CN104023653A - 连续缝合器械 - Google Patents
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- 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
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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
- A61B17/07292—Reinforcements for staple line, e.g. pledgets
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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
- A61B2017/07214—Stapler heads
- A61B2017/07235—Stapler heads containing different staples, e.g. staples of different shapes, sizes or materials
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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
- A61B2017/07214—Stapler heads
- A61B2017/07271—Stapler heads characterised by its cartridge
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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
- A61B2017/07214—Stapler heads
- A61B2017/07278—Stapler heads characterised by its sled or its staple holder
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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
- A61B2017/07214—Stapler heads
- A61B2017/07285—Stapler heads characterised by its cutter
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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
- A61B17/28—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
Abstract
一种外科缝合器械可包括:能够容纳钉仓的钳口;能够从所述钉仓弹出钉的击发构件;和用于将连续的多个钉仓供应给所述钳口的系统。
Description
背景技术
对于先前的外科缝合器械,外科缝合器械可包括柄部、轴和端部执行器,其中所述端部执行器可被插入到患者体内的手术部位中以缝合和/或切开位于所述手术部位内的组织。在各种实施例中,端部执行器能够容纳钉仓,其中在已至少部分地消耗所述钉仓之后,可自所述端部执行器移除钉仓并用新的未动用钉仓来替换。为了替换钉仓,在各种情况下,必须从手术部位移除端部执行器。尽管这些程序对于其所要达到的目的而言是适合的,但仍需要可观的执行时间。本文中公开了对前述内容的改善;然而,先前的外科缝合器械的此论述并非旨在以任何方式限制权利要求的范围。
发明内容
在至少一种形式中,一种外科缝合器械可包括:包括触发器的柄部,从所述柄部延伸的轴,其中所述轴包括位移凸轮,和定位在所述轴内的多个钉仓,其中每个钉仓包括具有多个孔的仓体;和多个钉,所述钉各自包括定位在一个孔中的至少一个钉腿,其中所述钉腿能够在所述孔内滑动。所述外科缝合器械还可包括:包括能够容纳钉仓的通道的第一钳口,其中所述第一钳口包括定位在所述通道内的多个钉驱动器,并且其中击发构件能够与钉驱动器接合并使钉驱动器在第一位置与第二位置之间运动;和包括砧座的第二钳口,其中在将钉驱动到其第二位置中时钉腿能够接触所述砧座。所述外科缝合器械还可包括:能够将钉仓顺序地推进到所述通道中的仓驱动器;和与所述触发器可操作地联接的击发构件,使得击发动作能够从触发器传递到击发构件以使击发构件沿着击发路径运动,其中所述击发路径包括:一,近侧位置,在所述近侧位置处所述击发构件接触位移凸轮且相对于击发路径在横向方向上发生位移,其中当击发构件在横向方向上发生位移时钉仓可滑动穿过所述击发构件;二,多个击发位置,在所述击发位置处所述击发构件接触钉驱动器;和三,远侧位置。
在至少一种形式中,一种外科缝合器械组件可包括:轴,所述轴包括可移除的盒和位移凸轮;和定位在所述盒内的多个钉仓,其中每个钉仓包括具有多个孔的仓体和多个钉,所述钉各自包括定位在一个孔中的一个钉腿,其中所述钉腿能够在所述孔内滑动。所述外科缝合器械还可包括:包括能够容纳钉仓的通道的第一钳口,包括砧座的第二钳口,其中钉腿能够接触所述砧座,能够将钉仓顺序地推进到所述通道中的仓驱动器;和能够沿着击发路径运动的击发构件,其中所述击发路径包括:近侧位置,在所述近侧位置处所述击发构件接触所述位移凸轮且相对于击发路径在横向方向上发生位移,其中当所述击发构件在所述横向方向上发生位移时钉仓可滑动经过所述击发构件,和多个击发位置,在所述击发位置处所述击发构件相对于所述砧座驱动所述钉。
在至少一种形式中,一种外科缝合器械可包括:轴,所述轴包括框架;和定位在所述轴内的多个钉仓,其中每个钉仓包括具有多个孔的仓体和多个钉,所述钉各自包括定位在一个孔中的一个钉腿,其中所述钉腿能够在所述孔内滑动。所述外科缝合器械还可包括:包括能够容纳钉仓的通道的第一钳口;包括砧座的第二钳口,其中钉腿能够接触所述砧座;能够将钉仓顺序地推进到所述通道中的仓驱动器;和能够沿着击发路径运动的击发构件,其中所述击发路径包括:近侧位置,在所述近侧位置处所述击发构件接触所述框架且相对于击发路径在向下方向上发生位移,其中当击发构件在向下方向上发生位移时钉仓可滑动穿过所述击发构件;和多个击发位置,在所述击发位置处所述击发构件相对于所述砧座驱动所述钉。
在至少一种形式中,一种外科缝合器械可包括:包括触发器的柄部;从所述柄部延伸的轴;和与所述触发器可操作地联接的击发构件,使得击发动作能够从所述触发器传递到所述击发构件以使所述击发构件沿着击发路径运动。所述外科缝合器械还可包括:定位在所述轴内的多个钉仓,其中每个钉仓包括仓体和多个钉;和第一钳口,所述第一钳口包括:从所述轴延伸的近端、远端、能够容纳钉仓的通道、和多个钉驱动器,其中击发构件能够接合所述钉驱动器,并在击发构件从所述近端运动到所述远端时使每个钉驱动器从未被部署的位置运动到已部署的位置中,并且其中所述击发构件能够接合所述钉驱动器,并在击发构件从所述远端运动到所述近端时使钉驱动器从所述已部署的位置运动到所述未被部署的位置中。所述外科缝合器械还可包括:包括砧座的第二钳口,其中在部署所述钉时所述钉能够接触所述砧座;和能够将钉仓顺序地推进到通道中的仓驱动器。
在至少一种形式中,所述外科缝合器械组件可包括:轴;定位在所述轴内的多个钉仓,其中每个钉仓包括仓体和多个钉;和能够沿着击发路径运动的击发构件。所述外科缝合器械组件还可包括第一钳口,所述第一钳口包括:附接到所述轴的近侧部分;远侧部分;能够容纳钉仓的通道;和多个钉驱动器,其中所述击发构件能够接合所述钉驱动器并在击发构件从所述近侧部分运动到所述远侧部分时使每个钉驱动器从第一位置运动到第二位置中,并且其中所述击发构件能够接合所述钉驱动器并在所述击发构件从所述远侧部分运动到所述近侧部分时使所述钉驱动器从所述第二位置运动到所述第一位置中。所述外科缝合器械组件还可包括:一,包括砧座的第二钳口,其中在部署所述钉时所述钉能够接触所述砧座;和二,能够将钉仓顺序地推进到所述通道中的仓驱动器。
