CN104135951B - 具有用于确定仓和击发动作状态的设备的外科切割和紧固器械 - Google Patents

具有用于确定仓和击发动作状态的设备的外科切割和紧固器械 Download PDF

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CN104135951B
CN104135951B CN201380009048.2A CN201380009048A CN104135951B CN 104135951 B CN104135951 B CN 104135951B CN 201380009048 A CN201380009048 A CN 201380009048A CN 104135951 B CN104135951 B CN 104135951B
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resistive elements
surgical
resistor
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CN104135951A (zh
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J·R·摩根
F·E·谢尔顿四世
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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
    • A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A61B17/105—Wound clamp magazines
    • 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
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/76—Manipulators having means for providing feel, e.g. force or tactile feedback
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00115—Electrical control of surgical instruments with audible or visual output
    • A61B2017/00128—Electrical control of surgical instruments with audible or visual output related to intensity or progress of surgical action
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00685—Archimedes screw
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07285—Stapler heads characterised by its cutter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2902—Details of shaft characterized by features of the actuating rod
    • A61B2017/2903—Details of shaft characterized by features of the actuating rod transferring rotary motion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0807—Indication means
    • A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument

Abstract

用于确定击发元件在外科器械的端部执行器中的位置的传感器构造。在各种形式中，传感器构造包括被支撑在端部执行器中的电阻元件(152)。随着击发元件(32,33,36)在端部执行器内平移，其移动地接触电阻元件以产生指示击发元件位置的信号。在其它构造中，传感器可检测钉仓在端部执行器中的状态或存在。传感器构造可与存储器装置(160)、处理器(180)和指示器(1005)连通。

Description

具有用于确定仓和击发动作状态的设备的外科切割和紧固 器械
技术领域
一般来讲，本发明涉及外科器械，更具体地，涉及具有能够确定仓和击发动作状态的电子传感器的外科切割和紧固器械。
背景技术
外科器械通常包括远侧端部执行器(如，直线切割器、抓紧器、切割器、缝合器、施夹器、进入装置、药物/基因治疗递送装置、以及使用超声、射频、激光等的能量装置)，该远侧端部执行器在手术部位接合组织，以达到诊断或治疗的效果。例如，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切开纵向切口，同时在切口的相对侧上施加成排的钉。此类外科缝合器通常具有击发杆，该击发杆响应于手动或马达驱动动作在端部执行器中平移。击发杆驱动切割元件穿过端部执行器中持有的组织，并驱动多个楔形物抵靠支撑钉的驱动器以实现钉从端部执行器的击发。
外科器械在操作期间大体不提供足够的用户反馈。一般来讲，例如，在切割和缝合操作期间，许多机器人控制的外科缝合器不警示用户部署力和切割元件的位置。因此，马达驱动内切割器在驱动动作仅通过挤压按钮致动的情况下大体不会为医生所接受。因此，本领域中需要解决上述一些不足之处的外科器械。
上述讨论仅仅是为了举例说明本领域中目前存在的一些不足之处，而不应看作是对权力要求范围的否定。
发明内容
本公开涉及一种电子传感器，该电子传感器用于确定击发元件在端部执行器中的位置和/或钉仓在端部执行器中的状态。该电子传感器具有支撑在端部执行器中的电阻构件。能够在端部执行器内平移的击发元件随着该击发构件的平移来移动地接触电阻构件。随着击发元件平移，附接至其的切割元件可切断电阻构件中的电阻器。该电子传感器可与存储器装置、处理器和指示器连通。
根据本发明的各种实施例的一般方面，提供一种包括外科端部执行器的外科器械，该外科端部执行器包括具有近端和远端的细长通道；击发元件，该击发元件能够在被施加驱动动作时在所述细长通道的所述近端和所述细长通道的所述远端之间选择性地平移；电阻构件，该电阻构件被支撑用于随着所述击发元件被从所述细长通道的所述近端驱动至所述远端由所述击发元件移动接触，使得所述电阻构件产生指示所述击发元件在所述细长通道内的位置的输出信号；和存储器装置，该存储器装置操作地与所述电阻构件连通，并能够随着所述击发元件平移穿过所述细长通道来记录所述输出信号。
根据本发明的各种实施例的其它一般方面，提供用于结合外科器械的钉仓，所述钉仓包括能够操作地由外科器械支撑的仓体，使得外科器械的击发元件在被施加驱动动作时能够纵向平移穿过所述仓体；和电阻构件，该电阻构件被支撑在所述仓体上以随着击发元件平移穿过仓体由该击发元件移动接触，所述电阻构件能够操作地将指示击发元件在所述仓体内的位置的输出信号传输至外科器械的存储器部分。
根据本发明的各种实施例的其它一般方面，涉及一种包括机器人系统的外科器械，所述机器人系统包括处理器和外科端部执行器，所述外科端部执行器操作地与所述机器人系统交接以接收来自所述机器人系统的驱动动作。该外科端部执行器包括具有近端和远端的细长通道；击发元件，所述击发元件能够在所述机器人系统向其施加驱动动作时在所述细长通道的所述近端和所述细长通道的所述远端之间选择性地平移；和电阻构件，所述电阻构件被支撑用于随着所述击发元件被从所述细长通道的所述近端驱动至所述远端由所述击发元件移动接触，使得所述电阻构件产生指示所述击发元件在所述细长通道内的位置的输出信号并将所述输出信号传输至所述处理器。
附图说明
通过结合附图参考本公开的非限制性实施例的以下说明，本文所述的实施例将会变得更加明显，并更好地理解。
图1为根据各种实施例的外科切割和紧固器械的透视图。
图2为根据各种实施例的外科切割和紧固器械的另一透视图。
图3-5为根据各种实施例的器械的端部执行器和轴的分解视图。
图6为根据各种实施例的端部执行器的侧视图。
图7为根据各种实施例的器械的柄部的分解视图。
图8和图9为根据各种实施例的柄部的局部透视图。
图10为根据各种实施例的柄部的侧视图。
图10A和图10B示出了可根据各种实施例使用的比例传感器。
图11为根据各种实施例在器械中使用的电路的示意图。
图12为根据各种实施例示出在细长通道中的电子传感器的端部执行器的顶视图。
图13为根据各种实施例具有电子传感器的钉仓的底部透视图。
图14为根据各种实施例的电子传感器的顶视图。
图15为根据各种实施例的一个机器人控制器的透视图。
图16为操作地支撑多个外科工具实施例的机器人系统的一个机器人外科臂车/操纵器的透视图。
图17为根据各种实施例的图16中描述的机器人外科臂车/操纵器的侧视图。
图18为具有定位连杆的示例性车结构的透视图，该定位连杆用于操作地支撑可与各种外科工具实施例一起使用的机器人操纵器。
图19为根据各种实施例的外科工具的透视图。.
图20为用于将各种外科工具实施例附接至机器人系统的适配器和工具保持器构造的分解组件视图。
图21为图20中所示的适配器的侧视图。
图22为图20中所示的适配器的底视图。
图23为图20和图21的适配器的顶视图。
图24为图19的外科工具实施例的局部底部透视图。
图25为根据各种实施例的可关节运动的外科端部执行器的一部分的局部分解视图。
图26为图10的工具安装外壳去除的外科工具实施例的透视图。
图27为图24的工具安装外壳去除的外科工具实施例的后透视图。
图28为图24的工具安装外壳去除的外科工具实施例的前透视图。
图29为图28的外科工具实施例的局部分解透视图。
图30为图24的外科工具实施例的局部横截面侧视图。
图31为图30中所描述的外科工具的一部分的放大剖面图。
图32为图24中所描述的外科工具实施例的工具安装部分的一部分的分解透视图。
图33为图32的工具安装部分的一部分的放大分解透视图。
图34为图24的外科工具的细长轴组件的一部分的局部剖面图。
图35为根据各种实施例示出在细长通道中的电子传感器的端部执行器的顶视图。
图36为根据各种实施例的具有电子传感器的钉仓的底部透视图。
具体实施方式
