CN103429184B - 具有可稳定铰接致动器的可铰接的电外科器械 - Google Patents
具有可稳定铰接致动器的可铰接的电外科器械 Download PDFInfo
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Abstract
本技术的实施方式提供一种可铰接的电外科器械及用铰接能力执行电外科手术的方法。电外科器械包括伸长轴,所述伸长轴具有与伸长轴的远端相关联的末端执行器,所述末端执行器能够将能量递送到目标组织部位。可铰接接头定位在所述轴与末端执行器之间。可铰接接头的铰接由可稳定铰接致动器控制,所述可稳定铰接致动器可包括驻留在井内的旋转可稳定的圆盘。末端执行器可采用包括上钳口及下钳口的夹钳的形式;所述钳口经配置以抓紧目标组织并递送能量,例如,射频能量。在一些所述器械中,末端执行器适用于通过施加射频能量来封合组织并随后切穿所封合的组织部分。
Description
相关申请案的交叉引用
本申请案是Kerver等人于2008年2月6日申请的名为“METHOD ANDAPPARATUS FOR ARTICULATING THE WRIST OF A LAPAROSCOPICGRASPING INSTRUMENT”的美国专利申请案第12/027,231号的部分接续案。本申请案进一步请求Walberg等人于2010年9月14日申请的名为“ARTICULABLE ELECTROSURGICAL INSTRUMENT”的美国临时专利申请案第61/382,868号的优先权。
参考引用
本说明书中提及的所有公开案及专利申请案通过引用的方式以犹如具体并独立地指示通过引用的方式并入每一独立公开案或专利申请案的相同程度并入本文中。
技术领域
本技术涉及在腹腔镜手术期间使用的医疗装置。更特别地,本技术涉及具有可铰接接头的电外科器械,所述可铰接接头可操作以铰接末端执行器。
背景技术
双极电外科器械将射频(RF)能量施加到手术部位以切割、切除或凝固组织。所述电外科效果的特定应用是封合血管或组织薄片。典型器械采用一对相对钳口或夹钳,其中每一钳口尖端上有一或多个电极。在电外科手术中,在钳口闭合在目标部位上时电极彼此紧邻地放置,以使得两个电极之间的交流电的通路通过目标部位内的组织。由钳口施加的机械力与电流组合以产生所要的手术效果。通过控制机械参数及电气参数(例如,由钳口施加的压力、电极之间的间隙距离及电压、电流、频率以及施加到组织的电外科能量的持续时间)的级别,外科医生可凝固、烧灼或封合组织趋向治疗结束。
可在开放环境中通过常规切口进行电外科手术,或可通过通常长度为0.5cm至1.5cm的小切口以腹腔镜方式进行所述电外科手术。腹腔镜手术可包括使用连接到摄影机及光缆系统的伸缩杆透镜系统,所述光缆系统传送来自冷光源的光以照亮手术区。腹腔镜通常通过5mm或10mm插管插入到体内的开口中以观察手术区。在腹腔镜手术期间用任一各种工具进行手术,所述工具通常布置在轴的远端并可通过操纵定位在轴的近端的把手或其他致动器来操作。
腹腔镜操作环境在空间上十分受限;关于对外科医生而言腹腔镜装置的可操纵性的改进,或更特别地,对电外科装置的末端执行器可达到的移动度的改进在本领域中将是有利的。
发明内容
本技术的实施方式提供一种可铰接的电外科器械及用铰接能力执行电外科手术的方法。电外科器械的实施方式包括伸长轴,所述伸长轴具有末端执行器和把手,所述末端执行器与伸长轴的远端相关联,所述把手与伸长轴的近端相关联,所述末端执行器能够将射频能量传递到目标组织部位。在器械的典型实施方式中,末端执行器可采用夹钳或一组钳口的形式,包括第一钳口(例如下钳口)或第二钳口(例如下钳口)。钳口组经配置以抓紧目标组织并传递能量,例如,射频能量。在一些所述器械中,钳口组尤其适用于通过施加射频能量来封合组织并随后用刀片切穿所封合的组织部分。
器械的实施方式可进一步包括定位在轴与末端执行器之间的可铰接接头;所述接头经配置以有角度地将末端执行器铰接在铰接弧内,所述可铰接接头包括至少一个可枢转连接件或可挠性元件,或者一或多个互连可枢转连接件的组、圆盘或挠曲元件。器械可进一步包括邻近可铰接接头放置的可稳定铰接致动器。器械的一些实施方式可包括轴旋转器或轴旋转致动器。轴旋转器可邻近可铰接接头放置、通常可放置在沿轴的近端部分的位置处,且可与装置的把手部分相关联。在特定实施方式中,可稳定铰接致动器可包括在轴旋转器内或与轴旋转器相关联。轴旋转器本身经配置以使轴相对于把手旋转,且由于轴的旋转,末端执行器也旋转。可稳定铰接致动器的优点包括允许外科医生例如在使用末端执行器收回组织时向末端执行器施加侧向力,而不必手动操作旋钮或其他装置来锁定且随后解锁末端执行器的角度定向。可稳定铰接致动器可允许外科医生在没有单独的锁定动作的情况下容易在不同铰接角度之间移动,而末端执行器的角度定向可有利地稳定在所选铰接角度。
器械可进一步包括用于将致动器机构的旋转运动转化为末端执行器的铰接运动的至少两个力传递部件或部件部分。力传递部件在所述力传递部件的近端处可操作地连接到铰接致动器,且在所述力传递部件的远端处通过可铰接接头可操作地连接到末端执行器的近端,从而允许铰接致动器的旋转运动转化为末端执行器的铰接运动。力传递部件可为任何合适的形式,例如,可传递张力及/或压缩力的金属线、线缆、棒、带或以上各物的部分。本文所述的器械的实施方式及图式中所示的实施方式的实例将指代或描绘线缆,但应理解,任何合适的力传递部件包括在本发明的范围内。可稳定铰接致动器可经配置以通过稳定力传递线缆而以一角度使可铰接接头稳定,可铰接接头的固定角度是在接头铰接弧内以一定距离间隔开的一组角度中的一个角度。
在器械的一些实施方式中,可稳定铰接致动器包括位于井中的旋转可稳定圆盘及经配置以使旋转可稳定圆盘旋转到稳定位置的手指可操作杆。手指可操作杆借助于通过力传递线缆从致动器将力传递到可铰接接头而使可铰接接头稳定在铰接位置中。在一些实施方式中,可稳定铰接致动器正交地安装到器械的(例如)由轴所表示的中心纵轴或横向于所述中心纵轴。因此,在所述实施方式中,旋转可稳定圆盘及手指可操作杆内的平面与器械的中心纵轴正交或横向。手指可操作杆的典型实施方式包括两个相对臂,杆的每一臂连接到力传递线缆,所述杆经配置以便杆的旋转使第一传递线缆在远端方向上移动,从而施加张力到第一传递线缆,且杆的旋转使第二线缆在近端方向上移动,由此,解除第二线缆的张力。
在器械的一些实施方式中,旋转可稳定圆盘包括针对圆形井壁圆周地向外偏斜的至少一个弹簧部分,弹簧的圆周外周边缘包含一或多个齿,圆形井的壁包含一或多个棘爪,一或多个齿及一或多个棘爪配置为互相啮合。其中齿和棘爪如此啮合的旋转配置表示铰接致动器的稳定位置。在一些实施方式中,旋转可稳定圆盘包含针对圆形井的壁圆周地向外偏斜的两个或两个以上弹簧部分,所述弹簧部分以等距间隔分布在圆周外周上。在一些实施方式中,弹簧部分的分布提供施加于可稳定圆盘的力的圆周式平衡分布。所述施加向心力的平衡有利地支持圆盘围绕圆盘中心的平稳旋转。
在一些实施方式中,旋转可稳定圆盘及圆盘所位于的井适用于将圆盘的旋转稳定在一组稳定位置中的任一位置处,所述一组稳定位置在圆盘旋转弧内以一定距离间隔开。在一些所述实施方式中,旋转可稳定圆盘的旋转弧环绕约90度,包括在从其中手指可操作杆正交于轴的中间位置的任一方向环绕约45度。稳定位置组通常在旋转弧内以规定间隔隔开,例如,以约15度隔开的设定位置。通常,稳定位置中的一个是中间位置,其中手指可操作杆正交于轴。一般来说,可铰接接头的铰接方面对应于旋转可稳定圆盘的旋转方面。因此,在一些实施方式中,可铰接接头的铰接弧实质上对应于旋转可稳定圆盘的旋转弧。此外,在一些实施方式中,可铰接接头适用于稳定在以一定间隔隔开的一组稳定位置处,所述稳定位置实质上对应于旋转可稳定圆盘的稳定位置。