在至少一种形式中,一种外科缝合器械可包括:一,能够储存多个钉仓的轴,其中每个钉仓包括仓体、多个钉、和组织接触表面;和二,能够沿着击发路径运动的击发构件。所述器械还可包括第一钳口,所述第一钳口包括:附接到所述轴的近侧部分;远侧部分;和多个钉驱动器,其中击发构件能够接合所述钉驱动器且当所述击发构件在所述近侧部分和所述远侧部分之间运动时朝组织接触表面提举每个钉驱动器,并且其中所述击发构件能够接合所述钉驱动器且当所述击发构件在所述远侧部分和所述近侧部分之间运动时使所述钉驱动器远离所述组织接触表面降低。所述器械还可包括具有砧座的第二钳口,其中在朝组织接触表面提举所述钉驱动器时所述钉能够接触所述砧座;和能够将钉仓顺序地推进到第一钳口中的仓驱动器。
在至少一种形式中,一种外科缝合器械可包括:包括触发器的柄部;从所述柄部朝远侧延伸的轴;和与所述触发器可操作地联接的击发构件,使得击发动作能够从所述触发器传递到所述击发构件以使所述击发构件沿着击发路径运动。所述器械还可包括:定位在所述轴内的第一钉仓,所述第一钉仓包括具有多个第一孔的第一仓体和多个第一钉,所述第一钉各自包括定位在一个第一孔中的至少一个第一钉腿,其中所述第一钉腿能够在所述第一孔内滑动,并且其中所述第一钉腿包括第一长度;和定位在所述轴内的第二钉仓,所述第二钉仓包括具有多个第二孔的第二仓体和多个第二钉,所述第二钉各自包括定位在一个第二孔中的至少一个第二钉腿,其中所述第二钉腿能够在所述第二孔内滑动,并且其中所述第二钉腿包括不同于所述第一长度的第二长度。所述器械还可包括:包括能够容纳钉仓的通道的第一钳口;包括能够使所述钉变形的砧座的第二钳口;和能够将所述第一钉仓和第二钉仓从暂存位置顺序地推进到所述通道中的仓驱动器。
在至少一种形式中,一种外科缝合器械组件可包括:包括可移除的盒的轴;可沿着击发路径运动的击发构件;和定位在所述盒内的第一钉仓,其中所述第一钉仓包括具有多个第一孔的第一仓体和多个第一钉,所述第一钉各自包括定位在一个第一孔中的一个第一钉腿,其中所述第一钉腿能够在所述第一孔内滑动,并且其中所述第一钉各自包括第一高度。所述器械组件还包括:定位在所述盒内的第二钉仓,其中所述第二钉仓包括具有多个第二孔的第二仓体和多个第二钉,所述第二钉各自包括定位在一个第二孔中的一个第二钉腿,其中所述第二钉腿能够在所述第二孔内滑动,并且其中所述第二钉包括不同于所述第一高度的第二高度。所述器械组件还可包括:包括能够容纳钉仓的通道的第一钳口;包括能够使所述钉变形的砧座的第二钳口;和能够将所述第一钉仓和第二钉仓从暂存位置顺序地推进到所述通道中的仓驱动器。
在至少一种形式中,一种外科缝合器械可包括:轴;可沿着击发路径运动的击发构件;定位在所述轴内的第一钉仓,其中所述第一钉仓包括第一仓体和多个第一钉,并且其中所述第一钉各自包括第一高度;和定位在所述轴内的第二钉仓,其中所述第二钉仓包括第二仓体和多个第二钉,其中所述第二钉各自包括不同于所述第一高度的第二高度。所述器械还可包括:包括能够容纳钉仓的通道的第一钳口;包括能够使所述钉变形的砧座的第二钳口;和能够将所述第一钉仓和第二钉仓顺序地推进到所述通道中的仓驱动器。
在至少一种形式中,一种外科缝合器械可包括:包括触发器的柄部;从所述柄部延伸的轴;与所述触发器可操作地联接的击发构件,使得击发动作能够从触发器传递到击发构件以使所述击发构件沿着击发路径运动;和定位在所述轴内的多个钉仓,其中每个钉仓包括具有多个孔的仓体和多个钉,所述钉各自包括定位在一个孔中的一个钉腿,其中所述钉腿能够在所述孔内滑动。所述器械还可包括:包括能够容纳钉仓的通道的第一钳口,其中所述第一钳口包括定位在其中的多个钉驱动器,并且其中所述击发构件能够接合所述钉驱动器并使所述钉驱动器在第一位置和第二位置之间运动。所述器械还可包括:包括砧座的第二钳口,其中当将所述钉驱动到所述第二位置中时所述钉腿能够接触所述砧座;能够将钉仓从暂存位置顺序地推进到通道中的仓驱动器;和能够将钉仓顺序地推进到所述暂存位置中的偏置构件。
在至少一种形式中,一种外科缝合器械组件可包括:包括可移除的盒的轴;可与致动器可操作地联接的击发构件,使得击发动作能够从致动器传递到击发构件以使所述击发构件沿着击发路径运动;和能够定位在所述盒内的多个钉仓,其中每个钉仓包括具有多个孔的仓体和多个钉,所述钉各自包括定位在一个孔中的一个钉腿,并且其中所述钉腿能够在所述孔内滑动。所述器械组件还可包括:包括能够容纳钉仓的通道的第一钳口,其中所述第一钳口包括定位在其中的多个钉驱动器,并且其中所述击发构件能够接合所述钉驱动器并使所述钉驱动器在第一位置与第二位置之间运动。所述器械组件还可包括:包括砧座的第二钳口,其中当将所述钉驱动到第二位置中时所述钉腿能够接触所述砧座;能够将钉仓从暂存位置顺序地推进到通道中的仓驱动器;和能够将钉仓顺序地推进到所述暂存位置中的偏置构件。
在至少一种形式中,一种外科缝合器械可包括:包括触发器的柄部;从所述柄部延伸的轴;和与所述触发器可操作地联接的击发构件,使得击发动作能够从所述触发器传递到所述击发构件以使所述击发构件沿着击发路径运动。所述器械还可包括:定位在所述轴内的多个钉仓,其中每个钉仓包括具有多个孔的仓体和多个钉,所述钉各自包括定位在一个孔中的一个钉腿,其中所述钉腿能够在所述孔内滑动。所述器械组件还可包括:包括能够容纳钉仓的通道的第一钳口;包括砧座的第二钳口,其中所述钉腿能够接触所述砧座;能够将钉仓从暂存位置顺序地推进到通道中的仓驱动器;和能够将钉仓顺序地推进到所述暂存位置中的偏置构件。
附图说明
通过结合附图来参考本发明实施例的以下说明,本发明的特征及优点及其获取方法将会变得更加明显,并可更好地理解发明本身,其中:
图1为外科缝合器械的端部执行器和轴的透视图;
图1A为图1的端部执行器沿着图1中的线1A-1A截取的剖面图;
图2为图1的端部执行器和轴的透视图,其示出了定位在所述端部执行器内的钉仓和定位在所述轴内的多个钉仓,所述钉仓被示出为已移除了一些元件;
图2A为图1的端部执行器和轴沿图2的线2A-2A截取的剖面图;
图3为图1的端部执行器和轴的分解图;
图4为图1的端部执行器的钳口的分解图,所述钳口能够容纳包括多个钉驱动器的钉仓,所述多个钉驱动器能够从钳口弹出钉仓;
图4A为图4的钳口的钉仓通道的剖面图;
图5为图1的端部执行器和轴的剖面正视图,其示出了在降落位置中的击发构件;
图5A为图5的击发构件的定位在其降落位置中的细节图;
图5B为图5的击发构件的细节图,其示出了所述击发构件的切割构件或远侧刀部分;
图6为图4的钉驱动器的透视图;
图7为图6的钉驱动器的另一透视图;
图8为图6的钉驱动器的另一透视图;
图8A为图6的钉驱动器的剖面正视图;
图8B为图6的钉驱动器的剖面透视图;
图8C为图6的钉驱动器的正视图;
图9为图5B的切割构件的透视图;
图10为图5B的切割构件的另一透视图;
图11为图4A的钉仓通道的剖开透视图;
图12为图4A的钉仓通道的剖开正视图;
图13为图2的钉仓的在未击发条件下示出的仰视透视图;
图14为图13的钉仓的局部剖面图;
图15为图1的轴的远端的透视图;
图16为图1的端部执行器的其中并未定位有钉仓的透视图;
图16A为图1的端部执行器的如图16中所示的剖面正视图;
图17为图1的端部执行器的透视图,其示出了定位在所述端部执行器中的钉仓和在降落条件下的图5B的切割构件;
图17A为图1的端部执行器的如图17中所示的剖面正视图;
图18为图1的端部执行器的透视图,其示出了在提升条件下的图5B的切割构件和在打开条件下的端部执行器的砧座;
图18A为图1的端部执行器的如图18中所示的剖面正视图;
图19为图1的端部执行器的剖面正视图,其示出了在部分推进条件下的切割构件和在闭合条件下的砧座;
