CN101028205B - 具有力控制间距的端部执行器的外科缝合器械 - Google Patents

具有力控制间距的端部执行器的外科缝合器械 Download PDF

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CN101028205B
CN101028205B CN2006101392922A CN200610139292A CN101028205B CN 101028205 B CN101028205 B CN 101028205B CN 2006101392922 A CN2006101392922 A CN 2006101392922A CN 200610139292 A CN200610139292 A CN 200610139292A CN 101028205 B CN101028205 B CN 101028205B
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弗雷德里克·E·谢尔顿四世
杰罗姆·R·摩根
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/0725—Stapler heads with settable gap between anvil and cartridge, e.g. for different staple heights at different shots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07278—Stapler heads characterised by its sled or its staple holder
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07285—Stapler heads characterised by its cutter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320052—Guides for cutting instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety

Abstract

一种随内窥镜和腹腔镜插入手术部位的外科器械，用于同时切割和缝合组织，包括在上钳口(钉砧)和下钳口(与细长缝钉通道接合的钉仓)之间的力调节间距，从而缝钉成型高度对应于组织的厚度，而且不会超过可由缝钉的长度适应的高度范围。具体地说，弹性结构形成在E形梁击发杆中，该击发杆包括切割表面(刀)，用于在接合钉砧的顶部销和接合下部钳口的中部销和下部之间切割组织。所述弹性构件的弹性响应于由被夹紧的组织施加的力而改变间距。

Description

具有力控制间距的端部执行器的外科缝合器械
技术领域
本发明总的涉及外科缝合器械，其能够对组织施加缝合线，同时在所述缝合线之间切割组织，更具体地说，本发明涉及改进缝合器械和改进形成这种缝合器械的各个部件的过程，包括添加用于所切断和缝合的组织的支撑材料。
背景技术
由于较小的切口易于减少术后恢复时间和并发症，内窥镜和腹腔镜外科器械通常比传统的开放手术装置更受到偏爱。腹腔镜和内窥镜外科手术已经比较受欢迎，从而产生了额外的动机来进一步发展这种手术。在腹腔镜手术中，通过较小的切口在腹部内部进行手术。同样，在内窥镜手术中，通过经由开在皮肤中的小的入口插入的内窥镜管在身体的任何中空内脏中进行手术。
腹腔镜和内窥镜手术通常需要喷吹手术区域。因此，任何进入体内的器械必须是密封的，以确保气体不会通过切口进入体内或者排出体外。而且，腹腔镜和内窥镜手术通常需要外科医生在远离切口的器官、组织和/或脉管上操作。因此，这些手术中使用的器械通常长而窄，同时其功能可从器械的近端控制。
