CN101036589B - 带有可弯曲的端部执行器的外科缝合器 - Google Patents

带有可弯曲的端部执行器的外科缝合器 Download PDF

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CN101036589B
CN101036589B CN2006101468461A CN200610146846A CN101036589B CN 101036589 B CN101036589 B CN 101036589B CN 2006101468461 A CN2006101468461 A CN 2006101468461A CN 200610146846 A CN200610146846 A CN 200610146846A CN 101036589 B CN101036589 B CN 101036589B
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end effector
jaw
nail
surgical stapling
stapling device
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CN101036589A (zh
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马克·S·奥尔蒂斯
迈克尔·斯托克斯
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Ethicon Endo Surgery Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • A61B17/07207Surgical 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003Steerable
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064Surgical staples, i.e. penetrating the tissue
    • A61B2017/0641Surgical staples, i.e. penetrating the tissue having at least three legs as part of one single body
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • A61B2017/07214Stapler heads
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • A61B2017/07214Stapler heads
    • A61B2017/07221Stapler heads curved

Abstract

本发明提供了一种外科缝合器,其具有可选择地弯曲的端部执行器。该端部执行器的钉保持钳口联接到另一个钳口,用于夹持待缝合的组织。所述缝合器适于以与端部执行器的所选形状一致的图式将钉驱动到组织中。特别地,该端部执行器适于在其以大致线性构造定向钉时以线性图式驱动钉,并且在其以非线性构造定向钉时以非线性图式驱动钉。本发明还讨论了用具有可弯曲的端部执行器的缝合器缝合组织的方法。

Description

带有可弯曲的端部执行器的外科缝合器
技术领域
本发明广义地涉及用于外科手术的装置,更具体地涉及以可选的图式或形状放置钉的装置。 
背景技术
内窥镜和腹腔镜外科器械通常比传统的开放式外科装置更受到偏爱,这是因为(内窥镜的)的天然孔或(腹腔镜的)较小的切口易于减少术后恢复时间和并发症。因此,在适合于将远端执行器精确地设置在所需手术部位的内窥镜和腹腔镜外科器械领域中已经有了显著发展。这些远端执行器以多种方式(例如,抓钳、切割器、缝合器、夹具施放器、进入装置、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)接合组织以达到诊断或治疗效果。 
例如,外科缝合器可被用于多种外科手术,以便连接组织。典型地,钉使用适合于配合穿过插管的刚性端部执行器,以输送到待缝合的组织部位。在现有的外科缝合器中,端部执行器的一对钳口夹持待缝合的组织。容纳在钉仓钳口中的钉被驱动进入夹紧的组织,并且通过碰撞到砧座钳口变形而保持组织。根据钉在该刚性的钉仓钳口中的布置,钉形成预定的图式(例如,一列或多列钉线)。 
