CN101313864A - 带有能进行关节运动的端部执行器的外科缝合和切割器械 - Google Patents

带有能进行关节运动的端部执行器的外科缝合和切割器械 Download PDF

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CN101313864A
CN101313864A CNA2008101081975A CN200810108197A CN101313864A CN 101313864 A CN101313864 A CN 101313864A CN A2008101081975 A CNA2008101081975 A CN A2008101081975A CN 200810108197 A CN200810108197 A CN 200810108197A CN 101313864 A CN101313864 A CN 101313864A
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end effector
surgical instruments
proximal stent
pipeline section
joint motions
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CN101313864B (zh
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J·M·布罗尔
J·J·弗洛特
J·H·卢阿
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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
    • 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
    • A61B17/28—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
    • 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
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of 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
    • A61B2017/2939—Details of linkages or pivot points

Abstract

本发明涉及一种具有能进行关节运动的端部执行器的外科缝合和切割器械。公开了用于将近侧支架部分连接到端部执行器上的各种无源关节运动接头，以便端部执行器相对于所述器械的近侧支架部分枢转行进。

Description

带有能进行关节运动的端部执行器的外科缝合和切割器械
技术领域
本发明整体上涉及内窥镜外科器械，其包括但不限于能够将成排缝钉施加到组织上同时切割这些缝钉排之间的组织的外科缝合器械，更具体而言，本发明涉及与带有能进行关节运动的端部执行器的外科缝合器械一起使用的关节运动接头有关的改进。
背景技术
与传统的开放式外科器械相比，内窥镜外科器械通常更受青睐，这是因为较小的切口易于减少术后恢复时间和并发症。因此，适于通过套管针的插管将远端执行器精确放置在需要进行外科手术的部位上的内窥镜器械领域已经有了显著的发展。这些远端执行器(例如，内镜切割器、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、以及使用超声波、RF、或激光等的能量装置)以各种方式与组织接合，以达到诊断或治疗的效果。
已知的外科缝合器包括端部执行器，该端部执行器在组织中形成纵向切口的同时在切口的相对两侧上施加多排缝钉。所述端部执行器包括一对相配合的钳口构件，如果器械用于内窥镜或者腹腔镜应用，这对钳口构件能够穿过插管通道。钳口构件中的一个容纳有具有至少两个横向间隔的缝钉排的钉仓。另一个钳口构件限定了具有缝钉成形凹口的砧座，所述凹口与钉仓中的缝钉排对准。该器械通常包括多个往复运动的楔形件，这些楔形件在被向远侧驱动时穿过钉仓中的开口并与支承缝钉的驱动器接合，向着砧座击发缝钉。
授予Jeffrey S.Swayze和Frederick E.Shelton，IV的专利号为No.6905057、题为“Surgical Stapling Instrument Incorporating a FiringMechanism Having a Linked Rack Transmission”的美国专利和授予Jeffery S.Swayze、Frederick E.Shelton，IV、Kevin Ross Doll和DouglasB.Hoffman的专利号为No.7083075、题为“Multi-Stroke MechanismWith Automatic End of Stroke Retractions”的美国专利描述了适合于内窥镜应用的外科缝合器的实例，所述专利所公开的内容通过引用整体结合入本文。
根据手术的种类，可能需要进一步调整内窥镜外科器械的端部执行器的定位。特别是，经常需要相对于器械轴的纵向轴线倾斜地定向端部执行器。端部执行器相对于器械轴的横向运动或非轴向运动通常被称为“关节运动”。在某些情况下，例如在器官后面，该关节运动式定位使医生能更容易地接合组织。另外，关节运动式定位有利地允许将内窥镜定位在端部执行器后面而不被器械轴所阻碍。
由于要在内窥镜器械的较小直径约束范围内将关节运动的控制和闭合端部执行器以夹钳组织和击发端部执行器(即：缝合和切割)的控制结合起来，使得关节运动外科缝合和切割器械的方法变得复杂。通常，所述三个控制动作都通过器械轴作为纵向移动传递。例如，授予Schulze等人的专利号为No.5673840的美国专利公开了一种手风琴式关节运动机构(“柔性颈”)，其通过选择性地经过执行轴缩回两根连接杆中的一根来进行关节运动，每根杆分别在轴中心线的相对侧上偏置。所述连接杆渐进通过一组离散位置，所述专利公开的内容通过引用结合入本文。
专利号为No.5865361的美国专利公开了关节运动机构的纵向控制的另一种实例，其包括相对凸轮轴偏置的关节运动连接件，关节运动连接件的推或拉纵向移动实现向对应侧的关节运动。同样，专利号为No.5797537的美国专利公开了一种穿过轴来实现关节运动的类似的杆。美国专利No.6250532和6644532公开了能进行关节运动的外科缝合装置的其他实例。