在一些实施方式中,旋转可稳定圆盘及所述圆盘所位于的井经配置以使得圆盘可通过对圆盘旋转的一定水平的阻力而稳定在一位置,所述阻力可通过施加扭矩到手指可操作杆来克服。在另一方面,旋转可稳定圆盘及所述圆盘所位于的井经配置以使得圆盘穿过稳定位置的旋转需要通过手指可操作杆施加扭矩到机构,所述扭矩大于使圆盘穿过在稳定角度位置之间的圆弧部分旋转所需的扭矩。举例来说,用手指可操作杆使旋转可稳定圆盘旋转穿过稳定位置所需的扭矩可在约2lbs到约10lbs的范围中。另外举例来说,用手指可操作杆使旋转可稳定圆盘旋转穿过在稳定位置之间的旋转圆弧部分所需的扭矩可小于约2lbs。
在器械的一些所述实施方式中,可稳定铰接致动器可进一步包括邻近可旋转手指可操作杆的线缆拉紧机构。线缆拉紧机构的一个实例包括如下文进一步描述及本文中所描绘的弹簧板。弹簧板的实施方式包括两个相对臂;至少两个力传递线缆中的一个穿过可旋转手指可操作杆的每一臂、穿过弹簧板且接着终止于邻近弹簧板处。如上所述,当驱动末端执行器的铰接运动时,力线缆或线缆在相反的纵向方向上移动,一个在远端移动而另一个在近端移动。弹簧板经配置以维持力传递线缆上的张力,所述力传递线缆在远端方向上移动;由于没有弹簧所提供的力,远端移动的力线缆可以累积不确定的松弛度。在弹簧板的一些实施方式中,弹簧板的每一臂包括圆周式对外开口狭槽,力传递线缆中的一个穿过所述狭槽。进一步地,弹簧板的每一臂可包括经配置以啮合弹簧板保持片的圆周式对内开口狭槽。
在器械的一些所述实施方式中,手指可操作杆的每一臂包括在杆的面向远端的表面上的弹簧板保持片,且弹簧板包含两个相对的圆周式对内狭槽。片及对内狭槽经配置以通过在手指可操作杆处于旋转位置时抵挡侧向滑动稳定弹簧板的此方式互相啮合。
在一些实施方式中,铰接致动器进一步配置为以稳定角度稳定末端执行器,末端执行器的稳定角度是在末端执行器铰接弧内以一定间隔间隔开的一组角度中的任一角度。在电外科器械的一些实施方式中,末端执行器是包含第一钳口及第二钳口的一组夹钳或钳口。第一钳口及第二钳口还可参照例如上钳口和下钳口的术语。通常,所述钳口组包括多个双极电极,所述多个双极电极经配置以接收来自能量源的能量并将能量传递到目标部位。
在电外科器械的一些实施方式中,可铰接接头包括介入于伸长轴的远端与末端执行器的近端之间的一或多个可枢转连接件。可铰接接头的一些实施方式包括两个或两个以上互连可枢转连接件。具有例如一或多个介入可枢转连接件的属性还可被理解为可铰接接头作为整体具有两个或两个以上椎间空间或可被理解为可铰接接头作为整体具有枢转铰接的两个或两个以上的互连部位,在所述椎间空间内可发生枢转。在典型配置中,可铰接接头的互连连接件以及轴的远端及末端执行器的近端包括可啮合在互补凹槽中的球状或圆柱形凸起。
在各种实施方式中,可铰接接头经配置以使末端执行器在约90度弧内枢转,所述弧在从中间位置的任一方向上包括约45度。通常地,铰接角被认为是与可铰接接头的远端相切的线相对于对应于轴的中心纵轴的线的角度。由于旋转稳定机构且通过力传递线缆的操作,可铰接接头以在约90度弧内以一定间隔隔开的一组角度可稳定。在旋转弧内以一定间隔隔开的角度组包括以约15度间隔的设定角度。通常,稳定角度中的一个是中间角度,所述角度相对于轴的中心纵轴以0度设置。最终,在器械的一些实施方式中,可铰接接头适用于以所要的铰接角度可稳定。
可铰接接头及与末端执行器的远端连接及与轴的近端连接的实施方式经配置以便器械的末端执行器的各种操作方面不受末端执行器的铰接位置影响。因此,例如,打开及闭合钳口的操作,及在闭合时通过钳口施加的力均与钳口的铰接位置无关。类似地,发生刀片的移动并且所有电外科性能不受钳口的铰接位置影响。
在一些实施方式中,具有一组钳口的器械可进一步包括刀片及刀片驱动部件,所述刀片及刀片驱动部件共同地经配置以能够在组织由钳口组抓紧时将在目标部位处的组织分离成两个部分。刀片可经配置以驻留在可铰接接头远端的原始位置且经配置以能够在钳口组内在远端移动。刀片驱动部件通常通过可铰接接头放置且可通过接头在任何铰接位置操作。刀片驱动部件可配置为推拉机构;且经配置以控制刀片的远端行进及刀片的近端收回的致动器可驻留在器械的把手中。
电外科器械的一些实施方式采用不一定包括把手或轴的形式;相反,例如,钳口可安装在任何合适基底上。例如,所述形式的实施方式可例如并入机器人设备中。所述实施方式包括:与基底相关联的钳口组,所述钳口组能够传递射频能量到目标部位;定位在基底远端的可铰接接头;与基底相关联放置的可稳定铰接致动器;定位在基底与钳口组之间的可铰接接头;及用于将铰接致动器的旋转运动转化为钳口组的铰接运动的至少两个力传递线缆。在所述实施方式中,可铰接接头经配置以有角度地在铰接弧内铰接钳口组,且可铰接接头具有定位在轴的远端与钳口组的近端之间的至少一个可枢转连接件。在典型实施方式中,力传递线缆在所述力传递线缆的近端处可操作地连接到铰接致动器,且在所述力传递线缆的远端处通过可铰接接头可操作地连接到钳口组的近端部分。在一些所述实施方式中,可稳定铰接致动器经配置以通过稳定力传递线缆而以稳定角度稳定可铰接接头。可铰接接头的稳定角度可为在接头铰接弧内以一定间隔隔开的一组角度中的任一角度。
所提供技术的实施方式还包括电外科组织封合的方法,所述方法包括使电外科钳口组移动到目标组织部位附近。钳口定位在可铰接接头的远端上;可铰接接头定位为在电外科装置的轴的远端。方法的实施方式可包括用手指可操作杆旋转可稳定铰接致动器。方法可进一步包括使钳口组与可铰接接头铰接以便将钳口的远端定位在所要铰接角度或位置,以使得钳口在闭合时抓紧目标组织部位。然后,方法可进一步包括用钳口抓紧目标组织部位。然后,方法可进一步包括从钳口传递射频能量到目标组织部位以封合目标组织部位。方法还可进一步包括切穿新封合的组织部位。
方法的实施方式可包括使电外科器械的钳口组移动到目标组织部位附近,所述钳口组在器械上定位为在可铰接接头远端。方法可进一步包括用手指可操作杆旋转可稳定铰接致动器到所要旋转位置,且从而将可铰接接头铰接到所要铰接角度。方法可进一步包括使可稳定铰接致动器稳定在所要旋转位置,且从而使可铰接接头稳定在所要铰接角度。
可铰接接头以一角度的角向铰接可被理解为是指与可铰接接头的远端相切的线相对于器械的轴的中心纵轴的角度。类似地,与末端执行器(例如,钳口组)相关联的铰接角是指与钳口的共同纵轴(当钳口闭合时所取的纵轴)相关联的线相对于与器械的轴的中心纵轴对应的线的角度。通常地,可铰接接头或在所述接头远端的末端执行器的所要铰接角度是指使钳口闭合的角度,所述钳口将围绕电外科啮合的目标组织闭合且抓紧所述组织。
在一些实施方式中,使可稳定铰接致动器旋转借助于使旋转可稳定圆盘旋转而发生,且其中使可稳定铰接致动器稳定借助于稳定旋转可稳定圆盘而发生。
方法的一些实施方式可进一步包括根据旋转可稳定铰接致动器来铰接钳口组。且在一些实施方式中,方法可进一步包括根据使可铰接接头稳定在所要铰接角度而使钳口组稳定在所要铰接角度。
方法的一些实施方式包括旋转与铰接致动器相关联的手指可操作杆,从而使旋转可稳定圆盘在致动器内旋转。一些所述实施方式可进一步包括用与手指可操作杆相关联的拉紧机构拉紧力传递线缆。方法可进一步包括根据使旋转可稳定圆盘旋转来驱动至少两个力传递线缆的运动。在所述实施方式中,驱动至少两个力传递线缆的运动包括从一根所述线传递线缆的近端施加张力及从另一力传递线缆释放张力,力线缆的近端可操作地啮合到可稳定铰接致动器。