在一些外科手术中,被定制成特定布置的钉的非线性图式的形成是很有利的。例如,某些胃旁路手术要求医生以弯曲的形状制成胃袋。使用目前的内窥镜外科缝合器和切割器,形成胃袋通常要用3或4个单独的切割和缝合步骤。在大多数情况中,内窥镜缝合器/切割器在每次切割之后要被取出并重新装载,以便插入新的用于缝合的钉仓。这种重复的取出和插入很耗时,并且增加了外科并发症的可能性。使用在端部执行器下方具有关节运动接头或者适于驱动预定曲线图式的 钉的刚性钉仓钳口的外科缝合器仍然有些问题,因为根据外科手术的特定需要具体定制钉的图式有时会受到端部执行器的刚性构造和需要将端部执行器穿过窄的输送管输送到组织部位的限制。 
因此,需要用于缝合和/或切割组织的改进的装置和方法。 
发明内容
本发明总的提供用于形成与外科缝合器端部执行器的所选择的形状一致的钉的图式的方法和装置。在一种实施方式中,外科缝合器包括连接到细长外壳的近端的手柄和联接到所述外壳的远端的可选择地弯曲的端部执行器。所述端部执行器包括具有钉供应器的第一钳口和联接到第一钳口的第二钳口。所述端部执行器还可具有选择的形状,并且适于以与所选的形状一致的图式将钉驱动穿过夹持在钳口之间的组织。在另一种实施方式中,外科缝合器包括联接到细长连接器的近端的手柄和联接到所述连接器的远端的两个钳口。所述钳口可联接到一起,用于夹持组织。至少一个所述钳口适于携载钉供应器。每个钳口可独立地弯曲成所选择的形状。所述钳口适于在具有线性构造时装配到进入口内。该钳口还适合在离开进入口时可弯曲。 
在一种示例性实施方式中,端部执行器适于在其选择的形状为大致线性构造时以线性图式驱动钉。该端部执行器还适于在其选择的形状为大致非线性构造时以非线性图式驱动钉。端部执行器还适于在至少一个方向相对于另一个方向更具有柔性。或者,另外,端部执行器适于在至少两个方向上可选择地弯曲。一些实施方式采用适于包括用于将端部执行器偏压成预定形状的弹性材料的端部执行器。在一个实施例中,所述预定形状为线性构造。 
在一些实施方式中,一个或多个钳口挠曲构件可被联接到端部执行器的远侧部分。所述钳口挠曲构件适于在该构件拉紧时使端部执行器弯曲。在一个特定的实施例中,可以采用两个或多个钳口挠曲构件,端部执行器的每个钳口的远侧部分被联接到一个钳口挠曲构件。而且,可以将一个或多个挠曲引导件联接到端部执行器,以便保持端部执行器附近的挠曲构件。一些实施方式还包括至少一个远侧刚性化元件,该远侧刚性化元件适于可拆卸地联接到端部执行器的每个钳口的远端。该远侧刚性化元件阻止钳口的远侧部分的弯曲。实施方式还包括一个或多个驱动元件,所述驱动元件可以设置在细长外壳的至少一部分中。驱动元件适于沿着端部执行器的所选择的形状运动,以便使钉从其展开。其它实施方式包括一个或多个钉闭合元件,所述钉闭合元件可拆卸地设置在细长外壳的至少一部分内,并且适于沿着端部执行器的所选择的形状运动,以使钉变形。其它实施方式包括可动地设置在细长外壳的至少一部分中的刀元件。该刀元件适于沿着端部执行器的一部分运动,以切割被缝合的组织。 
另一个实施方式涉及外科钉供应器。所述钉供应器具有可选择地弯曲的基部,以与外科缝合器的钳口形状一致。可变形的齿可被联接到所述基部,或从该基部延伸出。该可变形的齿适于穿刺组织。所述基部还适于包括用于将该基部偏压成预定构造的弹性材料。 
在又一个实施方式中包括了一种用于缝合组织的方法。所述方法包括使外科缝合器的端部执行器的钳口与所选择的形状一致,其中一个钳口在其中设置了钉。使所述钳口靠近组织。从钳口将钉顺序地驱动到组织中。被驱动的钉然后变形,以闭合在组织上。端部执行器的每个钳口可以独立的所需形状弯曲。可以将钉展开到组织中,以形成所选择的非线性图式。还可通过弯曲被驱动的钉的齿来使钉变形。 
更具体地说,本发明涉及如下内容: 
(1)一种外科缝合器,包括: 
具有手柄部分的细长的外壳;以及 
联接到所述外壳的远端的可选择地弯曲的端部执行器,该端部执行器包括具有钉供应器的第一钳口和联接到该第一钳口的第二钳口,所述端部执行器具有可调节构造来实现形状的选择,并能够以与所选的形状一致的图式驱动钉穿过抓持在钳口之间的组织,其中,所述外壳的手柄部分对将所述端部执行器调节成具有所选的形状进行控制。 
(2)如第(1)项所述的外科缝合器,其中,所述端部执行器适于在其所选的形状为大致线性构造时以线性图式驱动钉,并且在其所选的形状为大致非线性构造时以非线性图式驱动钉。 