该具体实施方式此外公开用于外科器械的端部执行器中的电子传感器构造。在各种实施例中，电子传感器确定击发元件在端部执行器中的位置和/或钉仓在端部执行器中的状态。本公开的独特和新颖方面可使各种不同的电子传感器能够有效地与各种类型和各种形式的外科器械、端部执行器和钉仓结合使用。虽然本文的说明书指的是切割/缝合操作等，但是应认识到这是示例性实施例，并不意味着是限制性的。也可以使用其它组织紧固技术。此外，在其它实施例中，可使用不同类型的端部执行器，诸如用于其它类型的外科装置的端部执行器，诸如抓紧器、切割器、缝合器、施夹钳、进入装置、药物/基因治疗装置及超生波、射频或激光装置等。
本专利申请的申请人还拥有以下专利申请，并且其各自的全文以引用方式并入本文：
●名称为ROBOTICALLY-CONTROLLED SURGICAL INSTRUMENT WITH FORCE-FEEDCAPABILITIES的序列号为13/118,272的美国专利申请
●名称为SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES的序列号为12/949,099的美国专利申请
●名称为SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES的序列号为11/343,803(当前为美国专利申请7,845,537)的美国专利申请
●名称为MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITHUSER FEEDBACK SYSTEM的序列号为11/343,498(当前为美国专利申请7,766,210)的美国专利申请
●名称为MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITHLOADING FORCE FEEDBACK的序列号为11/343,573(当前为美国专利申请7,416,101)的美国专利申请
●名称为MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITHTACTILE POSITION FEEDBACK的序列号为11/344,035(当前为美国专利申请7,422,139)的美国专利申请
●名称为MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITHADAPTIVE USER FEEDBACK的序列号为11/343,447(当前为美国专利申请7,770,775)的美国专利申请
●名称为MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITHARTICULATABLE END EFFECTOR的序列号为11/343,562(当前为美国专利申请7,568,603)的美国专利申请
●名称为MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITHMECHANICAL CLOSURE SYSTEM的序列号为11/344,024(当前为美国专利申请2007/0175955)的美国专利申请
●名称为SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURETRIGGER LOCKING MECHANISM的序列号为11/343,321(当前为美国专利申请2007/0175955)的美国专利申请
●名称为GEARING SELECTOR FOR A POWERED SURGICAL CUTTING AND FASTENINGSTAPLING INSTRUMENT的序列号为11/343,563(当前为美国专利申请2007/0175951)的美国专利申请
●名称为SURGICAL INSTRUMENT HAVING A REMOVABLE BATTERY的序列号为11/344,020(当前为美国专利申请7,464,846)的美国专利申请
●名称为ELECTRONIC LOCKOUTS AND SURGICAL INSTRUMENT INCLUDING SAME的序列号为11/343,439(当前为美国专利申请7,644,848)的美国专利申请
●名称为ENDOSCOPIC SURGICAL INSTRUMENT WITH A HANDLE THAT CANARTICULATE WITH RESPECT TO THE SHAFT的序列号为11/343,547(当前为美国专利申请7,753,904)的美国专利申请
●名称为ELECTRO-MECHANICAL SURGICAL INSTRUMENT WITH CLOSURE SYSTEMAND ANVIL ALIGNMENT COMPONENTS的序列号为11/344,021(当前为美国专利申请7,464,849)的美国专利申请
●名称为DISPOSABLE STAPLE CARTRIDGE HAVING AN ANVIL WITH TISSUELOCATOR FOR USE WITH A SURGICAL CUTTING AND FASTENING INSTRUMENT AND MODULAREND EFFECTOR SYSTEM THEREFOR的序列号为11/343,546(当前为美国专利申请2007/0175950)的美国专利申请
●名称为SURGICAL INSTRUMENT HAVING A FEEDBACK SYSTEM的序列号为11/343,545(当前为美国专利申请2007/0175949)的美国专利申请
●名称为SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES的序列号为13/021,105(当前为美国专利申请2011/0121052)的美国专利申请
●名称为SURGICAL INSTRUMENT WITH WIRELESS COMMUNICATION BETWEEN ACONTROL UNIT OF A ROBOTIC SYSTEM AND REMOTE SENSOR的序列号为13/118,259的美国专利申请
●名称为ROBOTICALLY-CONTROLLED DISPOSABLE MOTOR DRIVEN LOADING UNIT的序列号为13/118,210的美国专利申请
●名称为ROBOTICALLY-CONTROLLED ENDOSCOPIC ACCESSORY CHANNEL的序列号为13/118,194的美国专利申请
●名称为ROBOTICALLY-CONTROLLED MOTORIZED SURGICAL INSTRUMENT的序列号为13/118,253的美国专利申请
●名称为ROBOTICALLY-CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCEFORMED STAPLES HAVING DIFFERENT LENGTHS的序列号为13/118,278的美国专利申请
●名称为ROBOTICALLY-CONTROLLED MOTORIZED SURGICAL CUTTING ANDFASTENING INSTRUMENT的序列号为13/118,190的美国专利申请
●名称为ROBOTICALLY-CONTROLLED SHAFT BASED ROTARY DRIVE SYSTEMS FORSURGICAL INSTRUMENTS的序列号为13/118,223的美国专利申请
●名称为ROBOTICALLY-CONTROLLED SURGICAL INSTRUMENT HAVING RECORDINGCAPABILITIES的序列号为13/118,263的美国专利申请
●名称为ROBOTICALLY-DRIVEN SURGICAL INSTRUMENT WITH E-BEAM DRIVER的序列号为13/118,246的美国专利申请
●名称为SURGICAL STAPLINGINSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENTARRANGEMENTS的序列号为13/118,241的美国专利申请
●名称为ROBOTICALLY-CONTROLLED END EFFECTOR、提交于2012年2月13日、代理人案卷号为END5773USCIP6/050698CIP6、序列号为_________的美国专利申请。
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。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“在各种实施例中”、“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，结合一个示例性实施例示出或描述的具体特征、结构或特性可与在一个或多个实施例中以任何合适的方式与其它示例性实施例的特征、结构或特性结合。这种修改形式和变型旨在包括在本公开的范围内。
该具体实施方式将根据本公开的一些实施例首先描述马达驱动动力辅助的外科切割和紧固器械。然而，本领域的普通技术人员将会知道根据本公开的各种实施例可以可供选择的方式对外科器械提供动力和控制，例如，通过手动的力和/或机器人控制。如在下文中更详细地描述，马达驱动动力辅助的外科器械的端部执行器或者可由机器人系统提供动力和控制。
外科切割和紧固器械
图1和图2示出根据本发明的各种实施例的马达驱动动力辅助的外科切割和紧固器械10。图示实施例是内窥镜式外科器械10，通常本文描述的器械10的实施例是内窥镜式外科切割和紧固器械。然而，应该指出的是，根据本发明的其它实施例，器械10可以是非内窥镜式外科切割器械，例如腹腔镜式器械。另外，本领域的普通技术人员将易于理解，本文中公开的各种方法和装置可用于许多外科手术和包括例如与开放外科手术结合的应用。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，诸如通过自然腔道、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。
图1和图2中示出的外科器械10包括柄部6、轴8和在关节运动枢轴14处枢转地连接至轴8的进行关节运动的端部执行器12。关节运动控件16可被设置成与柄部6相邻，以使端部执行器12绕关节运动枢轴14旋转。应当理解，各种实施例可包括非枢转的端部执行器，因此可能不具有关节运动枢轴14或关节运动控件16。
