CN1883406A - 带有流体致动对置钳口的外科器械 - Google Patents

带有流体致动对置钳口的外科器械 Download PDF

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CN1883406A
CN1883406A CNA2006100930538A CN200610093053A CN1883406A CN 1883406 A CN1883406 A CN 1883406A CN A2006100930538 A CNA2006100930538 A CN A2006100930538A CN 200610093053 A CN200610093053 A CN 200610093053A CN 1883406 A CN1883406 A CN 1883406A
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surgical instruments
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actuator
anvil block
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肯尼思·S·威尔士
弗雷德里克·E·谢尔顿四世
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Ethicon Endo Surgery Inc
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
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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
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • 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
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • 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
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Abstract

一种手术钉合和切割器械，通过拥有上和下钳口(例如，砧座和钉槽)而具有执行微创外科手术的能力，所述上和下钳口通过手术切口、尤其是通过套管针的插管和细长轴以及手柄一起定位。一对流体致动器囊(升降袋)在钉槽中被放置在向近侧凸出的杠杆架下方，这样来自手柄的流体传递将导致砧座的闭合和夹紧。双向液压控制可以在手柄中通过机械方式产生，或是通过激励电活性聚合物致动器产生。一旦检测到击发，插到细长轴中的药物注射器中的EAP柱塞被启动以分配药物(例如，麻醉剂、粘合剂、烧灼物、抗生素等)，并且将药物沿着击发杆被引导到E形梁的切割表面，从而在组织被切割时将药物放在组织上。

Description

带有流体致动对置钳口的外科器械
相关申请的交叉参照
本申请要求Kenneth Wales和Chad Boudreaux于2005年2月18日提交的、名称为“SURGICAL INSTRUMENT INCORPORATING AFLUID TRANSFER CONTROLLED ARTICULATIONMECHANISM”的美国专利申请11/061,908的优先权，该申请的内容全部包括在这里作为参考。
技术领域
本发明总的涉及能够在向组织施加成排的钉的同时切割那些位于该成排钉之间的组织的外科钉合器械，尤其涉及与钉合器械相关的改进以及用于形成这些钉合器械的各组成元件的加工工艺的改进。
背景技术
微创手术外科器械受到越来越多地依赖，以减少各种外科手术的住院和恢复时间。在这些外科器械中有许多器械都包括通过细长轴致动端部执行器的机构，执行使两个相对表面彼此相对的手术步骤。例如，可枢转地对置的钳口被用在抓钳中。可枢转地连接的剪切刀片被结合到切割装置中。由于将横截面设计为最小以便穿过套管针的小插管的设计目的，使得沿具有足够强度的细长轴设置致动控制器变得复杂化。而且，细长轴通常具有多个控制功能(例如，旋转、关节运动等)。此外，降低设计复杂度以提供经济的装置也是合乎需要的。
作为特定的复杂外科器械的一个示例，手术钉合器在现有技术中已经被用于同时在组织上切开纵向切口并在切口的相对侧施加成排的钉。上述器械通常包括一对协作的钳口构件，如果该器械用于内窥镜或腹腔镜用途，则这对钳口构件能够穿过插管通路。其中一个钳口构件容纳有钉仓，所述钉仓具有至少两列横向隔开的钉。另一个钳口构件则限定了砧座，该砧座具有和钉仓中的各列钉对准的钉成形槽。该器械包括多个往复式楔形件，当这些往复式楔形件被向远侧驱动时，它们穿过钉仓中的各开口并与支撑钉的各驱动器接合，以便向砧座发射钉。