(3)如第(1)项所述的外科缝合器,其中,所述端部执行器适于在至少一个方向相对于另一个方向更具有柔性。 
(4)如第(1)项所述的外科缝合器,其中,所述端部执行器包括有效地将该端部执行器偏压成预定形状的弹性材料。 
(5)如第(4)项所述的外科缝合器,其中,所述预定形状为线性构造。 
(6)如第(1)项所述的外科缝合器,其中,所述端部执行器适于在至少一个平面中可选择地弯曲。 
(7)如第(1)项所述的外科缝合器,还包括: 
至少一个钳口挠曲构件,其联接到所述端部执行器的远侧部分和手柄部分并适于在其被张紧时使端部执行器弯曲。 
(8)如第(7)项所述的外科缝合器,还包括: 
至少两个钳口挠曲构件,所述端部执行器的每个钳口的远侧部分联接到一个钳口挠曲构件。 
(9)如第(7)项所述的外科缝合器,还包括: 
至少一个挠曲引导件,其联接到所述端部执行器,用于将所述至少一个钳口挠曲构件保持在端部执行器的附近。 
(10)如第(1)项所述的外科缝合器,还包括: 
至少一个远侧刚性化元件,其适于可拆卸地联接到所述端部执行器的每个钳口的远端,并有效地防止每个钳口的远侧部分的弯曲。 
(11)如第(1)项所述的外科缝合器,还包括: 
至少一个驱动元件,其可动地设置在所述细长外壳的至少一部分内,并且适于沿着所述端部执行器的所选的形状运动,以使钉从该处展开。 
(12)如第(1)项所述的外科缝合器,还包括: 
至少一个钉闭合元件,其可动地设置在所述细长外壳的至少一部分内,并且适于沿着所述端部执行器的所选的形状运动,以使钉变形。 
(13)如第(1)项所述的外科缝合器,还包括: 
刀元件,其可动地设置在所述细长外壳的至少一部分内,并且适于沿着所述端部执行器的至少一部分运动,以切割被缝合的组织。 
(14)一种外科缝合器,包括: 
手柄; 
在其近端联接到外壳的细长的连接器; 
联接到所述连接器的远端的两个钳口,所述钳口可动地联接到一起,用于夹持待缝合的组织,至少一个钳口适于携载钉供应器,每个钳口单独地弯曲成所选择的形状。 
(15)如第(14)项所述的外科缝合器,其中,所述钳口适于在具有线性构造时装配入进入口,并适于在离开进入口时可弯曲。 
(16)如第(14)项所述的外科缝合器,其中,至少一个钳口包括可选择地弯曲成所述所选择的形状的钉保持仓。 
(17)一种外科钉供应器,包括: 
可选择地弯曲的基部,其适于与外科缝合器的钳口的形状一致;以及 
从所述基部延伸的多个可变形的齿,所述齿适于穿刺组织。 
(18)如第(17)项所述的外科缝合器,其中,所述基部适于具有弹性,以便将基部偏压成预定的构造。 
(19)一种用于缝合组织的方法,包括: 
使外科缝合器的端部执行器的钳口与所选择的形状一致,一个钳口在其中设置有多个钉; 
使所述钳口靠近,以在其间放置组织; 
从所述一个钳口将钉驱动到组织中;以及 
使被驱动的钉变形,以将钉闭合在组织上。 
(20)如第(19)项所述的方法,其中,将钉展开到组织中,以形成所选择的非线性图式。 
(21)如第(19)项所述的方法,其中,所述使钳口一致的步骤包括使端部执行器的每个钳口符合所需的形状。 
(22)如第(19)项所述的方法,其中,通过弯曲被驱动的钉的 齿来使钉变形。 
附图说明
从结合附图的以下详细说明可以更充分地理解本发明,其中: 
图1是根据本发明一个实施方式的外科缝合器的透视图; 
图2是描绘了图1所示外科缝合器的端部执行器的钳口的透视图,其中钳口处于闭合位置; 
图3是描绘了图1所示外科缝合器的端部执行器的一组坐标轴和钳口的透视图,其中钳口处于张开位置; 
图4A是图1所示外科缝合器的远端的分解图,没有示出细长外壳; 
图4B是图4A所示钉携载钳口的外侧壳体的放大透视图; 
图5是用于图1的外科缝合器的手柄和细长外壳的远端的透视图; 
图6是用于与本发明的一种实施方式一致的外科缝合器的端部执行器的可选实施方式的透视图; 
图7是与本发明的一种实施方式一致的包括金属片的钉支撑件的一部分的透视图; 
图8是用于图1所示外科缝合器的端部执行器的近端的放大透视图; 
图9是两个钉供应器的透视图,其中每个钉供应器由相应地驱动元件驱动;以及 
图10是与钉支撑件和I形梁刀具接合的两个钉供应器的透视图,其中每个钉供应器由相应地驱动元件驱动,并且齿由相应的钉闭合元件变形。 
具体实施方式
现在将描述一些示范性实施例,以提供在此公开的装置和方法的原理、结构、功能、制造和使用的全面理解。在附图中示出了这些实 施方式的一个或多个实施例。本领域技术人员将会意识到,在此具体描述和在附图中示出的装置和方法是非限定性的示例性实施例,而本发明的范围仅由权利要求书限定。就一种示例性实施方式示出或描述的特征可与其它实施方式的特征相结合。这种修改和改变应包括在本发明的范围内。 