在图示实施例中，端部执行器12能够充当直线切割器用于夹紧、切断和缝合组织，然而在其它实施例中可使用不同技术来紧固或密封切断的组织。例如，也可使用利用射频能量或粘合剂来紧固切断的组织的端部执行器。授予Yates等人的名称为“Electrosurgical Hemostatic Device”的美国专利5,709,680和授予Yates等人的名称为“Electrosurgical Hemostatic Device With Recessed And/Or Offset Electrodes”的美国专利5,688,270公开使用射频能量来紧固切断的组织的切割器械，其各自的全文以引用的方式并入本文。授予Morgan等人的序列号为11/267,811的美国专利申请和授予Shelton等人的序列号为11/267,363的美国专利申请公开使用粘合剂来紧固切断的组织的切割器械，其各自的全文以引用的方式并入本文。
器械10的柄部6可包括用于致动端部执行器12的闭合触发器18和击发触发器20。应当理解，具有涉及不同手术任务的端部执行器的器械可具有用于操作端部执行器12的不同数量或类型的触发器或其它合适的控件。端部执行器12被显示为优选地通过细长轴8与柄部6分开。在一个实施例中，器械10的临床医生或操作者可通过利用关节运动控件16使端部执行器12相对于轴8进行关节运动，如Geoffrey C.Hueil等人2010年3月2日公布的名称为“Surgical Instrument Having An Articulating End Effector”的待审美国专利7,670,334更详细描述的，该美国专利全文以引用的方式并入本文。
在此例子中，端部执行器12此外包括钉通道22和诸如砧座24的可枢转地平移的夹紧构件，它们以确保有效缝合和切断夹持在端部执行器12中的组织的间距保持。柄部6包括手枪式握把26，由临床医生将闭合触发器18枢转地拉向手枪式握把26，以使砧座24朝着端部执行器12的钉通道22夹持或闭合，从而夹持定位在砧座24和通道22之间的组织。击发触发器20在闭合触发器18的更外侧。如以下进一步描述的，一旦闭合触发器18被锁定在闭合位置，击发触发器20即可朝向手枪式握把26略微旋转，以使得其可由操作者单手触及。然后，操作者可将击发触发器20枢转地拉向手枪式握把26以缝合和切断夹持在端部执行器12中的组织。在其它实施例中，可使用除砧座24之外的不同类型的夹紧构件，诸如，例如相对的钳口等。
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。
在图示实施例中，可首先致动闭合触发器18。一旦临床医生对于端部执行器12的定位感到满意，该临床医生即可将闭合触发器18拉回至其紧邻手枪式握把26的完全闭合的锁定位置。然后，可致动击发触发器20。当临床医生移除压力时，击发触发器20返回至打开位置(在图1和图2中示出)，如下文将更全面描述。当压下柄部6上的释放按钮时，可释放被锁定的闭合触发器18。
图3-6示出根据各种实施例的旋转驱动端部执行器12和轴8的实施例。图3是根据各种实施例的端部执行器12的分解图。如图示实施例所示，除了先前提到的通道22和砧座24之外，端部执行器12还可包括切割器械32、滑动件33、可移除地坐置在通道22中的钉仓34、和螺旋状螺杆轴36。例如，切割器械32可为刀。砧座24可在枢轴销25处枢转地打开和闭合，枢轴销25连接至通道22的近端。砧座24还可包括位于其近端处的突出部27，所述突出部27插入机械闭合系统(下文进一步描述)的部件中以打开和闭合砧座24。当闭合触发器18被致动即被器械10的使用者拉动时，砧座24可围绕枢轴销25枢转入夹持或闭合位置。如果操作者对端部执行器12的夹持满意，则可致动击发触发器20，这将如下文更详细地描述，使刀32和滑动件33沿通道22纵向行进，从而切割被夹持在端部执行器12内的组织。滑动件33沿通道22的运动导致钉仓34的钉(未示出)被驱动穿过切断的组织并贴靠闭合的砧座24，这使钉弯曲以将切断的组织紧固。在各种实施例中，滑动件33可为仓34的一体部件。授予Shelton,IV等人的名称为“SURGICAL STAPLING INSTRUMENT INCORPORATING AN E-BEAMFIRING MECHANISM”的美国专利6,978,921提供了更多关于二冲程切割和紧固器械的详细信息，该专利申请全文以引用的方式并入本文。滑动件33可为仓34的一部分，使得当刀32在切割操作后回缩时，滑动件33不回缩。
图4和图5为根据各种实施例的端部执行器12和轴8的分解图，而图6为其侧视图。正如图示实施例中所示，轴8可包括由枢轴连接件44枢转地连接的近侧闭合管40和远侧闭合管42。远侧闭合管42包括开口45，砧座24上的突出部27插入开口45中以便打开和闭合砧座24，如下文进一步描述。近侧脊管46可设置在闭合管40，42内。主旋转(或近侧)驱动轴48可设置在近侧脊管46内，其经由锥齿轮组件52与次(或远侧)驱动轴50连通。次驱动轴50连接至与螺旋状螺杆轴36的近侧驱动齿轮56接合的传动齿轮54。立式锥齿轮52b可位于近侧脊管46远端的开口57中且可在其中枢转。远侧脊管58可用来包封次驱动轴50和传动齿轮54、56。总的来说，主驱动轴48、次驱动轴50和关节运动组件(例如锥齿轮组件52a-c)在本文中有时称为“主驱动轴组件”。
定位在钉通道22远端处的轴承38接收螺旋状驱动螺杆36，从而允许螺旋状驱动螺杆36可相对于通道22自由旋转。螺旋状螺杆轴36可与刀32的螺纹开口(未显示)进行交互，使得轴36的旋转导致刀32朝远侧或近侧(根据旋转方向)平移穿过钉通道22。因此，当击发触发器20的致动造成主驱动轴48旋转(在下面更详细解释)时，锥齿轮组件52a-c使次驱动轴50旋转，这继而又由于驱动齿轮54、56的接合而导致螺旋状螺杆轴36旋转，这使刀驱动构件32沿通道22纵向行进以切割被夹持在端部执行器12内的任何组织。
在各种实施例中，钉通道22具有近端23a和远端23b，并且刀或切割元件32能够当驱动动作被施加至切割元件32时纵向穿过近端23a和远端23b之间的通道22行进。在其它实施例中，钉通道22具有内表面28和延伸穿过内表面28的狭槽30。参见图12。随着纵向行进穿过钉通道22，刀32可沿狭槽30平移。滑动件33可由例如塑料制成，并且可具有倾斜的远侧表面。由于滑动件33横贯通道22，前倾表面可向上推动或驱动钉仓中的钉穿过被夹持的组织，并抵靠砧座24。砧座24使钉弯折，从而缝合切断的组织。当刀32收缩时，刀32和滑动件33可变得不接合，从而将滑动件33留在通道22的远端或该滑动件可和刀一起返回。
如上所述，由于缺乏针对切割/缝合操作的使用者反馈，医生普遍不太接受仅通过按下按钮来致动切割/缝合操作的马达驱动直线切割器。相比之下，本发明的实施例提供具有针对端部执行器12中切割器械32的部署、力和/或位置的使用者反馈的马达驱动的直线切割器。
图7-10示出马达驱动直线切割器(特别是其柄部)的示例性实施例，该实施例提供关于端部执行器12中的切割器械32的部署和加载力的使用者反馈。此外，该实施例可利用使用者在回缩击发触发器20时提供的动力来对装置供能(所谓的“动力辅助”模式)。该实施例可与上述的旋转驱动端部执行器12和轴8的实施例一起使用。
如图示实施例中所示，柄部6包括外部下侧件59，60和外部上侧件61，62，它们配合在一起以在整体上形成柄部6的外部。诸如锂离子电池之类的电池64可设置在柄部6的手枪式握把部26中。电池64对设置在柄部6的手枪式握把26上部内的马达65供能。根据各种实施例，马达65可以是具有大约5000RPM的最大转速的有刷直流驱动马达。马达65可驱动包括第一锥齿轮68和第二锥齿轮70的90°锥齿轮组件66。锥齿轮组件66可驱动行星齿轮组件72。行星齿轮组件72可包括连接至驱动轴76的小齿轮74。小齿轮74可驱动配对的环形齿轮78，该环形齿轮经由驱动轴82来驱动螺旋齿轮鼓80。环84可螺旋接合在螺旋齿轮鼓80上。因此，当马达65旋转时，导致环84利用介于其间的锥齿轮组件66、行星齿轮组件72和环形齿轮78沿螺旋齿轮鼓80行进。
柄部6还可包括与击发触发器20连通的马达运转传感器110(见图10)，以检测操作者何时已将击发触发器20拉近(或“闭合”)柄部6的手枪式握把部26，从而通过端部执行器12致动切割/缝合操作。传感器110可为诸如比例传感器，例如变阻器或可变电阻器。当拉回击发触发器20时，传感器110检测到该运动并发出电信号，该电信号指示要供给马达65的电压(或功率)。当传感器110为可变电阻器等时，马达65的转速可与击发触发器20的运动量大致成比例。即，如果操作者仅以短距离拉动或闭合击发触发器20，马达65的转速相对较低。当完全拉回击发触发器20(或处于完全闭合位置)时，马达65的转速为其最大值。换句话讲，使用者越用力牵拉击发触发器20，施加到马达65上的电压就越大，从而转速就越大。
柄部6可包括邻近击发触发器20上部的中间柄部件104。柄部6还可包括连接在中间柄部件104上的柱与击发触发器20上的柱之间的偏置弹簧112。偏置弹簧112可将击发触发器20偏置到其完全打开位置。这样，当操作者释放击发触发器20时，偏置弹簧112将击发触发器20牵拉至其打开位置，由此移除传感器110的致动，从而停止马达65的旋转。此外，借助于偏置弹簧112，每当使用者闭合击发触发器20时，使用者将感受到对闭合操作的阻力，从而向使用者提供有关马达65所施加的旋转量的反馈。另外，操作者可停止回缩击发触发器20以由此将力从传感器110移除，从而使马达65停止。这样，使用者即可停止端部执行器12的部署，从而为操作者提供对切割/紧固操作进行控制的方式。
在各种实施例中，螺旋齿轮鼓80的远端包括驱动环形齿轮122的远侧驱动轴120，该环形齿轮122与小齿轮124配合。小齿轮124连接至主驱动轴组件的主驱动轴48。这样，马达65的旋转使得主驱动轴组件旋转，从而致动端部执行器12，如上所述。
螺纹连接在螺旋齿轮鼓80上的或换句话讲附接到螺旋齿轮鼓80的环84可包括设置在开槽臂90的狭槽88内的柱86。参见图8和9。开槽臂90在相对端94中具有开口92，所述开口接收连接在柄部外侧件59和60之间的枢轴销96。枢轴销96还穿过击发触发器20中的开口100和中间柄部件104中的开口102而设置。
此外，柄部6可包括反向马达传感器(或行程结束传感器)130和止动马达(或行程开始)传感器142。参见图10。在各种实施例中，该反向马达传感器130可为位于螺旋齿轮鼓80的远端处的限位开关，使得螺纹连接在螺旋齿轮鼓80上的环84当到达螺旋齿轮鼓80的远端时接触并启动反向马达传感器130。反向马达传感器130在被启动时向马达65发送信号，以使其旋转反向，从而在切割操作后回缩端部执行器12的刀32。
止动马达传感器142可为例如常闭限位开关。在各种实施例中，其可位于螺旋齿轮鼓80的近端处，以使当环84到达螺旋齿轮鼓80的近端时致动开关142。
在操作过程中，器械10的操作者回拉击发触发器20时，传感器110检测到击发触发器20的部署并向马达65发出信号以使马达65正向旋转，例如使马达以与操作者回拉击发触发器20的力度成比例的速率旋转。马达65的正向旋转继而使得行星齿轮组件72的远端处的环形齿轮78旋转，从而使得螺旋齿轮鼓80旋转，使螺纹连接在螺旋齿轮鼓80上的环84沿螺旋齿轮鼓80朝远侧行进。螺旋齿轮鼓80的旋转还驱动如上所述的主驱动轴组件，这继而使得部署端部执行器12中的刀32。也就是说，使得刀32和滑动件33纵向横贯通道22，从而切割被夹持在端部执行器12中的组织。此外，在使用缝合型端部执行器12的实施例中使端部执行器12进行缝合操作。