图20为图1的端部执行器的剖面正视图,其示出了在部分推进条件下的切割构件以及在击发条件下的多个钉驱动器和钉;
图21为图1的端部执行器的剖面正视图,其示出了在完全推进条件下的切割构件;
图22为图1的端部执行器的剖面正视图,其示出了在部分回缩条件下的切割构件和返回到未击发条件的多个钉驱动器;
图23为图1的端部执行器的剖面正视图,其示出了在完全回缩并压缩条件下的切割构件以及在打开条件下的砧座,其中在已从端部执行器中移除前一钉仓之后可将定位在轴内的钉仓推进到所述端部执行器中;和
图24为根据至少一个实施例的外科缝合器械的柄部的透视图。
贯穿多个视图,对应的参考符号指示对应的部件。本文示出的范例以一种形式示出了本发明的某些实施例,并且不应将此类范例理解为以任何方式限制本发明的范围。
具体实施方式
本申请的申请人还拥有以下的美国专利申请,这些专利申请与本申请同一天提交,并且每个都以引用方式各自整体并入本文:
FIRING MEMBER DISPLACEMENT SYSTEM FOR A STAPLINGINSTRUMENT,代理人案卷号END6853USNP/100538,发明人:BrettSwensgard;
STAPLING INSTRUMENT COMPRISING RESETTABLE STAPLEDRIVERS;代理人案卷号END6852USNP/100537,发明人:BrettSwensgard;和
STAPLING INSTRUMENT COMPRISING A PLURALITY OF STAPLECARTRIDGES STORED THEREIN;代理人案卷号END6854USNP/100539,发明人:Brett Swensgard。
现在将描述某些示例性实施例,以从整体上理解本文所公开的装置和方法的结构、功能、制造和用途。这些实施例的一个或多个实例在附图中示出。本领域的普通技术人员将会理解,本文具体描述和在附图中示出的装置和方法为非限制性的示例性实施例,并且本发明各种实施例的范围仅由权利要求书限定。就一个示例性实施例进行图解说明或描述的特征,可与其它实施例的特征进行组合。这种修改形式和变化形式旨在包括在本发明的范围之内。
本说明书通篇引用的“各种实施例”、“一些实施例”、“一个实施例”或“实施例”等,是指结合所述实施例描述的具体特征、结构或特性包括在至少一个实施例中。因此,本说明书通篇出现的短语“在多个实施例中”、“在一些实施例中”、“在一个实施例中”或“在实施例中”等并不一定都指相同的实施例。此外,在一个或多个实施例中,具体特征、结构或特性可按任何合适的方式组合。因此,在无限制的情况下,结合一个实施例示出或描述的具体特征、结构或特性可全部或部分地与一个或多个其它实施例的特征、结构或特性结合。这种修改形式和变化形式旨在包括在本发明的范围之内。
本文所用术语“近侧”和“远侧”是相对于操纵外科器械的柄部部分的临床医生而言的。术语“近侧”是指最靠近临床医生的部分,术语“远侧”是指远离临床医生的部分。还应当理解,为简洁和清楚起见,本文可以结合附图使用诸如“竖直”、“水平”、“上”和“下”之类的空间术语。然而,外科器械在许多方向和位置中使用,并且这些术语并非限制性的和/或绝对的。
提供了各种示例性装置和方法以执行腹腔镜式和微创外科手术操作。然而,本领域的普通技术人员将容易理解,本文所公开的各种方法和装置可用于许多外科手术和应用(例如,包括与开放式外科手术相结合)中。继续参阅本具体实施方式,本领域的普通技术人员将进一步理解,本文所公开的各种器械可以任何方式插入体内,例如通过自然腔道、通过形成于组织中的切口或穿刺孔等。器械的工作部分或端部执行器部分可被直接插入患者体内或可通过具有工作通道的进入装置而插入,外科器械的端部执行器及细长轴可通过所述工作通道而推进。
在各种实施例中,一种外科缝合器械可包括储存在其中的多个钉仓。在至少一个实施例中,所述缝合器械可包括能够以顺序次序容纳所述钉仓的端部执行器。例如,所述端部执行器可包括:能够将第一钉仓容纳在其中的钳口,其中在已部署所述第一钉仓之后,可将第二或顺序的钉仓进给到所述钳口中,使得所述外科缝合器械可被再使用一次。在至少一个此实施例中,可将所述端部执行器附接到外科缝合器械的轴,并且可将钉仓储存在所述轴中。为了将钉仓顺序地插入到端部执行器中,在各种实施例中,所述缝合器械还可包括可将所述钉仓推进到适合位置中的往复式驱动器。
在各种实施例中,现在参见图1,例如,缝合器械(例如,缝合器械100)可包括轴110和端部执行器120。主要参见图1A,轴110可包括框架111和外部外壳112。在至少一个实施例中,外部外壳112可整体地或至少部分地环绕框架111。在某些实施例中,现在参见图2,轴110可包括定位在其中的多个钉仓130。在至少一个实施例中,外部外壳112可包括可分离部分,所述可分离部分可从轴110上拆下,使得钉仓130可被填塞到轴110中。在某些实施例中,轴110可包括入口,钉仓130可通过所述入口被填塞到轴中。在各种实施例中,钉仓130可被个别地填塞到轴110中。在某些实施例中,钉仓130可被预填塞到盒内,所述盒可被插入到轴110中且可从轴110中移除。
在各种实施例中,再次参见图1和图2,可在已将钉仓(例如,第一钉仓130a)填塞到端部执行器120内的前提下将外科器械100供给至医生。在某些其它实施例中,可在并未将钉仓定位在端部执行器120内的前提下将外科器械100供给至医生。为了将钉仓定位在端部执行器120内,在各种实施例中,外科器械100可包括能够将钉仓推进到端部执行器120中的仓驱动器或进给杆140。现在参见图16和图16A,端部执行器120可包括具有仓通道122的第一钳口121,其中在至少一个此实施例中,例如,仓驱动器140能够将第一钉仓130a推进到仓通道122中。如图16和图16A中所示,在钉仓130a被推进到端部执行器120中之前,所述钉仓可相对于端部执行器120朝近侧定位。在此位置中,仓驱动器140的远端141能够定位在近侧凹陷部131内,所述近侧凹陷部被限定在钉仓130a的近端中。为了将钉仓130a推进到仓通道122中,现在参见图17和图17A,仓驱动器140可朝远侧运动以接合限定近侧凹陷部131的侧壁,并且然后使钉仓130a朝远侧运动到仓通道122中。
在各种实施例中,再次参见图16和图16A,仓通道122可包括(例如)位于仓通道122的相对侧上的一个或多个支撑凸台125,所述支撑凸台能够支撑钉仓(例如,钉仓130a),例如,如图17和图17A中所示。相似地,参见图2和图2A,例如,轴110可包括(例如)位于轴框架111的相对侧上的一个或多个支撑凸台115,所述支撑凸台能够支撑一个或多个钉仓,例如第一钉仓130a、第二钉仓130b、第三钉仓130c、第四钉仓130d和/或第五钉仓130e。在各种实施例中,现在参见图13和图14,每个钉仓130a至130e(例如)可包括仓体132和多个钉190,所述钉至少部分地定位在仓体132内。在下文中,例如,对钉仓130的任何一般引用可适用于钉仓130a至130e中的任何一个或多个。在各种实施例中,仓体132可包括:沿着仓体132的第一侧延伸的第一侧向支撑导轨133,和沿着仓体132的第二侧延伸的第二侧向支撑导轨133。在某些实施例中,仓体132的侧向支撑导轨133可由支撑凸台115和/或支撑凸台125支撑,其中在钉仓130从轴110运动到端部执行器120时,钉仓130可在其中由轴110中的支撑凸台115支撑钉仓130的位置和其中由端部执行器120中的支撑凸台125支撑钉仓130的位置之间滑动。