总的来说,本发明提供了一种外科缝合器,其具有可选择地弯曲的端部执行器,所述端部执行器包括联接到一起抓持组织的第一钳口和第二钳口。第一钳口包括用于缝合被夹持的组织的钉供应器。所述端部执行器具有可选择的形状,这样钉可以与该端部执行器的所选形状一致的图式被驱动进入被夹持的组织。例如,端部执行器适于在其所选的形状以线性构造保持钉时(例如,当端部执行器处于大致线性构造时)以线性图式驱动钉。同样地,端部执行器适于在其所选的形状以非线性构造保持钉时(例如,当端部执行器处于大致非线性构造时)以非线性图式驱动钉。 
图1示出了外科缝合器100的一个示例性实施方式,该外科缝合器100具有可独立地弯曲成所选择的形状的一对钳口200和300。该外科缝合器100包括联接到细长外壳400的手柄600,该外壳400从手柄的远端605延伸出。包括一对钳口200和300的端部执行器700联接到细长外壳的远端405。一个钳口300适于携载由外科缝合器100使用的钉供应器。钳口挠曲元件520、530分别在近端联接到手柄600上的控制元件610和在远端联接到端部执行器700的钳口200、300。在使用过程中,细长外壳400和端部执行器700例如通过进入口(诸如输送管或插管)插入患者体内。端部执行器可被设定成闭合或者靠近位置(例如,所述钳口可被设置成线性构造),从而使其横截面积足够小以装配在进入口内。当从进入口的远端出来时,可运动控制元件610,以便在钳口挠曲元件520、530上是施加张紧力,从而使每个相应的钳口200、300根据控制元件610的定位弯曲成所选择的形状。尽管在图1的实施方式中示出了细长外壳400处于直的构造,外壳400还可采取其它形状,和/或可弯曲,以便于将端部执行器输送到患者体 内的特定位置。细长外壳可采用多种构造(例如,该外壳可具有沿其长度的开口,不是闭合的结构)。总的来说,细长连接器可用于将端部执行器连接到手柄,细长外壳是细长连接器的一种实施方式。还如图1所示,所述手柄还包括其它控制元件620、630、640,用于如在这里更详细描述的那样操纵该外科缝合器和端部执行器的其它部分。尽管示出的控制元件620、630、640为滑杆(slider bar),但是手柄600可另外或者可选地包括其它机构,例如旋钮、杆、滑动钮等等,用于操纵该缝合器100。本领域技术人员将会理解,所述装置可包括没有在此公开的各种其它部件。例如,该装置可包括在细长外壳400和端部执行器700之间形成的关节运动接头,用于使端部执行器700相对于细长外壳400以一定角度地运动。可在手柄上设置扳机或其它机构,以便成角度地调节端部执行器700。另外或者可选地,可具有接头,以便使端部执行器700、或者外壳400和端部执行器700二者围绕该装置100的纵向轴线旋转。 
参照图2和3所示的缝合器100的远端的透视图和图4A所示的分解图更详细地说明端部执行器700,在图4A中为了清楚起见省略了细长外壳400。钉保持钳口300包括外侧壳体310,该外侧壳体310的中央带有狭槽312。壳体310能够容纳柔性脊元件320、钉支撑件340和钉供应器330。所述成对柔性脊元件320可朝着外侧壳体310的中央定位,并且使狭槽312穿过其间。钉支撑件340可在外侧壳体310中定向成使两个钉供应器330在钉支撑件340的狭槽中交错(interlaced)。作为例子,钉支撑件340和两个钉供应器330可被定位在外侧壳体310的两侧上。端部执行器适于允许在装置中多次重新加载钉或钉供应器(例如,缝合器的多次使用可通过如下方式实现,即,使钉支撑件340和钉供应器330可拆卸地联接到钉保持钳口300,从而其它钉供应器可以被加载到钉保持钳口300中)。相对的钳口200包括外侧壳体210。钳口200、300可联接到细长外壳400的远端,并适于进行相对枢转运动,从而它们能够靠近(即闭合)和分开(即张开)。每个钳口200、300的远端适于接收可选择地拆卸的远侧刚性 化元件250、350。每个钳口200、300在钳口的远端270、370联接到钳口挠曲构件520、530(此处示例性地示出为索)。每个钳口200、300还包括一个或多个挠曲引导件260、360,相应的钳口挠曲构件520、530穿过该挠曲引导件260、360。 