在美国专利US 5,465,895中描述了一种适于内窥镜用途的手术钉合器的实例，其有利地提供了分开的闭合和击发动作。由此，医生能够在发射之前闭合组织上的钳口构件以定位组织。一旦医生已经确定钳口构件正确夹住了组织，医生就能够击发手术钉合器，从而切割和钉合组织。切割和钉合同时进行可以避免在使用只能分别切割或钉合组织的不同手术器械顺序执行上述动作时引起的混乱。
这些微创外科器械已经被广泛使用，而且已经证明这是相对于传统开放式手术技术的重大进展。应当理解，微创外科器械结合其它特征和能力也是合乎需要的。
发明内容
通过包括适合执行微创外科手术的如下外科器械，本发明克服了现有技术的上述和其它缺点，所述外科器械具有手柄，该手柄借助细长轴穿过手术开口定位端部执行器。所述端部执行器具有一对与组织相对接触的枢转构件。流体致动闭合机构以如下方式响应闭合动作，即，借助被连接到手柄上的流体致动器通过在流体导管中向已定位的流体储存器双向传递流体以推动该成对枢转构件闭合。因此，在细长轴内采用流体导管能够使用可执行重要手术操作的具有所需小横截面的轴。
在本发明的一个方面，外科器械具有端部执行器，所述端部执行器由流体致动器致动，以在组织上打开和闭合。一旦端部执行器被闭合，被容纳在细长轴中用于往复执行纵向击发运动的击发杆传递来自手柄的纵向击发运动，用于致动钉仓和切断在端部执行器中被钳夹的组织。
在本发明的另一个方面，外科器械包括产生闭合致动的手柄，上述闭合致动将流体通过细长轴内的流体导管传递到位于杠杆腔内的流体致动器中以定位杠杆。第一组织接触构件的杠杆从和第二组织接触构件的枢转连接件向近侧延伸到杠杆腔中。流体传递有利地实现了成对组织接触构件的枢转运动。
(1)本发明涉及一种外科器械，其包括：
手柄，其被可操作地配置成产生闭合致动；
细长轴，其被连接到所述手柄；
端部执行器，其在远侧连接到所述细长轴，并包括用于钳夹组织的对置钳口；
一对枢转构件，它们相对地接触组织，每一个枢转构件均包括各自的向近侧凸出的杠杆，所述杠杆被限定为围绕枢轴连接件相对于另一个杠杆枢转；以及
流体致动闭合机构，所述机构包括：
流体致动器，其定位于所述各杠杆之间，
流体导管，其与所述流体致动器和细长轴连通，以及
流体储存器，其通过所述手柄响应闭合致动，有选择地且双向地通过流体导管与流体制动器传递流体。
(2)根据第(1)项所述的外科器械，其中，所述手柄被可操作地配置成产生往复机械闭合运动，所述流体储存器通过往复机械闭合运动有选择地被压缩和扩张。
(3)根据第(1)项所述的外科器械，进一步包括通过所述手柄响应闭合动作以有选择地产生闭合信号的控制电路，所述流体储存器进一步包括电活性聚合物致动的双向液压泵。
(4)根据第(1)项所述的外科器械，其中，所述成对的枢转构件包括相对地切割组织的切割刀片。
(5)根据第(1)项所述的外科器械，其中，所述成对的枢转构件包括夹取钳口。
(6)根据第(1)项所述的外科器械，其中，从所述成对枢转构件的下部枢转构件向近侧凸出的杠杆包括被连接到手柄的细长轴的框架。
(7)根据第(6)项所述的外科器械，其中，所述下部枢转构件包括钉槽，并且上部枢转构件包括砧座，所述外科器械进一步包括：
钉仓，其容纳在所述钉槽中；
击发杆，其滑动地容纳在细长槽中，并且可穿过已闭合的端部执行器向远侧运动，以便对被夹持的组织进行切割和钉合。
(8)根据第(1)项所述的外科器械，其中，所述轴进一步包括关节运动接头，所述流体导管进一步包括穿过关节运动接头的挠性部分。
(9)根据第(8)项所述的外科器械，进一步包括：
外部护套，其包围所述细长轴的框架和砧座杠杆；以及
流体致动器，为使左和右流体致动器反向从而打开砧座，该流体致动器定位于砧座杠杆和外部护套之间，所述手柄进一步被可操作地配置成有差别地扩张和压缩反向流体致动器以及成对的左和右流体致动器。
(10)根据第(7)项所述的外科器械，其中，所述手柄被可操作地配置成产生往复机械闭合运动，通过往复机械闭合运动使流体储存器被有选择地压缩和扩张。
(11)根据第(7)项所述的外科器械，进一步包括通过手柄响应闭合动作以有选择地产生闭合信号的控制电路，所述流体储存器进一步包括电活性聚合物致动的双向流体致动器。
(12)根据第(1)项所述的外科器械，其中，所述流体致动器包括流体致动器囊。
(13)根据第(7)项所述的外科器械，进一步包括用于钳夹、钉合和切割组织的部件。
(14)根据第(1)项所述的外科器械，进一步包括被可操作地配置成检测端部执行器阻塞状况的监测系统，该阻塞状况下所述成对枢转构件处于和命令位置不一致的相对位置。
(15)根据第(14)项所述的外科器械，其中，所述监测系统进一步包括对被检测命令位置和被检测端部执行器的当前位置之间的比较做出响应的控制电路。
(16)根据第(15)项所述的外科器械，其中，所述监测系统进一步包括所述各枢转构件中至少一个构件的位置检测。
(17)根据第(15)项所述的外科器械，其中，所述监测系统进一步包括被定位成响应流体致动闭合机构中的流体压力的压力检测。
(18)本发明还涉及一种外科器械，其包括：
手柄，其被可操作地配置成产生双向流体运动和纵向击发运动；