适于通过套管针的插管在所需手术部位精确放置远端执行器的各种内窥镜外科器械取得了显著的发展。这些远端执行器(例如，内切割器、抓钳、切割器、缝合器、夹具施放器、接触装置、药物/基因治疗输送装置和使用超声波、RF、激光等的能量装置)以各种方式接合组织，以实现诊断和治疗效果。
已知的外科缝合器包括同时在组织中形成纵向切口和在切口的相对两侧施加缝合线的端部执行器。该端部执行器包括一对相配合的钳口构件，如果该器械用于内窥镜或者腹腔镜检查，所述钳口构件能够通过插管通道。钳口构件中的一个接受具有至少两排横向隔开的缝钉的钉仓。另一个钳口构件限定了钉砧，该钉砧具有与钉仓中的至少两排缝钉对齐的缝钉成型袋。该器械包括多个往复楔形件，所述往复楔形件在被向远侧驱动时，通过钉仓中的开口并且接合支撑缝钉的驱动器，朝着钉砧击发缝钉。
近来，披露了一种用于外科缝合和切割器械的改进的“E形梁”击发杆，该击发杆有利地包括在形成于上钳口(钉砧)中的内部狭槽中滑动的顶部销，并具有中部销以及在端部执行器(或者具体地说缝钉施加组件)的下钳口的相对两侧上滑动的底座。在中部销的远侧，接触表面致动容纳在形成下钳口的细长缝钉通道内的钉仓。在接触表面和顶部销之间，切割面或者切割刀切割夹在钉砧和下钳口的钉仓之间的组织。由于两个钳口由E形梁接合，E形梁在钳口之间保持所需的间隔，以确保正确的缝钉成型。因此，如果夹住的组织量偏少，E形梁抬起钉砧，以确保足够的间距，使缝钉在钉砧的底面上正确成型。另外，如果夹住的组织量偏多，E形梁拉下钉砧，以确保所述间距不会超过缝钉的长度，从而每个缝钉的端部不会充分的弯曲，以实现所需的保持角度。这种E形梁击发杆在2003年5月20日提交的名称为“具有E形梁击发机构的外科缝合器械”的美国专利申请No.10/443,617中进行了描述，该申请的内容通过引用并入本文。
尽管E形梁击发杆具有用于外科缝合和切割器械的多种优点，但是经常需要的是切割和缝合各种厚度的组织。薄的组织层会导致缝钉成型较松，这可能需要支撑材料。厚的组织层会导致成型的缝钉在所捕获的组织上施加太强的压缩力，这可导致坏死、出血或较差的缝钉成型/保持。这就需要用相同的外科缝合和切割器械来适应较宽范围的组织厚度，而不是限于给定外科缝合和切割器械的组织厚度的范围。
因此，极需一种改进的外科手术和缝合器械，其结合有缝钉施加组件(端部执行器)，该缝钉施加组件调节夹钳的组织的量。
发明内容
本发明通过提供一种结合有击发杆的外科器械克服了现有技术的上述和其它缺陷，所述击发杆通过具有下钳口和枢转连接的上钳口的缝钉施加组件平移，从而接合每个钳口，有助于保持内表面之间的所需间距，所述内表面之间压缩组织。有利的是，两个钳口之间的距离允许稍微弯曲开，以允许更大厚度的压缩组织，击发杆防止超过装置极限的过度弯曲，以通过压缩组织形成缝钉。因此，用相同的外科器械改善了临床灵活性，该器械适于更大范围的外科手术，或者适应各种患者。
在本发明的一个方面，该外科器械具有下钳口，该下钳口包括有纵向通道狭槽的细长缝钉通道，该纵向通道狭槽装纳钉仓。钉仓中的缝钉的长度尺寸适于在各种组织厚度范围内形成闭合缝钉。击发杆具有垂直部分，该垂直部分通过钉砧中的纵向钉砧狭槽并且通过形成在细长缝钉通道中的纵向通道狭槽，该钉砧枢转地连接到细长缝钉通道上。从垂直部分延伸的上部横向表面在击发平移期间在钉砧上施加向内的压缩力，从垂直部分延伸的下部横向表面在击发平移期间在细长缝钉通道上施加向内的压缩力。击发杆通过设有弹性部分而有利地适应各种有效的缝钉成型，该弹性部分的高度在钉砧的缝钉成型底面和钉仓的上表面之间变化。