在各种实施例中,现在参见图24,例如,外科器械100还可包括柄部(例如,柄部160),其中柄部160可包括外壳161和手枪式握把162。在某些实施例中,柄部160还可包括第一触发器163和第二触发器164,其中第一触发器163和第二触发器164可以能够枢转的方式联接到外壳161。在某些实施例中,仓驱动器140可操作地联接到第一触发器163,使得当使第一触发器163在未致动位置(图24)和致动位置之间朝向手枪式握把162运动时,可使仓驱动器140朝向端部执行器120朝远侧运动。在至少一个实施例中,第一触发器163的完全冲程可致使仓驱动器140将钉仓130完全推进到端部执行器120中,如上文所述。在至少一个此实施例中,例如,仓驱动器140的近端可包括齿条,其中第一触发器163可包括能够接合所述齿条并使仓驱动器140朝远侧发生位移的驱动器。在各种其它实施例中,可利用任何适合的驱动安排以可操作地联接第一触发器163和仓驱动器140。在各种实施例中,柄部160还可包括锁165,所述锁能够将第一触发器163保持在致动位置中。在各种其它实施例中,柄部160还可包括第一触发器弹簧,所述第一触发器弹簧能够在已致动第一触发器163之后使第一触发器163往回偏置到它的未致动位置(图24)。在某些其它实施例中,返回弹簧可连接到仓驱动器140和柄部外壳161,其中当第一触发器163和仓驱动器140已到达其冲程末端时,驱动构件可与仓驱动器140脱离、或被旋转以解除接合。在此类情况下,返回弹簧可使仓驱动器140朝近侧往回偏置到它的未致动位置。在任何情况下,均可将仓驱动器140从近侧、未致动位置推进到远侧、致动位置,以便将钉仓130推进到端部执行器120中且然后再次返回到它的近侧位置。
一旦已将第一钉仓130a定位在端部执行器120中,如图2中所示,便可将端部执行器120定位在手术部位内。在各种实施例中,端部执行器120还可包括第二钳口123,所述第二钳口可围绕枢轴129以能够枢转的方式联接到第一钳口。在至少一个实施例中,第二钳口123可通过致动器而在打开位置(图2)和闭合位置(图1)之间枢转。在至少一个此实施例中,现在主要地参见图3、图18、图18A和图19,外科器械100还可包括击发构件170,所述击发构件可被朝远侧推进以便接合第二钳口123,并使第二钳口123朝第一钳口121向下枢转。在各种实施例中,击发构件170可包括第一凸缘172和第二凸缘173,其中第一凸缘172能够接合第一钳口121,并且第二凸缘173能够接合第二钳口122。更具体地,主要地参见图19,第一凸缘172能够沿着第一钳口121的外表面滑动,并且第二凸缘173能够进入到在第二钳口123中限定的槽103中并接合槽103的侧壁,以便使第二钳口123从打开位置(图18)凸轮转换到闭合位置(图19)。在各种实施例中,再次参见图24,柄部160的第二触发器164可可操作地联接击发构件170,使得在第二触发器164朝手枪式握把162运动时,击发构件170可被朝远侧驱动,如上文所述。在至少一个实施例中,击发构件170的近端可包括具有多个齿的齿条,并且第二触发器164可包括齿轮部分,所述齿轮部分能够接合齿条的齿并在第二触发器164在未致动位置(图24)和致动位置之间运动时朝远侧驱动所述齿条和击发构件170。在至少一个此实施例中,第二触发器164的完全致动可导致击发构件170的完全致动,在下文中将更详细地描述这一点。
如上文概述,驱动构件140和击发构件170可由两个单独触发器顺序地且彼此独立地致动。在某些其它实施例中,然而,外科器械可包括单个触发器,所述单个触发器在被致动时可顺序地致动驱动构件140和击发构件170。在任一情况下,读者都将认识到,驱动构件140和击发构件170可在外科器械100的操作期间相对于彼此运动。例如,在朝远侧推进驱动构件140以将钉仓130定位在端部执行器120中时,驱动构件140可相对于击发构件170运动。然而,在某些实施例中,现在参见图18A,击发构件170可包括远侧刀部分175,当击发构件170在它的未致动位置中时,所述远侧刀部分能够定位在端部执行器120的仓通道122和轴110的框架111中间。换句话说,当在仓通道122和框架111之间推进钉仓130时,远侧刀部分175可阻挡钉仓130的推进,除非如下文中更详细地描述,当钉仓130被推进到仓通道122中时远侧刀部分175被移动开。
为了将远侧刀部分175移动开,除了上述之外,还可使远侧刀部分175从其未致动位置(图18)运动到图5A和图16A中所示的降落位置。在各种实施例中,击发构件170可朝近侧回缩,使得远侧刀部分175可接触轴110的框架111和/或第一钳口121的一部分,并向下发生位移(例如)到一个位置,在所述位置处钉仓130的仓体132可在远侧刀部分175的顶部上方滑动,如下文更详细地描述。在至少一个此实施例中,现在参见图4A,第一钳口121可包括至少一个下倾斜坡或凸轮118,其中刀部分175能够接触下倾斜坡118并在所述下倾斜坡的下倾表面上向下滑动。在某些实施例中,刀部分175还可包括至少一个对应的下倾表面或从动件178,所述对应下倾表面或从动件能够接合至少一个下倾斜坡118。在至少一个此实施例中,下倾斜坡118和下倾表面178可在相同、或至少基本上相同的角度上取向。因此,在某些实施例中,(例如)击发构件的刀部分175可在横向于击发构件的击发路径的方向上下降,所述击发路径即其中推进击发构件170以击发或部署钉仓130的钉的路径,如下文进一步更详细地描述。在至少一个此实施例中,例如,此击发路径可包括在击发路径的近侧、未致动位置和所述击发路径的远侧、致动位置之间延伸的纵向轴。
在各种实施例中,参见图4A和图5A,第一钳口121可包括一个或多个窗、开口、狭槽、通道和/或凹陷部,所述窗、开口、狭槽、通道和/或凹陷部能够容许远侧刀部分175从其未致动位置运动到其降落位置。在至少一个实施例中,第一钳口121可包括:能够容纳击发构件170的第二凸缘173的凹陷部119,和能够当刀部分175运动到它的降落位置时容许击发构件170的第一凸缘172至少部分地向下降落离开第一钳口121的窗或开口109。在此点处,再次参见图16A,远侧刀部分175可不再阻挡钉仓的路径,并且因此,钉仓130可朝远侧滑动经过远侧刀部分175,如图17和图17A中所示,如上文所述。在至少一个此实施例中,第二凸缘173的顶表面可完全凹陷到凹陷部119中,或定位成基本上与凹陷部119的顶部齐平,使得钉仓130的仓体132可在所述顶部上滑动。在各种实施例中,第二凸缘173的顶表面可与仓支撑表面115和/或仓支撑表面125对准,和/或定位在仓支撑表面115和/或仓支撑表面125下面,使得钉仓130的仓体132可在所述仓支撑表面上无干扰地、或几乎无干扰地在其之间滑动。除了上述之外,大体参见图2A,随着钉仓130被推进经过远侧刀部分175进入到仓通道122中,每个钉仓130可包括可在第一侧向通道113内、沿着侧向刀部分175的第一侧滑动的多行钉,以及可在第二侧向通道113内、沿着远侧刀部分175的第二、或相对侧滑动的多行钉。
在各种实施例中,除了上述之外,击发构件170还可以选择性地接合第一触发器163,使得在朝手枪式握把162拉动第一触发器163以将钉仓130推进到端部执行器120中时,如上文所述,第一触发器163可朝近侧拉动击发构件170以使所述击发构件接触下倾斜坡118,以便使远侧刀部分175运动到它的下降位置中。在各种实施例中,第一触发器163可包括另一驱动构件,在致动第一触发器163时,所述驱动构件能够接合击发构件170的齿条部分并朝近侧拉动击发构件170。还类似于上文,在第一触发器163已到达其致动末端时,此驱动构件可与击发构件170脱离,使得击发构件170可由第二触发器164顺序地且独立地致动。尽管如此,一旦钉仓130已滑动经过被降低的刀部分175且钉仓130已充分地定位在端部执行器120内,仓驱动器140便可回缩到它的未致动位置,如上文所述,并且击发构件170可向上返回到它的未致动位置。在此类情况下,击发构件170可朝远侧发生位移,使得下倾表面178沿着下倾斜坡118向上滑动。在至少一个此实施例中,当远侧刀部分175运动到它的降落位置中时,击发构件170可回弹性地向下偏转,使得击发构件170可回弹性地返回到它的未致动位置。在某些实施例中,外科器械100还可包括弹簧,所述弹簧能够将击发构件170偏置到它的未致动位置中。在任何情况下,一旦钉仓130已定位在端部执行器120中,并且仓驱动器140和击发构件170已返回到它们的未致动位置,用以部署钉仓130的击发序列便可开始,如下文更详细地进一步描述。