在方法的典型实施方式中,铰接可铰接接头或末端执行器是指在从平面内的中心线的任一方向上在约45度弧内枢转从而提供约90度的总可枢转范围的能力。在器械的一些实施方式中,可铰接接头包括定位在器械的轴的远端与钳口的近端之间的一或多个可枢转连接件。在所述实施方式中,铰接可铰接接头可包括使一或多个可枢转连接件相对于彼此或相对于轴的远端或钳口的近端枢转。
将钳口组移动到目标组织部位附近可在几个方面发生,包括使钳口组前进穿过套管针到腹腔镜操作空间的步骤,及旋转钳口的步骤。在此上下文中,旋转是指使钳口绕中心共同纵轴旋转,当钳口处于闭合位置时,所述轴由钳口界定,或由钳口的共同基底部分表示。
在一些实施方式中,使钳口组围绕中心纵轴旋转包括在中间位置的任一侧上在高达约180度的范围内从中间位置旋转。在各种实施方式中,其中使钳口组围绕钳口组的中心纵轴旋转借助于旋转电外科器械的轴而发生,所述旋转进而通过旋转器械的轴旋转致动器而发生。
在方法的各种实施方式中,将钳口组稳定在所要铰接角度是与将可铰接接头铰接到所要铰接角度结合或同时执行的步骤。将钳口稳定在特定铰接角度,例如用于抓紧目标组织的理想角度,可与稳定可铰接接头、稳定控制可铰接接头的角度的力传递部件及用可稳定铰接致动器稳定旋转可稳定圆盘有密切关系或因果关系而发生。
更特别地,使可稳定铰接致动器稳定在所要位置可包括用在井的内面上的互补棘爪将齿啮合在旋转可稳定圆盘的外周上,可旋转圆盘容纳在井的所述内面中。在另一方面,稳定可稳定铰接致动器可包括使可稳定铰接致动器的杆旋转穿过具有相对较低旋转阻力的圆弧部分直到杆到达具有相对较高旋转阻力的位置,所述位置是具有铰接稳定性的位置。在又另一方面,其中稳定可稳定铰接致动器可包括使稳定致动器的杆旋转穿过圆弧部分,直到杆到达具有高旋转阻力的特定位置,所述圆弧部分可包括具有适当旋转阻力的一或多个区域及具有高旋转阻力的一或多个区域,在所述特定位置中,钳口处于所要铰接位置。在此后一实施方式的上下文中,使杆旋转穿过具有低旋转阻力的区域可包括在小于约2lb英寸的范围中施加扭矩到杆,且使杆旋转穿过具有高旋转阻力的区域可包括在约2lb英寸到约15lb英寸的范围中施加扭矩到杆。
方法的实施方式可包括另外的步骤,例如,用钳口组抓紧目标组织且例如在抓紧步骤之前打开钳口组。方法可进一步具体地包括:在钳口抓紧目标组织部位之后,从钳口组传递射频能量到目标组织部位。一旦钳口进入腹腔镜操作空间,方法的一些实施方式可包括多个电外科处理。因此,方法可进一步包括使钳口组移动到第二部位附近同时以先前的铰接角度维持钳口组,且重复抓紧步骤及传递能量步骤,所述步骤针对第二目标部位。
在另一方面,所公开的铰接及稳定电外科器械的末端执行器的方法可被理解为一系列铰接步骤,所述铰接步骤可与一系列稳定步骤结合以达成末端执行器在所要铰接角度的铰接及稳定。因此,铰接末端执行器可包括:旋转手指可操作杆;旋转可稳定旋转圆盘;平移力传递线缆;铰接可铰接接头,及铰接末端执行器。稳定末端执行器可包括使可稳定旋转圆盘稳定在所要旋转位置处、使手指可操作杆稳定在所要旋转位置处、使力传递线缆的平移稳定在所要平移位置、以所要铰接角度稳定可铰接接头,及以所述所要铰接角度稳定末端执行器。通过所述方法的实施方式,旋转手指可操作杆可导致可稳定圆盘旋转穿过具有相对较低旋转阻力及相对较高旋转阻力的一或多个区域。进一步地,通过此方法,稳定末端执行器可包括停止可稳定圆盘在具有相对较高旋转阻力的位置处的旋转。
附图说明
图1是图示可铰接电外科器械的可铰接接头的透视图。
图2A是图示可铰接电外科器械的可铰接接头的平面图。
图2B是图示可铰接电外科器械的可铰接接头的平面图,其中可铰接接头包含介入在轴与钳口之间的一个连接件。
图3是图示可铰接电外科器械的接头铰接控制机构的顶部剖面图的示意图。
图4是图示可铰接电外科器械的透视示意图。
图5是图示可铰接电外科器械的另一透视图。
图6是可铰接电外科器械的分度机构的透视示意图。
图7是可铰接电外科器械的棘爪机构的透视示意图。
图8是可铰接电外科器械的棘爪机构及分度机构的透视示意图。
图9是可铰接电外科器械的梯级球状物棘爪机构的平面示意图。
图10是可铰接电外科器械的梯级球状物棘爪机构的透视示意图。
图11是可铰接电外科器械的梯级球状物棘爪机构的第二透视示意图。
图12是可铰接电外科器械中的用于铰接控制的推锁机构的透视示意图。
图13是可铰接电外科器械中的用于铰接控制机构的闭锁机构的透明透视示意图。
图14是在可铰接电外科器械的铰接控制中的闭锁机构的握柄的透视示意图。
图15是可铰接电外科器械的部分透视剖视图,图示驱动部件。
图16是用于可铰接电外科装置内的刀片的驱动组件的透视图。
图17是可铰接电外科装置的实施方式的透视图,其中分度机构邻近轴,且可铰接接头定位在轴的远端及邻近钳口组,所述可铰接接头处于铰接位置中。所述实施方式的其他方面视图图示在图18到图28中。
图18是用透明地图示的轴旋转器描绘的可铰接电外科装置的近端部分、所述近端部分中所含有的可稳定铰接致动器的实施方式的透视图。
图19是可铰接电外科装置的轴旋转器部分的部分曝露的顶部视图;所述轴旋转器部分中所含的可稳定铰接致动器的实施方式图示为具有处于中间位置的手指杆。
图20是可铰接电外科装置的轴旋转器部分的部分曝露的顶部视图;所述轴旋转器部分中所含的可稳定铰接致动器的实施方式图示为具有处于部分旋转位置的手指杆。
图21是可稳定铰接致动器的分离部分的顶视图,图示旋转可稳定的圆盘、所述圆盘的手指可操作杆及力传递线缆。
图22是可稳定铰接致动器的暴露基底部分的略微近端观看角度的顶视图,图示旋转可稳定圆盘可坐落的容器部分。
图23是可稳定铰接致动器的分解透视图,图示旋转可稳定圆盘所坐落的容器部分、分度圆盘、旋转圆盘的手指可操作杆及定位在手指可操作杆远端的弹簧板。
图24是所构造分度圆盘的透视图;所述实施方式包含两个向外偏斜的弹簧部分。
图25是可稳定铰接致动器方面的分离部分的透视图,所述可稳定铰接致动器包括手指可操作杆、弹簧板及与远端定位的可铰接接头连通的致动金属线。
图26是可稳定铰接致动器的弹簧板部分的透视图。
图27是针对手指可操作杆对准的弹簧板的侧视图。
图28是用于铰接可铰接接头及将所述可铰接接头以所要铰接角度稳定的方法方面的示意图。
具体实施方式
本文所提供技术方面包括用于铰接可铰接电外科器械的接头的方法及设备,所述可铰接电外科器械通常可用于腹腔镜环境中,但还适用于开放手术环境中。可并入如本文中所述的可铰接特征的电外科装置的实例包括如在以下专利案中所述的装置:发布于2011年01月04日的名为“METHOD FOR TISSUECAUTERIZATION”的美国专利案第7,862,565号;发布于2010年09月28日的名为“METHOD AND APPARATUS FOR SURGICAL ELECTROCAUTERY”的美国专利案第7,803,156号;发布于2010年09月14日的名为“METHODAND APPARATUS FOR SURGICAL ELECTROCAUTERY”的美国专利案第7,794,461号;申请于2007年05月02日并在2008年07月17日公开为美国公开案第2008/0172052A1号的名为“SURGICAL TOOL”的美国专利案第11/743,579号;申请于2006年05月10日并在2006年11月16日公开为美国公开案第2006/0259034A1号的名为“APPARATUS FOR TISSUECAUTERIZATION”的美国专利案第11/382,652号;申请于2007年02月06日并在2007年06月07日公开为美国公开案第2007/0129726A1号的名为“ELECTROCAUTERY