由于通常采用的端部执行器击发系统的类型，用于使端部执行器进行关节运动的致动器装置通常必须产生大的扭矩来弯曲击发结构。这一问题由于缺乏用于装纳大到足够产生所需力的致动装置的可用空间而恶化。
在努力应对这种挑战的过程中，开发出了具有“无源关节运动接头”的外科器械。例如Kvin W.Smith、Matthew A.Palmer、KoreyRobert Kline和Derek Dee Deville的公开号为2007/0027469 A1的美国专利申请公开了一种采用无源关节运动接头的医疗器械，所述专利申请所公开的内容通过引用结合入本文。当被致动时，关节运动接头被释放进入自由的关节运动状态以便允许端部执行器随着施加在端部执行器上的外部力而相对于控制手柄做自由关节运动。
虽然带有无源关节运动装置的上述医疗器械有效地解决了有源关节运动装置所面临的挑战，但是仍然需要具有改进的无源关节运动接头装置的医疗器械。
发明内容
在本发明的一个方面中，提供了一种外科器械，其可以包括手柄部分和近侧支架部分，所述近侧支架部分连接到手柄部分上并且在所述近侧支架部分上形成有多个第一行星齿轮齿。外科器械还可以包括用于执行外科手术的端部执行器。所述端部执行器可以在其上形成有多个第二行星齿轮齿。至少一根枢轴杆能枢转地连接到近侧支架部分和远侧支架部分上以使第一行星齿轮齿和第二行星齿轮齿保持永久啮合，从而便于端部执行器相对于近侧支架部分的枢转式行进。
在本发明的各种实施方式的另一个总的方面中，提供了一种外科器械，其可以包括手柄部分和连接到所述手柄部分上的近侧支架部分。所述外科器械还可以包括用于执行外科手术的端部执行器。至少两条柔性带被连接到近侧支架部分和端部执行器上并在近侧支架部分和端部执行器之间延伸，所述至少两条柔性带中的至少一条与所述至少两条柔性带中的另一条相交。
在本发明的各种实施方式的又一个总的方面中，提供了一种外科器械，其可以包括手柄部分和连接到手柄部分上的近侧支架部分。所述外科器械还可以包括用于执行外科手术的端部执行器。互锁柔性套节组被连接到近侧支架部分和端部执行器上并在近侧支架部分和端部执行器之间延伸。
在本发明的各种实施方式的另一个总的方面中，提供了一种外科器械，其可以包括手柄部分和连接到手柄部分上的近侧支架部分。所述近侧支架部分可以限定纵向轴线。所述外科器械还可以包括用于执行外科手术的端部执行器。至少两根基本刚性的杆可以枢转地连接到近侧支架部分和端部执行器上并在近侧支架部分和端部执行器之间延伸，所述刚性杆的至少一根的一个端部沿着纵向轴线连接到近侧支架部分上。
在本发明的各种实施方式的另一个总的方面中，提供了一种外科器械，其可以包括手柄部分和连接到手柄部分上的近侧支架部分。所述近侧支架部分可以限定纵向轴线。所述外科器械还可以包括用于执行外科手术的端部执行器，其通过关节运动接头连接到近侧支架部分上。所述关节运动接头还可以包括处于端部执行器和近侧支架部分之一中的第一弧形槽和第二弧形槽。每个弧形槽被定向成能滑动地装纳与之对应的销，所述销从端部执行器和近侧支架部分中的另一个突出以便于端部执行器围绕大致垂直于所述纵向轴线的枢轴轴线相对于近侧支架部分枢转行进。
在本发明的各种实施方式的另一个总的方面中，提供了一种外科器械，其可以包括手柄部分和连接到手柄部分上的近侧支架部分。所述近侧支架部分可以限定纵向轴线。所述外科器械还可以包括用于执行外科手术的端部执行器，其通过关节运动接头连接到近侧支架部分上。所述关节运动接头还可以包括凹形表面，所述凹形表面在端部执行器和近侧支架部分的其中一个上限定出碗形。凸形表面可以形成在近侧支架部分和端部执行器的另一个上并且与凹形表面处于相对，以便限定延伸通过凸形表面和凹形表面的枢轴轴线，端部执行器可以围绕所述枢轴轴线相对于近侧支架部分枢转，从而端部执行器只能在大致垂直于所述枢轴轴线的平面中枢转。
本发明的这些和其它目的和优点将从附图和对附图的描述中变得清晰。
更具体地说，本发明涉及如下内容：
(1).一种外科器械，其包括：
手柄部分；
近侧支架部分，其连接到所述手柄部分上并且具有形成在其上的多个第一行星齿轮齿；
端部执行器，其用于执行外科手术并具有形成在其上的多个第二行星齿轮齿；和
至少一根枢轴杆，其能枢转地连接到所述近侧支架部分和所述远侧支架部分上以使所述第一齿轮齿与所述第二齿轮齿永久啮合，以便于所述端部执行器相对于所述近侧支架部分枢转行进。
(2).根据第(1)项所述的外科器械，其中所述端部执行器具有远侧支架部分并且所述第二行星齿轮齿形成在所述远侧支架部分中。
(3).根据第(1)项所述的外科器械，其中所述近侧支架部分延伸经过将所述端部执行器连接到所述手柄部分上的细长轴组件，并且所述细长轴组件被构造成将张开和闭合动作以及击发和回缩动作传递至所述端部执行器。
(4).根据第(3)项所述的外科器械，其中所述细长轴组件包括：
近侧闭合管段，其能操作地连接到所述手柄部分上；和
远侧闭合管段，其能枢转地连接到所述近侧闭合管段上并被构造成将闭合和张开动作施加到所述端部执行器上。
(5).根据第(4)项所述的外科器械，其还包括柔性罩构件，所述柔性罩构件在所述近侧闭合管段和所述远侧闭合管段之间延伸，以防止碎屑进入其间。
(6).一种用于处理外科器械的方法，所述方法包括：
获取根据第(1)项所述的外科器械；
对所述外科器械进行消毒；和
将所述外科器械存放在无菌容器中。
(7).一种外科手术方法，其包括：
将根据第(1)项所述的外科器械导入患者体内；和
使所述端部执行器相对于所述近侧支架部分进行关节运动。
(8).根据第(7)项所述的方法，其中所述关节运动包括使所述端部执行器与患者身体的一部分或其它器械接触以便将关节运动力施加在所述端部执行器上，使得所述端部执行器相对于所述近侧支架部分进行关节运动。
(9).一种外科器械，其包括：
手柄部分；
近侧支架部分，其连接到所述手柄部分上；
用于执行外科手术的端部执行器；和
至少两条柔性带，其连接到所述近侧支架部分和所述端部执行器上并且在所述近侧支架部分和所述端部执行器之间延伸，所述至少两条柔性带中的至少一条与所述至少两条柔性带中的另一条相交。
(10).根据第(9)项所述的外科器械，其中所述所述至少两条柔性带包括：
第一柔性带，其连接到所述近侧支架部分和所述端部执行器上并且在所述近侧支架部分和所述端部执行器之间延伸；和
第二柔性带，其连接到所述近侧支架部分和所述端部执行器上并且与所述第一柔性带的一部分相交。