在本发明的另一方面，外科器械具有枢转连接到细长缝钉通道上的钉砧并且包括在内部形成的钉砧通道。具体地说，垂直狭槽沿着钉砧的纵向轴线向内开口并且具有左侧和右侧直角棱镜形凹槽，这些凹槽与所述垂直狭槽连通、由所述垂直狭槽等分、与所述垂直狭槽垂直，其中所述左侧和右侧直角棱镜形凹槽基本上沿着所述垂直狭槽的纵向长度延伸。击发装置包括位于远侧的切割刃，所述切割刃切割纵向地接收在所述细长缝钉通道和钉砧的钉砧通道的垂直狭槽之间的组织。击发装置的上部构件具有左侧和右侧横向上部销，所述上部销的尺寸适于滑动地接合所述钉砧通道的左侧和右侧矩形凹槽的上部和下部内表面。击发装置的下部构件接合细长钉仓中的通道狭槽。击发装置的中部构件通过向远侧平移钉仓的楔形构件而致动钉仓。击发装置在纵向击发行程期间形状配合地接合细长缝钉通道和钉砧，以提供细长通道和钉砧之间的间距，用于缝钉成型。击发装置在击发期间的接合抵抗由于不充分夹紧的组织产生的狭缩和由于过量夹紧的组织产生的局部张开，而保持在细长缝钉通道和钉砧之间的垂直间距。通过在击发装置中结合有弹性部分，确定的间距有利地在钉仓的缝钉长度的有效范围内变化，以允许一定的弯曲，从而适应由于更厚的夹紧组织层而增加的压缩力。
在本发明的又一方面，外科器械通过具有上钳口和下钳口的闭合端部执行器的细长轴有利地操作，所述细长轴的尺寸适于通过套管针的插管插入吹气的体腔或体内腔。
本发明还涉及如下方面：
(1)一种外科器械，包括：
细长缝钉通道，其中有纵向通道狭槽；
钉砧，枢转连接到所述细长缝钉通道上以握持组织，并且具有缝钉成型底面，该缝钉成型底面内有纵向钉砧狭槽；
钉仓，具有上表面并且装纳在所述细长缝钉通道中，该钉仓包含多个缝钉，每个缝钉的缝钉长度尺寸适于形成在第一高度和第二高度之间的闭合缝钉；
连接到下部钳口上的细长轴；
手柄，其近侧通过细长轴可操作地连接以闭合钉砧并且将在钉砧和钉仓之间的组织夹紧成被夹紧组织的厚度；以及
击发杆，通过手柄使其平移，该击发杆能够在所述细长轴中纵向往复运动，该击发杆包括：
垂直部分，其通过所述纵向钉砧狭槽和所述纵向通道狭槽；
从垂直部分延伸的上部横向表面，该上部横向表面定位成在
击发平移期间在钉砧上施加向内的压缩力；
从垂直部分延伸的下部横向表面，该下部横向表面定位成在
击发平移期间在细长缝钉通道上施加向内的压缩力；以及
弹性部分，其定位成允许钉砧的缝钉成型底面和钉仓的上表面之间的高度相对于被夹紧组织的厚度在第一高度和第二高度之间变化。
(2)如第(1)项所述的外科器械，其特征为，击发杆的所述垂直部分包括连接到选自所述上部横向表面和所述下部横向表面中的一个上的基本上水平的弯曲臂。
(3)如第(2)项所述的外科器械，其特征为，所述垂直部分包括上部远侧开口水平狭缝、下部远侧开口水平狭缝以及位于所述上部远侧开口水平狭缝和所述下部远侧开口水平狭缝之间的位于远侧的切割表面，所述上部远侧开口水平狭缝限定了连接到所述上部横向表面上的上部臂。
(4)如第(1)项所述的外科器械，其特征为，所述上部横向表面和所述下部横向表面中的一个包括销，该销具有凹入的底座和向内延伸的外侧支撑点。
(5)如第(4)项所述的外科器械，其特征为，还包括在所述销的相对垂直侧上的相对的凹入的底座。
(6)如第(1)项所述的外科器械，其特征为，所述垂直部分包括内弹性层。
(7)如第(1)项所述的外科器械，其特征为，所述上部横向表面和所述下部横向表面中的一个包括由弹性材料形成的销。
(8)如第(1)项所述的外科器械，还包括弹性构件，该弹性构件连接到所述上部横向表面和所述下部横向表面中的一个的内表面上。
(9)如第(1)项所述的外科器械，其特征为，所述上部横向表面和所述下部横向表面中的一个包括后延伸弹簧指状件，该弹簧指状件向内弹性地偏置成与所述钉砧和所述细长缝钉通道中的相应一个偏压接触。
(10)如第(1)项所述的外科器械，还包括环绕所述垂直部分的至少一部分的水平弹簧垫圈，该弹簧垫圈位于所述上部横向表面和所述下部横向表面中的一个与所述钉砧和所述细长缝钉通道中的相应一个之间，施加向内的弹性偏压。
(11)一种外科器械，包括：
手柄部分，操作该手柄部分能够产生击发运动；
执行部分，其响应于来自手柄部分的击发运动，该执行部分包括：
细长缝钉通道，其连接到手柄部分上并且包括通道狭槽；
钉仓，具有上表面并且装纳在所述细长缝钉通道中，该钉仓包含多个缝钉，每个缝钉的缝钉长度尺寸适于形成在第一高度和第二高度之间的闭合缝钉；
