的制动板218中的相应锁定扇形齿轮217接合。制动板218中的远侧和近侧孔221、222收纳从顶部近侧凹槽220向上突出的远侧和近侧销223、224。
特别参照图6，细长轴16描绘为处于铰接位置，其中闭合套管组件46从框架组件44周围被去除，因而没有细长通道40和砧座42。关节运动致动器80显示为横向运动到左侧以压缩右侧近侧储存囊90和膨胀的远侧右致动囊100，使T形杆104运动到所示的位置。因此，如图所示，关节运动致动器80的横向运动使远侧框架114围绕单枢轴框架底48顺时针关节运动。有利地，关节运动致动器80还自动与关节运动锁定机构200接合和脱离接合。特别地，沿着关节运动致动器80的近端上表面的齿棘表面225收纳从铰接闭合元件111的近端204向上突起的锁定销226。锁定销226在齿棘表面225根部中的接合提供了足够的关节运动锁定构件111向远侧的运动，用于将锁定扇形齿轮217在制动板218中锁定接合。操作人员使压缩构件272进行的横向运动，向近侧推动锁定销226，由此使关节运动锁定构件111与制动板218脱离接合。当操作人员释放关节运动致动器80时，锁定销226被压缩弹簧202推动到棘表面225中的相邻棘中，使锁定机构111锁定，并由此缝钉施加组件20，通过将近侧左右储存囊90、92限制和扩张为膨胀的形状，将关节运动机构14限制在所需的关节运动位置。
关节运动锁定机构200在Dale R.Schulze和Kenneth S.Wales等于1996年3月10日提交的题为“SURGICAL INSTRUMENT”的共有美国专利US5673841A中有详细描述，其内容在此全部引入作为参考。
作为选择或者另外，可在平行的流体囊236、238中设置一孔口，以控制近端致动囊100、102和远端储存囊90、92之间的流速。在图16、18中，流体流路258、264的尺寸可设置为提供改变关节运动的角度的阻力，起孔的作用，或者它们可包括流体流速限制结构。
在图10中，一种替代的外科器械2004的关节运动机构2002的锁定机构2000通常是未锁定的，并由于支撑负载通过发射横向运动的T形杆2006来致动.一狭槽2008定位于框架底2010中，以收纳并引导从T形杆2006向下伸出的肋2012.如果端部执行器2016支撑负载，则与肋2012正交连接的细长纵向部分2014偏转.例如，当端部执行器2016受到如箭头2018所示向右的力，例如，其近侧扇形齿轮2020作用于T形杆2006的齿条2022上，提供非正交的后驱动力(backdriving force)，如箭头2024所示。因此，细长纵向部分2014弯曲，将肋2012斜置到狭槽2008中。这种斜置产生了相对的束缚力，如箭头2026、2028所示，该力将T形杆2006锁定并阻止进一步的关节运动。当关节运动囊的致动使横向运动的T形杆2006解锁时，则产生释放。此后，肋2016可帮助引导T形杆2006。
在图11中，显示了另一种用于外科器械2102的关节运动锁定机构2100，其通常由与端部执行器2106的齿轮齿2104和T形杆2110的齿条齿2108成20度压力角的近侧力向量来解锁和致动。当端部执行器2106支撑负载时(如非垂直箭头2112表示)压力角的纵向向量(以箭头2114表示)使T形杆2110向近侧运动。该纵向力向量施加到位于T形杆2110的齿条2120后面的刚性弹簧2118上。当弹簧2118随着T形杆2110向近侧移动而偏转时，从齿条2120向近侧突出的锁定齿2126开始接合，同时在底部框架2124上近侧横向对准的锁定元件2122与从齿条2120向近侧突出的锁定齿2126接合。当通过除去端部执行器2106的支撑负载并通过弹簧2118的推动使T形杆2110向远侧运动，使近侧力向量减小或消除时，锁定齿2126和锁定元件2122脱离接合。
双枢轴闭合套管和单枢轴框架底的结合