(11).根据第(10)项所述的外科器械，其中所述近侧支架部分具有第一和第二侧面并且所述端部执行器具有远侧支架部分，所述远侧支架部分具有主侧面和次侧面，其中所述第一柔性带被连接到所述近侧支架部分的所述第一侧面和所述远侧支架部分的所述次侧面上并且在所述第一侧面和所述次侧面之间延伸，所述第二柔性带被连接到所述近侧支架部分的所述第二侧面和所述远侧支架部分的所述主侧面上并且在所述第二侧面和所述主侧面之间延伸。
(12).根据第(9)项所述的外科器械，其中所述至少两条柔性带中的至少一条由弹簧钢制成。
(13).根据第(9)项所述的外科器械，其中所述近侧支架部分延伸经过能操作地连接到所述手柄部分上的近侧闭合管段，并且其中所述外科器械还包括能枢转地连接到所述近侧闭合管段上的远侧闭合管段，并且所述远侧闭合管段被构造成将闭合和张开动作施加在所述端部执行器上。
(14).根据第(13)项所述的外科器械，其还包括柔性罩构件，所述柔性罩构件在所述近侧闭合管段和所述远侧闭合管段之间延伸以便防止碎屑进入其间。
(15).一种用于处理外科器械的方法，所述方法包括：
获取根据第(9)项所述的外科器械；
对所述外科器械进行消毒；和
将所述外科器械保存在无菌容器中。
(16).一种外科手术方法，其包括：
将根据第(9)项所述的外科器械导入患者体内；和
使所述端部执行器相对于所述近侧支架部分进行关节运动。
(17).根据第(16)项所述的方法，所述关节运动包括使所述端部执行器与患者身体的一部分或其它器械接触以便将关节运动力施加在所述端部执行器上，使得所述端部执行器相对于所述近侧支架部分进行关节运动。
(18).一种外科器械，其包括：
手柄部分；
近侧支架部分，其连接到所述手柄部分上；
端部执行器，用于执行外科手术；和
互锁柔性套节组，其连接到所述近侧支架部分和所述端部执行器上并且在所述近侧支架部分和所述端部执行器之间延伸。
(19).根据第(18)项所述的外科器械，其还包括用于将所述互锁柔性套节组保持在所需的互锁方向上的保持装置。
(20).根据第(19)项所述的外科器械，其中所述保持装置包括连接到所述端部执行器上的绳索，用于沿着朝向所述手柄部分的方向选择性地拉动所述端部执行器。
(21).一种用于处理外科器械的方法，所述方法包括：
获取根据第(18)项所述的外科器械；
对所述外科器械进行消毒；和
将所述外科器械存放在无菌容器中。
(22).一种外科手术方法，其包括：
将根据第(18)项所述的外科器械导入患者体内；和
使所述端部执行器相对于所述近侧支架部分进行关节运动。
(23).根据第(22)项所述的方法，其中所述关节运动包括使所述端部执行器与患者身体的一部分或其它器械接触以便将关节运动力施加在所述端部执行器上，使得所述端部执行器相对于所述近侧支架部分进行关节运动。
(24).一种外科器械，其包括：
手柄部分；
近侧支架部分，其连接到所述手柄部分上并限定纵向轴线；
用于执行外科手术的端部执行器；和
至少两根基本刚性的杆，其能枢转地连接到所述近侧支架部分和所述端部执行器上并且在所述近侧支架部分和所述端部执行器之间延伸，至少一根所述刚性杆的一个端部沿着所述纵向轴线连接到所述近侧支架部分上。
(25).根据第(24)项所述的外科器械，其中所述至少两根刚性杆包括：
处于第一平面中的下侧刚性杆；和
处于与所述第一平面不共面的第二平面中的上侧刚性杆。
(26).根据第(24)项所述的外科器械，其中所述至少两根刚性杆包括：
具有远端和近端的上侧刚性杆，所述远端能枢转地连接到所述端部执行器上以便围绕基本垂直于所述纵向轴线的第一轴线相对于所述端部执行器枢转行进，所述近端能枢转地连接到所述近侧支架部分上以便围绕基本垂直于所述纵向轴线的第二轴线相对于所述近侧支架部分枢转行进；和
具有远端和近端的下侧刚性杆，所述远端能枢转地连接到所述端部执行器上以便围绕基本垂直于所述纵向轴线的第三轴线相对于所述端部执行器枢转行进，所述近端能枢转地连接到所述近侧支架部分上以便围绕基本垂直于所述纵向轴线的第四轴线相对于所述近侧支架部分枢转行进。
(27).根据第(26)项所述的外科器械，其中所述近侧支架部分延伸通过能操作地连接到所述手柄部分上的近侧闭合管段，并且其中所述外科器械还包括远侧闭合管段，所述远侧闭合管段能枢转地连接到所述近侧闭合管段上并且被构造成将闭合和张开动作施加在所述端部执行器上。
(28).根据第(27)项所述的外科器械，其还包括柔性罩构件，所述柔性罩构件在所述近侧闭合管段和所述远侧闭合管段之间延伸以便防止碎屑进入所述近侧闭合管段和所述远侧闭合管段之间。
(29).一种用于处理外科器械的方法，所述方法包括：
获取根据第(24)项所述的外科器械；
对所述外科器械进行消毒；和
将所述外科器械保存在无菌容器中。
(30).一种外科手术方法，其包括：
将根据第(24)项所述的外科器械导入患者体内；和
使所述端部执行器相对于所述近侧支架部分进行关节运动。
(31).根据第(30)项所述的方法，其中所述关节运动包括使所述端部执行器与患者身体的一部分或其它器械接触以便将关节运动力施加在所述端部执行器上，使得所述端部执行器相对于所述近侧支架部分进行关节运动。
(32).一种外科器械，包括：
手柄部分；
近侧支架部分，其连接到所述手柄部分上并限定纵向轴线；和
用于执行外科手术的端部执行器，其通过关节运动接头连接到所述近侧支架部分上，所述关节运动接头包括：
第一弧形槽和第二弧形槽，其处于所述端部执行器和所述近侧支架部分中的一个中，每个所述弧形槽被定向成能滑动地装纳从所述端部执行器和所述近侧支架部分中的另一个突出的对应的销，以便于所述端部执行器围绕基本垂直于所述纵向轴线的枢轴轴线相对于所述近侧支架部分枢转行进。
(33).根据第(32)项所述的外科器械，其中所述近侧支架部分延伸通过能操作地连接到所述手柄部分上的近侧闭合管段，并且其中所述外科器械还包括能枢转地连接到所述近侧闭合管段上的远侧闭合管段，并且所述远侧闭合管段被构造成将闭合和张开动作施加在所述端部执行器上。
(34).根据第(33)项所述的外科器械，其还包括柔性罩构件，所述柔性罩构件在所述近侧闭合管段和所述远侧闭合管段之间延伸以便防止碎屑进入所述近侧闭合管段和所述远侧闭合管段之间。
(35).一种用于处理外科器械的方法，所述方法包括：
获取根据第(32)项所述的外科器械；
对所述外科器械进行消毒；和
将所述外科器械保存在无菌容器中。
(36).一种外科手术方法，其包括：
将根据第(32)项所述的外科器械导入患者体内；和
使所述端部执行器相对于所述近侧支架部分进行关节运动。