细长轴，其被连接到所述手柄，并被可操作地配置成传递双向流体运动；
端部执行器，其在远侧连接到所述细长轴，并包括用于钳夹组织的对置钳口；
击发杆，为进行往复纵向击发运动其被容纳在所述细长轴中以传递纵向击发运动，并且其在远侧终止于切割面，以切割端部执行器中被钳夹的组织；
钉仓，其被容纳在所述对置钳口的一个钳口中，响应于击发构件驱动钉并穿过被钳夹的组织使钉成形；以及
流体致动器，其被可操作地连接到端部执行器，以通过细长轴响应来自手柄的双向流体运动来有选择地打开和闭合端部执行器。
(19)根据第(18)项所述的外科器械，其中，所述流体致动器包括流体致动器囊。
(20)根据第(18)项所述的外科器械，其中，所述端部执行器包括被连接到细长槽的框架上的钉槽和被可枢转地连接到钉槽上的砧座，所述砧座包括从枢转附件向近侧凸出到钉槽的杠杆，所述流体致动器定位于杠杆和钉槽之间以闭合砧座。
(21)根据第(18)项所述的外科器械，其中，所述手柄被可操作地配置成产生往复机械闭合运动，通过往复机械闭合运动流体储存器被有选择地压缩和扩张。
(22)根据第(18)项所述的外科器械，进一步包括通过手柄响应闭合动作以有选择地产生闭合信号的控制电路，流体储存器进一步包括电活性聚合物致动的双向液压泵。
(23)本发明还涉及一种外科器械，其包括：
手柄，其被可操作地配置成产生闭合致动；
细长轴，其被连接到所述手柄；
第一和第二组织接触构件，它们以可枢转的方式彼此接合且从细长轴向远侧凸出；以及
流体致动闭合机构，其包括：
流体致动器，其连接在第一和第二组织接触构件之间，
流体导管，其与流体致动器和细长轴连通，以及
流体储存器，其通过手柄响应闭合致动，通过流体导管有选择地且双向地与流体制动器传递流体。
(24)根据第(23)项所述的外科器械，其中，所述第一和第二组织接触构件包括切割刀片。
(25)根据第(23)项所述的外科器械，其中，所述第一和第二组织接触构件包括夹持钳口。
(26)根据第(23)项所述的外科器械，其中，所述第一组织接触构件包括从与第二组织接触构件的枢转接合件向近侧延伸的杠杆，所述细长轴包括容纳杠杆的杠杆腔，流体致动器被定位在杠杆腔中。
本发明的上述和其它目的和优点可借助本发明的说明和附图而更加清楚。
附图说明
下述附图被包括在说明书中并构成说明书的一部分，这些附图说明了本发明的实施方案，并且和上文给出的本发明的总体说明以及下文给出的各种实施方案的具体描述一起用于说明本发明的原理。
图1是外科钉合和切割器械的透视图，该器械具有处于打开位置的流体致动上钳口(砧座)和电活性聚合物(EAP)药物分配轴。
图2是图1所示外科钉合和切割器械的执行部分的分解透视图。
图3是在图1所示外科钉合和切割器械的执行部分的左侧剖视图，该左侧剖视图沿大致经过纵向轴线的横截面、并经过和E形梁击发杆中的分配槽流体连通的偏置EAP注射器和接收器截取。
图4是在图1所示外科钉合和切割器械的执行部分的在大致经过纵向轴线的横截面中获取的左侧剖视图，图中显示了打开砧座的横向偏置流体致动器囊致动器。
图5是结合有药物导管的E形梁击发杆的左侧详示图。
图6是图4所示外科钉合和切割器械执行部分的远侧部分的左侧详细剖视图，该图是大致经过其纵向轴线的横截面获取的，并且砧座处于闭合状态。
图7是图6所示E形梁击发杆的左侧详示图。
图8是在经过线8-8的横截面中获取的端部执行器和细长轴的下钳口(钉槽)的结合部分的详细俯视图，描绘了E形梁击发杆的导向。
图9是图2所示外科钉合和切割器械的执行部分的击发杆导向件的主视图。
图10是在沿线9-9的横截面中获取的图9所示击发杆导向件的左视图。
图11是沿线11-11经过EAP药物注射器的远端获取的图3所示外科钉合和切割器械的细长轴的主剖视图。
图12是图11所示EAP药物注射器的左视图。
图13是图1所示外科钉合和切割器械的执行部分被部分剖开以显示EAP药物注射器近侧零部件的左视图。
图14是图13所示外科钉合和切割器械的细长轴的EAP药物注射器和接收器的左侧详示图。
图15是图2所示外科钉合和切割器械的击发杆的俯视图。
图16是薄板状击发杆的左视图，以虚线示出了用于图1所示外科钉合和切割器械的内部流体通道。
图17是一E形梁方案的左视图，以虚线示出了内部流体通道。
图18是沿线18-18的横截面并通过流体通道的近侧开口槽的图15所示薄板状击发杆的主视图。
图19是图1所示的外科钉合和切割器械方案被部分剖开的左视图，描绘了控制电路和控制器。
图20所示流程图显示了由图19所示外科钉合和切割器械的控制电路执行的操作的顺序。
具体实施方式
参见附图，其中在附图中相同的附图标记表示相同的组成元件，图1-2显示了能够实施本发明独特优点的外科钉合和切割器械10，所述优点包括端部执行器14的上钳口(砧座)12的流体致动(例如，打开、闭合/夹紧)以及组织被切割时在组织上分配药物。端部执行器14的流体致动提供了多种设计方案，这些方案避免了传统机械连杆机构的某些设计局限性。例如，可以避免束缚或组成元件失效。此外，在被切割组织上分配液体允许应用多种有利的治疗处理，诸如麻醉剂、粘合剂、烧灼物、抗生素、凝血剂等的应用。