现在再次转到图19,可将击发构件170从其未致动位置朝远侧推进,以接合第二钳口123并使第二钳口123运动到闭合位置中,如上文所述。在各种情况下,击发构件170的此运动可由第二触发器164的部分致动产生,其中如果医生需要,所述医生便可释放被部分致动的第二触发器164以将击发构件170返回到它的未致动位置,并使第二钳口123返回到它的打开位置。在至少一个此实施例中,端部执行器120可包括弹簧,所述弹簧能够在击发构件170回缩时将第二钳口123偏置到它的打开位置。此外,柄部160还可包括可操作地接合第二触发器164的触发器弹簧,所述触发器弹簧能够在由医生释放第二触发器164时将所述第二触发器返回到它的未致动位置。在任何情况下,医生均可重新打开端部执行器120,以便相对于目标组织重新定位钳口121和123,并且一旦医生对钳口121和123的位置感到满意,所述医生便可致动第二触发器164以再次闭合第二钳口123。随着第二钳口123运动到它的闭合位置,第二钳口123便可接触定位在第一钳口121和第二钳口123中间的组织,并相对于仓体132的顶表面或组织接触表面136来定位所述组织。在至少一个此实施例中,钉的顶端可相对于组织接触表面136凹陷,和/或定位成与组织接触表面136齐平,使得在相对于仓体132按压所述组织时,钉顶端不会刺穿或至少基本上刺穿相对于其定位的组织。一旦已闭合第二钳口123并已按压所述组织,便可朝远侧推进击发构件170,如上文所述。
在比较图19和图20时,读者将注意到,击发构件170已被部分地推进到端部执行器120中。如图20中所示,击发构件170的远端能够顺序地接合定位在第一钳口121内的多个钉驱动器180,以便朝第二钳口123提举多个钉190。现在参见图9和图10,击发构件170的远侧部分还可包括一个或多个提举斜坡171,所述提举斜坡能够接合钉驱动器180并在提举斜坡171通过所述钉驱动器下方时向上提举所述钉驱动器180。现在参见图6、图7、图8、图8A、图8B、和图8C,每个钉驱动器180可包括可由提举斜坡171接触的对应倾斜表面181。在各种实施例中,击发构件的提举斜坡171和钉驱动器180的倾斜表面181可以相同、或至少基本上相同的角度倾斜。主要地参见图6和图7,每个钉驱动器180可包括一个或多个钉支架187,所述钉支架可各自能够在它上面支撑钉190,如图19中所示。在至少一个实施例中,现在参见图13和图14,每个钉190可包括能够定位在支架187中的基底197和从基底197向上延伸的一个或多个钉腿196。如图13和图14中同样所示,钉腿196的至少一部分能够定位在仓体132内和/或延伸穿过仓体132,其中如下文更详细地描述,钉驱动器180能够在推进击发构件170时使钉190相对于仓体132运动。
主要地参见图120,击发构件170的提举斜坡171可接触最近侧的钉驱动器180,并开始朝第二钳口123提举所述钉驱动器以及所述钉驱动器上面所支撑的钉190。随着击发构件170甚至更进一步地朝端部执行器120的远端行进,提举斜坡171可顺序地接触钉驱动器180并朝第二钳口123提举在所述钉驱动器上面所支撑的钉190。如图20中所示,随着提举斜坡171在钉驱动器下面滑动,钉驱动器180可沿着提举斜坡171逐渐地向上滑动。在各种实施例中,钉仓130的仓体132可由组织和第二钳口123保持在适当位置,其中在钉190被向上提举时,钉190的钉腿196可因此相对于仓体132运动。在各种实施例中,再次参见图13和图14,仓体132可包括多个引导狭槽139,所述引导狭槽可各自能够在钉腿196相对于仓体132运动时引导所述钉腿。在至少一个实施例中,引导狭槽139能够紧密地容纳钉腿196,使得它们之间的相对运动可被限制为本文中所述的向上运动。随着钉腿196被向上提举,钉腿196可通过仓体132中所限定的洞或孔138而从仓体132中出现。在各种实施例中,再次参见图13和图14,仓体132还可包括多个纵向导轨134,引导狭槽139和孔138均可限定在所述纵向导轨中。在至少一个此实施例中,例如,纵向导轨134可限定纵向狭槽157的第一侧上的三行钉190和狭槽157的第二侧上的三行钉190。
如上文所述,钉驱动器180可朝第二钳口123向上发生位移。在各种实施例中,现在主要地参见图4A,第一钳口121的仓通道122可包括一个或多个结构,所述一个或多个结构能够在钉驱动器180相对于仓通道122运动时沿着预定路径引导所述钉驱动器。在至少一个实施例中,参见图6和图7,每个钉驱动器180可包括导轨182,所述导轨能够以能够滑动的方式容纳在仓通道122的外部侧壁中所限定的引导狭槽126内。在至少一个此实施例中,例如,引导狭槽126可各自能够局限钉驱动器180沿着直线或轴的运动,所述直线或轴可垂直于或至少基本上垂直于仓体132的顶表面136。除了上文之外或代替上文,例如,仓通道122还可包括(例如)限定在仓通道122的内部侧壁中的一个或多个引导通道127,所述仓通道可至少部分地包括能够以能够滑动的方式将驱动器180的至少一部分容纳在其中的腔体。在各种实施例中,例如,引导通道127可各自能够局限钉驱动器沿着直线的运动,所述直线可垂直于或至少基本上垂直于仓体132的顶表面136。在包括引导狭槽126和引导通道127两者的实施例中,例如,可在驱动器的相对两侧上引导每个驱动器180。
在各种实施例中,除了上述之外,第二钳口123还可包括砧座124,所述砧座能够使钉190的钉腿196变形,如图20和图21所示。在某些实施例中,砧座124可包括多个钉凹坑,例如,所述钉凹坑可各自能够将至少一个钉腿196容纳在其中,并使钉腿196变形到期望的构型。随着钉腿196发生变形,每个钉190可将组织的一部分捕获在其中并相对于仓体132的顶表面136按压所述组织。在各种实施例中,每个钉190的钉腿196可朝彼此向内弯曲,并将所捕获的组织抵靠桥接件195保持和/或按压在它们之间,例如,所述桥接件在仓体132中所限定的钉腿孔198之间延伸。在某些实施例中,钉190可被向上推动,直到钉190的基底196毗邻或接触桥接器195定位为止。在至少一个实施例中,主要地参见图14,例如,仓体132可包括具有两行或更多行钉190的第一部分和具有两行或更多行钉190的第二部分,其中所述第一部分可通过一个或多个连接器156连接到所述第二部分。在至少一个此实施例中,连接器156可跨越在仓体132中限定的纵向狭槽157延伸,其中如上文所述,在击发构件170朝远侧推进以部署钉190并截断组织时,连接器156可由远侧刀部分175断开和/或切开。在连接器156已被分离、断开或切开之后,仓体132的第一部分和第二部分可彼此不连接。
如图21中所示,击发构件170可被朝远侧推进,直到击发构件170的远侧刀部分175已到达端部执行器120的远端为止。此时,在各种情况下,所有钉驱动器180将已从它们的未击发位置运动到它们的击发位置,同样如图21中所示。在某些其它情况下,击发构件170将不被完全推进到端部执行器120内,并且仅一些钉驱动器180可从它们的未击发位置向上运动。在任一情况下,击发杆170可在击发至少一些钉190之后回缩到它的未致动位置。在各种实施例中,现在参见图22,击发构件170的远侧刀部分175能够接合被击发的钉驱动器180,并在击发杆170回缩时将钉驱动器180返回到它们的未击发位置。现在参见图8A和图8B,每个驱动器180还可包括复位斜坡186,所述复位斜坡可由从击发构件170延伸的复位构件174接合。更具体地,击发构件170的复位构件174可进入到限定在驱动器180中的复位腔体184中,使得沿着复位构件174的底侧延伸的底部驱动表面或凸轮表面176可接合复位斜坡186,并向下推动、即朝复位斜坡的未击发位置推动复位斜坡186。在各种实施例中,驱动表面176和复位斜坡186可以相同、或至少基本上相同的角度取向,而在其它实施例中,其可以不同的角度取向。在各种其它实施例中,钉驱动器180可包括任何适合的表面,驱动表面176可将力施加到所述适合的表面。在至少一个实施例中,复位构件174可包括近侧引入端部分174a,在某些情况下,所述近侧引入端部分能够在驱动表面176接触复位斜坡186之前便进入复位腔体184。在至少一个此实施例中,近侧引入端部分174a可包括斜表面,所述斜表面可初始地接触钉驱动器180并在钉驱动器180由驱动表面176向下转移之前调整钉驱动器180的位置。如上文所论述,每个钉驱动器180的运动可被局限在垂直路径上,例如,其中在复位构件174通过此垂直路径时,每个钉驱动器180可沿着此垂直路径向下发生位移。到复位构件174的远侧部分174b已退出钉驱动器180的复位腔体184时为止,在各种实施例中,钉驱动器180将已经返回到它的未击发位置。