在一个示例性实施方式中,可通过向相应的钳口挠曲元件施加张力来实现端部执行器的每个钳口独自弯曲成所选择的形状。参考图2和3,由于每个钳口挠曲构件520、530联接到相应的钳口200、300的远端,拉动构件520、530将使钳口200、300弯曲。随着进一步张紧钳口挠曲构件,相应的钳口响应于由钳口挠曲构件施加到钳口远端的附加的力而进一步弯曲。在特定的实施方式中,钳口可选择地弯曲,从而相对于装置100定向为线性构造时的纵向轴线定向成高达大约45度的角度,或高达大约90度的角度。钳口挠曲构件和端部执行器的可选设置可提供其它功能。尽管可使用如图5所示手柄600的联接到两根索520、530的单个控制元件610来实现协作的钳口弯曲,但也可在手柄上使用两个控制元件,以提供用于将张紧力分别施加到各个索上的分开的部件,从而允许单独地选择钳口的形状。另外,端部执行器适于在多于一个方向上弯曲。例如,钳口挠曲元件可以用在端部执行器700的相对侧上,索520、530从该处开始,允许端部执行器700相对于图2和3所示的适合的弯曲方向的相反方向弯曲。因此,实施方式可包括适于可选择地在至少一个平面(也就是两个方向)中弯曲的端部执行器。尽管图2和3所示的实施方式使用索作为钳口挠曲元件,但是本领域技术人员将会理解,也可以采用其它类型的结构,以便将力施加到钳口或端部执行器上,从而导致弯曲。例如,图6描绘了由钳口挠曲元件815、825弯曲的端部执行器800的钳口810、820,其中钳口挠曲元件815、825具体化为柔性条带。同样地,钳口挠曲元件可为通过铰链联接到钳口的远端的刚性结构(诸如杆)。作用在该杆上拉动杆的轴向力使联接的钳口弯曲并离开该杆,从而根据所述轴向力的大小使钳口形成所选的形状。 
如图2和3所示,挠曲引导件260、360可联接到每个钳口200、 300上,用于将相应的钳口挠曲元件520、530保持在端部执行器附近。参照钉保持钳口300,当柔性索530被拉动并张紧时,索530趋向于直的绷紧的形状,而钳口300趋向于弯曲并成弓形地从索530离开。通过将索530穿过一个或多个挠曲引导件360,索530可被限制在靠近钳口300的位置处。在端部执行器被用于小的腔体区域时或者端部执行器通过带有很大曲率的进入口输送以帮助保持端部执行器的有限的横截面时,这都是非常有益的。在另一个方面中,挠曲引导件的位置和数量适于改变钳口具有的可选的形状。例如,在钳口的特定截面中使用数个精密隔开的挠曲引导件将会使该钳口部分相对于具有以更远距离隔开的挠曲引导件的其它部分刚性更大。因此,所选择的形状可具有多种曲率半径。但是很显然地,挠曲引导件的使用是任选的。例如,如图6所示,端部执行器800被弯曲成所选择的形状,而没有使用挠曲引导件。 
端部执行器适于具有弹性材料,这样端部执行器可被偏压成与预定形状一致。使用具有弹性特性的材料(例如弹簧钢)可使端部执行器具有优选的形状,同时允许端部执行器在受到某些力时变形并且在力移除时回到优选的形状。参考图2和3,钳口200、300载索520、530被张紧时具有所选的弯曲形状。但是,当索520、530张紧程度很小或者没有张紧时,钳口200、300趋向于呈现它们的通常构造,从而形成大致直的形状。特别地,当钉携载钳口300形成直的形状时,钳口300中的钉以线性构造对准。这样,缝合器可以随着端部执行器的所选形状而展开线性图式的钉或者非线性图式的钉。本领域技术人员将会理解,端部执行器可适于向着其它预定形状(例如带有特定曲率的弧形)偏压,并且在端部执行器具有特定的预定形状时在端部执行器中的钉也可被布置成各种所需的构造。 
在一些实施方式中,端部执行器适于沿一个方向比另一个方向更具柔性。例如,参考图3所描绘的坐标轴800,端部执行器700适于在x-y平面中的某个特定方向上弯曲,而在x-z平面中具有足够刚性,从而驱动钉。总的来说,可以通过所使用的材料、端部执行器的零部 件的形状以及零部件相对于作用在其上的力的定向而将端部执行器制成可弯曲的。例如,如图4B所示,钉保持钳口300的外侧壳体310包括两条塑性条带313,它们用作外侧壳体310的基部,每条塑性条带313在由坐标轴800标示的y方向上是柔性的。在一个示例性实施方式中,壳体310的侧部由可嵌件注塑到塑性条带313上的薄的金属条带311(例如,弹簧钢的小片)制成。每条薄的金属条带311的形状和定向可被设置成在y方向大致比z方向薄。片311在y方向的薄的尺寸(大约1mm)允许该片在y方向上弯曲。在z方向的相对较高刚性可通过在z方向的相对较大厚度(大约6mm)来实现,这样在某些实施方式中赋予了端部执行器优选的弯曲方向。弹簧钢的弹性还允许端部执行器具有优选的形状、也就是偏压的预定形状(通过施加力弯曲到所选的形状,当撤掉该力时回到预定的形状)。