参照图3-4和7，有利地，执行部分12包括纵向平移的双枢轴闭合套管组件46，其包围一单枢轴框架底48。下面将进一步详细描述这些机构和其它操作。特别参照图7，关节运动机构14显示为处于铰接状态，其中闭合套管组件46向近侧回缩到砧座打开状态。随着砧座42的打开，关节运动控制器18的致动引起铰接的闭合环116分别围绕上部和下部双枢轴闭合连接件134、140的向上指向的远侧销136和向下指向的远端销142枢转。框架底48围绕单销(图示为将框架底48与近侧框架构件114连接的近侧销157)枢转。当砧座42打开时，框架底48的近侧销147与闭合套管组件46的上部和下部双枢轴连接件134、140的最远侧位置对准。当砧座42打开时，该定位很容易使缝钉施加组件20进行枢转及旋转。当闭合套管组件46向远侧运动以使闭合的砧座42枢转时，随着枢轴连接件134、140的推动，闭合直管52围绕框架底48向远侧运动，并且铰接的闭合环116沿着铰接的远侧框架构件114的轴线向远侧运动。当装置被铰接时(未显示)，连接件134、140上的双枢轴销136、138以及142、144在它们被推向远端闭合位置有利于与闭合直管52和铰接的闭合环116的接合。当有效运行时，在远侧闭合位置，框架底枢轴销(“近侧销”)147与近侧枢轴销138、144在完全关节运动时垂直对准，或者落在远端销136、142和近端销138、144之间的任一点上。
实心发射杆支撑件
在图8中，图7中的关节运动机构14被部分分解并从底部看去，显示实心壁发射杆支撑设计(狗骨状连接件160)，其提供了常规挠性支撑板所不具备的优点.支撑板用于填平间隙，并通过单框架底枢轴关节运动接头1801，引导和支撑发射杆66.挠性发射杆是公知的，但结合实心壁发射杆，例如图4、8、9中显示的那些发射杆，提供了独特的优点.下面参见图8，框架底48包括一沿着框架底48的底部延伸的框架小刀槽1802，一沿着关节运动的远端框架元件114的底部延伸的远侧小刀槽164，用于将发射杆66(未显示)滑动地收纳于其中.框架底48如上所述，并包括一带有远侧框架构件114的导向单枢轴连接件157.可旋转地连接在近侧销末端157上并可移动地连接在远侧销末端159上的固定壁狗骨形连接件160包括左右横向导向件1818、1820，在其间限定了一导向狭槽1822，用于滑动地通过发射杆66(图4).
因此，为了填平框架底48和远侧框架构件114之间的间隙，固定壁枢轴狗骨形连接件160与框架底48枢转连接，并与框架构件114滑动地连接。枢转狗骨形160的近侧销157枢转地收纳于框架底48中的腔1824中，使狗骨连接件160能够围绕穴1824枢转。一远侧销159从枢转狗骨连接件160向上伸出，并滑动地容纳于远端框架114中的狭槽1826中。缝钉施加组件20相对纵向轴线成例如45度角关节运动，使腔1824中的枢转狗骨形连接件116在其近端销157处枢转，并且远端销157在其远端1814滑进狭槽1826中，使发射杆66弯曲成两个间隔开的角，它们的角度是缝钉施加组件20的角度的一半。与以前参照的将发射杆66弯曲成45度角的挠性支撑板不同，固定壁枢转狗骨形连接件160将发射杆66弯曲成两个间隔的角，例如每个22.5度。将一或多个挠性发射杆66弯曲成该角度的一半，将发射杆66中的弯曲应力分割成传统的关节运动支撑件中的一半。发射杆66中的弯曲应力的减小降低了发射杆中的永久弯曲或位置固定的可能性，降低了发射阻塞的可能性，确保了较小的发射杆回缩力，并为发射系统提供了更平稳的操作。
在图9中，外科器械1900包括双闭合枢轴。单框架枢轴关节运动接头1902显示了一种作为替代的实心壁支撑板机构1904，其可替代下部双枢轴连接件140和狗骨连接件1812。左右发射杆支架1906、1908从闭合套管组件1912的下部双枢轴连接件1904向上伸出。在框架底1916中提供间隙1914，从当闭套管组件向远侧运动闭合砧座42(在图9中未显示)以及向近侧运动打开砧座42时，使发射杆1906、1908能够运动。如上所述的枢转狗骨形连接件1812，作为替代的下部双枢轴连接件1910还可弯曲并支撑发射杆66(在图9中未显示)，形成两个间隔开的弯曲角，其中的每个达到缝钉施加组件20的弯曲角的一半。
横向构件导向机构
继续参照图9，框架底1916上的左右向上的凸缘1918、1920包括近侧和远侧横向销导向件1922、1924，它们横向穿过T形杆1926中的孔，帮助在关节运动机构1928中减小束缚。作为另一例子，在图7中，有利地，T形杆104包括一燕尾横向导向件1930，其可在T形杆104中形成的燕尾状通道1932中横向滑动。作为另一例子，在图12中，一从框架底1936上的突出肋1934容纳于在T形杆1940中形成的矩形狭槽1938中。为了进一步便于无束缚地横向平移，近侧和远侧横向轴承轨道每个都包括多个球轴承1946、1948。作为另一个例子，在图13中，与T形杆1964中的T形杆纵向沟槽1958-1962相对应，在框架底1956中形成多个框架横向沟槽1950-1954。滑动滚子1966-1970被捕获于每对纵向沟槽1950/1958、1952/1960、1954/1962中。这些决不意味着对防止T形杆1940意外的倾斜或旋转的横向导向构件的穷尽列举。