特别参考图2，外科钉合和切割器械10包括由细长轴18和端部执行器14形成的执行部分16，其中端部执行器14被描绘成钉合组件20。外科钉合和切割器械10还包括在近侧连接到轴18上的手柄22(图1)。当执行部分16通过形成用于执行微创外科手术的气腹的手术切口或者尤其是套管针的插管被插入到患者体内时，手柄22保留在患者体外。
左、右流体致动器囊(升降袋)24、26被支撑在钉槽30的后部28内。砧座12包括一对朝内的横向枢轴销32、34，上述枢轴销32、34和在钉槽30中在后部28的远侧形成的向外开口的横向枢轴凹槽36、38转动接合。砧座12包括朝向近侧的杠杆架(lever tray)140，该杠杆架伸入到钉槽30的后部28并位于流体致动器囊(升降袋)24、26上与之保持接触，这样填充流体致动器囊24、26会导致砧座12的远侧夹钳部分41像跷跷板一样向保持在钉槽30的远侧部分44中的钉仓42枢转。流体致动器囊24、26的排空和塌缩、或端部执行器14的其它弹性零件会导致砧座12打开。左、右流体导管46、48分别和左、右流体致动器囊24、26相连，用于双向传递用于致动的流体。
应当理解，这里使用的术语“近侧”和“远侧”是相对于握持器械手柄的医生而言的。因此，钉施加组件20相对于更近侧的手柄22而言处于远侧。还应理解，为了描述方便和清楚，这里使用的诸如“垂直”、“水平”这样的空间术语是相对于附图而言的。但是，外科器械可以以各种方向和位置使用，这些术语并不是限制性的和绝对的。
细长轴18包括框架50(图2)，框架50的近端被以可旋转的方式接合到手柄22上，旋钮52可以使框架50与端部执行器14一起旋转。框架的远端具有和钉槽30的远侧凸缘56接合的横向凹槽54。框架50包括横向居中的底部发射槽58，发射槽58纵向穿过框架50用于容纳两件式击发杆60，该击发杆60由在远侧连接有E形梁64的击发杆62构成，该E形梁64在钉施加组件20中平移以切断和钉合组织。框架50的远侧部分包括上部腔66，上部腔66的远端和近端通过远侧和近侧孔口68、70连通，其间限定了横梁72，弹簧夹76的远侧凸出夹74在横梁72上与下弹簧臂78接合，下弹簧臂78穿过上部腔66向远端且向下凸出用于向下偏压击发杆62，使其和钉槽30接合，尤其是当下弹簧臂78碰到在击发杆62上的凸起部分80时。
通过包括在框架50中形成的横向偏置圆柱形腔90，药物分配被结合到细长轴18中，框架50在它的纵向长度上通过矩形孔口90与外部相通，其中矩形孔口92的长度要略短于电活性聚合物(EAP)注射器100，电活性聚合物(EAP)注射器100通过矩形孔口92被插入到圆柱形腔90中。圆柱形腔90的近侧部分包括沿纵向对准的压缩弹簧102，该弹簧102将EAP注射器100的远侧分配锥形件104向远侧推压成和框架50密封地接触，并且允许插入和撤出EAP注射器100的平移。电导体106穿过框架50并且被连接到压缩弹簧102上，其中压缩弹簧102也由导电金属构成。EAP注射器的后部是导电的，并接触弹簧102以形成EAP致动器110的阴极，上述EAP致动器110被容纳在EAP注射器100的近侧部分。应当理解，可能和导体106一起行进的另一个导体也可以和EAP致动器110电连接以用作阳极。
当被激励时，EAP致动器110沿纵向扩张，用作柱塞，以将位于EAP注射器100的远侧部分的药物112驱动通过远侧分配锥形件104。当EAP致动器110横向收缩以补偿它的纵向扩张时，柱塞密封件114维持在EAP注射器100内的横向密闭。当药物112被分配时，诸如导体106周围的通气孔(未显示)允许空气重新填充EAP注射器100。通气孔可以依靠药物112的表面张力防止泄漏。作为另一种选择，单向阀可以用于实现相同目的。如下所述，药物112通过框架50被传递到横向流体槽120，在击发杆62和E形梁64中形成的横向流体槽120将药物引导到E形梁64的切割表面122。框架槽58的尺寸被设定成密封横向流体槽120。横向流体槽120被放置在弹簧夹76下面的那一部分被击发杆导向件124密封。在示例性方案中，外部护套82包围框架50和砧座12的向近侧凸出的杠杆架40。顶部远侧开口131允许砧座12闭合。
外部护套130的外部矩形孔口132的尺寸被设置和纵向定位成和在框架50中形成的矩形孔口92对应。在一些应用中，外部护套130可以被旋转成有选择地将矩形孔口92和外部矩形孔口132对准，以插入或移除EAP注射器100。应当理解，在一些应用中，EAP注射器100可以被一体地组装到细长轴中，这样就不允许选择所需药物。例如，医生可整体地选择带有一体的钉仓和医药分配储存器的一次性执行部分。但是，相信允许在使用时插入具有一定优势，这包括选择药物(例如麻醉剂、粘合剂、抗生素、烧灼化合物等)时的临床灵活性和延长保存期/简化执行部分16的存储和包装。
在示例性方案中，多个盘形EAP层的长条形堆叠被纵向对齐，并且被配置成沿其纵向轴线扩张。电活性聚合物(EAP)是一组导电的掺杂聚合物，当施加电压时，它们可以改变形状。实际上，这种导电聚合物与一些形式的离子流体或离子凝胶和电极配合。在所施加电势的作用下，离子流从流体/凝胶中进入或离开导电聚合物，并且这种离子流引起聚合物的形状变化。电势可以在1V到4kV之间变化，这取决于所使用的聚合物和离子流体。当施加电压时，一些EAP收缩，一些EAP扩张。EAP可以和弹簧或挠性板这样的机械装置配合，以改变施加电压时所产生的效果。