再次参见图22和图23,在击发构件170回缩到它的未致动位置时,击发构件170的复位构件174可初始地复位最远侧的钉驱动器180,并且然后顺序地复位其余的钉驱动器180。在击发构件170回缩时,击发构件170的第二凸缘173可退出第二钳口123的纵向狭槽103,从而允许第二钳口123重新打开,如上文所论述。一旦第二钳口123已被充分地重新打开,如图23中所示,则第一钳口121可移动远离所植入的钉仓130a。更具体地,如上文所论述,钉190可捕获抵靠组织的仓体132,使得在第一钳口121移动远离所述组织时,仓体132可与第一钳口121分离并与组织留在一起。在2011年4月29日提交的名称为STAPLE CARTRIDGE COMPRISING STAPLESPOSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF的美国专利申请13/097,856的公开全文以引用方式并入本文。在2010年9月30日提交的名称为IMPLANTABLE FASTENER CARTRIDGE COMPRISING ASUPPORT RETAINER的美国专利申请12/894,369的公开全文也以引用方式并入本文。在已植入钉仓130a并将其从钉仓通道122中移除之后,可将第二钉仓(例如,钉仓130b)推进到钉仓通道122中。如上文所述,击发构件170可从它的未致动位置回缩到它的下降位置,使得钉仓130b可由仓驱动器140朝远侧推进经过击发构件170并进入到端部执行器120中。此时,可再次使用被重新填塞的外科缝合器100。
在已植入第二钉仓130b之后,除了上述之外,还可将第三钉仓130c推进到端部执行器120中。事实上,外科缝合器100的所示实施例可包括定位在其中的五个钉仓130,但还可以想到包括定位在其中的少于五个钉仓或多于五个钉仓的其它实施例。在任何情况下,钉仓130的连续、或顺序供给可使医生重复地使用外科缝合器100,而不必从手术部位移除端部执行器120以便重新填塞。换句话说,某些先前的外科缝合器需要从手术部位移除其端部执行器以便重新填塞,这增加了完成外科手术所需要的时间。此外,某些先前的外科缝合器需要医生从其端部执行器中移除已用完的钉仓以便插入新的钉仓,这也增加了完成外科手术所需要的时间。在任何情况下,在本文中都可以想到某些实施例,其中一旦已耗尽容纳在轴110内的钉仓130的供给,便可将额外的钉仓130插入到外科缝合器100的轴110中,使得钉仓130可被进给到端部执行器120中,如上文所述。此外,还可以想到至少一个实施例,其中在已耗尽容纳在外科缝合器100内的钉仓130的供给之后,可将钉仓130手动地插入到钉仓通道122中。
如上文所述,外科缝合器100能够将连续的、或顺序的多个钉仓130供给到端部执行器120中。同样如上文所述,外科缝合器100的仓驱动器140可在近侧位置和远侧位置之间往复运动,以便将容纳在轴110内的最远侧钉仓130顺序地推进到仓通道122中。换句话说,仓驱动器140能够将钉仓130从暂存位置(图16)推进到填塞位置(图2),并且在仓驱动器140已返回到它的近侧位置且已植入被填塞的钉仓130之后,仓驱动器140可将另一钉仓130从暂存位置再次推进到填塞位置。在至少一个此实施例中,仓驱动器140可在最近侧钉仓130上延伸,使得仓140的远端可直接接合最远侧钉仓130。在各种实施例中,再次参见图3,外科器械100还可包括偏置构件150,所述偏置构件能够在先前定位在暂存位置中的钉仓130被推进到仓通道122中时为另一钉仓130供给暂存位置,如上文所述。在至少一个此实施例中,偏置构件150可包括远侧滑动件151,所述远侧滑动件能够接触最近侧的仓130且另外接触一个或多个推动棒152,所述推动棒能够将偏置力传输到远侧滑动件151。在至少一个此实施例中,偏置构件150可包括弹簧和/或任何其它适合的回弹性构件,所述回弹性构件能够将连续的偏置力施加到最近侧的仓130。再次参见图13,每个钉仓130的仓体132可包括对准突出部137,所述对准突出部可由远侧滑动件151接合以将偏置力传输到仓体132。在某些实施例中,对准突出部137可限定近侧凹陷部131,其中远侧滑动件151可容纳在近侧凹陷部131内。
在各种实施例中,除了上述之外,由偏置构件150施加到最近侧钉仓130的偏置力可使最近侧的钉仓130向前滑动,和/或邻接朝其远侧定位的毗邻钉仓130。参见图3,偏置构件150可将偏置力施加到钉仓130e,所述钉仓130e可邻接钉仓130d并将偏置力传输到钉仓130d。相似地,例如,钉仓130d可邻接钉仓130c,并且钉仓130c可邻接钉仓130b,使得偏置力从偏置构件150一路传输到第二钉仓130b。正如读者将了解,由偏置构件150施加到最近侧钉仓130e的偏置力趋于朝远侧推动所有钉仓130,并且具体来说,趋于朝远侧推动第二钉仓130b离开暂存位置。为了使第二钉仓130b和/或任何其它钉仓130在由仓驱动器140朝远侧推进之前被保持在暂存位置中,如上文所述,例如,轴框架111可包括一个或多个保持构件,所述保持构件能够以能够释放的方式将钉仓130保持在暂存位置中。现在参见图15,轴框架111可包括固位臂107,所述固位臂可各自包括能够阻挡钉仓130朝远侧推进的止动件106。更具体地,止动件106可与支撑凸台115对准,使得钉仓130的仓体132可邻接止动件106,并使得止动件106可以能够释放的方式将仓体132保持在支撑凸台115内。在至少一个此实施例中,止动件106可限定暂存位置的远端,其中当钉仓接触止动件106时,钉仓130可被保持在暂存位置中。在各种实施例中,如上文所述,固位臂107足够刚性以承受和抵抗由偏置构件150通过钉仓130传输的偏置力。然而,在此类实施例中,仓驱动器140能够将足够的力供给到第二仓130b,以便使第二仓130b离开暂存位置并朝远侧推进所述第二仓130b。在此类情况下,固位臂107和限定在所述固位臂中的止动件106可折曲或向上运动,使得(例如)第二钉仓130b可经过那里。随着钉仓130b朝远侧运动,固位臂107可与仓体132的侧面导轨133接合,并且一旦仓体132已经过固位臂107,固位臂107便可回弹性地向内返回。
除了上述之外,读者还将注意到,随着第二钉仓130b朝远侧推进,偏置构件150可用于保持第三钉仓130c接触第二钉仓130b。在此类情况下,固位臂107可从它们的伸展位置回弹性地返回,以捕捉第三钉仓130c并将钉仓130c保持在暂存位置中。在至少一个实施例中,例如,每个钉仓的仓体132可包括限定在侧面导轨133的远端中的凹痕或凹陷部,所述凹痕或凹陷部可提供对回弹性臂107的适合捕捉,以接合钉仓130并使其不过早地被推进离开暂存位置。除了上述之外或替代上述,每个仓体132的侧面导轨133还可包括近侧凹痕或凹陷部,例如,所述近侧凹痕或凹陷部可在后续钉仓130到达其完全暂存位置之前使回弹性臂107回弹性地返回到它们的未折曲状态,从而阻止后续钉仓130被推进经过所述暂存位置。在任何情况下,一旦第二钉仓130b已由仓驱动器140定位在端部执行器120中,仓驱动器140便可回缩到它的近侧、未致动位置,使得仓驱动器140的远端141定位在第三钉仓131c的远侧凹陷部131内。在已部署第二仓130b之后,在偏置构件150将第四钉仓130d推进到暂存位置中时,仓驱动器140可将第三钉仓130c从暂存位置推进到端部执行器120中。相似地,在已部署第三仓130c之后,在偏置构件150将第五钉仓130e推进到暂存位置中时,仓驱动器140可将第四钉仓130d从暂存位置推进到端部执行器120中,并且依此类推。