钉砧，枢转连接到所述细长缝钉通道上并且包括钉砧通道，该钉砧通道包括沿着钉砧的纵向轴线向内开口的垂直狭槽，并且包括左侧和右侧直角棱镜形凹槽，该凹槽与所述垂直狭槽连通、由所述垂直狭槽等分、与所述垂直狭槽垂直，其中所述左侧和右侧直角棱镜形凹槽基本上沿着所述垂直狭槽的纵向长度延伸；
击发装置，包括位于远侧的切割刃、上部构件、下部构件和中部构件，所述切割刃纵向装纳在所述细长缝钉通道和钉砧的钉砧通道的垂直狭槽之间，所述上部构件由左侧和右侧横向上部销构成，所述上部销的尺寸适于可滑动地接合所述钉砧通道的左侧和右侧矩形凹槽的上部和下部内表面，所述下部构件接合所述通道狭槽，操作所述中部构件能够通过向远侧平移钉仓的楔形构件而致动钉仓，所述击发装置在纵向击发行程期间形状配合地接合细长缝钉通道和钉砧，在细长通道和钉砧之间产生间距用于缝钉成型，所述击发装置在击发期间的接合抵抗由于未充分夹紧的组织产生的狭缩和由于过量夹紧的组织产生的局部张开，保持在细长缝钉通道和钉砧之间的垂直间距；以及
击发装置的弹性部分，其允许在钉砧的缝钉成型底面和钉仓的上表面之间的高度相对于夹钳组织的厚度在第一高度和第二高度之间变化。
(12)如第(11)项所述的外科器械，其特征为，所述钉砧与细长缝钉通道形成向内偏置的关系，该细长缝钉通道在钉仓致动期间以钉砧和细长缝钉通道之间的确定间距辅助击发装置。
(13)如第(12)项所述的外科器械，还包括闭合构件，其可操作地将闭合运动纵向的转移到执行部分上，向内偏压钉砧和细长缝钉通道的远端，从而在钉仓致动期间以钉砧和细长缝钉通道之间的确定间距辅助击发装置。
(14)如第(11)项所述的外科器械，其特征为，所述钉仓选自多种钉仓类型，每种钉仓类型的特征为其厚度适于钉砧和细长缝钉通道之间的所需间距，并且缝钉的长度适于所需间距。
(15)如第(14)项所述的外科器械，其特征为，所述楔形构件包括楔形滑块，该楔形滑块具有多个连接凸轮楔，每个具有用于所选类型的钉仓的预选高度，击发装置的中部构件定向成抵靠所述多种钉仓中的每一个。
(16)一种外科器械，包括：
手柄部分，操作该手柄能够产生击发运动和闭合运动；以及
执行部分，其响应于来自手柄部分的击发运动，该执行部分的直径适于内镜手术中使用，该执行部分包括：
连接到所述手柄部分上的轴，操作该轴能够分别转移击发运动和闭合运动；
细长缝钉通道，其连接到所述轴上并且包括通道狭槽，并且可操作地装纳具有上表面的钉仓；
钉砧，其枢转连接到所述细长缝钉通道上并且响应于来自所述轴的闭合运动，该钉砧包括钉砧通道；以及
击发装置，包括位于远侧的切割刃，所述切割刃纵向装纳在所述细长缝钉通道和钉砧之间，所述击发装置在钉砧与细长缝钉通道之间的纵向行程期间确定地将钉砧与细长缝钉通道间隔开；
击发装置的弹性部分，其允许在钉砧的缝钉成型底面和钉仓的上表面之间的高度相对于被夹紧组织的厚度在第一高度和第二高度之间变化；
其中，所述击发装置通过包括具有上表面和下表面的上部构件而在钉砧与细长缝钉通道之间的纵向行程期间确定地将钉砧与细长缝钉通道间隔开，所述上表面和下表面纵向滑动地接合钉砧。
(17)如第(16)项所述的外科器械，其特征为，所述钉砧包括具有上表面和下表面的纵向狭槽，所述上表面和下表面分别滑动地抵靠击发装置的上部构件的下表面和上表面。
(18)如第(17)项所述的外科器械，其特征为，所述纵向狭槽包括与狭窄垂直狭槽连通的内部纵向通道，所述击发装置在所述狭窄纵向通道中平移并且包括具有位于所述内部纵向通道中的上表面和下表面的上部构件，用于将钉砧确定地与细长缝钉通道间隔开。
(19)如第(16)项所述的外科器械，其特征为，所述击发装置通过包括具有上表面和下表面的下部而在钉砧与细长缝钉通道之间的纵向行程期间确定地将钉砧与细长缝钉通道间隔开，所述上表面和下表面纵向滑动地接合细长缝钉通道。
(20)如第(19)项所述的外科器械，其特征为，击发装置的所述下部包括具有邻接细长缝钉通道的上表面的下部销，并且包括具有相对地邻接细长缝钉通道的下表面的中部销。
(21)如第(20)项所述的外科器械，其特征为，所述击发装置还包括具有上表面和下表面的上部构件，所述上表面和下表面纵向滑动地接合钉砧。