下面描述EAP的两种基本类型和每一种类型的多种配置。两种基本类型是纤维束和层压型。纤维束由大约30-50微米的纤维组成。这些纤维可以类似织物那样被编织成束，因此通常也被称为EAP纱。当施加电压时，这种类型的EAP收缩。电极通常由中央线芯和导电外部护套构成，其中导电外部护套也用于容纳包围纤维束的离子流体。美国专利US 6,667,825描述了可从商业途径获得的纤维EAP材料的一个实例，该纤维EAP材料由Santa Fe Science and Technology生产且以PANIONTM纤维销售，该专利在此全部引入作为参考。
另一种类型是层压结构，该结构包括一层EAP聚合物、一层离子凝胶和两个挠性板，其中挠性板被连接在层压结构的两侧。当施加电压时，方形层压板在一个方向上扩张并且在其垂直方向上收缩。可从商业途径获得的层压(板状)EAP材料的一个实例是由ArtificialMuscle公司(SRI实验室的一个部门)生产。板状EAP材料由日本EAMEX生产，并且被称为薄膜EAP。
应当理解，在提供能量时，EAP的体积没有发生变化；它们只是在一个方向上扩张或收缩，同时在其横向上出现相反的变化。层压型使用的基本形式是通过一侧抵靠刚性结构并且另一侧像活塞一样使用。层压型也可以被粘合到挠性板的任何一侧。当向挠性板EAP的一侧施加能量时，挠性板状EAP扩张，并且在相反方向上弯曲板。这就允许板根据哪一侧被通电而在某一个方向上被弯曲。
EAP致动器通常由许多层或捆扎到一起以协同工作的纤维组成。EAP的物理结构决定了EAP致动器和它的运动性能。EAP可以被做成长的导线束并包绕单个中央电极。挠性外部外套管将构成致动器的其它电极，并容纳执行装置功能所必需的离子流体。在这种构造中，当电场被施加到电极上时，EAP导线束缩短。EAP致动器的这种构造被称为纤维EAP致动器。同样，层压构造可以被放置在挠性板任何一侧的许多层中或是仅被放置在自身的层中，以增加它的性能。典型的纤维结构具有2-4％的有效伸长率(effective strain)，而使用更高的电压，典型的层压型则可以实现20-30％的有效伸长率。
例如，层压EAP复合物可以这样构成：在EAP层上连接正的板状电极层，该EAP层又连接到离子室(ionic cell)层，离子室层又连接到负的板状电极层。借助各层之间的粘合剂层，多层层压EAP复合物可以被层叠固定以形成EAP板形致动器。应当理解，可以形成能够在任一个方向上选择性弯曲的反向EAP致动器。
收缩的EAP纤维致动器可以包括纵向铂阴极导线，所述阴极导线经由在塑料圆筒壁内形成的细长圆柱形腔穿过绝缘聚合物近端帽，其中上述塑料圆筒壁被导电掺杂以用作阳极。铂阴极导线的远端被埋放入绝缘聚合物远端帽中。许多收缩聚合物纤维围绕阴极导线被平行布置，并且它们的端部被埋放到各自的端帽中。塑料圆筒壁沿外周围绕各自的端帽连接，用于封闭圆柱形腔，以密封入填充在收缩聚合物纤维和阴极导线之间空间的离子流体或凝胶。当跨过塑料圆筒壁(阳极)和阴极导线施加电压时，离子流体进入到收缩聚合物纤维中，这导致纤维外径膨胀，同时使纤维在长度上产生相应的收缩，从而将各端帽朝向彼此牵拉。
EAP致动器在外科器械中应用的其它描述参见2005年3月17日提交的标题为“SURGICAL INSTRUMENT INCORPORATING ANELECTRICALLY ACTUATED ARTICULATION MECHANISM”、序列号为No.11/082,495的共有美国专利申请，该专利申请在此全部引入作为参考。
现在参考图1，手柄22控制砧座12的闭合、两件式击发杆60的击发和药物分配。在示例性方案中，可以紧住手枪式握把140并根据需要按压拇指按钮142，以控制砧座12的闭合。拇指按钮142向和EAP注射器100类似的EAP分配致动器(未显示)提供成比例的电信号，从而通过导管46、48将流体传递给流体致动器囊24、26，以闭合砧座12(图2)。当拇指按钮142被完全按下时，机械肘杆锁(未显示)接合以保持拇指按钮142被按下的状态，直到完全按压释放肘杆锁释放拇指按钮142为止。因此，当拇指按钮142被按下时，医生可以看到端部执行器14被闭合且被夹紧的直观指示，并且通过EAP分配致动器的连续激励或通过锁定元件，可以将它们保持在该位置。例如，控制电路可以检测拇指按钮142的运动，从而使连通EAP分配致动器和导管46、48的常闭EAP截流阀(未显示)打开。一旦运动停止，EAP截流阀被允许再次关闭，以保持砧座12的状态。此外，可以采用手动释放来解除上述闭锁，以打开砧座12。
作为另一种选择，可以包括将流体双向传递到流体致动器囊24、26的闭合触发器(未显示)或其它致动器。在上面引用的专利申请No.11/061,908中描述了使枢转轴进行关节运动的许多这种流体致动器，这些流体致动器适于闭合砧座12。为了充分利用这些方案中的一些方案所描述的不同流体传递，可以理解，反向升降袋(未显示)可以被放置在砧座12的杠杆架40上，用于当左和右流体致动囊(升降袋)24、26塌缩时确保开启力。