(37).根据第(36)项所述的方法，其中所述关节运动包括使所述端部执行器与患者身体的一部分或其它器械接触以便将关节运动力施加在所述端部执行器上，使得所述端部执行器相对于所述近侧支架部分进行关节运动。
(38).一种外科器械，其包括：
手柄部分；
近侧支架部分，其连接到所述手柄部分上并限定纵向轴线；和
用于执行外科手术的端部执行器，其通过关节运动接头连接到所述近侧支架部分上，所述关节运动接头包括：
凹形表面，其在所述近侧支架部分和所述端部执行器中的一个上限定了碗形；和
凸形表面，其形成在所述近侧支架部分和所述端部执行器中的另一个上并且与所述凹形表面面对以便限定延伸通过所述凸形表面和凹形表面的枢轴轴线，所述端部执行器可以围绕所述枢轴轴线相对于所述近侧支架部分枢转，所述端部执行器只能在大致垂直于所述枢轴轴线的平面中枢转。
(39).根据第(38)项所述的外科器械，其中所述近侧支架部分延伸通过能操作地连接到所述手柄部分上的近侧闭合管段，并且其中所述外科器械还包括能枢转地连接到所述近侧闭合管段上的远侧闭合管段，并且所述远侧闭合管段被构造成将闭合和张开动作施加在所述端部执行器上。
(40).根据第(39)项所述的外科器械，其还包括柔性罩构件，所述柔性罩构件在所述近侧闭合管段和所述远侧闭合管段之间延伸以便防止碎屑进入所述近侧闭合管段和所述远侧闭合管段之间。
(41).一种用于处理外科器械的方法，所述方法包括：
获取根据第(38)项所述的外科器械；
对所述外科器械进行消毒；和
将所述外科器械保存在无菌容器中。
(42).一种外科手术方法，其包括：
将根据第(38)项所述的外科器械导入患者体内；和
使所述端部执行器相对于所述近侧支架部分进行关节运动。
(43).根据第(42)项所述的方法，其中所述关节运动包括使所述端部执行器与患者身体的一部分或其它器械接触以便将关节运动力施加在所述端部执行器上，使得所述端部执行器相对于所述近侧支架部分进行关节运动。
附图说明
结合在说明书中并构成说明书一部分的附图示出了本发明的实施方式，并且和以上给出的本发明的总体说明以及以下给出的实施方式的详细描述一起被用来解释本发明的各种原理。
图1是本发明的各种实施方式的外科缝合和切割器械的立体图。
图2是图1的外科缝合和切割器械的细长轴和关节运动机构的立体分解图。
图3是图1的外科缝合和切割器械的执行部分的远侧部分的立体分解图。
图4是本发明的一种实施方式的关节运动接头的剖视图。
图5是可以和本发明的各种实施方式一起使用的狗骨形连接件的立体图。
图6是本发明的另一种实施方式的关节运动接头的剖视图。
图7是图6的关节运动接头的俯视图，概略地示出了一些零部件的位置。
图8是本发明的另一种实施方式的关节运动接头的正面剖视图。
图9是图8的关节运动接头的俯视图，概略地示出了一些零部件的位置。
图10是本发明的另一种实施方式的关节运动接头的正面剖视图。
图11是图10的关节运动接头的俯视图，概略地示出了一些零部件的位置。
图12是本发明的另一种实施方式的关节运动接头的正面剖视图。
图13是图12的关节运动接头的俯视图，概略地示出了一些零部件的位置。
图14是本发明的另一种实施方式的关节运动接头的正面剖视图。
图15是图14的关节运动接头的俯视图，概略地示出了一些零部件的位置。
具体实施方式
参照附图，其中在所有附图中相同的附图标记代表相同的零件，图1示出了一种能够实现本发明的独特优点的外科器械，其中示意性地示出的器械更具体地指外科缝合和切割器械10。尤其是，外科缝合和切割器械10的大小在如图1所示不能进行关节运动的情况下能够穿过套管针的插管通道到达患者体内的外科手术位置处(未示出)，以便执行外科手术。在示意性的版本中显示为缝钉施加组件20的端部执行器通过关节运动接头100从远侧连接到轴部分16上。在缝钉施加组件20插入穿过套管针的插管通道之后，通过“无源地”使缝钉施加组件20与器官或身体其它部分或其它医疗器械接触以便将外部力施加到缝钉施加组件20上，从而使缝钉施加组件20像以下将更详细地讨论的那样进行关节运动，医生能够将缝钉施加组件20运动至所需的关节运动方向。这种带一定角度的位置在以下情况下可能具有优势：从期望的角度接近组织以便切割和缝合、接近被其它器官和组织阻碍的组织、和/或允许将内窥镜定位在缝钉施加组件20之后并与之对齐以便确认位置。
外科缝合和切割器械10还可以包括从近侧连接到执行部分12上的手柄部分22，所述手柄部分22用来为执行部分12提供定位、关节运动、闭合和击发动作。手柄部分22还可以包括手枪式把手24，医生朝着该手枪式把手24向近侧枢转地拉动闭合扳机26能够使缝钉施加组件20夹紧或闭合。击发扳机28可以定位在闭合扳机26外侧并且可以被医生枢转地拉动以便缝合和切割被夹钳在缝钉施加组件20中的组织。随后，按下闭合释放按钮30以释放被夹紧的闭合扳机26，由此释放被夹紧组织的已被切割和缝合的端部。手柄部分22还包括与细长轴16连接以便进行运动的旋转调节器32，用于使所述细长轴16和进行关节运动的缝钉施加组件20围绕轴16的纵向轴线转动。手柄部分22还包括击发回缩手柄34，用于在形成束缚时协助缩回击发机构(在图1中没有显示)，从而使缝钉施加组件20随后可以张开。
应当理解，在本文中使用的术语“近侧”和“远侧”以握持器械的手柄的医生为参考。因此，相对于更近侧的手柄部分22而言外科缝合组件20处于远侧。还应理解，为了方便和清楚起见，在本文中使用的空间术语，诸如“垂直”和“水平”是就附图而言。但是，所述外科器械可以很多方向和位置被使用，并且这些术语并不是限制性的和绝对的。
图1至2的用于外科缝合和切割器械10的示意性多冲程手柄部分22在以下共同未决和共同所有的美国专利申请中有更详细的描述，其中具有如本文所述的附加技术特征和各种变型，所述专利申请所公开的内容通过引用结合入本文：
(1)Kenneth S.Wales和Eugene L.Timperman的美国专利公开US2006/0289602A1、题为“Surgical Instrument With Articulating ShaftWith Double Pivot Closure And Single Pivot Frame Portion”；
(2)Kenneth S.Wales的美国专利公开US2006/0190029A1、题为“ Surgical Instrument With Laterally Moved Shaft Articulator Coupledto Pivoting Articulation Joint”；