(22)如第(21)项所述的外科器械，其特征为，所述钉砧包括具有狭窄垂直狭槽的内部纵向狭槽，所述击发装置在所述狭窄垂直狭槽中平移并且包括具有位于所述内部纵向狭槽中的上表面和下表面的上部构件，用于将钉砧确定地与细长缝钉通道间隔开。
(23)如第(16)项所述的外科器械，其特征为，还包括钉仓，该钉仓由细长缝钉通道接合并且包括用于接收击发装置的切割刃的近侧开口的狭槽，该钉仓包括多个通过击发机构的远侧纵向运动而向上凸起的缝钉。
(24)如第(23)项所述的外科器械，其特征为，所述钉仓还包括多个驱动器，该驱动器响应于击发机构的远侧纵向运动支撑所述多个缝钉和楔形块，以使驱动器向上凸起，从而在钉砧上形成多个缝钉。
(25)如第(23)项所述的外科器械，其特征为，所述钉砧与细长缝钉通道形成向内偏置的关系，该细长缝钉通道在钉仓致动期间以钉砧和细长缝钉通道之间的确定间距辅助击发装置。
(26)如第(23)项所述的外科器械，其特征为，所述钉仓选自多种钉仓类型，每种钉仓类型的特征为其厚度适于钉砧和细长缝钉通道之间的所需间距，并且缝钉的长度适于所需间距。
(27)如第(26)项所述的外科器械，其特征为，所述楔形滑块包括多个连接凸轮楔，每个具有用于所选类型的钉仓的预选高度，击发装置的中部构件定向成抵靠所述多种钉仓中的每一个。
通过附图和对其的描述将更清楚地了解本发明的这些和其它目的和优点。
附图说明
所结合的构成说明书的一部分的附图示例性地示出了本发明，并且与上述对本发明的总体描述和下述对实施例的详细描述一起，用于解释本发明的原理。
图1是具有打开的端部执行器(缝钉施加组件)的外科缝合和切割器械的左视图，其中轴部分去除以显示由框架基底引导和由闭合套管包围的近侧击发杆和远侧击发杆的击发构件。
图2是具有图1所示外科缝合和切割器械沿着线2-2纵向垂直截取的根据本发明的回缩力调节高度击发杆的闭合端部执行器(缝钉施加组件)的左视图。
图3是图2的力调节(适应)高度击发杆的左视等轴侧图。
图4是第一种类型的图2的力调节高度击发杆的远侧部分(“E形梁”)的左视图，其具有分别形成在顶部销和切割表面之间以及中部销与切割表面之间的水平狭缝，以增加垂直弯曲。
图5是第二种类型的图2的力调节击发杆的远侧部分(“E形梁”)的左下方等轴侧图，其上部销具有凹入的下部区域，以增加垂直弯曲。
图6是图5所示E形梁的上部沿着线6-6在上部销上垂直横截的主视图。
图7是第三种类型的图所示E形梁的上部沿着线6-6在上部销上垂直横截的主视图，其中顶部销还包括凹入的上部底座连接件，以增加垂直弯曲。
图8是第四种类型的图5所示E形梁的上部沿着线6-6在上部销上垂直横截的主视图，其中顶部销还包括弹性内层压层，而不是具有凹入的底面，以增加垂直弯曲。
图9是第五种类型的图5所示E形梁的上部沿着线6-6在上部销上垂直横截的主视图，其还包括由弹性材料形成的上部销，而不是在上部销上设有凹入的底面，以增加垂直弯曲。
图10是第六种类型的图2的力调节击发杆的远侧部分(“E形梁”)的左上方等轴侧图，其中在底部具有弹性材料以增加垂直弯曲。
图11是图1的外科缝合和切割器械的端部执行器(缝钉施加组件)的填塞的下部上垂直横截的主视图。
图12是第七种类型的图2的力调节击发杆的远侧部分(“E形梁”)的左视图，其具有向近侧和向上延伸的弹簧臂，该弹簧臂连接到下部以增加垂直弯曲。
图13是第八种类型的图2的力调节击发杆的远侧部分(“E形梁”)的左上方等轴侧图，其具有环绕下部的弹簧垫圈，以增加垂直弯曲。
具体实施方式
参照附图，在全部附图中，相同的附图标记表示相同的部件，在图1中，外科缝合和切割器械10包括手柄部分12，该手柄部分12被操纵以定位执行部分14，该执行部分14包括紧固的端部执行器(所示为缝钉施加组件16)，其远侧连接到细长轴18上。执行部分14的尺寸适于通过用于内窥镜或腹腔镜外科手术的套管针的插管(未示出)插入，其中通过朝着手柄部分12的手枪式握把26按压闭合触发器24，来闭合缝钉施加组件16的上钳口(钉砧)20和下钳口22，该闭合触发器推动细长轴18的外部闭合套管28，以枢转关闭钉砧20。