到端部执行器12的切割/缝合操作完成的时候，螺旋齿轮鼓80上的环84将已到达螺旋齿轮鼓80的远端，从而使得致动反向马达传感器130，进而发送信号至马达65使得马达65反向旋转。这继而使得刀32回缩，并且还使螺旋齿轮鼓80上的环84移动回到螺旋齿轮鼓80的近端。
中间柄部件104(图7)包括接合开槽臂90的后侧肩部106，如图8中最佳示出。中间柄部件104还具有接合击发触发器20的前移止挡件107。参见图10。如以上所解释，开槽臂90的运动受马达65旋转的控制。当开槽臂90随着环84从螺旋齿轮鼓80的近端行进到远端而逆时针旋转时，中间柄部件104将自由进行逆时针旋转。因此，当使用者拉近击发触发器20时，击发触发器20将与中间柄部件104的前移止挡件107接合，使中间柄部件104逆时针旋转。然而，由于后侧肩部106与开槽臂90接合，中间柄部件104将只能够在开槽臂90许可的范围内逆时针旋转。这样，如果马达65出于某种原因停止旋转，则开槽臂90就会停止旋转，而且使用者会无法进一步拉近击发触发器20，因为中间柄部件104由于开槽臂90不能不受约束而逆时针旋转。
图10A和10B示出了根据本发明的各种实施例的可用作马达运转传感器110的可变传感器的两种状态。传感器110可包括表面部分280、第一电极(A)282、第二电极(B)284以及电极282和284之间的可压缩电介质材料286，例如电活性聚合物(EAP)。传感器110可被定位成使得在回缩时使表面部分280接触击发触发器20。因此，当击发触发器20回缩时，电介质材料286被压缩，如图10B所示，使得电极282和284一起靠得更近。电极282和284之间的距离“b”直接关系到电极282和284之间的阻抗，距离越大阻抗就越大，距离越小阻抗就越小。这样，由于击发触发器20的回缩而使电介质286被压缩的量(图42中以力“F”表示)与电极282和284之间的阻抗成比例，这可用于按比例控制马达65。
图7-10中还显示了用于通过回缩闭合触发器18来闭合(或夹持)端部执行器12的砧座24的示例性闭合系统的部件。在图示实施例中，该闭合系统包括通过枢轴销251连接至闭合触发器18的轭250，所述枢轴销251被插入穿过在闭合触发器18和轭250这二者中对准的开口。闭合触发器18围绕枢轴销252枢转，枢轴销252插入穿过闭合触发器18中的另一开口，该开口偏离销251插入穿过闭合触发器18的位置。因此，闭合触发器18的回缩使得闭合触发器18的上部逆时针旋转，轭250经由销251附接到闭合触发器18。轭250的远端经由销254连接至第一闭合托架256。第一闭合托架256连接至第二闭合托架258。总的来讲，闭合托架256和258共同限定开口，而近侧闭合管40(见图4)的近端坐置和保持在该开口中，使得闭合托架256和258的纵向运动引起近侧闭合管40的纵向运动。器械10还包括设置在近侧闭合管40内部的闭合杆260。闭合杆260可包括窗261，而位于柄部外部件中的一个(诸如图示实施例中的外部下侧件59)上的柱263设置在该窗261中，以将闭合杆260固定地连接至柄部6。这样，近侧闭合管40能够相对于闭合杆260纵向移动。闭合杆260还可包括远侧衬圈267，其装配在近侧脊管46中的腔体269内并由顶盖271(见图4)保持在腔内。
在操作中，当轭250由于闭合触发器18的回缩而旋转时，闭合托架256和258使得近侧闭合管40朝远侧移动(即，远离器械10的柄部端)，这使得远侧闭合管42朝远侧移动，从而使得砧座24绕枢轴销25旋转到夹持或闭合位置。当闭合触发器18被从锁定位置释放时，导致近侧闭合管40朝近侧滑动，从而使得远侧闭合管42朝近侧滑动，凭借插入远侧闭合管42的窗45中的突出部27，导致砧座24绕枢轴销25枢转至打开或松开位置。这样，通过回缩并锁定闭合触发器18，操作者可将组织夹持在砧座24和通道22之间，并可在切割/缝合操作后通过将闭合触发器20从锁定位置解锁来松开该组织。
图11是根据本发明各种实施例的器械10的电路的示意图。当操作者在锁定闭合触发器18后开始牵拉入击发触发器20时，传感器110被启动，允许电流穿过其流动。如果常开反向马达传感器开关130打开(表明还未到达端部执行器行程的端部)，则电流将流向单刀双掷继电器132。由于反向马达传感器开关130未闭合，则继电器132的电感器134将不通电，因此继电器132将处于其未通电状态。该电路还包括钉仓闭锁传感器136。如果端部执行器12包括钉仓34，则传感器136将处于闭合状态，从而使电流流动。相反，如果端部执行器12不包括钉仓34，则传感器136断开，从而防止电池64向马达65供电。
当钉仓34存在时，传感器136闭合，为单刀单掷继电器138供电。当为继电器138供电时，电流流经继电器136，通过可变电阻器传感器110并经由双刀双掷继电器140流向马达65，从而为马达65供电并使其正向旋转。
当端部执行器12达到其行程结束时，反向马达传感器130将被启动，从而闭合开关130并为继电器134供电。这使继电器134处于其通电状态(图11中未示出)，这导致电流绕过钉仓闭锁传感器136和可变电阻器110而流向常闭双刀双掷继电器142并流回至马达65，但是以导致马达65反向其旋转方向的方式经过继电器140。
因为止动马达传感器开关142是常闭的，电流将流回到继电器134以保持其闭合，直到开关142断开。当刀32完全回缩时，止动马达传感器开关142被启动，使得开关142断开，从而使马达65断电。
在其它实施例中，可使用通断型传感器而不是比例型传感器110。在此类实施例中，马达65的转速将不与由操作者施加的力成比例。相反，马达65大体以恒速旋转。但是由于击发触发器20与齿轮传动系啮合，因此操作者仍将感受到力反馈。
击发动作和仓状态传感器
在其它实施例中，外科切割和紧固器械10可不包括马达运转传感器110、反向马达传感器130和/或止动马达传感器142，如上所述。在其它实施例中，例如外科器械10可采用电子传感器150用于确定击发元件在端部执行器12中的位置和/或钉仓34在端部执行器12中的状态或存在。为了描述图示实施例，能够在端部执行器12中平移的切割元件32、滑动件33、驱动杆36和其它元件在本文统称为击发元件。如图14中所示，在一种形式中，电子传感器150包括被支撑在外科器械10的端部执行器12内的电阻构件152。电阻构件152可由端部执行器12中的钉通道22、夹紧构件20、钉仓34或另一元件支撑。随着击发元件纵向平移穿过端部执行器12，击发元件可与电阻构件152移动接触。
如上文所指出，在各种实施例中，电子传感器150的电阻构件152由细长通道22支撑。例如，在至少一个实施例中，通过粘合剂将电阻构件152固定至细长通道22。在其它实施例中，可将电阻构件152紧固至细长通道22中的部件。参照图12，电阻构件152可定位在钉通道22的内表面28上，使得随着击发元件纵向行进穿过钉通道22，该击发元件接触电阻构件152。在可供选择的实施例中，电阻构件152由钉仓34支撑或换句话讲附接至钉仓34。参照图13，电阻构件152可由钉仓34的仓体35支撑。例如，可通过合适的粘合剂将电阻构件152附接至仓体35的底表面。在其它实施例中，电阻构件152可被支撑在形成于仓体35的底表面中的狭槽构造(未显示)中或换句话讲通过其中形成的附接特征结构保留在该位置中。在图13中所示的实施例中，电阻构件152被定位在钉仓34的仓体35上，使得击发元件的一部分随着击发元件纵向行进穿过钉通道22而接触电阻构件152。
在各种实施例中，电子传感器150的电阻构件152包括一个电阻器154或多个电阻器154。例如，电阻构件152可包括具有多个电阻器154a,154b和154c等和多个节点156a,156b和156c等的电路。参照图12，节点156可被定位在每个电阻器154的中间。例如，第一节点156a被定位在第一电阻器154a和第二电阻器154b的中间；第二节点156b被定位在第二电阻器154b和第三电阻器154c的中间；并且第三节点156c被定位在第三电阻器154c和第四电阻器154d的中间；等等。换句话将，节点156可被定位在电阻构件152中的电路中的每个连续电阻器154之间。贯穿每个节点156的电压是均匀的，或大体上均匀的。虽然电阻器156是完整的，但在每个节点156处的电压和其它节点156处的电压不同。参照图12，电阻器154a,154b,154c,…,154z可以并列构造布置，使得电阻构件152的等效电阻(REq)可通过以下公式计算：
1/REq＝1/Ra+1/Rb+1/Rc+…+1/Rz，
其中，Ra为电阻器154a中的电阻，Rb为电阻器154b中的电阻，Rc为电阻器154c中的电阻，并且Rz为电阻构件152中最远侧电阻器154z中的电阻。电阻可以单位欧姆(Ω)测量。在一种可供选择的实施例中，电阻器154a,154b,154c,…,154z可以串联构造布置，使得电阻构件152的等效电阻(REq)可通过以下公式计算：
REq＝Ra+Rb+Rc+…+Rz。
如上所述，在端部执行器12中的击发元件随着该击发元件在钉通道22中的近端23a和钉通道22中的远端23b之间平移而与电阻构件152移动接触。在一个实施例中，击发元件可随着滑动件33和刀32被驱动穿过细长通道22而沿着电阻构件152的表面滑动。在另一个实施例中，击发元件可随着滑动件33和刀32被驱动穿过细长通道22而接触电阻构件152上的突起。随着击发元件平移穿过钉通道22并移动地接触电阻构件152，该电阻构件152产生指示击发元件在细长通道22内的位置的输出信号。电阻构件152产生的输出信号可为沿电阻构件152的电压(或电力)的测量值。例如，电阻构件152可产生指示在连续电阻器154之间的每个节点156处的电压的信号。
在各种实施例中，参照图12，击发元件可移动地接触电阻构件152，使得电阻元件切断电阻构件152的部分。例如，切割元件32可随着该切割元件32响应于被施加的驱动动作纵向行进穿过细长通道22而横贯穿过电阻构件152的部分。在至少一个实施例中，例如，电阻构件152可被定位在细长通道22的内表面28上并被取向成使得所述电阻元件152至少部分地覆盖狭槽30穿过通道22的内表面28。如上所述，当击发触发器20被致动导致切割元件32和滑动件33沿着通道22纵向行进时，狭槽30能够接收切割元件32。例如，切割元件32可从沿狭槽30的近侧位置处的第一位置行进到沿狭槽30的中间位置处的第二位置并从该第二位置行进到沿狭槽30的远侧位置处的第三位置。第一位置可与第一节点156a相对应，第二位置可与另一个节点156m相对应，并且第三位置可与另一个节点156z相对应。随着切割元件32沿着狭槽30在节点之间纵向行进，该切割元件32切断通道22和砧座20之间夹持的组织。切割元件32还切断覆盖狭槽30的部分的电阻条152的部分并平移穿过该狭槽。再次参见图12，切割元件32被定位在细长通道22的近端23a和通道22的远端23b的中间。如所述图所示，切割元件32具有横贯的节点156a,156b和156c。此外，切割元件32具有切断的近侧电阻器154a,154b和154c；然而，中间的和远侧电阻器154m,154n和154z等等是完整的。应当理解，随着切割元件32被朝远侧推进从起始位置穿过钉通道22至其中的最终结束位置，该切割元件将具有横贯的每个节点156并在该击发行程期间切断在电阻构件152中的每个电阻器154。