METHOD AND APPARATUS”的美国专利案第11/671,891号;申请于2008年05月18日并在2008年09月11日公开为美国公开案第2008/0221565A1号的名为“ELECTROCAUTERY METHOD ANDAPPARATUS”的美国专利案第12/121,734号;申请于2008年04月04日并在2008年09月18日公开为美国公开案第2008/0228179A1号的名为“ELECTROCAUTERY METHOD AND APPARATUS”的美国专利案第12/062,516号;申请于2009年03月24日并在2009年07月16日公开为美国公开案第2009/0182323A1号的名为“ELECTROCAUTERY METHOD ANDAPPARATUS”的美国专利案第12/410,322号;申请于2007年02月26日并在2007年08月09日公开为美国公开案第2007/0185482A1号的名为“ELECTROCAUTERY METHOD AND APPARATUS”的美国专利案第11/671,911号;申请于2010年03月26日的名为“IMPEDANCE MEDIATEDPOWER DELIVERY FOR ELECTROSURGERY”的美国申请案第12/748,229号及申请于2010年10月19日的名为“IMPEDANCE MEDIATED CONTROL OFPOWER DELIVERY FOR ELECTROSURGERY”的美国申请案第12/907,646号,以上所有专利案全文并入本文中。
当前所述医疗器械,例如,双极电外科装置可经配置以封合组织及/或切割组织,且具有可通过可铰接接头的操作而铰接的末端执行器。器械的实施方式通常具有一组相对的钳口,对于约90度的总铰接范围,所述钳口都可从由器械的轴的中心纵轴所界定的中心线向左及向右铰接高达约45度的角度。技术方面还提供适当的弯曲半径及用于钳口致动部件及切割器驱动部件的支撑件。在一些实施方式中,用于驱动器的可弯曲支撑件包括紧密缠绕的盘簧。
技术的一些实施方式进一步包括控制与放置在可铰接电外科器械的把手处的致动器的铰接度的机构及方法。技术的实施方式可进一步包括锁定机构,更普遍地,包括可稳定铰接致动器,以防止在操作者(通常是外科医生)用所述装置执行电外科手术时防止可铰接接头的移动。锁定机构的实施方式还包括分度特征结构,外科医生操作者可使用所述分度特征结构指示及选择预设角度之间的角度的所需量。
技术的一些实施方式以远端定位的可铰接接头或腕部的形式包括通过销或通过搭扣或通过力传递部件所施加的张力互连的一组枢转椎骨、连接件、铰链或可挠性元件。每一椎骨适用于关于轴及钳口组的纵轴枢转,因此允许左右铰接。通过沿着可铰接接头的两侧放置的连接部件或力传递部件(例如,金属线或线缆)控制铰接角度。在近端处将连接金属线引导到轴上且用张力将连接金属线连接到在装置把手处的控制机构,且所述连接金属线通过将力从把手传递到接头而工作。
连接件或椎骨的实施方式共同地形成远端可铰接接头的实施方式中的适当弯曲半径,所述弯曲半径足够大以允许力传递金属线或线缆穿过接头而无扭结。进一步地,在一些实施方式中,紧密缠绕盘簧容纳在接头内以引导金属线。紧密缠绕盘簧提供对金属线的额外支撑,以使得当金属线在近端或在远端前后移动时,金属线不弯曲或扭结。
把手处的控制机构的实施方式包括分度圆盘及收纳来自接头的力传递线缆或金属线的手指可操作杆。分度圆盘枢转地安装在器械的把手处,且控制机构的形状允许围绕枢轴的同轴旋转,以使得可基于枢轴到金属线或线缆的附接点的距离控制金属线或线缆沿轴的纵向移动。力传递线缆所移动的距离控制铰接位置或角度;所述距离可根据接头或分度圆盘及分度圆盘的杆的几何结构而用作预设选项。
技术的数个实施方式具有可稳定铰接致动器,所述可稳定铰接致动器包括分度特征结构或锁定特征结构。所述机构在各种实施方式中可指定特定铰接角度,且可以特定角度稳定在接头远端处的末端执行器。稳定角度或可锁定角度在铰接旋转弧内以间隔开的间距定位。在第一实施方式中,弹簧钢部件形成为在施加力时弯曲的几何结构,正如片簧。具有弹簧钢部件的此实施方式的实例图示于图6中;锁定及分度机构的其他方面图示于图7及图8中。片簧容纳在圆形载体内,其中仅弹簧的可挠曲部分可进入且从圆形载体突出。从枢转区域移除了圆形部分的旋转部件安装在圆形载体上方。也沿着旋转部件的圆形部分的内径移除齿纹。旋转部件包括从附接线缆或金属线的中心主体延伸的臂。片簧突出到由齿纹形成的凹痕中。齿之间的距离及从线缆或金属线的附接点到枢轴点的距离控制铰接角度。
在具有分度或锁定特征结构的可稳定铰接致动器的第二实施方式中,弹簧锁销安装在与梯级球状物相对的圆形载体内。弹簧锁销与由齿纹形成的凹痕紧密配合。可稳定铰接致动器的所述特定实施方式的实例图示在图9及图10中。
在具有分度特征结构或锁定特征结构的可稳定铰接致动器的第三实施方式中,上述旋转部分不具有从中心体延伸的臂。翼状件安装在旋转部件的顶部上。随后操纵翼状件以控制围绕圆形载体的旋转。
在具有分度特征结构或锁定特征结构的可稳定铰接致动器的第四实施方式中,还被称为活动铰链的可挠性塑料铰链安装在把手附近。活动塑料铰链使用V形,所述V形适合于围绕活动铰链的外部壳体的狭槽。V形的尖端从每一狭槽突出。存在沿着外部壳体的长度的一系列狭槽。壳体与控制接头铰接的线缆或金属线啮合。操作者可通过首先按压在活动铰链上以解除当前锁定部位,接着将外部壳体从近端部位移动到远端位置或反之亦然来调节及锁定接头铰接,然后,通过以狭槽所设定的任何各种预定距离与活动铰链再次啮合来锁定接头铰接。所述距离确定铰接接头的角度。
在具有分度特征结构或锁定特征结构的可稳定铰接致动器的第五实施方式中,上述旋转机构自由地围绕枢轴旋转。当操作者或外科医生确定了铰接角度时,按下安装在枢轴顶部上的分度销,所述分度销锁定接头角度及旋转机构,从而防止旋转机构和接头的任何进一步运动。此举可使用锚接在枢轴销内的楔状设计实现,所述楔状设计在此实施方式中为管道。最小单个狭槽经设计进入枢轴销中。当按下按钮时,按钮的内在弹簧属性从狭槽展开。展开材料使用摩擦来防止旋转机构的移动。按钮自身由于在顶部处的楔形设计而保持在固定位置。锁定及分度机构的此特定实施方式的实例图示于图12、图13及图14中,如下文进一步描述。
在所公开技术的第六实施方式中,电外科器械的可稳定铰接致动器包括具有弹簧片臂的分度或旋转位置稳定圆盘,所述弹簧片臂具有可啮合圆盘所旋转定位的容器或井中的互补棘爪的齿。铰接致动器的此特定实施方式包括非锁定机构。铰接接头的铰接角度未锁定到位,而相反是通过致动器中的相对较高水平的旋转阻力稳定,然而,所述致动器可由容易地施加到手指可操作杆的扭矩水平超控。所述第六实施方式的实例及视图图示在图17到图28中且在下文中进一步描述。
在所公开技术的描述中且如图1至图28中所示,针对设计考虑,可稳定铰接致动器的实施方式可包括在电外科器械的轴旋转器部分内或与所述轴旋转器部分相关联。然而,在所公开技术的其他实施方式中,所述两个功能致动器可定位在实体分离位置。进一步地,包括可稳定铰接致动器及可操作连接的可铰接接头的所公开技术的其他实施方式可包括在装置(例如不传递射频能量的所述装置)的广泛范围中或包括在不具有轴的装置、不具有把手的装置或既不具有轴也不具有把手的装置中。
另外对于前述描述,现结合如图1至图28中所描绘的技术的实例提供更详细的解释。未图示装置的实施方式的许多电外科特征结构(例如,双极电极对)以便着重于向装置提供可铰接性的特征结构。可在以上识别的专利申请案中找到电外科特征结构的细节。