一旦插入到被吹气的体腔或者内腔中，外科医生可以通过转动轴旋转旋钮30使执行部分14围绕其纵向轴线转动，所述轴旋转旋钮30接合手柄12的远端和细长轴18的近端。这样定位后，可以释放闭合触发器24，打开钉砧20，从而可以抓钳和定位组织。一旦对容纳在缝钉施加组件16的组织满意，外科医生按压闭合触发器24，直到锁定在手枪式握把26上，从而夹紧缝钉施加组件16中的组织。
然后按压击发触发器32，朝着闭合触发器24和手枪式握把26拉动，由此向远侧推动击发构件(所示的击发构件包括连接到远侧击发杆36上的近侧击发杆34)，该击发构件支撑在框架底38中，该框架底38将手柄12连接到缝钉施加组件16上。击发杆36接合细长缝钉通道40并且致动包含在缝钉通道40中的钉仓42，缝钉通道40和钉仓42两者形成下钳口22。击发杆36还接合闭合的钉砧20。在释放击发杆32以缩回击发杆36之后，按压闭合释放按钮44，使得闭合触发器24松开，从而可以缩回闭合套管28，以枢转和打开钉砧20，以便从缝钉施加组件16释放被切割和缝合的组织。
在图2中，缝钉施加组件16闭合在压缩的组织46上。在图2-3中，击发杆36具有连接到远侧E形梁50上的近侧部分48，该E形梁50在缝钉施加组件16内平移。如图所示在击发杆36缩回的情况下，在新的钉仓42插入细长缝钉通道40之后，E形梁50的垂直部分52基本上位于钉仓42的后面。从E形梁50的垂直部分52的上部横向延伸的上部销54开始位于在钉砧20的近侧转转端附近凹入的钉砧袋56中。当击发期间向远侧推动E形梁50时，垂直部分52经过形成在钉砧20的底面60中的狭窄纵向钉砧狭槽58(图1、11)、形成在钉仓42中的近侧开口的垂直狭槽62以及形成在细长缝钉通道40中的下面的纵向通道狭槽64。
在图2和11中，狭窄纵向钉砧狭槽58(图2)向上通向横向变宽的纵向钉砧通道66，该钉砧通道66的尺寸适于滑动地接收上部销54。纵向钉砧狭槽64向下通向横向变宽的纵向通道轨道68，该纵向通道轨道68装纳尺寸适于在其中滑动的下部底座70，该下部底座70连接在E形梁50的垂直部分52的底部。从E形梁50的垂直部分52延伸的横向变宽的中部销72被定位成沿着钉仓42的底盘74的顶表面滑动，该底盘74靠在细长缝钉通道40上。在底盘74上方形成在钉仓42中的纵向击发凹槽75的尺寸允许中部销72通过钉仓42平移。
E形梁50的垂直部分52的远侧驱动表面76定位成通过钉仓42的近侧开口的垂直狭槽62平移，并且向远侧驱动位于钉仓近侧中的楔形滑块78。E形梁50的垂直部分52在远侧驱动表面76上方和上部销54下方沿着远侧边缘具有切割表面80，该切割表面在缝合的同时切断夹住的组织46。
具体参照图11，应当理解的是，楔形滑块78向上驱动缝钉驱动器82，该缝钉驱动器又向上驱动缝钉83，使缝钉离开形成在钉仓42的缝钉体85中的缝钉孔84，以抵靠道钉砧20(图2)的底面上成型。
在图2、11中，有利的是，由箭头86(图2)表示的上部销54之间的所示间距相应地朝着压缩状态偏置，在该压缩状态中，0.015英寸的压缩组织46包含在缝钉施加组件16中。但是，通过E形梁50固有的弯曲允许最多约0.025英寸的更大量的压缩组织46。如果缝钉的长度不足以用额外的高度形成，则避免可能高达0.030英寸的过度弯曲。应当理解的是，这些尺寸是用于0.036英寸的缝钉高度的示例。但是对于各种类型的缝钉都是如此。
在图4中，第一种类型的适应E形梁50a包括从垂直部分52a的远侧边缘延伸的顶部和底部水平狭缝90、92，这些狭缝可由电钻机器(EDM)形成。垂直部分52a因此包括垂直适应的顶部远侧突出臂94、刀凸缘96、下部垂直部分98、中部销72和下部底座76，该臂94包含上部销54，该刀凸缘96包含切割表面80，该下部垂直部分98包含驱动表面76。水平狭缝90、92通过允许顶部远侧壁94向上枢转来允许适应的垂直间距，从压缩的组织(未示出)调节增加的力。