如上文所述,钉仓130可被滑动到端部执行器120中,使得可由钉驱动器180来部署或击发钉仓130的钉190。在各种实施例中,钉仓130可被推进到预定位置,在所述预定位置处钉190的基底197与钉驱动器180的钉支架187对准。在至少一个实施例中,仓通道122可包括正向止动件或基准,仓驱动器140可将钉仓130抵靠所述正向止动件或基准定位,其中当仓体132抵靠此基准定位时,钉190的基底197可与钉支架187对准。在各种实施例中,限定在仓通道122的侧面中的支撑凸台125和/或限定在轴框架111中的支撑凸台115(例如)可限定能够紧密地容纳支撑导轨133的通道、狭槽和/或凹陷部。在至少一个此实施例中,主要地参见图14,支撑凸台115和/或支撑凸台125可包括至少部分地被封闭的沟槽,所述沟槽可抑制或至少限制仓体132相对于轴框架111和/或仓通道122的向上运动。在各种实施例中,如上文所述,包括支撑凸台125的沟槽能够以能够释放的方式将仓体132保持在适当位置,直到第一钳口121从所植入的仓体132移动离开为止。在至少一个此实施例中,仓体132能够在将第一钳口121拉动离开时折曲,使得支撑导轨133可从支撑凸台沟槽中突出或跳出。在各种实施例中,仓体132可由至少一个可生物吸收的、生物相容性和/或生物稳定的塑料材料构成,例如,所述材料具有足够的柔性以如上文所述而折曲。
如上文所述,外科器械100可包括储存在其中的多个钉仓130a至130e,例如,所述钉仓可被连续地或顺序地供给至所述外科器械的端部执行器120。在各种实施例中,例如,钉仓130a至130e可为一致的或至少基本上一致的。在至少一个实施例中,例如,钉仓130a至130e的钉190可各自由具有相同或至少基本上相同直径的线材构成。在各种实施例中,例如,此线材可由至少一种金属(例如,不锈钢和/或钛)构成。例如,钉仓130a至130e的钉190也可由具有相同、或至少基本上相同长度的线材构成。在各种实施例中,钉仓130a至130e的钉190可具有相同、或至少基本上相同的总体未成形高度。在至少一个此实施例中,钉190的总体未成形高度可被限定为钉基底197的底表面和所述钉的钉腿196的尖端之间的距离。在至少一个实施例中,钉腿196可具有相同或至少基本上相同的长度,所述长度即钉基底197的顶表面和钉腿196的尖端之间的距离。在各种实施例中,在任何情况下,外科缝合器100均能够将连续一致、或几乎一致的钉仓130供给至端部执行器120。
在各种其它实施例中,在至少一个方面,储存在外科缝合器100中的一个或多个钉仓可不同于储存在外科缝合器100中的其它钉仓。在至少一个此实施例中,储存在外科缝合器100中的一个或多个钉仓可包括具有至少一个不同直径的钉。例如,储存在外科缝合器内的第一钉仓可包括多个由具有第一直径的线材构成的第一钉,储存在外科缝合器内的第二钉仓可包括多个由具有第二直径的线材构成的第二钉,并且储存在外科缝合器内的第三钉仓可包括多个由具有第三直径的线材构成的第三钉,其中所述第一直径可不同于所述第二直径,所述第二直径可不同于所述第三直径,并且所述第一直径可不同于所述第三直径。在某些实施例中,例如,钉仓可包括由具有第一直径的线材构成的第一行钉、由具有第二直径的线材构成的第二行钉、和/或由具有第三直径的线材构成的第三行钉,其中所述第一直径可不同于所述第二直径,所述第二直径可不同于所述第三直径,并且所述第一直径可不同于所述第三直径。在某些实施例中,储存在外科缝合器100内的一个或多个钉仓可包括具有至少一个不同的未成形高度的钉。例如,储存在外科缝合器内的第一钉仓可包括多个具有第一高度的第一钉,储存在外科缝合器内的第二钉仓可包括多个具有第二高度的第二钉,并且储存在外科缝合器内的第三钉仓可包括多个具有第三高度的第三钉,其中所述第一高度可不同于所述第二高度,所述第二高度可不同于所述第三高度,并且所述第一高度可不同于所述第三高度。在某些实施例中,例如,钉仓可包括具有第一高度的第一行钉、具有第二高度的第二行钉、和/或具有第三高度的第三行钉,其中所述第一高度可不同于所述第二高度,所述第二高度可不同于所述第三高度,并且所述第一高度可不同于所述第三高度。在某些实施例中,储存在外科缝合器100内的一个或多个钉仓可包括具有至少一个不同的未成形腿长度的钉。例如,储存在外科缝合器内的第一钉仓可包括多个具有第一腿长度的第一钉,储存在外科缝合器内的第二钉仓可包括多个具有第二腿长度的第二钉,并且储存在外科缝合器内的第三钉仓可包括多个具有第三腿长度的第三钉,其中所述第一腿长度可不同于所述第二腿长度,所述第二腿长度可不同于所述第三腿长度,并且所述第一腿长度可不同于所述第三腿长度。在某些实施例中,例如,钉仓可包括具有第一腿长度的第一行钉、具有第二腿长度的第二行钉、和/或具有第三腿长度的第三行钉,其中所述第一腿长度可不同于所述第二腿长度,所述第二腿长度可不同于所述第三腿长度,并且所述第一腿长度可不同于所述第三腿长度。
在各种实施例中,除了上述之外,包含在外科缝合器械内的钉仓130还可包括不同仓体。例如,第一钉仓130的仓体可具有第一厚度,而第二钉仓130的仓体可具有不同于所述第一厚度的第二厚度。在至少一个此实施例中,例如,所述第二厚度可比所述第一厚度厚。在某些实施例中,第一钉仓130的仓体可由第一材料构成,而第二钉仓130的仓体可由不同于所述第一材料的第二材料构成。在至少一个此实施例中,例如,所述第二材料可比所述第一材料更具有柔性。
在各种实施例中,可用预定次序将不同的钉仓填塞到轴110中,使得根据预定序列来利用所述钉仓。在至少一个此实施例中,外科手术可需要外科器械来缝合及截断具有第一厚度的第一胃组织部分、然后是具有较厚厚度的第二胃组织部分,其中在此类情况下,例如,第一钉仓所包括的钉可比第二钉仓中所包含的钉具有更短的未成形高度。例如,当执行Rouen-Y外科技术时,可出现此类情况。
在各种替代实施例中,除了上述之外且再次参见图9和图10,复位构件174的顶表面可包括能够接合钉驱动器180的驱动表面。在至少一个此实施例中,现在参见图6和图7,每个钉驱动器180可包括驱动表面183,在击发构件170朝远侧推进时所述驱动表面可由复位构件174的顶表面接合,以便使钉驱动器180和支撑在所述钉驱动器上面的钉190向上发生位移。在至少一个实施例中,复位构件174的顶表面可限定倾斜的提举表面,所述提举表面可平行于或至少基本上平行于底部较低表面176。在某些实施例中,由于上述的结果,复位构件174可包括斜坡,所述斜坡包括提举钉驱动器180的顶表面和使钉驱动器180降低的底表面。在各种实施例中,复位构件174能够使得每个复位构件174的端部174a和174b相对于远侧刀部分175的切割边缘朝远侧定位。在至少一个此实施例中,在切割边缘经过组织的被缝合部分并切开所述被缝合部分之前,所述钉可形成为其完全击发高度,或至少基本上为完全击发高度。在各种实施例中,再次参见图9和图10,击发构件170的远侧刀部分175可包括底表面177,所述底表面能够沿着钉仓通道122的底表面滑动。在至少一个此实施例中,第一钳口121还可包括具有辐射式边缘和/或斜边缘的引入端108(图4A),例如,所述引入端能够将底表面177引导到仓通道122中,尤其是在远侧刀部分175已运动到它的较低位置中之后。
可将本发明所公开的装置设计为单次使用后即进行处理,或者可将它们设计为可多次使用。然而,在任一种情况下,所述装置均可被修复,以在至少一次使用后再次使用。修复可包括如下步骤的任意组合:拆卸所述装置、然后清洗或置换特定部件以及随后重新装配。特别是,所述装置可被拆卸,而且可以任意组合选择性地置换或移除所述装置的任意数目的特定部件或部分。清洗和/或置换特定部件之后,所述装置可以在修复设施处、或者在即将进行外科手术前由手术团队重新装配以便随后使用。本领域的技术人员将了解到,装置的修复可利用多种用于拆卸、清洗/置换和重新装配的技术。这些技术的使用以及所得的被修复装置均在本发明的范围内。