图1是根据技术方面的可铰接电外科装置的实施方式的远端部分的透视图;图1图示电外科装置的主轴24的远端部分及末端执行器,在此实例中,末端执行器为包括下钳口11及上钳口13的钳口组件25。在更普遍方面,钳口组件可描述为具有第一钳口11及第二钳口13。由于装置的一些实施方式具有可旋转轴且因此具有可旋转钳口组,术语上及下可能并不具有绝对意义,但所述术语可在出现在图式中时用于描述钳口,或可通过标记或通过惯例如此指定。在此实施方式中,上钳口可远离及朝向下钳口围绕枢轴点17枢转,所述上钳口通常包括销及轮轴。在技术的其他实施方式中,下钳口也可以是可枢转的,但在此特定实施方式中,下钳口是固定的。通过传输张力到钳口激活销18来完成对上钳口的枢转,所述钳口激活销18可在激活狭槽19中移动。通常,通过附接到钳口激活销的电缆来施加张力。在末端执行器的所述实例中,钳口组或组件25经配置用于例如电外科组织封合及切割的腹腔镜手术。因此,如在底钳口11中所示,提供嵌入在塑料载体15中的远端电极12。还图示了第二近端电极16。图示切割凹槽14用于在结合组织封合而发生的组织分离程序期间收纳刀片(不可见)。可铰接腕部或接头22也在图1及图2中可见,如下文进一步描述。
在腹腔镜电外科手术期间,需要能够在具有铰接自由的平面的弧内从左到右定位装置的钳口,以达到接近目标组织部位的最好角度;通过包括一或多个铰接圆盘、连接件或椎骨21的一或多个可铰接接头22提供所述能力。在可铰接接头22的所述特定实施方式中,两个可枢转连接件21图示为介入在轴24的远端与钳口组件25的近端之间。通过拉紧在远端处终止的一对线缆(如下文所描述)实现铰接,其中所述线缆焊接或卷缩在线缆终止点处的凹槽中。图1进一步图示夹持狭槽23,所述夹持狭槽23充当用于外部轴管道或夹持机构的锁以将可铰接接头22保持到管道。
图2A是可铰接电外科装置的实施方式的远端部分的顶部视图或平面图,图示放置在可铰接接头22的相对末端上的钳口25及轴24。图2B是图示可铰接电外科器械的可铰接接头的平面图,其中可铰接接头包含介入在轴与钳口之间的一个连接件。可铰接接头的实施方式包括互连可枢转铰接连接件或圆盘;圆盘21彼此铰接且包括一系列球状或圆柱形凸起27,所述凸起啮合在互补凹槽28中。此实施方式的钳口组件25图示特定最远端的近端导向的球状凸起29,所述凸起29与啮合在铰接连接件的凹槽中的钳口组件25相关联,且轴24包括用于收纳铰接圆盘的球状或圆柱形凸起的远端开口的互补凹槽30。在一些实施方式中,可铰接接头的铰接范围包含在平面的弧内,尽管近端放置的轴旋转器可使末端执行器作为整体而旋转。可铰接接头的一些实施方式是可以所要铰接角度稳定,从而还以所要铰接角度稳定末端执行器。线缆31的短节段也图示在图2A及图2B中;线缆包括盘管护套组件且用于操作钳口内的可滑动刀片。如上所述,盘绕组件允许线缆随着装置的铰接弯曲而无扭结。
本文中所提供的可铰接接头的实施方式包括介入在轴的远端与末端执行器的近端之间的一或多个可枢转连接件。与多个连接件(例如,两个或两个以上的介入可铰接连接件)相关联的优点在于所述多个连接件可提供提高的铰接角度范围及铰接角的增强的解析度及稳定性。相对较少介入连接件(例如一个连接件)的优点涉及容易制造组件及较低成本。包括一个介入连接件的可铰接接头的实例图示在图2B中。包括两个介入连接件的可铰接接头的实例图示在图1及图2A中。包括三个连接件的可铰接接头的实例图示在图15中。包括四个连接件的可铰接接头的实例图示在图17中。铰接连接件(例如,所述及所描绘的连接件)的实施方式仅是适当连接件配置的实例;在本项技术中已知其他合适连接件配置且可包括所述配置作为技术的实施方式。
图3是用于操作铰接接头的铰接控制或致动机构32的实施方式的部分剖面侧视图。接头铰接控制部件或杆33图示为具有在控制部件的相对末端处的两个手指表面;所述手指表面允许外科医生围绕枢轴点35枢转控制部件。平行预拉紧控制线缆34a/34b(包括镍钛诺或其他合适的线缆材料)附接到在控制部件上的各别点。控制部件33的所述枢转行为分别施加张力到控制线缆34a/34b对并从所述线缆对牵引张力。接头铰接控制的操作使成对线缆中的一根线缆在钳口组件25上撤回,同时其他线缆释放张力,因此在需要时使钳口组件左移或右移。
图4是根据技术方面的可铰接电外科装置10的近端部分的透视图,图示具有把手44及钳口致动触发器45的壳体43,所述钳口致动触发器45操作四连杆联动装置或其他类型的联动装置46以通过主轴24传输张力且从而在需要时操作钳口以打开及闭合。还图示了刀片致动器部件42,刀片可由所述刀片致动器部件42牵引穿过切割凹槽14(图1中所示)。轴旋转器或末端执行器旋转致动器41允许轴围绕轴入口旋转,而接头铰接控制部件33允许接头机构得以操作。注意,在图4中接头铰接控制机构32包括控制狭槽40,所述控制狭槽40引导并限制接头铰接控制部件33的行进。
图5是可铰接电外科装置10的实施方式的近端部分的透视图,其中轴旋转器51包含在壳体57内。所述实施方式还包括刀片致动器52、接头铰接控制部件53、把手54及钳口激活触发器55。
图6是图5中所示的可铰接电外科装置的接头铰接控制机构的实施方式的示意性透视图;控制机构的所述实施方式包括分度能力。分度所述分度铰接控制机构的基底部分66支撑环形凸起65,所述基底部分66进而容纳控制部件53。拉紧线缆34a/34b各者具有充当线缆止挡的终止球64a/64b。线缆34a/34b通过各别凹槽63a/63b穿过控制致动器部件53。分度圆盘97包括多个棘爪62。平板弹簧61布置为啮合在棘爪内,以提供止挡机构以通过防止铰接控制部件53的移动而将钳口紧固在选定位置,除了在装置操作者需要移动所述止铰接控制部件53之外。
图7及图8提供图6中所示的分度铰接致动机构的各种特征结构的详细视图。图7是铰接控制机构的基底部分66的示意性透视图,所述透视图图示位于环状凸起65的凹座70中的弹簧机构61。图8是铰接控制部件53的示意性透视图,更详细地图示了棘爪62。
图9提供用于可铰接接头的分度铰接控制或致动机构90的替代性实施方式的顶视图。基底部分96支撑铰接控制部件93,所述铰接控制部件93包括形成在棘爪分度圆盘97中的多个棘爪。控制部件及棘爪分度圆盘旋转安装在基底结构96上。控制部件93的操作导致分度圆盘97围绕枢轴点91旋转,且结果导致梯级球状物95啮合到分度环内的多个棘爪92中的一个中。圆周式地与梯级球状物95相对的球状柱塞机构94维持在梯级球状物上的偏斜。分度控制部件93包括用于远端延伸到可铰接接头或腕部的控制线缆的一对近端附接点98a/98b。
图10是用于铰接致动机构90(如图9中的顶视图可见)的实施方式的分度控制机构的透视图。图11是用于根据技术方面的可铰接电外科装置中的铰接接头的控制机构的更水平定向透视图。图示铰接控制部件93结合分度环97的布置,且特别地,所述布置图示了在一对销98a/98b之间的附接。图11还图示了用于收纳控制线缆(在此视图中未图示线缆)的一对凹槽100a/100b。
图12到图14图示包括分度销的分度铰接致动机构的进一步实施方式。图12图示啮合在狭槽121中的分度销120。图13是剖面透视内视图,图示包含头部131及多个展开部分130的分度销120,所述多个展开部分130与锁定块133啮合或分离。因此,所述技术实施方式包括挤紧锁定装置,其中销120的按压将销130的展开部分挤紧到块133中且因此防止致动控制机构的旋转。图14是挤紧机构的详细视图,更详细地图示了销120、头部131及展开部分130。