在图5-6中，第二种类型的适应E形梁50b包括在垂直部分52的两侧在上部销54b中形成的下部凹入的左侧和右侧区域110和112，分别保留左侧和右侧下部支撑点114和116(未凹入)。支撑点114、116的外侧位置提供长的力矩臂，以施加弯曲力。应当理解的是，对于所需的弯曲角度、给定的缝钉尺寸和其他考虑，可以选择凹入区域110和112的尺寸以及适应E形梁50b的材料。
在图7中，如上述在图5-6中所示的一样，示出了第三种类型的适应E形梁50c，其中由在上部销54c的相对的顶座表面中在垂直部分52附近形成的左侧和右侧上部狭窄的凹入区域120、122提供进一步的弯曲。
在图8中，如上述在图2-3中所示的一样，示出了第四种类型的E形梁50d，其具有复合/层压垂直部分52d的附加特征，该垂直部分52d包括夹设于左侧和右侧垂直层132、134之间的中心弹性垂直层130，所述左侧和右侧垂直层132、134分别支撑上部销54d的左侧和右侧部分136、138。当左侧和右侧部分136、138向上或者向下弯曲时，所导致的左侧和右侧垂直层132、134的弯曲通过中心弹性垂直层130的相应压缩或膨胀来适应。
在图9中，如上述在图2-3中所示的一样，示出了第五种类型的E形梁50e，其具有由挠性更大的材料形成的分立的上部销54e的附加特征，该上部销54e通过穿过垂直部分52e的水平孔140插入。这样，分立的上部销54e的左侧和右侧外端142、144根据加载力弯曲。
作为另一种选择，或者除了使上部销54能弯曲之外，在图10-11中，如上述在图2-3中所示的一样，示出了第六种类型的E形梁50f，其还包括连接到底座70的上表面152上的弹性垫150。弹性垫150根据施加在底座70上的压缩力调节上部销54的间距。
在图12中，如上述在图2-3中所示的一样，示出了第七种类型的E形梁50g，其中具有底座(鞋状)70g的附加特征，该底座70g具有向后上方延伸的弹簧指状件160，其向下弹性地推压E形梁50g，以根据加载力调节垂直间距。
在图13中，如上述在图2-3中所示的一样，示出了第八种类型的E形梁50h，其具有椭圆形弹簧垫圈170的附加特征，该弹簧垫圈170靠在底座70上，环绕垂直部分52并且具有向上弯曲的中心部分172，该中心部分172向下弹性地推压E形梁50h，根据加载力调节垂直间距。
尽管通过对各实施例进行描述示例性地描述了本发明，尽管非常详细地描述了这些示例性实施例，但是申请人并不意图把后附权利要求的范围限制或者以任何方式局限于该细节。本领域技术人员很容易能想到其它优点和变型。
例如，尽管为了清楚起见描述了手动操纵的外科缝合和切割器械10，但应当理解的是，机器人操纵或者控制的紧固装置可以结合有力控制击发杆。
又如，按照本发明的上述方面所述的适应E形梁可包括与在细长缝钉通道的相对侧滑动的两种结构的示例性类型中的接合件类似的接到钉砧的接合件。同样，适应E形梁可通过具有在形成于下部钳口结构中的通道内部滑动的横向变宽的部分而接合下部钳口。
再如，在示例性类型中，钉仓42是可置换的，从而缝钉施加组件16的其它部分可以被再利用。基于上述公开内容，应当理解，基于本发明的申请可以包括更多的可置换部分，如细长轴的远侧部分和上下钳口，其中钉仓永久地接合为下钳口的一部分。
又如，有利的是，示例性E形梁明确地将上下钳口彼此间隔开。这样，E形梁具有向内接合的表面，其在压缩组织量偏大倾向于扩张钳口的情况下在击发期间将钳口拉在一起。这样E形梁防止了缝钉由于超过有效长度而变形。另外，E形梁具有向外接合的表面，其在压缩组织量偏小或者器械的其它结构属性倾向于将钳口收缩在一起可能导致缝钉变形的情况下在击发期间推动钳口。通过基于本发明的申请可提高这些功能中的一个或两者，其中E形梁的固有弯曲将力调节到允许钳口闭合或者钳口打开的不同程度。

Claims (10)

1.一种外科器械，包括：
细长缝钉通道，其中有纵向通道狭槽；