优选的是,本文所述的本发明将在手术前得以处理。首先,获取新的或用过的器械,并在必要时对器械进行清洁。然后对器械进行消毒。在一种消毒技术中,将所述器械置于闭合并密封的容器中,例如塑料或TYVEK袋中。然后将容器和器械置于能够穿透所述容器的辐射场内,例如γ辐射、x-射线或高能电子。辐射将器械上和容器中的细菌杀死。然后将消毒后的器械储存在无菌容器中。该密封容器将器械保持无菌,直到在医疗设施中打开该容器为止。
以引用方式全文或部分地并入本文的任何专利、专利公开或其它公开材料均仅在所并入的材料不与本发明所述的现有定义、陈述或其它公开材料相冲突的范围内并入本文。由此,在必要的程度下,本文所明确阐述的公开内容将取代以引用方式并入本文的任何相冲突的材料。任何据称为以引用方式并入本文但与本文所述的现有定义、陈述或其它公开材料相冲突的任何材料或其部分将仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。
尽管已经将本发明作为示例性设计进行了描述,但还可以在本公开的精神和范围内对本发明进行另外的修改。因此本专利申请旨在涵盖采用本发明一般原理的任何变型、用途或适应型式。此外,本专利申请旨在涵盖本发明所属领域中出自已知或惯有实践范围内的背离本公开的型式。
Claims (20)
1.一种外科缝合器械,包括:
包括触发器的柄部;
从所述柄部延伸的轴;
击发构件,所述击发构件与所述触发器可操作地联接,使得击发动作能够从所述触发器传递到所述击发构件以使所述击发构件沿着击发路径运动;
定位在所述轴内的多个钉仓,其中每个所述钉仓包括:
包括多个孔的仓体;和
多个钉,所述钉各自包括定位在所述孔中的钉腿,其中所述钉腿能够在所述孔内滑动;
第一钳口,所述第一钳口包括能够容纳所述钉仓的通道,其中所述第一钳口包括定位在其中的多个钉驱动器,并且其中所述击发构件能够接合所述钉驱动器,并且使所述钉驱动器在第一位置和第二位置之间运动;
包括砧座的第二钳口,其中当所述钉被驱动到所述第二位置中时,所述钉腿能够接触所述砧座;
仓驱动器,所述仓驱动器能够将所述钉仓从暂存位置顺序地推进到所述通道中;和
偏置构件,所述偏置构件能够将所述钉仓顺序地推进到所述暂存位置中。
2.根据权利要求1所述的外科缝合器械,其中所述多个钉仓包括近侧钉仓和定位在所述暂存位置中的远侧钉仓,并且其中所述仓驱动器能够直接接合所述远侧钉仓并将所述远侧钉仓推进到所述通道中,并且其中所述偏置构件能够直接接合所述近侧钉仓。
3.根据权利要求2所述的外科缝合器械,其中所述多个钉仓还包括定位在所述近侧钉仓和所述远侧钉仓中间的中间钉仓,并且其中所述偏置构件能够通过推动所述近侧钉仓而将所述中间钉仓推动到所述暂存位置中。
4.根据权利要求1所述的外科缝合器械,其中所述偏置构件包括往复式进给杆,所述往复式进给杆在并非定位在所述第一钳口和所述暂存位置中的所述钉仓上方延伸。
5.根据权利要求1所述的外科缝合器械,其中每个所述仓体包括近端和远端,其中每个所述近端包括驱动凹陷部,并且其中所述仓驱动器能够接合所述驱动凹陷部中的所述仓体。
6.根据权利要求1所述的外科缝合器械,其中每个所述钉仓包括第一行钉和第二行钉,其中所述轴包括第一通道和第二通道,其中所述第一行钉能够定位在所述第一通道内,并且其中所述第二行钉能够定位在所述第二通道内。
7.根据权利要求1所述的外科缝合器械,其中所述第一钳口还包括多个驱动器腔体,其中每个所述驱动器腔体限定部署轴线,并且其中所述钉驱动器定位在所述驱动器腔体中并且能够沿着所述部署轴线运动。
8.一种外科缝合器械组件,包括:
包括可移除的盒的轴;
击发构件,所述击发构件与致动器可操作地联接,使得击发动作能够从所述致动器传递到所述击发构件以使所述击发构件沿着击发路径运动;
能够定位在所述盒内的多个钉仓,其中每个所述钉仓包括:
包括多个孔的仓体;和
多个钉,所述钉各自包括定位在所述孔中的钉腿,其中所述钉腿能够在所述孔内滑动;
第一钳口,所述第一钳口包括能够容纳所述钉仓的通道,其中所述第一钳口包括定位在其中的多个钉驱动器,并且其中所述击发构件能够接合所述钉驱动器,并且使所述钉驱动器在第一位置和第二位置之间运动;
包括砧座的第二钳口,其中当所述钉被驱动到所述第二位置中时,所述钉腿能够接触所述砧座;
仓驱动器,所述仓驱动器能够将所述钉仓从暂存位置顺序地推进到所述通道中;和
偏置构件,所述偏置构件能够将所述钉仓顺序地推进到所述暂存位置中。
9.根据权利要求8所述的外科缝合器械组件,其中所述多个钉仓包括近侧钉仓和定位在所述暂存位置中的远侧钉仓,并且其中所述仓驱动器能够直接接合所述远侧钉仓并将所述远侧钉仓推进到所述通道中,并且其中所述偏置构件能够直接接合所述近侧钉仓。
10.根据权利要求9所述的外科缝合器械组件,其中所述多个钉仓还包括定位在所述近侧钉仓和所述远侧钉仓中间的中间钉仓,并且其中所述偏置构件能够通过推动所述近侧钉仓而将所述中间钉仓推动到所述暂存位置中。
11.根据权利要求8所述的外科缝合器械组件,其中所述偏置构件包括往复式进给杆,所述往复式进给杆在并非定位在所述第一钳口和所述暂存位置中的所述钉仓上方延伸。
12.根据权利要求8所述的外科缝合器械组件,其中每个所述仓体包括近端和远端,其中每个所述近端包括驱动凹陷部,并且其中所述仓驱动器能够接合所述驱动凹陷部中的所述仓体。
13.根据权利要求8所述的外科缝合器械组件,其中每个所述钉仓包括第一行钉和第二行钉,其中所述盒包括第一通道和第二通道,其中所述第一行钉能够定位在所述第一通道内,并且其中所述第二行钉能够定位在所述第二通道内。
14.根据权利要求8所述的外科缝合器械组件,其中所述第一钳口还包括多个驱动器腔体,其中每个所述驱动器腔体限定部署轴线,并且其中所述钉驱动器定位在所述驱动器腔体中并且能够沿着所述部署轴线运动。
15.一种外科缝合器械,包括:
包括触发器的柄部;
从所述柄部延伸的轴;
击发构件,所述击发构件与所述触发器可操作地联接,使得击发动作能够从所述触发器传递到所述击发构件以使所述击发构件沿着击发路径运动;
定位在所述轴内的多个钉仓,其中每个所述钉仓包括:
包括多个孔的仓体;和
多个钉,所述钉各自包括定位在所述孔中的钉腿,其中所述钉腿能够在所述孔内滑动;
第一钳口,所述第一钳口包括能够容纳所述钉仓的通道;
包括砧座的第二钳口,其中所述钉腿能够接触所述砧座;
仓驱动器,所述仓驱动器能够将所述钉仓从暂存位置顺序地推进到所述通道中;和
偏置构件,所述偏置构件能够将所述钉仓顺序地推进到所述暂存位置中。
16.根据权利要求15所述的外科缝合器械,其中所述多个钉仓包括近侧钉仓和定位在所述暂存位置中的远侧钉仓,并且其中所述仓驱动器能够直接接合所述远侧钉仓并将所述远侧钉仓推进到所述通道中,并且其中所述偏置构件能够直接接合所述近侧钉仓。
17.根据权利要求16所述的外科缝合器械,其中所述多个钉仓还包括定位在所述近侧钉仓和所述远侧钉仓中间的中间钉仓,并且其中所述偏置构件能够通过推动所述近侧钉仓而将所述中间钉仓推动到所述暂存位置中。
18.根据权利要求15所述的外科缝合器械,其中所述偏置构件包括往复式进给杆,所述往复式进给杆在并非定位在所述第一钳口和所述暂存位置中的所述钉仓上方延伸。
19.根据权利要求15所述的外科缝合器械,其中每个所述仓体包括近端和远端,其中每个所述近端包括驱动凹陷部,并且其中所述仓驱动器能够接合所述驱动凹陷部中的所述仓体。
20.根据权利要求15所述的外科缝合器械,其中每个所述钉仓包括第一行钉和第二行钉,其中所述轴包括第一通道和第二通道,其中所述第一行钉能够定位在所述第一通道内,并且其中所述第二行钉能够定位在所述第二通道内。
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