CN101011276A - 带有单根索致动器的外科紧固件和切割器 - Google Patents

带有单根索致动器的外科紧固件和切割器 Download PDF

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CN101011276A
CN101011276A CNA2007100069331A CN200710006933A CN101011276A CN 101011276 A CN101011276 A CN 101011276A CN A2007100069331 A CNA2007100069331 A CN A2007100069331A CN 200710006933 A CN200710006933 A CN 200710006933A CN 101011276 A CN101011276 A CN 101011276A
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end effector
actuator
driving shaft
clutch
slender axles
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CN101011276B (zh
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F·E·谢尔顿四世
S·J·巴利克
E·L·蒂姆珀曼
M·S·奥尔蒂斯
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Ethicon Endo Surgery Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • 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
    • A61B2017/00371—Multiple actuation, e.g. pushing of two buttons, or two working tips becoming operational
    • A61B2017/0038—Simultaneous actuation of two tools by pushing one button or the like
    • 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
    • A61B2017/0688—Packages or dispensers for surgical staplers
    • 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

Abstract

本发明提供用于控制外科紧固装置上的端部执行器的旋转和致动的方法和装置。在一种示例性实施方式中提供了单根索致动器，其可在第一位置和第二位置之间运动，在所述第一位置中，它有效地用于在不使所述端部执行器致动(即，闭合和击发)的情况下令其旋转，在所述第二位置中，它有效地用于在不使所述端部执行器旋转的情况下使其致动。所述单根索还可有效地用于闭合所述端部执行器的相对的钳口。