为了避免不期望的击发，检测可以被有利地结合到控制电路中。例如，压力转换器和/或位置检测可以被放置用于监测流体传递和/或砧座位置。例如，可以检测砧座12和钉槽30的接近度，如果没有闭合，击发可以被闭锁。监测系统可以检测到超出阈值的流体压力，这表示在某些物体阻止砧座闭合(例如，端部执行器14中组织过多)的情况下命令砧座12闭合。同样，在命令砧座12打开的情况下，低于下阈值的流体压力表示砧座12不能打开(例如，抵靠着组织)。手柄22上的彩色发光二极管(LED)(未显示)可以通过色彩、闪烁等为医生提供指示。这些指示可以包括通电、自检正常、自检失败、电池电压过低、砧座打开、砧座闭合、砧座打开阻塞、砧座闭合阻塞。用于确保阻止击发的指示可以用于禁止击发。
尤其是参考图3，手柄22包括击发触发器150(图1)，击发触发器被向着手枪式握把140朝近侧拉动，从而使击发杆152在细长轴18的近侧部分154中向远侧运动。击发杆152的远侧托架156接合击发杆62的朝上近侧钩状件158。框架50内的动态密封件160密封击发杆152，这样当执行部分被插入到充气腹部时，执行部分气密密封。
击发杆152的防倒退(anti-backup)机构170可以被有利地包括在手柄22中，手柄22包括多冲程击发触发器150和与击发杆152连接的回缩偏压击发机构(未显示)。尤其是，当回缩击发杆152如图所示使锁板172向后倾斜且锁板底部在框架50内保持适当位置时，防倒退锁板172使被束缚的击发杆152通过紧密配合通孔(未显示)。防倒退凸轮套管174被放置在防倒退锁板172的远侧，并且被更远侧的压缩弹簧176推动，使其和防倒退锁板172接触，其中压缩弹簧176在框架50中被压缩，并且击发杆152从压缩弹簧176中穿过。应当理解，手柄22中的机构可以针对击发杆152的回缩，手动释放防倒退机构170。
在图4-5中，在示例性方案中，端部执行器14(即钉施加组件20)通过给流体致动器囊24放气使砧座12的杠杆架40下移而被打开，其中砧座12的杠杆架40围绕销32枢转，抬升远侧夹钳部分41，由此允许在砧座12和钉仓42之间定位身体组织180。E形梁64具有位于砧座凹槽184中的上部销182，以允许砧座12的反复打开和闭合。当砧座12被闭合并且两件式击发杆60被向远侧推动时，沿砧座12长度方向形成的砧座槽186容纳上部销182。中部销188在钉仓42内沿着和底部销或底脚190相反的方向在钉槽30上滑动，其中底部销或底脚190沿钉槽30的底面滑动。
在图6-7中，钉施加组件20已经通过如下方式被闭合，即，扩张流体致动器囊(升降袋)24，抬升砧座12的杠杆架40直到它和外部护套130平齐，而且杠杆架40的近侧向上弯曲尖端192进入顶部远侧开口131。和开口131配合的上述弯曲尖端192有利地允许砧座12更大的径向行程，并且将抵接面而不是穿孔尖端提供给下方的流体致动器24。当砧座12被闭合时，上部销182和砧座槽186对齐用于击发，并且组织180被压扁到适合切割和钉合的厚度。
在图7-8中，E形梁64被剖切开，用于显示它的底脚190，底脚190骑跨在向下开口的横向加宽凹槽200上，凹槽200和纵向窄槽202相连，而且E形梁的64的垂直部分204穿过纵向窄槽202。朝向纵向窄槽202的近侧孔口206为底脚190提供了组装入口。底部凸起208被定位在击发杆62上，用于在击发行程的初始部分期间在紧靠击发杆62的上部80的弹簧夹76的推动下落入近侧孔口206中，以便和端部执行器击发锁定机构(未显示)正确接合并产生可能的相互作用。而且，该位置允许端部执行器14被夹紧关闭，从而便于通过像套管针的插管(未显示)这样的外科进入点进行插入。参考图8-10，击发杆导向件124和一部分击发杆62横向接触，以闭合横向流体槽120的对应部分。在图11中，圆柱形腔90中的EAP注射器100具有和径向流体通道220相通的远侧分配锥形件104，在框架50中形成的径向流体通道220又和横向流体槽120相连通。在图12中，在安装外科钉合和切割器械10之前，EAP注射器100可以有利地使用一次性帽230密封。在图13-14中，显示了不带一次性帽230的EAP注射器100，EAP注射器100被弹簧向远侧推动，用于将远侧分配锥形件104接合成和径向流体通道220相通。
应当理解，在外科钉合和切割器械10中可以有一个或多个传感器检测击发条件(例如，击发杆或与击发杆连接的机构的运动、击发触发器的位置、用于分配的独立用户控制等)，并激励分配控制电路以实现分配。
在图15-18中，可选的两件式击发杆300由纵向薄板状的击发杆左半部分和右半部分302、304构成，这两部分构成了被连接到E形梁309上的击发杆305。因此，沿击发杆305传递的流体可以被进一步约束。尤其是，位于击发杆左半部分302的左侧流体槽310向远侧转变成一对分别位于击发杆左半部分和右半部分302、304中的对准的内部流体槽312、314，这对流体内部槽312、314形成内部流体通道316。因为E形梁309横向厚度大且纵向长度短，所以钻出的流体通道320在切割面322和对准的后部边缘之间形成，用于连通内部流体通道316。