双枢轴框架底和单枢轴闭合机构的结合
在图14-15中，一种替代的框架底和闭合机构2200包括具有双枢轴框架组件2204的外科器械2202.特别地，框架底2206通过双枢轴框架狗骨形件2210与远端框架构件2208连接，所述双枢轴框架狗骨连接件2210具有一与框架底2206中的近侧腔2214枢转接合的近侧枢轴销2212和一与远侧框架构件2208的远侧腔2218接合的远侧枢轴销2216.一导向狭槽2220设置于狗骨件2210的下侧，以在其中引导发射杆66(在图14-15中未显示).小刀槽2222设置在远侧框架构件2208中.如图所示，闭合环2230以45度角的关节运动使远侧框架构件2208以45度角关节运动，并使框架狗骨件2210以该角度的一半关节运动.因此，发射杆66受到间隔的两个浅的半弯曲，并达到上述列举的优点.
最外侧闭合套管组件2224的不同点在于，框架组件2204的双枢轴设计中仅一个枢轴提供其纵向闭合运动。如图所示，一闭合管轴2226远端具有一U形夹(clevis)2228。U形夹2228与闭合环2230枢转接合。闭合环2230具有一在远端形成的近侧齿轮2232，并且销2234与U形夹2228的上柄脚2236枢转接合，下2238与U形夹2228的下柄脚2240接合。U形夹2228中的孔2242收纳横向导向销2243，并且T形杆2244可滑动地连接于其中，以接合闭合环2230的近侧齿轮2232。因此，这种替代机构2200使用与前面描述机构相反的单/双枢轴的替代构想。也就是说，这种替代的闭合机构具有单枢轴，而替代的框架底具有双枢轴，这与前面描述的具有单枢轴框架底的双枢轴闭合机构不同。
应理解，根据本发明的内容，位于近侧和远侧框架部分之间的双枢轴框架连接件具有许多优点。虽然不能全部列举，这些优点包括通过以更宽的弯曲半径关节运动而方便引导发射构件，从而减小了发射所需的力，降低了束缚和失败的可能性，和/或可采用更强但更为刚性的发射构件。与本发明的方面一致的应用可包括闭合管组件，其同样具有多个枢转接头，或者位于关节运动接头处的挠性圆柱部分。此外，多个关节运动接头可一接一地顺序连接，从而没有一个关节运动接头需要提供较大的偏转角度。作为选择，关节运动闭合套管可纵向固定，用作盖，其中发射杆执行闭合、切割及缝合。双枢轴框架连接件用于方便发射杆的运动。
还应理解，尽管如上所述引导发射杆具有某些优点，双枢轴连接件还可由一个或多个从关节运动发射杆的路径偏移的框架连接件形成。还应理解，一个或多个发射连接件可沿着其长度包括至少一部分弹性材料，以进一步有利于关节运动。
还应理解，所包含的定位近侧框架底部分、远侧框架底部分和它们之间的双枢轴框架连接件的关节运动致动器，可致动闭合套管，从而允许框架底组件响应于闭合套管组件的关节运动而被动地进行关节运动。
横向运动关节运动机构
在图16中，用于外科器械2402的执行部分2412包括多个枢轴闭合组件2204。最外侧闭合套管组件2424通过一包围单枢轴框架关节运动接头(在图16中未显示)的挠性闭合接头2425与闭合管轴2426连接。作为选择，可包括一挠颈型框架关节运动接头。多个枢轴闭合组件2446通过具有在弹性材料(例如，聚合物、硅树脂)中形成的左右垂直切口2427、2429而具有横向弹性。材料的顶部和底部带2451保持挠性闭合接头2425的纵向长度并传送发射运动。
尽管通过对多个实施例的描述对本发明进行了示例，尽管这些示例性的实施例描述得非常详细，但申请人并不是想将所附的权利要求书的范围限制或以任何方式限定到这些细节。其它优点和变化对本领域技术人员来说是显而易见的。
例如，尽管这里公开了液压关节运动方法，还应理解，与本发明的一些方面一致的应用还可以使用机械动力或电力动力。
作为另一个例子，外科器械的端部执行器可包括多种类型的致动构件，其可连接来收纳套管组件在关节运动轴上的选择性往复纵向运动.