图15及图16描绘可铰接电外科装置的实施方式的末端执行器驱动部件的方面。末端执行器驱动部件通常驱动与末端执行器相关联的特定功能。在电外科装置的所述实施方式中,末端执行器为钳口组,且因此,驱动部件可控制钳口的打开及闭合。图15是可铰接电外科装置的远端末端执行器部分的透视部分剖面图,图示根据技术方面的驱动部件。图15图示装置的可铰接接头22,而图16图示钳口致动带150、闭合销160及切割刀片161,所述切割刀片161的远端部分延伸回到器械的把手,使刀片前进及后退的致动器常驻在把手。控制钳口打开及闭合的驱动部件150的操作及通过远端前进及后退对刀片的操作由独立操作的单独机构执行。
驱动部件可使用用于支撑的紧密缠绕盘簧而由圆金属线(不锈钢或镍钛诺)制成。驱动部件还可为不锈扁钢带150,如图15及图16中所示。代替在一些实施方式中充当驱动部件的圆金属线,此实施方式可包括平带且可支持具有连接件的内结构方面的带。其他实施方式可使用聚合物平带以提供额外支撑。所述带可由聚合物(例如,聚四氟乙烯(PTFE,TeflonTM)或氟化乙烯丙烯(FEP))形成。支撑结构还可包括在刀片及/或钳口致动带上的PTFE或FEP热缩管。
可铰接接头22的实施方式还图示于图15中。在可铰接接头22的此特定实施方式中,三个可枢转连接件21图示为介入在轴24的远端与钳口组件25的近端之间。
图17至图28提供根据上文所述的技术的第六实施方式的具有可稳定铰接致动器的可铰接电外科装置的特定实施方式及用于所述可铰接电外科装置使用的相关联方法。在一些实施方式中,可稳定铰接致动器为实质上非锁定机构,原因在于,与在表示稳定位置的角度之间的机构旋转期间遭遇的相对较低阻力相比,借助于对将机构移出稳定角度位置所需的旋转的相对较高阻力来稳定旋转角。在另一方面,可理解,移动经过具有相对较高旋转阻力的区域是正常程序的部分,通过所述正常程序,达到所要的铰接角度。可稳定铰接致动器的实施方式通过线缆与末端执行器合作以便控制及稳定末端执行器的铰接角度。可稳定铰接致动器的进一步细节提供在以下描述图20的上下文中。
可稳定铰接致动器包括线缆拉紧机构170,所述线缆拉紧机构170与手指可操作杆的横杆相关联,所述手指可操作杆提升远端可铰接接头的铰接性能。线缆拉紧机构维持线缆34a/34b上的张力,且允许可铰接机构的近端元件及远端元件的更大尺寸容差或制造规格范围,以及线缆长度,且所述线缆拉紧机构通常进一步用于将所述元件保持或稳定在功能配置中。在一些实施方式中,线缆拉紧机构170可包括弹簧板,如图19到图21、图23及图25到图27中所示。
图17是可铰接电外科装置10的实施方式的透视图,其中可稳定铰接致动器邻近轴,且远端可铰接接头22定位在轴24远端及邻近呈钳口组25形式的末端执行器。远端可铰接接头22处于铰接位置。装置的近端部分包括邻近把手部分44的壳体143。近端部分进一步包括钳口激活触发器45及刀片致动器部件42。可稳定铰接致动器未展示在此图式中;可稳定铰接致动器包括在轴旋转器设备141内。在此实施方式中,末端执行器25可产生朝向中间位置的任一侧的铰接,铰接角度接近到中间位置的任一侧的约45度的最大值。中间位置是其中末端执行器的中心纵轴平行于电外科器械的轴的中心纵轴的一个位置。
钳口相对于轴的铰接角度由可稳定铰接致动器控制且所述铰接角度反映或近似由可稳定铰接致动器的杆的操作确定的角度。因此,对于约90度的总可枢转范围或旋转弧而言,钳口组可枢转到约45度范围内的中间位置的任一侧。进一步地,以由可稳定铰接致动器确定的方式,由钳口组假定的枢转角度可以隔开的角度间隔稳定。在一些实施方式中,所述间隔角度以15度间隔发生。
图18是用透明地图示的轴旋转器组件141描绘的可铰接电外科装置10的近端部分的透视图;可见可稳定铰接致动器190的实施方式包含在其中。尽管在此系列图式中所描绘的装置的实施方式图示包括在轴旋转器组件内的可稳定铰接致动器,而可稳定铰接致动器通常放置在邻近轴的位置而不一定容纳在轴旋转器组件内。
图19是可铰接电外科装置10的轴旋转器部分141的顶部部分展示图。可稳定铰接致动器190的实施方式包含在其中,且手指可操作杆图示为处于中间位置。所述中间位置将保持远端可铰接接头在中间位置或非铰接位置。可见拉紧的铰接线缆34a/34b的近端部分穿过手指可操作杆233的中心杆部分235及邻近中心杆的弹簧板170。在以下图式中可见所述后一种布置的细节。
图20是可铰接电外科装置的轴旋转器部分的部分展示顶视图。可稳定铰接致动器的实施方式图示为具有处于部分旋转位置中的手指杆235。绘图比例扩展高于图19的比例,此举允许特征结构的更详细视图。在此处尤其明显可见的是放置在分度圆盘162的圆周式向外偏斜弹簧片或臂164的外周上的齿165。所述齿啮合到放置在容器151的内面上的一系列棘爪152中。随着圆盘162的旋转,弹簧片向内弯曲且随后滑入到所述弹簧片可用的下一个棘爪。
可稳定铰接致动器的此特定实施方式具有在分度圆盘的每一臂或弹簧片上的两个齿165。在容器的内面上存在两个系列对应棘爪152;每一系列具有八个棘爪。齿及对应棘爪的所述布置支持总共七个稳定可旋转位置、中心中间位置及在中间位置的任一侧上的三个位置。可稳定铰接致动器的实施方式可具有更少或更多齿及更少或更多棘爪。然而,通常,所述布置导致奇数个稳定可旋转位置,即中心中间位置(处于零度,以使得杆相对于轴处于正交位置)及在中间位置的任一侧上的偶数个稳定旋转位置。可见,两个弹簧片臂彼此圆周式相对地布置。此布置产生向外导向力地稳定对中,此举有助于围绕中心杆啮合柱168的平衡旋转运动。可稳定铰接致动器的实施方式包括旋转稳定圆盘与多于两个向外偏斜臂的布置,所述多于两个向外偏斜臂支撑棘爪啮合齿,所述臂通常以等距间隔分布。
可稳定铰接致动器的实施方式利用对可用旋转弧内的旋转的可变阻力。旋转弧中需要相对高度的移动力的位置表示旋转度是稳定的位置,且可稳定铰接致动器的所述稳定性位置转化为在末端执行器处的铰接角度的稳定性位置。相比之下,旋转弧的提供对旋转的相对较小阻力的位置或部分并不是旋转稳定的,且通常表示介入在旋转稳定性的位置之间的旋转区域。
通常,可稳定铰接致动器的旋转弧大约与可铰接接头的铰接弧相同,且延伸开来,与末端执行器的铰接弧相同。举例而言,在本文所述的一些实施方式中,可稳定铰接致动器及可铰接接头/末端执行器均在约90度的弧(即,在中间位置的任一侧上的约45度的弧)内进行运动。
通过手指可操作杆235旋转分度圆盘162需要相对较大的力,例如约2lb磅-英寸到约15磅-英寸,以便将分度圆盘旋转出稳定位置,此举在分度圆盘的齿啮合在互补棘爪中时发生。需要例如小于约2lb磅-英寸的相对较小力以在圆盘的齿处于棘爪之间的位置中时旋转分度圆盘。甚至将圆盘移出稳定角度位置所需的相对较大力可通过如施加到手指可操作杆的正常水平的指压提供。注意,相对较大的力是将分度圆盘旋转出稳定位置所需的力表征为小于在分度圆盘的齿定位在棘爪的锯齿状形态之间时旋转分度圆盘所需的力。然而,相对较大的力是手动方式的手指可操作杆的简单可操作性的范围内。由于可容易将机构推动穿过稳定角度位置且由于所述运动包括在机构的正常操作中,可稳定铰接致动器可理解为实质上非锁定系统。