当切割元件32切断电阻条152的部分时，切割元件可切断沿电路的部件布置在电阻构件152中的电阻器154。例如，参照图12，切割元件32可切断电阻器154a，然后电阻器154b，之后电阻器154c等等，直到击发元件到达细长通道22的远端23b。电阻器154a,154b,154c,…,154z可并列布置，如图14中所示。在此种实施例中，电阻构件152的等效电阻可随着切割元件32根据如下关系切断每个连续的电阻器而增加：
1/REq＝1/Ra+1/Rb+1/Rc+…+1/Rz。
在一种可供选择的实施例中，电阻器154a,154b,154c等等可串联布置。在此种实施例中，电阻构件152的等效电阻可随着切割元件32根据如下关系切断每个连续的电阻器而降低：
REq＝Ra+Rb+Rc+…+Rz。
另外，横跨电阻构件152的电压可通过欧姆定律确定，其中规定：
V＝I×REq，
其中，V代表电压，I代表电流，并且REq代表等效电阻。电压可以伏特(V)为单位测量，电流可以安培(A)为单位测量，并且电阻可以欧姆(Ω)为单位测量。假设恒定电流穿过电阻构件152，当等效电阻随着电阻器154的切断而变化时，电阻构件中的电压相应地变化。因此，切割元件32随着其沿电阻构件152平移的位置可由当电阻器154被切断时指示电阻构件152产生的电压的输出信号确定。
在另一个实施例中，当电阻构件152被钉仓34的仓体35支撑时，切割元件32可切断电阻构件152的部分。参照图13，电阻构件152可被定位在钉仓34的仓体35上并被取向成使得电阻构件152至少部分地覆盖狭槽37穿过仓体35。与上述类似，当击发触发器20被致动导致切割元件32和滑动件33沿着通道22纵向行进时，在仓体35中的狭槽37能够接收切割元件32。例如，切割元件32可从沿狭槽37的近侧位置处的第一位置行进到沿狭槽37的中间位置处的第二位置并从该第二位置行进到沿狭槽37的远侧位置处的第三位置。随着切割元件32沿着狭槽37在多个位置之间纵向行进，该切割元件32切断通道22和砧座20之间夹持的组织。切割元件32还切断覆盖在钉仓34中的狭槽37的部分的电阻条152的部分并平移穿过该狭槽。与上述类似，当切割元件切割在电阻构件152中的电阻器154时，电阻构件152中的等效电阻改变，导致横跨电阻构件152的电压相应改变。
在各种实施例中，参照图3，钉通道22可包括接触垫、接触部分、触点或接触面158。接触垫158可被定位在钉通道22的内表面28上。在各种实施例中，当电阻构件152被定位在钉仓34(图14)的仓体35上时，在通道22中的接触垫158能够接触电阻构件152的一部分。接触垫158可接触电阻构件152中的电路、延伸自电阻构件152的线168或操作地与电阻构件接合的接触垫。另外，接触垫158可经由有线/无线连接与导电构件170，172和/或存储器装置160连通，如以下更详细地描述。
外科器械还包括操作地与电子传感器150的电阻构件152连通的存储器装置160。参见图1。电阻构件152直接地或间接地向存储器装置160提供信号，如下文所详述所述存储器装置记录该信号。存储器装置160可被整合进电子传感器150。在另一个实施例中，存储器装置160可在电子传感器的外部并被定位在电阻构件152附近，诸如在端部执行器12的细长通道22中。在其它实施例中，参照图1，存储器装置160可被定位在电阻构件152更远处，诸如在器械10的柄部6中。存储器装置160可为能够存储或记录传感器信号的任何种类的装置。例如，存储器装置160可包括微处理器、电可擦除可编程只读存储器(EEPROM)或任何其它合适的存储装置。存储器装置160可以任何合适的方式记录电阻构件152提供的信号。例如，在一个实施例中，当信号改变时，诸如当切割元件32切断在电阻构件152中的电阻器154，导致等效电阻的改变和横跨电阻构件152的电压的相应改变时，存储器装置160可记录源自电阻构件152的信号。在另一个实施例中，当源自任何传感器的信号改变状态时，存储器装置160可记录电阻构件152的状态和来自其它传感器的信号，诸如在外科器械10中的马达运转传感器110、反向马达传感器130和/或止动马达传感器142。这可提供关于器械10的状态的快照。在各种实施例中，存储器装置160和/或一个或多个传感器可被实施成包括购自诸如DALLAS SEMICONDUCTOR的1-WIRE总线产品，例如1-WIRE EEPROM。
在各种实施例中，存储器装置160是可从外部存取的，允许外部装置诸如计算机访问由存储器装置160记录的器械条件。例如，存储器装置160可包括数据端口162。数据端口162可根据任何有线或无线通信协议以例如串行或并行格式提供所存储的器械条件。存储器装置160还可包括除了输出端口162以外的或取代输出端口162的可移除介质164。可移除介质164可为可从器械10取下的任何种类的合适的数据存储装置。例如，可移除介质164可包括任何合适类型的闪存存储器，诸如个人计算机内存卡国际协会(PCMCIA)卡、压缩闪存卡、多媒体卡、闪速媒体卡等。可移除介质164还可以包括任何合适类型的磁盘式存储器，包括例如便携式硬盘驱动器、光盘(CD)、数字化视频光盘(DVD)等。
可例如经由模数转化器(未显示)向存储器装置160提供电阻构件152的输出。在各种实施例中，电阻构件152的输出信号可首先传输至集成电路(未显示)用于放大信号。另外，可根据一种调制方案编码和/或调制输出。
可通过有线通信向存储器装置160提供电子传感器150的输出。参照图1，绝缘线或类似的导体168可将指示击发元件在端部执行器12中的位置的电子信号传输至存储器装置160。线168可由导电聚合物和/或金属(如，铜)制成，并充分柔性穿过关节运动枢轴14且不被关节运动破环。
在另一个实施例中，可将信号无线传输至存储器装置160。授予James R.Giordano等人提交于2011年5月27日的序列号为13/118,259的美国专利申请中描述了各种无线通信实施例，该专利申请全文以引用的方式并入本文。参照图12，要以无线方式传输信号，电阻构件152可包括充当传输天线的导电元件170。导电元件170可同时传输源自电阻构件152的信号并接收来自诸如外科器械10外部或内部的电池等功率源的电力。电阻构件152的导电元件170优选地与器械10的导电的外部轴8绝缘。
在另一个实施例中，导电元件170可包括端部执行器12的部件和轴8。在此实施例中，电阻构件152电连接到轴8，并且存储器装置与轴绝缘。例如，细长通道22的内表面30可包括导电材料，继而可通过直接或间接的电接触电联接至轴8(诸如闭合管40，42)的导电元件。可通过由诸如塑料等非导电材料制成的外部下侧和上侧件59-62使轴8接地。端部执行器12的另外部件可包括非导电材料，并且存储器装置160与轴8绝缘。电连接至传感器150的导电元件170的端部执行器12的部件和轴8可用作天线的部件以用于将源自电阻构件152的指示信号传输至存储器装置160。作为另外一种选择，存储器装置160可与端部执行器12的选择部件以及轴8电连通，并且电阻构件152可被绝缘。与存储器装置160电连接的端部执行器12的选择部件和轴可用作天线的部件以用于接收来自传感器150的信号。电阻构件152可通过将其定位在细长通道22的内表面28上绝缘，所述细长通道由塑料等非导电材料制成。
外科器械10可包括用于将信号从电阻构件152传输至存储器装置160的多个导电元件。例如，再次参见图12，电阻构件152可将信号传输至导电元件170。可通过绝缘线168传输信号。可将此类中间导电元件170定位于例如在端部执行器12中，沿着轴8，或在器械10的柄部6上。导电元件170可将信号转发至远侧中间导电元件172a，该远侧中间导电元件进而将信号转发至近侧中间导电元件172b或存储器装置160(如图1中的图解所显示)。如果较多的导电联接保持在电阻构件152和存储器装置160之间的适当的位置，则导电元件170，172之间的距离可被减小，并可利用较弱的信号来传输该信号。作为另外一种选择，如果较少的导电联接保持在适当的位置，由于较大的传输距离可要求较强的信号。因为可固定并已知导电元件170，172之间的距离，可最优化电力水平至低水平，进而减少对在器械10的环境中的其它系统的干扰。
作为另外一种选择，可采用有线连接和无线连接的结合来将信号从电阻构件152传输至存储器装置160。例如，参照图1，端部执行器12可包括线168，所述线将电阻构件152连接至器械的轴6上的远侧中间导电元件172a。然后可将信号从远侧中间导电元件172a无线传输至近侧中间导电元件172b。近侧中间导电元件172b可经由导电线168或无线方式将信号传输至存储器装置160。
电阻构件152可使用任何合适的频率(如，ISM带)与存储器装置160连通。另外，电阻构件152可以与接收自存储器装置160的信号的频率范围不同的频率范围传输信号。另外，参照电子传感器150虽然上文只描述了一根天线，但在其它实施例中，电子传感器150可包括单独的接收和传输天线。
外科器械10还可包括操作地与存储器装置160交接的处理器180。参照图1，处理器180和存储器装置160可包括整合部件。在另一个实施例中，处理器180和存储器装置160是外科器械的分立部件。处理器180根据电阻构件152的输出确定击发元件在端部执行器12中的位置。在一个实施例中，处理器180根据电阻构件152指示电压的信号计算切割元件32在端部执行器12中的位置。例如，如果电阻条152的电阻器154并联连接，电阻构件152的等效电阻随着每个连续电阻器154被切割而增加。横跨电阻构件152的电压中的相应变化指示切割元件32沿电阻条152的节点位置，该电阻条进一步地对应于切割元件32在细长通道22中的位置。
在确定击发元件在细长通道22中的位置时，可将该位置传输至指示击发元件的位置的指示器。指示器可为用户可见的器械的柄部6上的视觉指示画面190。另外或作为另外一种选择，可通过触觉指示将该位置传输至用户。例如，当刀32到达狭槽30在钉通道22中的端部时，可通过击发触发器20的增加的电阻警示用户。在另一个实施例中，参照图7，可通过操作地与处理器180连通的振动元件192使器械10的手枪式握把26中的振动来警示用户。