两个钳口的其它结构(例如,上部钳口壳体、柔性脊元件、钉供应器、钉支撑件、挠曲引导件,等等)可同样地被构造成赋予类似的优选的方向性的柔性或者刚性。当特定结构具有沿y方向的大的宽度,两个或多个材料片可被层叠到一起,以提供在x-y平面中的柔性和在x-z平面中的刚性。所述片可被定向成平的表面平行于x-z平面,并且片厚尺寸垂直于y轴。例如,如图7所描绘的,钉支撑件340由并排组装的弹簧钢的片341构成。允许片341之间的一些相对运动允许所述片在沿着y方向施加力时挠曲。定向片或者多个片来制造用于外科缝合器的结构的概念还可应用于以与端部执行器的可选形状一致的图式分别驱动钉和使钉变形的驱动元件430和钉闭合元件410,如此处更详细描述的。除了前述概念之外,特定的结构(例如柔性脊元件320)也可或者可选地使用条带材料之间的间隔或间隙,以允许所需尺度中的结构柔性。尽管此处讨论的实施方式涉及弹簧钢片和柔性塑性材料的使用,本领域技术人员将会容易理解,可以使用具有适当特性的其它材料。同样地,在可弯曲端部执行器中还可使用各种其它结构的几何形状(例如,外侧壳体310的基部313可由沿着细长壳体310的轴线对准的薄金属条带构造成,该薄条带在y方向上具有柔性)。当然,此 处对柔性钉保持钳口的构造的说明可被应用到总的包括可选地弯曲的钉保持仓的实施方式。 
可使用刚性化元件来改变端部执行器的弯曲特性,以阻止钳口或者端部执行器的特定部分的弯曲。如图3和4A所示,每个钳口的远端270、370适于接收可拆卸的远侧刚性化元件250、350。远侧刚性化元件350包括刚性延伸件351。如图8所示,延伸件351适于在狭槽312的钳口的远侧区域内骑跨在下部钳口300中的柔性脊元件320的远端上。刚性延伸件351阻止钳口300在对应于该延伸件351的远侧区域中的弯曲。因此,可弯曲的钳口的所述所选择的形状能够被改变成取决于该刚性延伸件的长度而具有不同的曲率分布。显然,可采用具有变化的延伸件长度的多种远侧刚性化元件,以便根据钉操作者的需要来弯曲钳口。另外,远侧刚性化元件不必使用适于装配入钳口的狭槽中的刚性延伸件。本领域技术人员将会理解,该远侧刚性化元件的形状和尺寸可被设定成各种构造,以便限制钳口的远侧部分的弯曲。例如,远侧刚性化元件可采用在钳口的远侧部分一侧附近支起的延伸件。这种实施方式增加了钳口的远侧部分相对于具有延伸件的一侧的方向上的弯曲的刚性,而不会影响钳口在相对方向上的刚性。 
参照图4A、5和8讨论示例性实施方式的用于闭合端部执行器700的钳口以及驱动钉和使钉变形的其它元件。闭合元件400在其近端联接到手柄600上的控制元件620(例如按钮或其它致动器)。该闭合元件440从外壳400的远端在端部执行器700的近端附近显示出。驱动元件430在它们的近端联接到手柄600上的驱动器控制元件630,并且也可被设置在细长外壳400的至少一部分内。每个驱动元件430在其远端具有楔形形状,并且可被轴向推进到端部执行器700中,以便驱动钉供应器330。钉闭合元件410在它们的近端联接到手柄600上的控制元件640。钉闭合元件410适于设置在细长外壳400内,并从其露出,被推进穿过端部执行器700,以使钉变形。隔离块450用于保持驱动元件430和钉闭合元件410的相对间隔。 
如前面简要所述地,可使用闭合元件440进行钳口200、300的 张开和闭合。在一种实施方式中,钳口200、300适于由弹簧或其它偏压机构(未示出)趋向于分开的位置(如图3所示)。例如,控制元件620的向前滑动导致闭合元件440推进撞击到上部钳口200,随后迫使上部钳口200靠近并接触钉保持钳口300。如图2所描绘的,闭合元件440不必推进穿过钳口的整个长度来使钳口闭合。由于钳口闭合机构可独立于驱动钉的机构,待缝合的组织可被夹持由用户确定的时间段,以使组织“泌乳”。闭合元件440的缩回导致钳口200、300回复到张开位置。如容易明白的那样,闭合元件可采用与它们的迫使端部执行器的钳口朝着彼此运动的使用一致的各种材料和构造。例如,闭合元件不必是沿着细长外壳400的长度延伸的一体式实体;它可具体体现为较短的细长结构,在其近端联接到延伸穿过细长外壳400的径向柔性但轴向刚性的连接器。同样地,端部执行器的钳口不必向张开位置偏压。分开的机构可用于致动钳口的分离。本领域的技术人员将会理解,可使用各种可选的机构来使钳口运动。 