(3)Kenneth S.Wales和Cad P.Boudreaux的美国专利公开US2006/0190031 A1、题为“Surgical Instrument With Articulating ShaftWith Rigid Firing Bar Supports”；和
(4)Swayze和Shelton IV的美国专利公开US2005/0070958 A1、题为“Surgical Stapling Instrument Incorporating a Multistroke FiringPosition Indicator and Retraction Mechanism”。
虽然多冲程手柄部分22有利地在很长的距离上施以高击发力，但是与本发明一致的应用可以结合例如在Frederick E.Shelton IV、Michael E.Setser和Brian J.Hemmelgarn共同所有的专利号为7000818、题为“Surgical Stapling Instrument Having Separate DistinctClosing And Firing Systems”的共同未决的美国专利中所述的单击发冲程手柄部分，该专利所公开的内容通过引用整体结合入本文。
在图2和3中，执行部分12可以有利地在适合于内窥镜和腹腔镜手术的较小直径内集成纵向旋转、关节运动、闭合和击发的多个致动动作。缝钉施加组件20(“端部执行器”)具有一对能枢转的对置钳口，显示为带有枢转连接的砧座42的细长通道40(图1和3)。砧座42相对于细长通道40的闭合和夹紧通过以下方式实现，即，使用旋转地连接到手柄部分22上的支架组件44(图2)纵向地支承细长通道40，双枢轴闭合套管组件46在所述支架组件44上纵向地运动，向砧座42施加闭合和开口动作，即使缝钉施加组件20进行关节运动。
特别参照图2，支架组件44可以包括单枢轴支架部分48，所述单枢轴支架部分48的近端接合到旋转调节器32上，在图2中示出了旋转调节器32的右半壳体50。应当理解的是，闭合套管组件46的近端，具体指闭合直管52的近端，包围支架部分48的近端，进一步内部地通至手柄部分22，与使闭合套管组件46纵向移动的闭合零件(未示出)接合。闭合直管52的近端处的圆形凸缘54提供与所述零件的旋转接合。旋转调节器32的接合零件穿过闭合直管52的近侧部分上的纵向槽56，以与在近侧设置在支架部分48上的孔58接合。纵向槽56具有足够长度，在旋转调节器32将闭合套管组件46和支架部分48设定成各种旋转角度时，纵向槽56允许闭合套管组件46做闭合纵向移动。
细长轴16通过装纳击发棒60来支持击发动作，所述击发棒60旋转地接合手柄部分22的击发零件(未示出)。击发棒60沿着支架部分48的纵向中心线进入近侧开口62中。支架部分48的远侧部分包括沿着其底部的与近侧开口62连通的击发杆槽64。击发杆66在击发杆槽64中纵向地移动并且包括向上凸起的近侧销68，所述近侧销68与击发棒60的远端70接合。
特别参照图3，关节运动接头100可以包括远侧闭合管段116，所述远侧闭合管段116可被设计成如图所示用于提高可制造性并且包括连接到关节运动连接卡圈148上的短闭合管146，所述关节运动连接卡圈148可以包括向近侧突出的枢轴接片126、128。类似的，闭合直管52可以从连接到后连接卡圈152上的长闭合管段150开始组装，所述后连接卡圈152可以包括向远侧突出的枢轴接片119、120。见图3，短管146中的马蹄形孔118被设计成与向上突起的砧座元件154接合，所述向上突起的砧座元件154在横向枢轴销156的稍微近侧，所述横向枢轴销156与细长通道40内部的枢轴凹口158接合。
在各种实施方式中，击发杆66可以远侧终止于包括上导销166的E形梁165，所述上导销166进入砧座42中的砧座槽168中，以便在缝钉成形和切割过程中确认和协助将砧座42保持在闭合状态中，见图3。通过细长通道40中的纵向开口174引导，中间销170沿着细长通道40的上表面滑动的同时下支脚173沿着细长通道40的底面相对地滑动，由此可以通过E形梁165进一步保持细长通道40和砧座42之间的间隙。处于上导销166和中间销170之间的E形梁165的指向远侧的切割表面176切割被夹钳的组织，同时，E形梁通过向远侧运动楔形滑块180来致动可更换的钉仓178，所述楔形滑块180使缝钉驱动器182向上凸轮运动，将缝钉184从钉仓主体188中的开口向上的缝钉孔186中驱动出来，抵靠砧座42的钉成形下表面190成形钉。钉仓盘192从底部包围钉仓178的其它零件以将这些零件保持就位。钉仓盘192包括向后开口的槽192，其与细长通道40中的纵向开口174重叠，由此中间销170进入钉仓盘192的内部。可以采用的端部执行器或缝钉施加组件的一种形式在下述文献中有更详细地描述：Frederick E.Shelton IV等人的共同未决且共同拥有的美国专利公开No.2007/0084897A1，其名称为“ArticulatingSurgical Stapling Instrument Incorporating a Two-Piece E-Beam FiringMechanism”，该文献的全部公开内容通过引用结合入本文。
参照图2至4，关节运动接头100可以有利地结合如上所述的双枢轴闭合套管组件46。现在将更详细地描述这些机构的一种示意性设置及操作。在各种实施方式中，例如近侧支架部分48的远端49可以设有面向下的凹形下表面200，所述凹形下表面200适合装纳远侧支架构件114上的对应形状的凸形表面204。本领域技术人员应当理解，在替代实施方式中，凹形表面可以设置在远侧支架构件114上并且凸形表面可以形成在近侧支架部分48上，而不脱离本发明的主旨和范围。
这种接头装置100便于远侧支架构件114相对于近侧支架部分48绕枢轴轴线(在图4中大致以轴线A-A表示)枢转行进，使得远侧支架构件114(和缝钉施加组件20)大致绕轴线A-A在平面P-P枢转，其中近侧支架部分48也处于平面P-P中。如图4所示，轴线A-A基本上垂直于平面P-P。换句话说，凹形表面200和凸形表面204的这种设置能够限制远侧支架构件114绕枢转轴线A-A相对于近侧支架部分48在共同旋转平面P-P中的转动。因此，该接头设置不能使远侧支架构件114在与近侧支架部分48所处的平面实质上不同的平面中枢转。但是，这样的设置确实能使缝钉施加组件20相对容易地枢转和旋转。当闭合套管组件46向远侧运动以使砧座42枢转闭合时，由于枢转连接件134、140的促动，闭合管52围绕近侧支架部分48向远侧运动并且进行关节运动的远侧闭合管段116沿着关节运动的远侧支架构件114向远侧运动。当使所述装置进行关节运动时(未示出)，闭合管52和进行关节运动的远侧闭合管段116被驱向远侧闭合位置，连接件134、140上的双枢轴销136、138和142、144分别易于与闭合管52和进行关节运动的远侧闭合管段116接合。