本公开的各种实施例的独特和新颖方面采用电子传感器来确定击发元件在外科器械的端部执行器中的位置和/或钉仓在端部执行器中的状态。因此，本公开的各种实施例的独特构造和原则可使本文所公开的和受权利要求书保护的各种不同形式的电子传感器能有效地和与击发元件一起使用的其它类型和形式的外科器械、端部执行器和钉仓连用。上述根据本公开的一些实施例描述了马达驱动动力辅助的外科切割和紧固器械。然而，如前所述，本领域的普通技术人员应理解到，根据本公开的各种实施例，可通过可供选择的方式诸如手动的力或机器人控制为外科器械提供动力和控制。例如，可通过诸如下文更详细地描述的机器人系统1000的机器人系统为上述端部执行器12提供动力和控制。
机器人系统
图15示出了可结合图16中示出的从属机械臂车1100类型使用的主控制器1001的一个型式。主控制器1001和从属机械臂车1100以及它们各自的部件和控制系统在本文中统称为机器人系统1000。Michael J.Tierney等人的公布于2009年4月28日的名称为“Mechanical Actuator Interface System for Robotic Surgical Tools”的美国专利7,524,320中公开了此类系统和装置的例子，该专利申请以引用的方式并入本文。因此，除了可能必要的理解本发明的各种实施例和形式以外，本文将不详细地描述此类装置的各种细节。正如所知，主控制器1001大体包括控制系统(大体示出为图15中的1003)，当外科医生通过立体显示器1002查看该程序时握紧该控制系统并在空间操纵。主控制器1001大体包括手动输入装置，该手动输入装置优选地用多个自由度移动并通常进一步地具有可进行关节运动的柄部用于致动工具(例如，用于闭合握紧钳口、向电极施加电势等)。名称为“SurgicalStapling Instruments with Rotatable Staple Deployment Arrangements”的序列号为13/118,241的美国专利申请中公开了各种机器人控制器构造和外科工具构造，该专利申请全部公开内容以引用方式并入本文。
如图16中所示，在一种形式中，机械臂车1100能够致动多个外科工具，一般称为1200。名称为“Multi-Component Telepresence System and Method”的美国专利6,132,368中公开了使用主控制器和机械臂车构造的各种机器人外科系统和方法，该专利申请的全部公开内容以引用的方式并入本文。在各种形式中，机械臂车1100包括基座1102，在图示实施例中，所述基座支撑有三个外科工具1200。在各种形式中，外科工具1200均由一系列手动关节运动的连杆(一般称为装置接头1104)和机器人操纵器1106支撑。本文示出的这些结构具有在机器人连杆的大部分之上延伸的护盖。这些护盖可以是任选的，并且可在尺寸上有所限制或在一些实施例中完全消除，以使用于操纵此类装置的伺服机构遇到的惯性最小化、限制运动部件的体积以避免碰撞并且限制车1100的总重量。车1100将大体具有适于在手术室之间搬运车1100的尺寸。车1100能够通常适于穿过标准的手术室门并放置到标准的医院电梯上。在各种形式中，车1100可优选地具有重量并包括轮(或其它运输)系统，所述轮系统允许由单个维护人员将车1100定位成邻近手术台。
现在参见图17，在至少一种形式中，机器人操纵器1106可包括限制外科工具1200的运动的连杆1108。在各种实施例中，连杆1108包括由旋转接头以平行四边形构造联接在一起的刚性连接件，以使外科工具1200围绕空间1110中的某一点旋转，如在公布的美国专利No.5,817,084中更完整地描述，所述专利的全部公开内容以引用的方式并入本文。平行四边形构造将旋转限制为围绕轴1112a(有时称为俯仰轴)枢转。支撑平行四边形连杆的连接件可枢转地安装至装置接头1104(图15)上，以使外科工具1200进一步围绕轴1112b(有时称为偏航轴)旋转。俯仰轴1112a和偏航轴1112b在远程中心1114处相交，所述远程中心沿着外科工具1200的轴1208对齐。当由操纵器1106支撑时，外科工具1200可具有另外的从动自由度，包括外科工具1200沿着纵向工具轴线“LT-LT”的滑动运动。当外科工具1200沿着工具轴线LT-LT相对于操纵器1106(箭头1112c)滑动时，远程中心1114相对于操纵器1106的基座1116保持固定。从而，使整个操纵器大体发生移动以重新定位远程中心1114。操纵器1106的连杆1108由一系列的马达1120驱动。这些马达响应于来自控制系统的处理器的命令而主动移动连杆1108。如将在下文中进一步详细描述，马达1120还用于操纵外科工具1200。
图18中示出了可供选择的装置接头结构。在该实施例中，外科工具1200由两个组织操纵工具之间的可供选择的操纵器结构1106'支撑。本领域的普通技术人员将会知道本发明的各种实施例可以包括多种可供选择的机器人结构，包括描述于名称为“AutomatedEndoscope System For Optimal Positioning”的美国专利5,878,193中的那些结构，该专利的全部公开内容以引用的方式并入本文。另外，虽然结合外科工具1200和主控制器1001之间的通信在本文中初步描述了机器人部件和机器人外科系统的处理器之间的数据通信，但应当理解，类似的通信可发生在操纵器、装置接头、内窥镜或其它图像捕获装置等的电路和机器人外科系统的处理器之间，所述机器人外科系统的处理器用于部件兼容性确认、部件类型识别、部件校正(诸如偏移等)通信、部件与机器人外科系统的联接确认等。
图19中示出了非常适于与机器人系统1000一起使用的示例性的非限制性外科工具1200，所述机器人系统具有操作地联接到主控制器1001的工具驱动组件1010(图20)，所述主控制器1001可通过操作者(即外科医生)的输入来运行。如图所示，外科工具1200包括外科端部执行器2012，所述端部执行器包括直线切割器。在至少一种形式中，外科工具1200大体包括细长轴组件2008，所述细长轴组件具有通过关节运动接头2011联接在一起的近侧闭合管2040和远侧闭合管2042。外科工具1200通过工具安装部分(一般称为1300)操作地联接到操纵器。外科工具1200还包括将工具安装部分1300机械联接且电联接到操纵器的接口1230。接口1230的一种形式在图20-24中示出。在各种实施例中，工具安装部分1300包括工具安装板1302，所述工具安装板操作地支撑多个(图24中示出了四个)可旋转主体部分、从动盘或从动元件1304，所述每个从动盘或从动元件均包括从该从动元件1304的表面延伸的一对销1306。一个销1306比相同从动元件1304上的其它销1306更靠近每个从动元件1304的旋转轴，这有助于确保从动元件1304的正向角对齐。接口1230包括能够与安装板1302以安装方式接合的适配器部分1240，如将在下文中进一步描述。适配器部分1240可包括一系列电连接销1242(图22)，所述电连接销1242可通过工具安装部分1300中的电路板联接到存储器结构。虽然结合机械耦合元件、电耦合元件和磁耦合元件在本文描述了接口1230，但应当理解，可使用多种遥测形式，包括红外、电感耦合等。
如图20-23所示，适配器部分1240大体包括工具侧1244和夹持器侧1246。在各种形式中，将多个可旋转主体1250安装到浮动板1248，所述浮动板相对于垂直于适配器1240主表面的周围适配器结构具有限定的运动范围。当沿着工具安装部分外壳1301的侧面致动杠杆1303时(参见图19)，浮动板1248的轴向运动有助于使可旋转主体1250从工具安装部分1300脱离。可采用其它机构/构造以可释放的方式将工具安装部分1300联接到适配器1240。在至少一种形式中，通过弹性径向构件将可旋转主体1250弹性地安装到浮动板1248，所述弹性径向构件围绕可旋转主体1250延伸到周边凹痕中。可旋转主体1250可通过偏转这些弹性结构相对于板1248轴向移动。当设置在第一轴向位置(朝工具侧1244)时，可旋转主体1250自由旋转而没有角度限制。然而，当可旋转主体1250朝工具侧1244轴向移动时，突出部1252(从可旋转主体1250径向延伸)横向接合浮动板上的闭锁装置以便限制可旋转主体1250围绕其轴线的角旋转。当驱动销1272将可旋转主体1250推动至受限的旋转位置直到销1234与开口1256’对齐(并滑动到其中)时，可使用该受限的旋转以协助可旋转主体1250与机器人系统1000的对应工具保持器部分1270的驱动销1272驱动接合。可旋转主体1250的工具侧1244上的开口1256和保持器侧1246上的开口1256’能够使工具安装部分1300的从动元件1304(图24)与工具保持器1270的驱动元件1271准确对齐。有关从动元件1304的内侧和外侧销1306如上所述，开口1256和1256’位于相距其各自的旋转主体1250的旋转轴线不同的距离处，以确保与之要达到的位置不呈180度对齐。另外，每个开口1256略微径向细长，以适当地接收周边取向上的销1306。这使得销1306在开口1256和1256’内径向滑动并适应工具1200和工具保持器1270之间的一些轴偏差，同时使驱动元件和从动元件之间的任何角偏差和角侧隙最小化。工具侧1244上的开口1256与保持器侧1246上的开口1256’(以虚线示出)成约90度的偏置，如图23中最明显地示出。
各种实施例还可包括位于适配器1240的夹持器侧1246上的一系列电连接器销1242，并且适配器1240的工具侧1244可包括狭槽1258(图23)以用于接收工具安装部分1300的销阵列(未示出)。除了在外科工具1200和工具保持器1270之间传输电信号之外，可通过适配器1240的电路板将这些电连接器中的至少一些联接至适配器存储器装置1260(图22)。
可使用可拆卸的闩锁构造1239以可释放的方式将适配器1240附连至工具架1270。如本文所用，术语“工具驱动组件”在用于机器人系统1000的上下文中时至少涵盖适配器1240和工具保持器1270的各种实施例，并且其在图20中一般称为1010。例如，如图20所示，工具保持器1270可包括第一闩锁销构造1274，所述第一闩锁销构造的尺寸设定成接收在设置于适配器1240中的相应的连接叉狭槽1241中。另外，工具保持器1270还可包括第二闩锁销1276，所述第二闩锁销的尺寸设定成保持在适配器1240中的相应的闩锁连接叉1243中。在至少一种形式中，闩锁组件1245被活动地支撑在适配器1240上，并且能够在第一闩锁位置和未闩锁位置之间偏置，在第一闩锁位置中，闩锁销1276保持在它们各自的闩锁连接叉1243中，在未闩锁位置中，第二闩锁销1276可进入闩锁连接叉1243或从中移除。使用一个或多个弹簧(未示出)以将闩锁组件偏置到闩锁位置。适配器1240的工具侧1244上的凸缘可滑动地接收工具安装外壳1301的横向延伸的突出部。