用于外科缝合器的钉可以钉供应器的形式提供。总的来说,钉供应器可具体化为适于穿刺组织的多个可变形的齿。所述齿联接到弯曲的基部,并从其延伸,该弯曲的基部适于与端部执行器的钳口的形状一致。参考图9所示的示例性实施方式,钉供应器330具有齿331,齿331可以链状图式(即,所述齿被布置成线性或者曲线形图式)连接到可弯曲的基部332的一侧。在一种实施方式中,所述齿由线切割冲压金属(wire cut stamped metal)构成,所述线切割冲压金属的长度大约为5mm,宽度大约为0.5mm,基部的厚度大约为0.5mm。可变形齿可用任何适于穿刺组织并可变形以使钉变形的材料构成。可变形齿适于具有弹性,这将基部偏压成预定的构造(例如通过弹性材料的使用)。例如,基部可具有与可弯曲端部执行器的钳口的优选直的形状对准的优选直的形状。该钉供应器的基部之后可与端部执行器的弯曲或放松一致,成为所选的形状。钉供应器的齿和基部可由被选择成补足特定元件的功能的相同的材料或不同的材料构成(例如,冲压金属用于齿,弹簧钢用于基部)。本领域技术人员将会理解,钉供应 器可被构造成与图9中所描绘的构造不同的构造。例如,钉供应器可采用多个平行的齿链,所述齿是互连的,或者,基部可以具有预定的弯曲形状。 
作为示例性实施方式,参考图4A、8和9说明钉从端部执行器钳口驱动进入组织。可以将四组钉供应器330定位在两个钉支撑件340的槽口中,所述钉支撑件340位于钳口300中。钉供应器330对准成每个钉供应器的基部没有被钉支撑件340覆盖。当将钳口200、300闭合在组织上时,具有楔状远侧部分431的驱动元件430能被推进到下部钳口300中。楔形件431的前缘适于在钉供应器330的基部332下方滑动。因此,驱动元件430的推进迫使基部随着驱动元件的表面形状运动。迫使联接到基部一侧的齿332与基部一起向上,行进穿过钉支撑件340(见图10)并穿刺组织。当采用多个钉供应器时,驱动元件可被联接到一起,以便根据预定安排同时或顺序地驱动钉,或者可以单独地推进驱动元件。相对于图9中所描绘的方向轴800,驱动元件430定位成其宽度(z方向)比其深度(y方向)大很多。这样,驱动元件430能够沿y方向弯曲,以适应端部执行器的所选择的形状,同时在z方向上保持足够的刚性,以便驱动钉供应器430。就其它实施方式采用更大尺寸的驱动元件来说,片层可夹在一起以具有y方向的柔性。 
在一种实施方式中,使被驱动进入组织的钉变形,使用钉闭合元件410(例如,滑动片)来闭合钉。参考图8和10,在将钉供应器的齿332驱动进入组织后,钉闭合元件410可从外壳400推进入端部执行器中。钉闭合元件410在其远端具有楔形件411,并包括沿其边缘412的沟槽。这样,当钉闭合元件410被推进时,沿着楔形件411的边缘412的沟槽与齿的尖端接触,并在钉闭合元件的平面内(即,水平地)弯曲该尖端,如图10所示。与驱动元件相同地,钉闭合元件具有根据预定程序的偶联运动,或者,它们可被单独地推进。另外,钉闭合元件还具有片状结构,该结构允许它们挠曲来随着端部执行器的所选的形状运动,同时保持竖直方向(即,z轴)的刚性来使钉变 形。 
在一些实施方式中,驱动元件和钉闭合元件的运动彼此独立。但是,其它实施方式可能使驱动元件和钉闭合元件的运动相关联。在图10中示出了一个特定的实施例,其中,驱动元件和钉闭合元件可被一起推进,并且驱动元件领先钉闭合元件预定距离和/或时间。在另一个实施例中,驱动元件的远侧部分被构造为达到中间平台的第一楔形件,在中间平台的后面是到终端平台的第二楔形件。使用这种结构,驱动元件和钉闭合元件可被联接在一起,从而使钉闭合元件的前缘与驱动元件的中间平台区域平齐(even)的定位。在推进所述组件时,当由于第一楔形件结构而升起时,钉齿可被驱动穿过组织。之后钉闭合元件接触齿的尖端,以便开始变形。由第二驱动楔形件引起的钉的进一步运动导致抵靠钉闭合元件的进一步变形,从而使钉完全闭合。 
其它实施方式可包括在腹腔镜或内窥镜手术过程中与外科缝合器一起使用的其它装置。例如,外科缝合器可包括刀元件(例如刀具),该刀元件适于沿着端部执行器的一部分运动,以便切割被缝合的组织。参考图3和10,I形梁刀具420联接到手柄600上的滑动钮(未示出)上。在闭合钳口200、300时,前缘421可从细长外壳400的远端推进到端部执行器700中,穿过形成于钳口300中的柔性脊元件340之间的狭槽312。位于上部钳口200上的狭槽210和位于下部钳口300上的相应狭槽可用于容纳角撑板422、423,并由此引导刀具420沿着端部执行器的形状的运动。由于角撑板422、423可牢固地接合钳口200、300,刀具420的推进在钉形成过程中帮助钳口牢固闭合。本领域技术人员将会理解,多种不同的刀具结构或者其它外科装置可与可弯曲的端部执行器一起使用。 