图20还图示作为线缆拉紧结构170的实例的弹簧板170且有助于传递对弹簧板的作用的理解。在所述视图中,从中间位置顺时针旋转圆盘162,以使得杆横杆235的上部(此视图中的每一上部)近端移动,且横杆的下部一直在远端处移动。通过此种行为,与下线缆34b相比,(通过此视图的)上线缆34a处于相对较大的拉紧度。在不存在补偿机构的情况下,在此位置中,线缆34b将累积松弛且产生铰接可铰接远端接头(在此视图中不可见)的铰接的不精确。然而,弹簧板170提供维持两个线缆之间的张力平衡的补偿。可见,弹簧板的弹性经适当的校准以使得装备有终端球34c的线缆34a及34b的近端维持在距杆横杆235提供的基底一距离处。在此视图中进一步可见定位在横杆235的近端形态上的稳定片237。所述片在旋转期间稳定弹簧板的侧向位置。在图27中可见此技术方面的进一步视图。
图21提供可稳定铰接致动器190的分离部分的顶视图,所述可稳定铰接致动器190包括手指杆233、分度圆盘162及拉紧线缆34a及34b。图22提供具有定位在轴旋转器141内的可稳定铰接致动器的暴露基底部分的略微近端观看角度的顶视图,图示旋转可稳定圆盘可能坐落的井或容器部分151。横向支柱或轮辐144跨越井151的底部布置。棘爪152布置在容器或井151的内面上。
图23是具有可稳定铰接致动器的略微远端观看透视图的分解顶视图,图示分度圆盘162旋转定位在容器151中的布置,所述容器151容纳在轴旋转器141中。手指可操作杆233定位在分度圆盘162上方且弹簧板170定位在圆盘上方。中心销166将圆盘162旋转紧固在容器内且将手指可操作杆233的附接紧固在装配的致动器内。销166的底部以孔159坐落在容器中。所述销166通过中心圆盘孔169穿过分度圆盘,且销的顶部以杆端接在中心孔239内。
图24是根据技术方面构造的分度或旋转位置可稳定圆盘162的透视图,所述实施方式包含在圆周向外方向上偏斜的两个弹簧部分或臂164。齿165定位在弹簧片164的外周上。中心孔经定位以容纳中心安装销(参见图23)。杆啮合柱168定位在圆盘的上表面上以提供用于手指可操作杆的连接部位。
图25是装置的分离部分的透视图,所述透视图图示手指可操作杆233、呈弹簧板170形式的线缆拉紧机构及传输穿过手指可操作杆233内的线缆传输孔236的致动金属线34a/34b的配合布置。致动线缆34a/34b与远端定位可铰接接头连通,如图1、图2、图15及图17中可见。
图26是装置的可稳定铰接致动器的线缆拉紧机构部分170的方面的前面透视图。线缆拉紧机构的此特定实施方式包含具有对外狭槽172的弹簧板,所述对外狭槽172经配置以容纳拉紧线缆34a/34b的近端,如图25中所见。对内狭槽174经配置以容纳定位在手指可操作杆上的稳定片,如图27中所见。所述狭槽的开放式面对方面有利于容易装配电外科装置且与将由圆周式完全封闭孔配置提供的性能相比,不会导致任何性能损耗。
图27是针对手指可操作杆的横杆部分235对齐的弹簧板170的侧视图。在此视图中图示稳定片237,所述稳定片237定位在横杆的近端侧上且插入对内狭槽174中。当手指可操作杆处于旋转位置中时,处于对内狭槽内的位置的所述片防止弹簧板在杆的近端拉动臂的方向上的侧向滑动。在图20中可见所述动态,其中弹簧板的下臂(在此视图中)通过使片针对由对内狭槽提供的凸耳稳定而保持到位。
图26及图27中所示的弹簧板提供为线缆拉紧机构的实例;弹簧板与手指可操作杆的横杆的布置仅为数个布置中的一个布置,所述数个布置还包括为技术的实施方式。线缆拉紧机构可附着到手指可操作杆,或可以非固定方式紧固到手指可操作杆,如在所示实施方式中,线缆34a/34b结合终端球34c的张力维持弹簧板针对杆的附接。技术的额外实施方式包括作为整体元件的手指可操作杆及线缆拉紧机构。就装配的容易度而言,图27中所描绘的布置是有利的。
图28是用于铰接可铰接接头及将所述接头稳定在所要铰接角度的方法方面的流程图。图28中所描绘的步骤图示最终铰接末端执行器的运动且图示可移动状态到稳定状态的过渡,所述稳定状态将末端执行器支撑在特定铰接角度。图式描绘与来自旋转致动器的旋转运动的铰接相关联的运动,包括手指可操作杆的旋转及旋转可稳定圆盘的相关联旋转、力传递线缆的平移运动(在远端方向及近端方向上)及可铰接接头的铰接运动以及最终钳口组的铰接运动。旋转可稳定圆盘的旋转位置出现在井内,且包括一组齿穿过旋转弧的交替部分的旋转,其中齿啮合在具有一系列互补棘爪的棘爪内(啮合)或啮合在棘爪之间(未啮合)。齿所啮合在棘爪中的位置(在一些实施方式中,两个或两个以上相邻棘爪中的两个或两个以上的相邻齿)表示显示为旋转阻力点的稳定位置,所述旋转阻力由操作者旋转手指可操作杆而感觉到。杆的稳定因此使力传递线缆的平移运动稳定,此举进而使可铰接接头的铰接角度稳定,此举进而使钳口的铰接角度稳定。
除非另有定义,本文中所使用的所有技术术语具有与在包括电外科手术的手术领域的一般技术人员所共同理解相同的意义。在此申请案中描述特定方法、装置及材料,但类似或等效于本文中所述的方法及材料的任何方法及材料可用于实践本技术。虽然已相当详细并通过图示的方式来描述技术实施方式,但所述图示仅出于清晰理解的目的,且不意在为限制。已在本描述中使用各种术语来传达对技术的理解,将理解,所述各种术语的意义延伸到常见的语言或语法变异或所述变异的形式。还将理解,当术语是指装置或装备时,所述术语及名称提供为当代实例,且技术不由所述文字范围限制。将来引入的可被合理地理解为当代术语的衍生物或指定当代术语所包含的体系子集的术语将被理解为通过当前当代术语来描述。进一步,虽然提出一些理论考虑来促进提供对技术的理解,但技术的附随权利要求书不受所述理论的束缚。此外,技术的任一实施方式的任何一或多个特征结构可与技术的任何其他实施方式的任何一或多个其他特征结构相结合,或与已通过引用方式并入的专利申请案或已发布的专利案中描述的任何技术结合,而不脱离技术范围。又进一步,应理解,所述技术并不限于出于示例性目的而阐述的实施方式,而将仅由对专利申请案所附加的权利要求书的正确阅读而定义,包括专利申请案的每一要素享有的全范围的等效性。
Claims (19)
1.一种电外科器械,所述电外科器械包含:
伸长轴,所述伸长轴具有末端执行器和把手,所述末端执行器与所述伸长轴的远端相关联,所述把手与所述伸长轴的近端相关联,所述末端执行器能够将射频能量传递到目标部位;
可铰接接头,所述可铰接接头定位在所述轴与所述末端执行器之间,所述接头经配置以有角度地将所述末端执行器铰接在铰接弧内,所述可铰接接头包含定位在所述轴的远端与所述末端执行器的近端之间的至少一个可枢转连接件;
可稳定铰接致动器,所述可稳定铰接致动器邻近所述可铰接接头放置且适用于控制所述可铰接接头的所述铰接角度;及
至少两个力传递部件,所述力传递部件在所述力传递部件的近端处可操作地连接到所述铰接致动器,且在所述力传递部件的远端处通过所述可铰接接头可操作地连接到所述末端执行器的近端部分,从而允许所述铰接致动器的旋转运动转化为所述末端执行器的铰接运动,
其中所述可稳定铰接致动器经配置以通过稳定所述力传递部件部分而以一稳定角度稳定所述可铰接接头,所述可铰接接头的所述稳定角度是在所述接头铰接弧内以一定距离间隔开的一组角度中的任一角度,
其中所述可稳定铰接致动器包含:
旋转可稳定圆盘,所述旋转可稳定圆盘位于井中;
可旋转手指可操作杆,所述可旋转手指可操作杆经配置以旋转所述旋转可稳定圆盘,所述杆包含两个相对臂,所述杆的每一臂连接到所述至少两个力传递部件部分中的一个,所述杆经配置以使得所述杆的旋转使第一传递部件部分在近端方向上移动且使第二部件部分在远端方向上移动,其中所述可稳定铰接致动器进一步包含与所述可旋转手指可操作杆相关联的力部件拉紧机构,所述力部件拉紧机构经配置以施加张力到所述至少两个力传递部件。
2.如权利要求1所述的器械,所述器械进一步包含邻近所述可铰接接头放置的轴旋转器,所述轴旋转器经配置以使所述轴关于所述把手旋转,所述可稳定铰接致动器放置在所述轴旋转器内或与所述轴旋转器相关联。