然后转到图24-31，在至少一个实施例中，外科工具1200包括外科端部执行器2012，在该例子中，所述外科端部执行器此外包括至少一个部件2024，所述部件相对于至少一个其它部件2022在第一位置和第二位置之间响应于施加至其上的各种控制运动而选择性地移动，如将在下文中进一步详细地描述。在各种实施例中，部件2022包括能够操作地支撑其中的外科钉仓2034的细长通道2022，并且部件2024包括可枢转地平移的夹紧构件，例如砧座2024。外科端部执行器2012的各种实施例能够使砧座2024和细长通道2022以确保有效缝合和切断夹持在外科端部执行器2012中的组织的间距保持。如图30所示，外科端部执行器2012还包括切割器械2032和滑动件2033。例如，切割器械2032可以为刀。外科钉仓2034操作地容纳其中支撑在可活动的钉驱动器(未示出)上的多个外科钉(未示出)。当切割器械2032朝远侧驱动穿过外科钉仓2034中居中设置的狭槽(未示出)时，其也向远侧推动滑动件2033。当滑动件2033朝远侧驱动时，其“楔形”构造接触可活动的钉驱动器并朝闭合砧座2024竖直驱动钉驱动器。当外科钉被驱动到位于砧座2024下侧的成形表面时，形成外科钉。滑动件2033可以是外科钉仓2034的一部分，使得当切割器械2032在切割操作后回缩时，滑动件2033不会回缩。砧座2024可在位于细长通道2022的近端的枢轴点2025处枢转地打开和闭合。砧座2024还可包括位于其近端的突出部2027，所述突出部与机械闭合系统(下文中进一步描述)的部件相互作用以利于砧座2024的打开。细长通道2022和砧座2024可以由导电材料(诸如金属)制成，以使它们可作为与端部执行器中的一个或多个传感器连通的天线的一部分，如上所述。外科钉仓2034可以由非导电材料(诸如塑料)制成，并且一个或多个传感器可连接至外科钉仓2034或设置在其中，如上所述。
如图24-31所示，根据各种实施例，通过细长轴组件2008将外科端部执行器2012附接到工具安装部分1300。如图示实施例所示，轴组件2008包括关节运动接头(通常表示为2011)，所述关节运动接头使外科端部执行器2012能够选择性地围绕关节运动轴线AA-AA进行关节运动，所述关节运动轴线AA-AA基本上横向于纵向工具轴线LT-LT。参见图25。在其它实施例中，省略了关节运动接头。在各种实施例中，轴组件2008可包括闭合管组件2009，所述闭合管组件包括通过枢转连接件2044枢转地连接和操作地支撑在脊组件(一般描述为2049)上的近侧闭合管2040和远侧闭合管2042。在图示实施例中，脊组件2049包括远侧脊部分2050，所述远侧脊部分附接到细长通道2022并且可枢转地联接到近侧脊部分2052。闭合管组件2009能够响应于施加至其上的致动运动在脊组件2049上轴向滑动。远侧闭合管2042包括开口2045，砧座2024上的突出部2027插入到所述开口中以当远侧闭合管2042在近侧方向“PD”上轴向移动时有利于砧座2024的打开。闭合管2040和2042可以由导电材料(例如金属)制成，以使它们可用作天线的一部分，如上所述。主驱动轴组件(如，驱动轴2048和2050)的部件可以由非导电材料(诸如塑料)制成。
在使用中，可能有利的是，围绕纵向工具轴线LT-LT旋转外科端部执行器2012。在至少一个实施例中，工具安装部分1300包括旋转的传输组件2069，所述旋转的传输组件能够接收来自机器人系统1000的工具驱动组件1010的对应的旋转输出运动，并将此旋转输出运动转化成旋转控制运动以使细长轴组件2008(和外科端部执行器2012)围绕纵向工具轴线LT-LT旋转。在各种实施例中，例如，近侧闭合管2040的近端2060通过向前的支撑支架1309和同样可活动地支撑在工具安装板1302上的闭合滑动件2100被旋转地支撑在工具安装部分1300的工具安装板1302上。在至少一种形式中，旋转的传输组件2069包括管齿轮段2062，所述管齿轮段形成于(或附接到)近侧闭合管2040的近端2060上，以通过操作地支撑在工具安装板1302上的旋转齿轮组件2070操作地接合。如图27所示，在至少一个实施例中，旋转齿轮组件2070包括旋转传动齿轮2072，当工具安装部分1300联接到工具驱动组件1010时，所述旋转传动齿轮联接到工具安装板1302的适配器侧1307上相应的从动盘或从动元件1304中的第一个。参见图24。旋转齿轮组件2070还包括旋转从动齿轮2074，所述旋转从动齿轮与管齿轮段2062和旋转传动齿轮2072以啮合的方式旋转地支撑在工具安装板1302上。将来自机器人系统1000的工具驱动组件1010的第一旋转输出运动施加到相应的从动元件1304，从而将引起旋转传动齿轮2072的旋转。旋转传动齿轮2072的旋转最终导致细长轴组件2008(和外科端部执行器2012)围绕纵向工具轴线LT-LT(图27中由箭头“R”表示)旋转。应当理解，在一个方向上施加来自工具驱动组件1010的旋转输出运动将引起细长轴组件2008和外科端部执行器2012围绕纵向工具轴线LT-LT在第一方向上旋转，并且在相反方向上施加旋转输出运动将引起细长轴组件2008和外科端部执行器2012在与第一方向相反的第二方向上旋转。
在至少一个实施例中，通过在脊组件2049上沿着远侧方向“DD”使闭合管组件2009轴向移动来实现砧座2024相对于钉仓2034的闭合。如上所述，在各种实施例中，近侧闭合管2040的近端2060由闭合滑动件2100支撑，所述闭合滑动件包括闭合传动装置(一般描述为2099)的一部分。在至少一种形式中，闭合滑动件2100能够将闭合管2009支撑在工具安装板1320上，使得近侧闭合管2040能够相对于闭合滑动件2100旋转并且随闭合滑动件2100轴向行进。具体地讲，如图32所示，闭合滑动件2100具有直立的突出部2101，所述直立的突出部2101延伸到近侧闭合管2040的近端部分中的径向凹槽2063中。另外，如图29和32所示，闭合滑动件2100具有延伸穿过工具安装板1302中的狭槽1305的突出部部分2102。突出部部分2102能够保持闭合滑动件2100与工具安装板1302滑动接合。在各种实施例中，闭合滑动件2100具有直立部分2104，所述直立部分具有在其上形成的闭合齿条齿轮2106。闭合齿条齿轮2106能够与闭合齿轮组件2110驱动接合。参见图29。
在各种形式中，闭合齿轮组件2110包括闭合正齿轮2112，所述闭合正齿轮联接到工具安装板1302的适配器侧1307上相应的从动盘或从动元件1304中的第二个。参见图24。因此，当工具安装部分1300联接到工具驱动组件1010时，将来自机器人系统1000的工具驱动组件1010的第二旋转输出运动施加到相应的第二从动元件1304上将引起闭合正齿轮2112的旋转。闭合齿轮组件2110还包括与闭合正齿轮2112以啮合的方式而被支撑的闭合减速齿轮组2114。如图28和29所示，闭合减速齿轮组2114包括与闭合正齿轮2112以啮合的方式而被旋转地支撑的从动齿轮2116。闭合减速齿轮组2114还包括与第二闭合传动齿轮2120啮合的第一闭合传动齿轮2118，所述第二闭合传动齿轮以与闭合齿条齿轮2106啮合的方式而被旋转地支撑在工具安装板1302上。因此，将来自机器人系统1000的工具驱动组件1010的第二旋转输出运动施加到相应的第二从动元件1304将引起闭合正齿轮2112和闭合传动装置2110的旋转，并且最终轴向驱动闭合滑动件2100和闭合管组件2009。闭合管组件2009移动的轴向最终取决于第二从动元件1304旋转的方向。例如，响应于从机器人系统1000的工具驱动组件1010接收的一个旋转输出运动，将在远侧方向“DD”上驱动闭合滑动件2100并且最终在远侧方向上驱动闭合管组件1009。当朝远侧驱动远侧闭合管2042时，闭合管段2042的末端将接合砧座2024的一部分并使砧座2024枢转到闭合位置。在施加来自机器人系统1000的工具驱动组件1010的“开口”输出运动时，将在近侧方向“PD”上驱动闭合滑动件2100和轴组件2008。当在近侧方向上驱动远侧闭合管2042时，其中的开口2045与砧座2024上的突出部2027相互作用以利于其打开。在各种实施例中，当将远侧闭合管2042移动至其起始位置时，可使用弹簧(未示出)以将砧座偏置至打开位置。在各种实施例中，闭合齿轮组件2110的各种齿轮的尺寸设定成产生所需的必要的闭合力，所述闭合力令人满意地在待由外科端部执行器2012切割和缝合的组织上闭合砧座2024。例如，闭合传动装置2110的齿轮的尺寸可设定成产生大约70-120磅的力。
在各种实施例中，通过刀杆2200驱动切割器械2032穿过外科端部执行器2012。参见图30和32。在至少一种形式中，刀杆2200可由例如不锈钢或其它类似材料制成并且具有大致矩形的横截面形状。此刀杆构造足够刚性以推动切割器械2032穿过夹持在外科端部执行器2012中的组织，同时还足够柔性以使外科端部执行器2012能够相对于近侧闭合管2040和近侧脊部分2052围绕关节运动轴线AA-AA进行关节运动，如将在下文中进一步详细地描述。如图33和34所示，近侧脊部分2052具有延伸穿过其中的矩形通路2054，以在其被轴向推动穿过其中时为刀杆2200提供支撑。近侧脊部分2052具有近端2056，所述近端可旋转地安装到附接到工具安装板1032的脊安装托架2057上。参见图32。此构造允许近侧脊部分2052在近侧闭合管2040内旋转但不轴向移动。
如图30中所示，将刀杆2200的远端2202附接到切割器械2032。刀杆2200的近端2204可旋转地附连到刀齿条齿轮2206，使得刀杆2200相对于刀齿条齿轮2206自由旋转。参见图32。如图26-31所示，刀齿条齿轮2206可滑动地支撑在附接到工具安装板1302的齿条外壳2210内，使得刀齿条齿轮2206保持与刀齿轮组件2220啮合。更具体地讲并结合图29，在至少一个实施例中，刀齿轮组件2220包括刀正齿轮2222，所述刀正齿轮2222联接到工具安装板1302的适配器侧1307上相应的从动盘或从动元件1304中的第三个。参见图24。因此，将来自机器人系统1000的另一旋转输出运动通过工具驱动组件1010施加到相应的第三从动元件1304，从而将引起刀正齿轮2222的旋转。刀齿轮组件2220还包括刀减速齿轮组2224，所述刀减速齿轮组包括第一刀从动齿轮2226和第二刀传动齿轮2228。刀减速齿轮组2224可旋转地安装至工具安装板1302，使得第一刀从动齿轮2226与刀正齿轮2222啮合。同样，第二刀传动齿轮2228与第三刀传动齿轮2230啮合，所述第三刀传动齿轮以与刀齿条齿轮2206啮合的方式而被旋转地支撑在工具安装板1302上。在各种实施例中，刀齿轮组件2220的齿轮的尺寸设定成产生如下所需的力：所述力驱动切割元件2032穿过夹持在外科端部执行器2012中的组织并致动其中的钉。例如，刀驱动组件2230的齿轮的尺寸可设定成产生大约40至100磅的力。应当理解，在一个方向上施加来自工具驱动组件1010的旋转输出运动将引起切割器械2032在远侧方向上轴向运动，并且在相反方向上施加旋转输出运动将引起切割器械2032在近侧方向上轴向运动。