在图19中，显示了能够实现本发明独特优点的可选外科钉合和切割器械410，所述优点包括端部执行器414的上钳口(砧座)412的流体致动(例如，打开、闭合/夹紧)以及在组织被切割时在组织上分配药物。执行部分416由细长轴418和端部执行器414构成，端部执行器414被描绘成钉合组件420。外科钉合和切割器械410还包括在近侧连接到轴418上的手柄22。当执行部分416通过形成用于执行微创外科手术的气腹的手术切口或者尤其是套管针的插管被插入到患者体内时，手柄422保留在患者体外。
流体致动器囊(升降袋)424在钉槽430内部在指向近侧的杠杆440下方被支撑，杠杆440如此伸出，即，对流体致动器囊424的填充会导致砧座412像跷跷板一样向钉仓442转动，其中钉仓442被容纳在钉槽430的远侧部分440中。在弹性压力转换器425的辅助下完成流体致动器囊424的排空和塌缩，以促使流体通过流体导管446向近侧流动，其中上述弹性压力转换器425位于砧座杠杆440上方和流体致动器囊424相对。
当通过ON/OFF开关452建立控制电路450和电池454的电连接时，控制电路450被接通电源，电池盖456可以关闭位于手柄422的手枪式握把458中的电池舱457，并且可以通过电池盖456更换电池454。控制器(例如，微控制器、可编程逻辑阵列、模拟控制电路等)460从被用户致动的开关或是从指示器械410的状态的传感器接收电信号。例如，用接触拇指按钮464的拇指按钮压力传感器462检测闭合命令。上述闭合命令信号可以是离散的开/关信号，或是表示闭合中间程度的连续值。作为另一种选择，控制器460可以在检测到拇指按钮464的第一次按压时用于闭合，在检测到拇指按钮464的第二次按压时用于打开。
控制器460通过激励电动流体控制器响应闭合信号，在示例性方案中电动流体控制器是EAP注射致动器470，EAP注射致动器470包含在圆柱体476内平移柱塞474以便通过流体导管446分配流体的EAP堆叠致动器472。可以有利地设置圆柱体476的尺寸，以便在期望的流体压力下产生期望的流体流速，即使夹紧太多的组织也可以在没有施加过大压力的情况下实现闭合。
流体压力可以通过连接在圆柱体476上的流体压力转换器478被有利地检测，和/或通过从弹性压力转换器425检测砧座412的运动被有利地检测。作为另一种选择或此外，被传递的流体体积可以被有利地检测，诸如通过连接在圆柱体476上的霍尔效应转换器480、482检测被结合到柱塞474上的目标。控制器460可以通过字符显示(未显示)或通过多个LED(诸如电源LED 490、砧座位置LED 492和故障LED 494)向医生提供指示。控制器460还可以检测击发，诸如触发器传感器496，并据此向EAP药物分配器100发出分配命令。
如图20所示，在使用时，端部执行器闭合和分配控制步骤或操作序列500由图19中的控制电路460执行。作为对电源接通的响应(方框502)，电源LED被点亮(方框504)。接着，做出是否已经检测到闭合命令的判定(方框506)。如果没有检测到闭合命令，闭合LED被熄灭(如果已经检测到，则被点亮)(方框508)。闭合致动器被释放(如果闭合致动器当前已经被激励)以允许砧座的弹性打开(方框510)。击发被禁止(方框512)，并且处理返回到方框504继续等待闭合命令。如果在方框506中检测到闭合命令，那么接着闭合致动器被激励(方框514)，并延迟一段预定时间等待砧座响应(方框516)。然后，诸如通过比较压力曲线或通过检测位置(例如，砧座)，在方框518中做出是否已经成功闭合的判定。如果不能令人满意，那么故障LED被点亮(方框520)。闭合致动器被释放(方框522)，并停止处理(方框524)。用户干扰可能要求电源周期性变化，以使装置复位。如果在方框518中砧座被成功闭合，那么闭合LED被点亮(526)。闭合致动器被保持在这种闭合状态下(方框528)，这可以在允许释放闭合致动器的夹紧锁的辅助下实现。允许击发(方框530)。接着，做出闭合命令是否仍然存在的判定(方框532)。如果闭合命令不存在，处理返回到方框504以打开端部执行器。如果在方框532中仍然处于闭合状态，那么需要进一步确定是否检测到了端部执行器的击发(方框534)。如果击发被检测到，启动药物分配(方框536)。否则，处理返回到方框532继续等待击发。
尽管已经通过描述一些实施方案对本发明进行了说明，尽管已经相当详细地描述了这些说明性实施方案，但是本申请并不意味着将所附权利要求的范围局限和以任何方式限制到如此具体的范围内。对本领域技术人员而言，其它优点和修改是显而易见的。
例如，为了清晰起见，在这里说明的是非关节运动轴，但是应当理解，流体致动端部执行器和/或药物分配可以被结合到关节运动轴中。尤其是可以采用穿过轴的关节运动接头的挠性流体导管。作为另一种选择，可以在挠性颈类型的关节运动接头中形成通道，以在其中传递流体。