在各种实施方式中，可以采用狗骨形连接件160，其被构造成为击发杆66提供支承，所述击发杆66可以构造成柔性的。支架部分48还可以包括沿着支架部分48的底部延伸的支架刀槽(未示出)和沿着远侧支架构件114的底部延伸的远侧刀槽(未示出)，用于在其中滑动接收击发杆66(未示出)。狗骨形连接件160可转动地连接到近侧销端部157上并且可动地连接到远侧销端部159上，其还包括左侧引导件1818和右侧引导件1820，在所述左侧引导件1818和右侧引导件1820之间限定出作为击发杆66的滑动通道的引导槽1822(图5)。因此，为了桥接支架部分48和远侧支架构件114之间的间隙，固定壁枢转式狗骨形连接件160可枢转地连接到支架部分48上并且滑动地连接到远侧支架构件114上。枢转式狗骨形连接件160的近侧销157可枢转地装纳在支架部分48中的孔1824中，所述孔1824能使枢转式狗骨形连接件160在其中枢转。远侧销159从枢转式狗骨形连接件160延伸出来并且滑动地装纳在远侧支架构件114的槽1826中。缝钉施加组件20从纵向轴线关节运动至例如45度的角度使得枢转式狗骨形连接件160在其近侧销157处在孔1824中枢转，并且远侧销159在远端1814处在槽1826中滑动，以便将击发杆66弯曲至两个间隔开的大小为缝钉施加组件20的角度一半的角度。
归功于凹形和凸形表面装置，远侧支架构件114能够绕枢轴轴线A-A相对于近侧支架部分48枢转。本领域技术人员应当理解，在各种实施方式中，表面200和204之间的摩擦用来将远侧支架构件114(和缝钉施加组件20)保持在相对于近侧支架部分48的关节运动位置中，并且附加夹紧装置可被用来施加夹紧力，以便将这些零件保持在所需的关节运动位置中。通过使端部执行器与患者身体的一部分或与其它也可以插入患者体内的器械接触，端部执行器可以通过由此而施加到其上的关节运动力做关节运动。
图6和7示出了可以结合本发明的各种实施方式使用的其它关节运动接头300。除了以下区别之外，该实施方式在结构上可以与上述实施方式大致相同。例如，在该实施方式中，远侧支架构件114的近端115可以具有形成在其中的两个弧形槽310、312，用于装纳形成在近侧支架部分48的远端49上的与之对应的销320、322。因此，远侧支架构件114被约束成通过销320、322在其对应的槽310、312中行进而绕枢轴轴线B-B相对于支架部分48枢转，所述枢轴轴线B-B经过弧形槽310、312之间的中心311延伸。枢轴轴线B-B可以大致垂直于近侧支架部分48的纵向轴线L-L。所述接头设置也可以用来限制远侧支架构件114围绕枢轴轴线B-B的枢转行进，使得远侧支架构件114与近侧支架部分48大致保持在共同的旋转平面P-P中。本领域技术人员应当理解，在替代实施方式中，弧形槽310、312可以设置在近侧支架部分48的远端49中并且销320、322可以设置在远侧支架构件114中而不脱离本发明的主旨和范围。在其他实施方式中，远侧支架构件114和近侧支架部分48的每一个都具有一个弧形槽和一个销，其中所述销被定向成能滑动地装纳在另一个的槽中。
同样在这些实施方式中，为了桥接支架部分48和远侧支架构件114之间的间隙，固定壁枢转式狗骨形连接件160可以可枢转地连接到支架部分48上并滑动地连接到远侧支架构件114上。枢转式狗骨形连接件160的近侧销157能枢转地装纳在支架部分48的孔1824中，使得枢转式狗骨形连接件160能在孔中枢转。远侧销159从枢转式狗骨形连接件160延伸出来并且可滑动地装纳在远侧支架构件114的槽1826中。缝钉施加组件20相对于纵向轴线关节运动至例如45度的角度使枢转式狗骨形连接件160在其近侧销157处在孔1824中枢转，并且远侧销159在远端1814处在槽1826中滑动，以便将击发杆66弯曲至两个间隔开的大小为缝钉施加组件20的角度一半的角度。在各种实施方式中，由弹性或聚合材料制成的波纹管式套筒或罩350可以在关节运动接头处设置在轴上以防止碎屑和流体进入接头，见图6。通过使端部执行器与患者身体的部分或与其它也可以插入患者体内的器械接触，端部执行器可以通过由此而施加到其上的关节运动力做关节运动。
图8和9示出了可以结合本发明的各种实施方式使用的其它关节运动接头400。除了以下区别之外，该实施方式在结构上可以与上述实施方式大致相同。例如，该实施方式可以采用一对基本刚性的连接杆410、420，以便将远侧支架构件114和支架部分48可枢转地相连。如图8所示，例如下侧连接杆410可以具有从其远端412突出的远侧销部分414，所述远侧销部分414构造用于装纳在远侧支架构件114的第一孔260中。远侧支架构件114也可以设有底切部分262，以适应下侧连接杆410的远端412在底切部分262中绕由远侧销414和孔262限定的第一枢轴轴线C-C枢转行进。也如图8所示，下侧连接杆410的近端416可以具有从其突出的近侧销418，所述近侧销418构造成装纳在支架部分48的远端49中的孔264中。所述近侧销418和孔264也用来限定第二枢轴轴线D-D。
如上所述，该实施方式可以进一步包括具有远端422和近端426的上侧连接杆420。远侧销424从所述远端422突出并被构造成装纳在远侧支架构件114中的第二孔266中。销424和孔266用来限定第三枢轴轴线E-E。近侧销428从上侧连接杆420的近端426突出并被构造成装纳在支架部分48的远端49中的第二孔268中。近侧销428和孔268用来限定第四枢轴轴线F-F。如图8所示，第一轴线C-C、第二轴线D-D、第三轴线E-E、第四轴线F-F都可以大致横向并垂直于近侧支架部分48的纵向轴线L-L。仍如图9所示，销424、428的至少一个沿着纵向轴线L-L定位。