本发明还提供了用可弯曲的端部执行器缝合组织的示例性方法。在一个示例性实施方式中,具有钉供应器的端部执行器定位在待缝合的组织部位。如果需要,端部执行器可通过闭合和对准其钳口来靠近,以配合进入管或插管。或者,端部执行器可以内镜方式插入天然开口或以腹腔镜方式通过小的切口。当穿过管或其它开口行进并从其出来 时,端部执行器的钳口可被运动到张大的分开位置。端部执行器的钳口可分别弯曲,以与所选的形状一致。然后可由钳口夹持待缝合的组织。钳口可任选地挤压组织一段时间,以使组织“泌乳”。钉此后可从端部执行器的钉容纳钳口被驱动进入组织中。可在被驱动的钉上进行钉的变形(例如,使被驱动的钉的齿弯曲),以使钉闭合在组织上。以与端部执行器的所选形状一致的图式将钉展开到组织上。例如,可以线性图式或者非线性图式展开钉。同样地,可形成钉的其它图式,例如,交错的列或者曲线形状。在其它实施方式中,端部执行器可选择地沿一个或多个方向定形。可选择地,或附加地,所选的形状具有变化的曲率半径。所述外科缝合器还执行附加的功能,例如,在组织已被缝合后切割组织。 
本领域技术人员将会理解,此处具体描述和参照附图示出的装置和方法是非限制性的示例性实施方式。就一个示例性实施方式示出或描述的部件可与其它实施方式的部件结合。旨在将这种变型和变化包括在本发明的范围内。同样地,本领域技术人员将会理解本发明基于上述实施方式的其它特征和优点。因此,本发明不由已经具体示出和描述的内容限制,而是由所附的权利要求表明。 

Claims (9)

1.一种外科缝合器,包括:
具有手柄部分的细长的外壳;以及
联接到所述外壳的远端的可选择地弯曲的端部执行器,该端部执行器包括具有钉供应器的第一钳口和联接到该第一钳口的第二钳口,所述端部执行器具有选择的形状并适于以与所选的形状一致的图式驱动钉穿过抓持在第一钳口和第二钳口之间的组织,
并且还包括:
至少一个钳口挠曲构件,其联接到所述端部执行器的远侧部分和手柄部分并适于在其被张紧时使端部执行器弯曲。
2.如权利要求1所述的外科缝合器,其中,所述端部执行器适于在其所选的形状为大致线性构造时以线性图式驱动钉,并且在其所选的形状为大致非线性构造时以非线性图式驱动钉。
3.如权利要求1所述的外科缝合器,其中,所述端部执行器适于在至少一个方向相对于另一个方向更具有柔性。
4.如权利要求1所述的外科缝合器,其中,所述端部执行器包括有效地将该端部执行器偏压成预定形状的弹性材料。
5.如权利要求4所述的外科缝合器,其中,所述预定形状为线性构造。
6.如权利要求1所述的外科缝合器,其中,所述端部执行器适于在至少一个平面中可选择地弯曲。
7.如权利要求1所述的外科缝合器,其中,
设有至少两个所述钳口挠曲构件,所述端部执行器的每个钳口的远侧部分联接到其中一个所述钳口挠曲构件。
8.如权利要求1所述的外科缝合器,还包括:
至少一个挠曲引导件,其联接到所述端部执行器,用于将所述至少一个钳口挠曲构件保持在端部执行器的附近。
9.如权利要求1所述的外科缝合器,还包括:
至少一个远侧刚性化元件,其适于可拆卸地联接到所述端部执行器的每个钳口的远端,并有效地防止每个钳口的远侧部分的弯曲。
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ATE476145T1 (de) 2010-08-15
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US7651017B2 (en) 2010-01-26
JP2007144168A (ja) 2007-06-14
CN101036589A (zh) 2007-09-19
DE602006015893D1 (de) 2010-09-16
CA2568580A1 (en) 2007-05-23
EP1790293A3 (en) 2007-08-15
EP1790293B1 (en) 2010-08-04
CA2568580C (en) 2014-09-09
AU2006236073A1 (en) 2007-06-07
MXPA06013577A (es) 2008-10-15
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US20070114261A1 (en) 2007-05-24
BRPI0604740B1 (pt) 2018-06-26

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