3.如权利要求1所述的器械,其中所述旋转可稳定圆盘包含针对所述井的壁圆周地向外偏斜的至少一个弹簧部分,所述弹簧部分的圆周外周边缘包含一或多个齿,所述井的所述壁包含一或多个棘爪,所述一或多个齿及所述一或多个棘爪经配置以互相啮合。
4.如权利要求1所述的器械,其中所述旋转可稳定圆盘及所述圆盘所位于的所述井适用于将所述圆盘的旋转稳定在一组稳定位置中的任一位置处,所述一组稳定位置在圆盘旋转弧内以一定距离间隔开。
5.如权利要求4所述的器械,其中所述旋转可稳定圆盘的所述旋转弧环绕约90度,包括在从其中所述手指可操作杆正交于所述轴的中间位置的任一方向环绕约45度。
6.如权利要求4所述的器械,其中所述可铰接接头适用于稳定在以一定距离间隔开的一组稳定位置处,所述稳定位置实质上对应于所述旋转可稳定圆盘的所述稳定位置。
7.如权利要求1所述的器械,其中所述旋转可稳定圆盘及所述圆盘所位于的所述井经配置以使得所述圆盘可通过对所述圆盘的旋转的一定水平的阻力而稳定在一位置,所述阻力可通过施加扭矩到所述手指可操作杆来克服。
8.如权利要求1所述的器械,其中所述旋转可稳定圆盘及所述圆盘所位于的所述井经配置以使得所述圆盘穿过稳定位置的旋转需要通过所述手指可操作杆施加扭矩到所述力部件拉紧机构,所述扭矩大于使所述圆盘旋转穿过在所述稳定角度位置之间的所述铰接弧的部分所需的所述扭矩。
9.如权利要求1所述的器械,其中所述力部件拉紧机构包含弹簧板,所述弹簧板包含两个相对臂,所述至少两个力传递部件部分中的至少一个穿过所述可旋转手指可操作杆的每一臂、穿过所述弹簧板且终止于邻近所述弹簧板处。
10.如权利要求1所述的器械,其中所述铰接致动器进一步配置为以稳定角度来稳定所述末端执行器,所述末端执行器的所述稳定角度是在所述末端执行器铰接弧内以一定间隔间隔开的一组角度中的任一角度。
11.如权利要求1所述的器械,其中所述可铰接接头的所述至少一个连接件以及所述轴的所述远端及所述末端执行器的所述近端包含可啮合到互补凹槽中的球状凸起。
12.如权利要求1所述的器械,其中所述可铰接接头包含定位在所述轴的所述远端与所述末端执行器的所述近端之间的两个或更多个互连连接件的组。
13.如权利要求1所述的器械,其中所述可铰接接头经配置以使所述末端执行器在约90度弧内枢转,所述90度弧在从中间位置的任一方向上包括约45度。
14.如权利要求1所述的器械,其中所述末端执行器为钳口组,所述器械进一步包含刀片及刀片驱动部件,所述刀片及刀片驱动部件共同地经配置以能够在组织由所述钳口组抓紧时将在目标部位处的所述组织分离成两个部分。
15.如权利要求14所述的器械,其中所述刀片经配置以驻留在所述可铰接接头远端的原始位置且经配置以能够在所述钳口组内在远端移动。
16.如权利要求14所述的器械,其中所述刀片驱动部件通过所述可铰接接头放置且可在任何铰接位置操作。
17.如权利要求14所述的器械,其中所述刀片驱动部件配置为推拉机构。
18.一种电外科器械,所述电外科器械包含:
伸长轴,所述伸长轴具有与所述伸长轴的远端相关联的钳口组,所述钳口组能够将射频能量传递到目标部位;
可铰接接头,所述可铰接接头定位在所述轴与所述钳口组之间,所述接头经配置以有角度地在铰接弧内铰接所述钳口组,所述可铰接接头包含定位在所述轴的远端与所述钳口组的近端之间的至少一个可枢转连接件;
可稳定铰接致动器,所述可稳定铰接致动器邻近所述轴放置且适用于控制所述可铰接接头的所述铰接角度;及
至少两个力传递部件,所述力传递部件在所述力传递部件的近端处可操作地连接到所述铰接致动器,且在所述力传递部件的远端处通过所述可铰接接头可操作地连接到末端执行器的近端部分,从而允许所述铰接致动器的旋转运动转化为所述末端执行器的铰接运动,
其中所述可稳定铰接致动器经配置以通过稳定所述力传递部件部分而以一稳定角度稳定所述可铰接接头,所述可铰接接头的所述稳定角度是在所述接头铰接弧内以一定距离间隔开的一组角度中的任一角度,
其中所述可稳定铰接致动器包含:
旋转可稳定圆盘,所述旋转可稳定圆盘位于井中;
可旋转手指可操作杆,所述可旋转手指可操作杆经配置以旋转所述旋转可稳定圆盘,所述杆包含两个相对臂,所述杆的每一臂连接到所述至少两个力传递部件部分中的一个,所述杆经配置以使得所述杆的旋转使第一传递部件部分在近端方向上移动且使第二部件部分在远端方向上移动,其中所述可稳定铰接致动器进一步包含与所述可旋转手指可操作杆相关联的力部件拉紧机构,所述力部件拉紧机构经配置以施加张力到所述至少两个力传递部件。
19.一种电外科器械,所述电外科器械包含:
钳口组,所述钳口组能够将射频能量传递到目标部位;
可铰接接头,所述可铰接接头定位在基底远端,所述接头经配置以有角度在铰接弧内铰接所述钳口组,所述可铰接接头包含定位在所述基底与所述钳口组的近端之间的至少一个可枢转连接件;
可稳定铰接致动器,所述可稳定铰接致动器与所述基底相关联放置且适用于控制所述可铰接接头的所述铰接角度;及
至少两个力传递部件,所述力传递部件在所述力传递部件的近端处可操作地连接到所述铰接致动器,且在所述力传递部件的远端处通过所述可铰接接头可操作地连接到末端执行器的近端部分,从而允许所述铰接致动器的旋转运动转化为所述末端执行器的铰接运动,
其中所述可稳定铰接致动器经配置以通过稳定所述力传递部件部分而以一稳定角度稳定所述可铰接接头,所述可铰接接头的所述稳定角度是在所述接头铰接弧内以一定距离间隔开的一组角度中的任一角度,
其中所述可稳定铰接致动器包含:
旋转可稳定圆盘,所述旋转可稳定圆盘位于井中;
可旋转手指可操作杆,所述可旋转手指可操作杆经配置以旋转所述旋转可稳定圆盘,所述杆包含两个相对臂,所述杆的每一臂连接到所述至少两个力传递部件部分中的一个,所述杆经配置以使得所述杆的旋转使第一传递部件部分在近端方向上移动且使第二部件部分在远端方向上移动,其中所述可稳定铰接致动器进一步包含与所述可旋转手指可操作杆相关联的力部件拉紧机构,所述力部件拉紧机构经配置以施加张力到所述至少两个力传递部件。
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MX2013010732A (es) | 2013-12-06 |
EP2688501A1 (en) | 2014-01-29 |
US20110230875A1 (en) | 2011-09-22 |
RU2013147153A (ru) | 2015-04-27 |
ES2550666T3 (es) | 2015-11-11 |
CA2828927A1 (en) | 2012-09-27 |
BR112013022126A2 (pt) | 2020-11-24 |
CN103429184A (zh) | 2013-12-04 |
JP2014515652A (ja) | 2014-07-03 |
AU2012230520A1 (en) | 2013-09-05 |
WO2012126783A1 (en) | 2012-09-27 |
US8870867B2 (en) | 2014-10-28 |
KR101561366B1 (ko) | 2015-10-16 |
BR112013022126B1 (pt) | 2021-05-25 |
JP5864716B2 (ja) | 2016-02-17 |
EP2688501B1 (en) | 2015-08-26 |
KR20140022844A (ko) | 2014-02-25 |
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