钉砧，枢转连接到所述细长缝钉通道上以握持组织，并且具有缝钉成型底面，该缝钉成型底面内有纵向钉砧狭槽；
钉仓，具有上表面并且装纳在所述细长缝钉通道中，该钉仓包含多个缝钉，每个缝钉的缝钉长度尺寸适于形成在第一高度和第二高度之间的闭合缝钉；
连接到由所述细长缝钉通道和所述钉仓形成的下部钳口上的细长轴；
手柄，其近侧通过细长轴可操作地连接以闭合钉砧并且将在钉砧和钉仓之间的组织夹紧成被夹紧组织的厚度；以及
击发杆，通过手柄使其平移，该击发杆能够在所述细长轴中纵向往复运动，该击发杆包括：
垂直部分，其通过所述纵向钉砧狭槽和所述纵向通道狭槽；
从垂直部分延伸的上部横向表面，该上部横向表面定位成在击发平移期间在钉砧上施加向内的压缩力；
从垂直部分延伸的下部横向表面，该下部横向表面定位成在击发平移期间在细长缝钉通道上施加向内的压缩力；以及
弹性部分，其定位成允许钉砧的缝钉成型底面和钉仓的上表面之间的高度相对于被夹紧组织的厚度在第一高度和第二高度之间变化。
2.如权利要求1所述的外科器械，其特征为，击发杆的所述垂直部分包括连接到选自所述上部横向表面和所述下部横向表面中的一个上的基本上水平的弯曲臂。
3.如权利要求2所述的外科器械，其特征为，所述垂直部分包括上部远侧开口水平狭缝、下部远侧开口水平狭缝以及位于所述上部远侧开口水平狭缝和所述下部远侧开口水平狭缝之间的位于远侧的切割表面，所述上部远侧开口水平狭缝限定了连接到所述上部横向表面上的上部臂。
4.如权利要求1所述的外科器械，其特征为，所述上部横向表面和所述下部横向表面中的一个包括销，该销具有凹入的底座和向内延伸的外侧支撑点。
5.如权利要求4所述的外科器械，其特征为，还包括在所述销的相对垂直侧上的相对的凹入的底座。
6.如权利要求1所述的外科器械，其特征为，所述垂直部分包括内弹性层。
7.如权利要求1所述的外科器械，其特征为，所述上部横向表面和所述下部横向表面中的一个包括由弹性材料形成的销。
8.如权利要求1所述的外科器械，还包括弹性构件，该弹性构件连接到所述上部横向表面和所述下部横向表面中的一个的内表面上。
9.如权利要求1所述的外科器械，其特征为，所述上部横向表面和所述下部横向表面中的一个包括后延伸弹簧指状件，该弹簧指状件向内弹性地偏置成与所述钉砧和所述细长缝钉通道中的相应一个偏压接触。
10.如权利要求1所述的外科器械，还包括环绕所述垂直部分的至少一部分的水平弹簧垫圈，该弹簧垫圈位于所述上部横向表面和所述下部横向表面中的一个与所述钉砧和所述细长缝钉通道中的相应一个之间，施加向内的弹性偏压。
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BRPI0603947A (pt) 2007-05-08
CA2560378A1 (en) 2007-03-21
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EP1767156B1 (en) 2009-08-26
AU2006220391B2 (en) 2012-11-01
AU2006220391A1 (en) 2007-04-05
CA2560378C (en) 2014-08-26
EP1767156B2 (en) 2017-06-21
US7407078B2 (en) 2008-08-05
CN101028205A (zh) 2007-09-05
BRPI0603947B8 (pt) 2021-06-22
US20070075114A1 (en) 2007-04-05
JP5037080B2 (ja) 2012-09-26
ATE440548T1 (de) 2009-09-15
EP1767156A1 (en) 2007-03-28
DE602006008714D1 (de) 2009-10-08
BRPI0603947B1 (pt) 2017-08-08

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