Claims (10)

1.一种外科器械，包括：
细长轴，它包括框架组件和围绕该框架组件而设置的关节运动闭合套管；
端部执行器，它包括下部钳夹和与下部钳夹枢转连接的上部钳夹；
关节运动接头，它包括近侧框架底部分、与端部执行器的下部钳夹连接的远侧框架底部分和与远侧框架底部分枢转连接并与近侧框架底部分枢转连接的框架连接件；以及
手柄部分，其连接到细长轴的近端上，并被构造成能可操作地将闭合运动与关节运动闭合套管纵向联接；
其中，关节运动闭合套管包括关节运动部分，该关节运动部分被定位成横跨并包围至少部分框架连接件，并且在远侧与上部钳夹接合，以执行上部钳夹的枢转。
2.如权利要求1所述的外科器械，其特征为，关节运动闭合套管还包括与上部钳夹接合的远侧闭合管部分和与手柄部分联接的近侧闭合管部分，该关节运动闭合套管的关节运动部分包括在远侧和近侧闭合管部分的每一个之中形成的上部和下部相对的并枢转销接的柄脚。
3.如权利要求1所述的外科器械，其特征为，远侧和近侧框架底部分的每一个都具有U形夹，所述U形夹相对设置，所述框架连接件包括横向突出的圆柱形销和分别枢转地收纳于相对的U形夹中的远侧和近侧端部。
4.如权利要求3所述的外科器械，其特征为，框架连接件包括与横向突出的圆柱形销横向相对的小刀槽开口。
5.如权利要求1所述的外科器械，还包括在细长轴中受引导并由手柄部分使其纵向往复运动的发射杆以及收纳在响应于发射杆的向远侧的运动的端部执行器中的缝钉筒，其中，枢转连接的上部钳夹包括具有缝钉形成表面的砧座。
6.如权利要求5所述的外科器械，其特征为，框架连接件包括定位成横向引导发射杆的小刀槽。
7.如权利要求1所述的外科器械，其特征为，框架连接件包括狗骨形连接件，该狗骨形连接件包括变细的中间部分。
8.如权利要求1所述的外科器械，其特征为，框架连接件包括弹性材料。
9.如权利要求1所述的外科器械，其特征为，框架连接件包括刚性材料。
10.如权利要求1所述的外科器械，其特征为，手柄部分还包括闭合触发器，该闭合触发器可操作地连接到关节运动闭合套管上，以执行关节运动闭合套管的闭合运动，并且手柄部分还包括一发射触发器，该发射触发器可操作地连接到发射杆上，以执行发射杆向远侧的发射运动。
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BRPI0601198A (pt) 2006-12-05
EP1709913A2 (en) 2006-10-11
EP1709913A3 (en) 2008-06-11
CN1843301A (zh) 2006-10-11
US20060229665A1 (en) 2006-10-12
SG126844A1 (en) 2006-11-29
JP5132893B2 (ja) 2013-01-30
CA2540902A1 (en) 2006-10-07
KR20060107394A (ko) 2006-10-13
EP1709913B1 (en) 2011-01-26
JP2006289090A (ja) 2006-10-26
RU2006111322A (ru) 2007-10-27
ATE496581T1 (de) 2011-02-15
AU2006201219A1 (en) 2006-11-16
AU2006201219B2 (en) 2012-03-08
US7784662B2 (en) 2010-08-31
DE602006019796D1 (de) 2011-03-10
CA2540902C (en) 2014-06-03

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