同样在该实施方式中，为了桥接支架部分48和远侧支架构件114之间的间隙，固定壁枢转式狗骨形连接件160可枢转地连接到支架部分48上并且滑动地连接到支架构件114上。枢转狗骨形连接件160的近侧销157能枢转地装纳在支架部分48的孔1824中，使得枢转式狗骨形连接件160能在孔中枢转。远侧销159从枢转式狗骨形连接件160延伸出来并且滑动地装纳在远侧支架构件114的槽1826中。如图8所示，下侧连接杆410处于下侧平面G-G上并且上侧连接杆420处于与下侧平面G-G不共面的上侧平面H-H中。这种设置使连接杆410、420能够枢转至其中轴16能够穿插过套管针通道的轴向对齐的位置(图1)和其他非轴向对齐的关节运动位置(图9)。在各种实施方式中，由弹性或聚合材料制成的波纹管式套筒450可以在关节运动接头400处设置在轴上，以防止碎屑和流体进入接头，见图9。通过使端部执行器与患者身体的部分或与其它也可以插入患者体内的器械接触，端部执行器可以通过由此而施加到其上的关节运动力做关节运动。
图10和11示出了可以结合本发明的各种实施方式使用的其它关节运动接头500。除了以下区别之外，该实施方式在结构上可以与上述实施方式大致相同。例如该实施方式可以采用由柔性互锁套节512组成的组510，用于将远侧支架构件114和支架部分48枢转地且能转动地相互连接。如图10所示，例如柔性互锁套节组的近端可以连接到支架部分48的远端49上。柔性套节组510的远端514可以连接到支架构件114上的近端115上。可以采用张紧绳索520，其从手柄部分(未示出)延伸经过近侧闭合管段150并连接到支架构件114上。当张力被施加到绳索520上时，套节512互锁以便将套节512保持在基本锁定的位置中。为了重新定位缝钉施加组件20，绳索520上的张力被释放，由此允许将外部力施加在缝钉施加组件20上，使得缝钉施加组件20能够进行关节运动和/或旋转至所需的方向。一旦缝钉施加组件20已经被定位在所需的方向上，在绳索520上重新施加张力以将互锁套节512保持就位。
同样在该实施方式中，为了桥接支架部分48和远侧支架构件114之间的间隙，固定壁枢转式狗骨形连接件160可枢转地连接到支架部分48上并滑动地连接到支架构件114上。枢转式狗骨形连接件160的近侧销157能枢转地装纳在支架部分48的孔1824中，使得枢转式狗骨形连接件160能在孔中枢转。远侧销159从枢转式狗骨形连接件160延伸出来并且滑动地装纳在远侧支架构件114的槽1826中。在各种实施方式中，由弹性或聚合材料制成的波纹管式套筒550可以在关节运动接头处设置在轴上，以防止碎屑和流体进入接头，见图10。通过使端部执行器与患者身体的部分或与其它也可以插入患者体内的器械接触，端部执行器可以通过由此而施加到其上的关节运动力做关节运动。
图12和13示出了可以结合本发明的各种实施方式使用的其它关节运动接头600。除了以下区别之外，该实施方式在结构上可以与上述实施方式大致相同。例如，在该实施方式中，第一组行星式齿轮齿610可以形成在支架构件114近端115的至少部分圆周上。同样地，第二组行星式齿轮齿620形成在支架部分48远端49的至少部分圆周上。枢轴杆630能将支架构件114的近端115和支架部分48的远端49枢转地相互连接，齿轮齿610和齿轮齿620通过枢轴杆630保持永久啮合。如图12所示，远侧销部分634从枢轴杆630的远端632突出并且被构造成能旋转地装纳在形成于支架构件114下侧中的孔260中。支架构件114也可以具有形成在其中的底切区域262，以适应枢轴杆630的枢转行进。同样地，枢轴杆630的近端636具有近侧销部分638，所述近侧销部分638从近端636突出并且其大小适合可旋转地装纳在支架部分48的孔640中。也可以在支架部分48的远端49中设置底切区域642，以适应枢轴杆630的枢转行进。
同样在该实施方式中，为了桥接支架部分48和远侧支架构件114之间的间隙，固定壁枢转式狗骨形连接件160可枢转地连接到支架部分48上并滑动地连接到支架构件114上。枢转式狗骨形连接件160的近侧销157能枢转地装纳在支架部分48的孔1824中，使得枢转式狗骨形连接件160能在孔中枢转。远侧销159从枢转式狗骨形连接件160延伸出来并且滑动地装纳在远侧支架构件114的槽1826中。在各种实施方式中，由弹性或聚合材料制成的波纹管式套筒650可以在关节运动接头处设置在轴上以防止碎屑和流体进入接头，见图12。
图14和15示出了可以结合本发明的各种实施方式使用的其它关节运动接头700。除了以下区别之外，该实施方式在结构上可以与上述实施方式大致相同。例如，在该实施方式中，支架部分48的远端49形成为沿着远侧方向延伸出的凸起710。在各种实施方式中，所述远侧凸起710具有第一侧面712和第二侧面714。同样，远侧支架构件114的近端115也形成为沿着近侧方向延伸出的与远侧凸起710成面对关系的凸起720。所述近侧凸起720具有与向远侧延伸凸起710的第一侧面712对应的主侧面722。向近侧延伸的凸起720还具有与向远侧延伸的凸起710的第二侧面714对应的次侧面724。
在该实施方式中，柔性接头700还可以包括具有近端732和远端734的第一柔性带730，所述近端732连接到向远侧延伸的凸起710的第一侧面712上，所述远端734连接到向近侧延伸的凸起720的次侧面724上。该实施方式还可以包括具有近端742和远端744的第二柔性带740，所述近端742连接到向远侧延伸的凸起710的第二侧面714上，所述远端744连接到向近侧延伸的凸起720的主侧面722上。在各种实施方式中，第一柔性带730和第二柔性带740可以由弹簧钢或其它合适的柔性材料制成并且可通过适当的紧固装置例如螺丝、粘接剂等分别连接到凸起710、720上。如图14所示，第一柔性带730中具有第一切口736并且第二柔性带740中具有第二切口746，以便使柔性带730、740能够被设置成如图15所示。
同样在该实施方式中，为了桥接支架部分48和远侧支架构件114之间的间隙，固定壁枢转式狗骨形连接件160可枢转地连接到支架部分48上并且滑动地连接到支架构件114上。枢转式狗骨形连接件160的近侧销157能枢转地装纳在支架部分48的孔1824中，使得枢转式狗骨形连接件160能在孔中枢转。远侧销159从枢转式狗骨形连接件160延伸出来并且滑动地装纳在远侧支架构件114的槽1826中。在各种实施方式中，由弹性或聚合材料制成的波纹管式套筒750可以在关节运动接头处设置在轴上，以防止碎屑和流体进入接头，见图14。通过使端部执行器与患者身体的部分或与其它也可以插入患者体内的器械接触，端部执行器可以通过由此而施加到其上的关节运动力做关节运动。
虽然已经描述了本发明的多种实施方式，但是应当理解的是，本领域技术人员利用本发明的一些或所有优点的收获可以对这些实施方式进行各种改进、变化和修改。例如，根据各种实施方式，可以用多个零件替代单个零件以及可以用单个零件替代多个零件来执行给定的一种功能或多种功能。因此，在不脱离由附带权利要求书限定的本发明所公开的范围和主旨的情况下，本申请意图覆盖所有这种改进、变化和修改。