例如，尽管在这里说明的是药物分配和流体致动砧座闭合，但是符合本发明这些方面的应用可以包括这些特征中的任何一个。此外，在粘合剂和/或烧灼药物被分配的应用中，应当理解，像钉合这样的特征可以被省略。
例如，尽管在这里说明的是钉合施加组件20，但是应当理解，其它端部执行器(抓钳、切割装置等)可以受益于流体受控闭合和药物分配中的任何一个或两个。
例如，容纳EAP注射器的接收器可以在手柄中而不是在细长轴中形成。
尽管电活性聚合物柱塞具有多种优点，但是应当理解，其它类型的电致动装置可以用于通过细长轴向端部执行器分配药物。
例如，可以在细长沟槽中形成第二EAP注射器的对称布置，这样可以在击发期间同时分配两种药物。
再如，尽管钉施加装置提供了一种说明性方案，但是应当理解，其它内窥镜器械可以从在其远端或远端附近分配液体的能力中受益。可能从中受益的器械实例包括但不限于消融装置、抓钳、烧灼工具、吻合环导入装置、手术钉合器、线性钉合器等。同样，由于击发杆在这里用作通向切割表面的方便的流体通道，所以作为替代那些没有使用击发杆的器械可以在恰当位置采用管道或流体导管。
尽管电活性聚合物柱塞具有多种优点，但是应当理解，其它类型的电致动装置可以用于通过细长轴向端部执行器分配药物。
例如，被限制在细长轴凹槽中的流体致动器囊可以用圆柱体和活塞杆取代。
应当理解，在符合本发明的一些应用中，端部执行器的两个枢转构件以剪刀形的布置相对于端部执行器的远端枢转。因此，可以将流体致动器囊定位成用于确保使各个杠杆分开或靠拢以实现闭合(例如，抓紧、切割)或打开，其中上述杠杆从这些枢转构件的枢转连接件向近侧伸出。
作为另一种选择，应当理解，流体致动器囊可以被放置在位于对置钳口之间的枢转动接合的远侧，以促使钳口张开。
例如，尽管为了清晰起见这里描述的是由医生直接操作的手柄22，但是符合本发明各个方面的机器人定位器械可以有利地利用这里描述的电动控制和采用流体传递致动的检测。

Claims (10)

1.一种外科器械，其包括：
手柄，其被可操作地配置成产生闭合致动；
细长轴，其被连接到所述手柄；
端部执行器，其在远侧连接到所述细长轴，并包括用于夹钳组织的对置钳口；
一对枢转构件，它们相对地接触组织，每一个枢转构件均包括各自的向近侧凸出的杠杆，所述杠杆被限定为围绕枢轴连接件相对于另一个杠杆枢转；以及
流体致动闭合机构，所述机构包括：
流体致动器，其定位于所述各杠杆之间，
流体导管，其与所述流体致动器和细长轴连通，以及
流体储存器，其通过所述手柄响应闭合致动，有选择地且双向地通过流体导管与流体制动器传递流体。
2.根据权利要求1所述的外科器械，其中，所述手柄被可操作地配置成产生往复机械闭合运动，所述流体储存器通过往复机械闭合运动有选择地被压缩和扩张。
3.根据权利要求1所述的外科器械，进一步包括通过所述手柄响应闭合动作以有选择地产生闭合信号的控制电路，所述流体储存器进一步包括电活性聚合物致动的双向液压泵。
4.根据权利要求1所述的外科器械，其中，所述成对的枢转构件包括相对地切割组织的切割刀片。
5.根据权利要求1所述的外科器械，其中，所述成对的枢转构件包括夹取钳口。
6.根据权利要求1所述的外科器械，其中，从所述成对枢转构件的下部枢转构件向近侧凸出的杠杆包括被连接到手柄的细长轴的框架。
7.根据权利要求6所述的外科器械，其中，所述下部枢转构件包括钉槽，并且上部枢转构件包括砧座，所述外科器械进一步包括：
钉仓，其容纳在所述钉槽中；
击发杆，其滑动地容纳在细长槽中，并且可穿过已闭合的端部执行器向远侧运动，以便对被夹持的组织进行切割和钉合。
8.根据权利要求1所述的外科器械，其中，所述轴进一步包括关节运动接头，所述流体导管进一步包括穿过关节运动接头的挠性部分。
9.根据权利要求8所述的外科器械，进一步包括：
外部护套，其包围所述细长轴的框架和砧座杠杆；以及
流体致动器，为使左和右流体致动器反向从而打开砧座，该流体致动器定位于砧座杠杆和外部护套之间，所述手柄进一步被可操作地配置成有差别地扩张和压缩反向流体致动器以及成对的左和右流体致动器。
10.根据权利要求7所述的外科器械，其中，所述手柄被可操作地配置成产生往复机械闭合运动，通过往复机械闭合运动使流体储存器被有选择地压缩和扩张。
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RU2006122355A (ru) 2007-12-27
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SG128562A1 (en) 2007-01-30
US7559452B2 (en) 2009-07-14
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KR20060134841A (ko) 2006-12-28
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CN1883406B (zh) 2010-11-17

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