图35示出另一个包括电子传感器2150的端部执行器2012。与上文描述的传感器150类似，电子传感器2150确定击发元件在端部执行器2012中的位置和/或钉仓2034在端部执行器2012中的状态或存在。能够在端部执行器2012中平移的切割元件2032、滑动件2033、刀杆2200和其它元件在本文统称为击发元件。在至少一种形式中，电子传感器2150包括被支撑在外科工具1200的端部执行器2012内的电阻构件2152。电阻构件2152可由在端部执行器2012中的钉通道2022、夹紧构件2024、钉仓2034或另一个元件支撑。随着击发元件纵向平移穿过端部执行器2012，击发元件可与电阻构件2152移动接触。
在各种实施例中，电子传感器2150的电阻构件2152可由细长通道2022支撑。例如，在至少一种形式中，电阻构件2152通过粘合剂被固定至在细长通道2022中的电阻构件2152。在其它实施例中，电阻构件2152可被固定至在细长通道2022中的部件。参照图35中显示的一个实施例，电阻构件2152被定位在钉通道2022的内表面2028上，使得击发元件随着该击发元件纵向行进穿过钉通道2022而接触电阻构件2152。在可供选择的实施例中，电阻构件2152由钉仓2034支撑。参照图36，电阻构件2152可由钉仓2034的仓体2035支撑。与上述类似，电阻构件2152可被定位在钉仓2034的仓体2035上，使得击发元件的至少一部分随着该击发元件纵向行进穿过钉通道2022而接触电阻构件2152。
如上文与电阻构件152有关的描述，电子传感器2150的电阻构件2152可包括多个电阻器2154和多个节点2156。电阻器2154可以并列构造布置或可以串联布置。参照图35，在端部执行器2012中的击发元件随着该击发元件在钉通道2022的近端2023a和钉通道2022的远端2023b之间平移而与电阻构件2152移动接触。随着击发元件平移穿过钉通道2022并移动地接触电阻构件2152，电阻构件2152产生指示击发元件在细长通道22内的位置的输出信号。电阻构件2152产生的输出信号可为沿电阻构件2152的电压(或电力)的测量值。
在各种实施例中，参照图35，击发元件可移动地接触电阻构件2152，使得击发元件切断电阻构件2152的部分，如上述与电阻构件152有关的更详细地描述。因此，切割元件32的位置可随着其沿着电阻构件2152平移根据当电阻器2154被切割时电阻构件2152产生的指示电压的输出信号而确定。
机器人系统1000还可包括操作地与主控制器1001交接的处理器2180。在各种实施例中，处理器2180可被整合进主控制器1001。如上述与处理器180有关的更详细地描述，处理器2180可根据来自传感器2150的输出信号确定击发元件在端部执行器12中的位置传感器2150可直接地或间接地向处理器2180提供信号，如上述更详细地描述。在各种实施例中，处理器2180可包括存储器装置2160。如上文与存储器装置160有关的更详细地描述，存储器装置2160可为任何种类的能够存储或记录传感器信号的装置，并可经由线168、导电元件170和接触垫158(图3)通过有线或无线通信或两者的结合与传感器2150的电阻构件2152连通。在其它实施例中，存储器装置2160可不整合进处理器2180；该存储器装置可为机器人系统1000的分立部件，该机器人系统操作地与传感器2150的电阻构件2152连通并然后将输出信号从传感器2150转发至处理器2180。
如果处理器2180未整合进主控制器1001，则处理器2180可将击发元件的位置传输至主控制器1001。在确定击发元件在细长通道2022中的位置时，可将该位置传输至指示击发元件位置的指示器2190。该指示器可为视觉指示画面，诸如反馈仪器1005或触觉指示器。
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取出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。此类技术的使用和所得修复装置全都在本申请的范围内。
如先前所述，本公开的各种实施例的独特和新颖方面采用电子传感器来确定击发元件在外科器械的端部执行器中的位置和/或钉仓在端部执行器中的状态或存在。因此，本公开的各种实施例的独特构造和原则可使本文所公开的和受权利要求书保护的各种不同形式的电子传感器能有效地和与击发元件一起使用的其它类型和形式的外科器械、端部执行器和钉仓连用。上述根据本公开的一些实施例描述了具有外科切割和紧固器械的机器人系统。然而，如前所述，本领域的普通技术人员应理解到，根据本公开的各种实施例，可通过可供选择的方式为外科器械提供动力和控制。上述描述和下述权利要求旨在覆盖本发明范围内的所有改变和变型。虽然一些图中示出了尺寸，但是这些尺寸意指示例性实施例，并不理解为限制性的。在公开材料用于某些部件的情况下，可使用其它材料。
据述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，在必要程度下，本文所明确阐述的公开内容将会取代以引用的方式并入本文中的任何相冲突的材料。如果据述以引用的方式并入本文但与本文所述现有定义、陈述或者其它公开材料相冲突的任何材料或其部分，仅在所并入的材料与现有公开材料之间不产生冲突的程度下并入本文。

Claims (18)

1.一种外科器械，包括：
外科端部执行器，所述外科端部执行器包括：
具有近端和远端的细长通道；
击发元件，在被施加驱动动作时，所述击发元件能够在所述细长通道的所述近端和所述细长通道的所述远端之间选择性地平移，其中所述击发元件包括切割元件；和
电阻构件，电阻构件被支撑用于随着所述击发元件被从所述细长通道的所述近端驱动至所述远端由所述击发元件移动接触，其中，所述电阻构件包括：
近侧节点，远侧节点，以及定位在所述近侧节点与所述远侧节点中间的中间节点；
定位在所述近侧节点与所述中间节点中间的第一可切断电阻器；和
定位在所述中间节点与所述远侧节点中间的第二可切断电阻器；
其中所述切割元件被构造成能够随着所述击发元件在所述细长通道的所述近端和所述远端之间平移而顺序地切断所述第一可切断电阻器和所述第二可切断电阻器，并且其中所述电阻构件随着所述击发元件顺序地穿过所述近侧节点、所述远侧节点和所述中间节点而产生指示所述击发元件在所述细长通道内的更新位置的输出信号；和
存储器装置，所述存储器装置操作地与所述电阻构件连通并能够随着所述击发元件平移穿过所述细长通道来记录所述输出信号。
2.根据权利要求1所述的外科器械，其中所述电阻构件包括多个电阻器，所述多个电阻器包括所述第一可切断电阻器和所述第二可切断电阻器，并且其中所述电阻构件的所述多个电阻器并联连接。
3.根据权利要求1所述的外科器械，其中所述电阻构件包括多个节点，所述多个节点包括所述近侧节点、所述远侧节点和所述中间节点，并且其中所述输出信号包括指示在所述电阻构件中的节点处的电压的信号。
4.根据权利要求3所述的外科器械，还包括处理器，所述处理器操作地与所述存储器装置交接并根据指示在所述电阻构件中的所述节点处的电压的所述信号来计算所述击发元件在所述外科端部执行器中的位置。
5.根据权利要求4所述的外科器械，还包括指示器，所述指示器与所述处理器连通以指示所述击发元件在所述细长通道内的位置。
6.根据权利要求5所述的外科器械，其中所述指示器包括视觉指示装置。
7.根据权利要求5所述的外科器械，其中所述指示器包括触觉指示构造。
8.根据权利要求1所述的外科器械，其中所述击发元件响应于操作地与所述外科端部执行器交接的机器人系统向其施加的驱动动作而平移，所述机器人系统包括处理器，所述处理器操作地与所述存储器装置交接并计算所述击发元件在所述外科端部执行器中的位置。
9.根据权利要求1所述的外科器械，其中所述外科端部执行器能够操作地支撑外科钉仓。
10.根据权利要求9所述的外科器械，其中所述电阻构件被支撑在所述钉仓上。
11.用于与外科器械结合的钉仓，所述钉仓包括：
仓体，所述仓体能够操作地由外科器械支撑，使得所述外科器械的击发元件在被施加驱动动作时能够纵向平移穿过所述仓体；和
电阻构件，所述电阻构件被支撑在所述仓体上以随着所述击发元件平移穿过仓体由所述击发元件移动接触，其中，所述电阻构件包括：
近侧电阻器；和
远侧电阻器；
其中所述击发元件被构造成能够随着所述击发元件沿纵向平移通过所述仓体而顺序地穿过所述近侧电阻器和所述远侧电阻器，并且其中所述电阻构件能够操作地将指示所述击发元件在所述仓体内的位置的输出信号传输至所述外科器械的存储器部分。
12.根据权利要求11所述的钉仓，其中所述仓体中具有细长狭槽，所述细长狭槽能够将所述击发元件的至少一部分接收在其中，其中所述击发元件包括切割元件，并且其中所述电阻构件的部分相对于所述细长狭槽取向成使得随着所述切割元件被从所述仓体的近端驱动至远端，所述切割元件依次切断所述电阻构件的所述部分。
13.根据权利要求12所述的钉仓，其中所述电阻构件包括：
多个电阻器，所述多个电阻器包括所述近侧电阻器和所述远侧电阻器；和
多个节点，其中所述节点定位在所述电阻构件中的相邻的电阻器之间。
14.根据权利要求13所述的钉仓，其中在所述电阻构件中的所述多个电阻器并联连接。
15.根据权利要求13所述的钉仓器械，其中所述输出信号包括指示在所述电阻构件中的所述节点处的电压的信号。
16.一种外科器械，包括：
机器人系统，所述机器人系统包括处理器；和
外科端部执行器，所述外科端部执行器操作地与所述机器人系统交接以接收来自所述机器人系统的驱动动作，所述外科端部执行器包括：
具有近端和远端的细长通道；
击发元件，在所述机器人系统向其施加驱动动作时，所述击发元件能够在所述细长通道的所述近端和所述细长通道的所述远端之间选择性地平移；和
电阻构件，所述电阻构件被支撑用于随着所述击发元件被从所述细长通道的所述近端驱动至所述远端由所述击发元件移动接触，其中，所述电阻构件包括：
近侧电阻器；和
远侧电阻器；
其中所述击发元件被构造成能够随着所述击发元件被从所述细长通道的所述近端驱动至所述远端而顺序地接合所述近侧电阻器和所述远侧电阻器，并且其中所述电阻构件产生指示所述击发元件在所述细长通道内的位置的输出信号并将所述输出信号传输至所述处理器。
17.根据权利要求16所述的外科器械，还包括指示器，所述指示器与所述处理器连通以随着所述击发元件被从所述细长通道的所述近端驱动至所述远端提供所述击发元件的位置的指示。
18.根据权利要求17所述的外科器械，其中所述指示器包括触觉指示构造。
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