本文所公开的装置能够被设计成在单次使用后丢弃或可以被设计成能够多次使用。在任何情况下，所述装置在使用至少一次后可以修复以便再次使用。修复还可以包括所述装置的拆卸步骤的任何组合，接着清洗或更换特定件，继而重新组装。更具体而言，所述装置可以拆卸，并且可以以任何组合的方式选择性地更换或去除所述装置的任何数量的特定件或部件。更具对特定部件的清洗和/或更换，所述装置可以在修复设施处重新组装或者由外科团队即将进行手术之前重新组装以便随后使用。本领域技术人员应当理解，设备的修复可以采用各种用于拆卸、清洗/更换和重新组装的技术。这些技术的使用和获得的修复好的器械都在本申请的保护范围之内。
优选地，本文所述的发明将在外科手术之前进行加工。首先获取新的或用过的器械，在必要时进行清洗。然后可以对所述器械进行消毒。在一种消毒技术中，器械被放置在闭合且密封的容器例如塑料袋或TYVEK袋中。随后将容器和器械放置在能穿透容器的辐射区域(例如伽马射线、X射线或能量更高的电子)中。辐射将器械和容器中的细菌杀死。随后可以将经过消毒的器械存放在无菌容器中。所述密封容器保持器械无菌直到在医疗设施中被打开为止。
所述通过引用被整体或部分地结合到本文中的任何专利、专利申请或其它公开材料仅在所结合的材料不与本文中提出的现有定义、陈述或其它公开材料冲突的情况下结合入本文。因此，在必要的限度内，本文中明确提出的公开内容代替任何通过引用结合入本文的冲突材料。所述通过引用结合入本文但又与本文提出的现有定义、陈述或其它公开材料相冲突的任何材料或材料部分仅在不引起结合入的材料和现有公开材料发生冲突的限度以内结合入本文。
意图保护的发明并不应理解成限于所公开的特定实施方式。因此，所述实施方式被认为是示意性的而不是限制性的。其他人可以做出变型和变化而不脱离本发明的主旨。由此清楚地表明，落入由权利要求书限定的本发明的主旨和范围内的所有这样的等同物、变型和变化都包括在本文中。

Claims (18)

1.一种外科器械，包括：
手柄部分；
近侧支架部分，其连接到所述手柄部分上并且具有形成在其上的多个第一行星齿轮齿；
端部执行器，其用于执行外科手术并具有形成在其上的多个第二行星齿轮齿；和
至少一根枢轴杆，其能枢转地连接到所述近侧支架部分和所述端部执行器上以使所述第一齿轮齿与所述第二齿轮齿永久啮合，以便于所述端部执行器相对于所述近侧支架部分枢转行进。
2.根据权利要求1所述的外科器械，其特征在于，所述端部执行器具有远侧支架部分并且所述第二行星齿轮齿形成在所述远侧支架部分中。
3.根据权利要求1所述的外科器械，其特征在于，所述近侧支架部分延伸经过将所述端部执行器连接到所述手柄部分上的细长轴组件，并且所述细长轴组件能够将张开和闭合动作以及击发和回缩动作传递至所述端部执行器。
4.根据权利要求3所述的外科器械，其特征在于，所述细长轴组件包括：
近侧闭合管段，其能操作地连接到所述手柄部分上；和
远侧闭合管段，其能枢转地连接到所述近侧闭合管段上并能将闭合和张开动作施加到所述端部执行器上。
5.根据权利要求4所述的外科器械，其特征在于还包括柔性罩构件，所述柔性罩构件在所述近侧闭合管段和所述远侧闭合管段之间延伸，以防止碎屑进入其间。
6.一种用于处理外科器械的方法，所述方法包括：
获取根据权利要求1所述的外科器械；
对所述外科器械进行消毒；和
将所述外科器械存放在无菌容器中。
7.一种外科手术方法，包括：
将根据权利要求1所述的外科器械导入患者体内；和
使所述端部执行器相对于所述近侧支架部分进行关节运动。
8.根据权利要求7所述的方法，其特征在于，所述关节运动包括使所述端部执行器与患者身体的一部分或其它器械接触以便将关节运动力施加在所述端部执行器上，使得所述端部执行器相对于所述近侧支架部分进行关节运动。
9.一种外科器械，包括：
手柄部分；
近侧支架部分，其连接到所述手柄部分上；
用于执行外科手术的端部执行器；和
至少两条柔性带，其连接到所述近侧支架部分和所述端部执行器上并且在所述近侧支架部分和所述端部执行器之间延伸，所述至少两条柔性带中的至少一条与所述至少两条柔性带中的另一条相交。
10.根据权利要求9所述的外科器械，其特征在于，所述至少两条柔性带包括：
第一柔性带，其连接到所述近侧支架部分和所述端部执行器上并且在所述近侧支架部分和所述端部执行器之间延伸；和
第二柔性带，其连接到所述近侧支架部分和所述端部执行器上并且与所述第一柔性带的一部分相交。
11.根据权利要求10所述的外科器械，其特征在于，所述近侧支架部分具有第一和第二侧面，所述端部执行器具有远侧支架部分，所述远侧支架部分具有主侧面和次侧面，其中所述第一柔性带被连接到所述近侧支架部分的所述第一侧面和所述远侧支架部分的所述次侧面上并且在所述第一侧面和所述次侧面之间延伸，所述第二柔性带被连接到所述近侧支架部分的所述第二侧面和所述远侧支架部分的所述主侧面上并且在所述第二侧面和所述主侧面之间延伸。
12.根据权利要求9所述的外科器械，其特征在于，所述至少两条柔性带中的至少一条由弹簧钢制成。
13.根据权利要求9所述的外科器械，其特征在于，所述近侧支架部分延伸经过能操作地连接到所述手柄部分上的近侧闭合管段，并且其中所述外科器械还包括能枢转地连接到所述近侧闭合管段上的远侧闭合管段，并且所述远侧闭合管段被构造成将闭合和张开动作施加在所述端部执行器上。
14.根据权利要求13所述的外科器械，其特征在于还包括柔性罩构件，所述柔性罩构件在所述近侧闭合管段和所述远侧闭合管段之间延伸以便防止碎屑进入其间。
15.一种用于处理外科器械的方法，所述方法包括：
获取根据权利要求9所述的外科器械；
对所述外科器械进行消毒；和
将所述外科器械保存在无菌容器中。
16.一种外科手术方法，包括：
将根据权利要求9所述的外科器械导入患者体内；和
使所述端部执行器相对于所述近侧支架部分进行关节运动。
17.根据权利要求16所述的方法，其特征在于，所述关节运动包括使所述端部执行器与患者身体的一部分或其它器械接触以便将关节运动力施加在所述端部执行器上，使得所述端部执行器相对于所述近侧支架部分进行关节运动。
18.一种外科器械，包括：
手柄部分；
近侧支架部分，其连接到所述手柄部分上；
端部执行器，用于执行外科手术；和
互锁柔性套节组，其连接到所述近侧支架部分和所述端部执行器上并且在所述近侧支架部分和所述端部执行器之间延伸。
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