Description

带有单根索致动器的外科紧固件和切割器
相关申请的交叉引用
本申请是于2006年1月31提交的名称为“Electro-MechanicalSurgical Cutting And Fastening Instrument Having A RotaryFiring And Closure System With Parallel Closure And AnvilAlignment Components”的美国专利申请No.11/344,021的部分继续申请，该文献的全部内容通过引用结合入本文。
技术领域
本发明主要涉及用于控制外科装置上的端部执行器的运动和致动的方法和装置。
背景技术
内窥镜外科器械通常比传统的开放式外科装置受欢迎，因为天然孔口的使用易于减小术后恢复时间和并发症。因此，在适合通过天然孔口将工具的工作端精确地放置在所需手术部位的内窥镜外科器械领域已经有了重大发展。这些工具能够用于以多种方式接合和/或处理组织，以获得诊断和治疗效果。
在内窥镜外科手术中常用的一种工具是外科缝合和切割器，它通常包括端部执行器，该端部执行器能够同时在组织中形成纵向切口并且在该切口的相对侧上施加钉线。该端部执行器包括一对能够穿过插管通道的协调操作的钳口构件。其中一个钳口构件容纳具有至少两排横向隔开的钉的钉仓。另一个钳口构件限定砧座，该砧座具有与钉仓中的成排钉对准的钉形成槽。该器械包括多个往复楔形件，在被向远侧驱动时，所述楔形件穿过在钉仓中的开口并且接合支撑钉的驱动器，以使钉向着砧座击发。该器械还包括用于切割钉合的组织的刀。
由于需要将装置以内镜方式引入，每代外科缝合器/切割器在复杂性和功能上都持续增强。但是，内窥镜外科需要该装置的轴是柔性的，同时还要允许端部执行器进行关节运动和/或转动以使端部执行器相对组织以一定角度定向，而且端部执行器还能受到致动而闭合并击发钉。使端部执行器进行关节运动、转动和/或致动的控制的结合由于柔性轴的使用和内窥镜器械尺寸的限制一般很复杂。总的来说，控制运动都是通过轴作为纵向平移来传递的，这可能影响轴的柔性。
还需要将致动端部执行器所需的力降低到所有或者大部分医生能够操作的水平。一种用于降低击发力的已知解决方案是使用电动机。但是，医生通常愿意体验从端部执行器的反馈，以确保该端部执行器的正确操作。而在目前的电动机驱动的装置中不能适当地实现这种用户反馈效果。
因此，仍然需要用于控制内窥镜外科装置上的端部执行器的运动和致动的改进的方法和装置。
发明内容
本发明总的提供用于控制内窥镜外科装置上的端部执行器的运动(即，旋转)和致动(即，闭合和/或击发)的方法和装置。在一种示例性实施方式中提供了内窥镜缝合装置，其包括细长轴，该细长轴具有近端和远端，端部执行器连接到该细长轴的远端，用于接合组织并将至少一个紧固件传递到被接合的组织，手柄连接到该细长轴的近端，并且致动器在操作上与所述端部执行器和手柄相关联。该致动器具有第一位置和第二位置，在第一位置中，该致动器的旋转有效地使端部执行器旋转，在第二位置中，该致动器的旋转有效地从端部执行器击发至少一个紧固件。该致动器还适于在第一和第二位置之间沿着该细长轴的纵向轴线平移。该致动器从第一位置到第二位置的平移能够闭合该端部执行器，以便接合组织。
该端部执行器可具有各种构造，但是在一种实施方式中，该端部执行器包括用于在其间接合组织的相对的钳口。所述致动器包括位于其远端的离合器，在致动器从第一位置平移到第二位置时，所述离合器适于抵靠形成于至少一个钳口上的凸轮表面，以闭合钳口。所述端部执行器还包括钉仓，该钉仓可拆卸地置于其中，并且容纳用于缝合组织的多个钉和用于切割被缝合组织的刀。
所述致动器也可具有各种构造，但是在一种实施方式中，它可以是在操作上与所述手柄和端部执行器相关联的可转动和平移的驱动轴。该驱动轴包括位于其远端的离合器。当致动器处于第一位置时，该离合器适于与所述端部执行器的外壳接合，从而该致动器和离合器的旋转能够旋转端部执行器。当致动器处于第二位置时，该离合器适于与齿轮组件接合并使之旋转，该齿轮组件用于使设置在端部执行器中的驱动器前进，以从该端部执行器击发至少一个钉。在另一种实施方式中，至少一部分驱动轴可由电活性聚合物材料制成，并且其中手柄有效地用于将能量传输到驱动轴，以便使电活性聚合物材料沿轴向收缩并沿径向扩张，由此使驱动轴平移。
该装置的手柄也可具有各种构造，但是在一种实施方式中，该手柄包括适于使致动器在第一和第二位置之间平移的平移构件，和适于使致动器相对于该细长轴旋转的可旋转构件。该装置还包括其它元件，诸如光学图像收集单元，该光学图像收集单元设置在细长轴的远端上并且被构造成在内窥镜手术过程中采集图像。该光学图像收集单元可被连接到外部图像显示屏，或者图像显示屏可设置在该装置的近侧部分上，用于与该光学图像收集单元通讯，以显示所采集的图像。
在另一种实施方式中，提供了一种内窥镜缝合装置，其具有细长轴，该细长轴具有连接到其远端的端部执行器，可动地连接到其近端的手柄，以及驱动轴，该驱动轴在操作上与所述手柄和端部执行器相关联，并适于使端部执行器相对于该细长轴转动，以闭合端部执行器来接合组织并从端部执行器击发至少一个紧固件。该驱动轴可以在第一位置和第二位置之间运动，在第一位置中，该驱动轴的旋转在不使端部执行器闭合和击发的情况下令其相对于细长轴相应地旋转，在第二位置中，该驱动轴的旋转在不使端部执行器相对于细长轴旋转的情况下使端部执行器闭合和击发。该驱动轴还适于相对于该细长轴的纵向轴线平移，以便在第一和第二位置之间运动。该驱动轴从第一位置到第二位置的平移适于闭合该端部执行器的相对钳口。例如，驱动轴的远端能与部分端部执行器接合，从而在该驱动轴处于第一位置时使端部执行器旋转，并且驱动轴的远端能与齿轮组件接合，从而在该驱动轴处于第二位置时使齿轮组件旋转。该齿轮组件的旋转可有效地用于使设置在端部执行器中的驱动器前进，以从该端部执行器击发至少一个钉。
还提供了用于紧固组织的方法，在一种示例性实施方式中，所述方法包括将细长轴插入体腔中，以将连接到细长轴远端的端部执行器定位在待紧固的组织附近。细长轴的近端包括可动地连接到其上的手柄组件。该方法还包括使在手柄组件上处于第一位置的可旋转构件旋转，以便使端部执行器围绕细长轴的纵向轴线旋转，以及使在手柄组件上处于第二位置的可旋转构件旋转，以便在不使端部执行器旋转的情况下击发设置在端部执行器中的至少一个钉。该方法还包括使在手柄组件上的平移构件运动，以围绕待紧固组织闭合端部执行器的相对钳口。尽管所述方法可用于各种手术中，但是在一种示例性实施方式中，该细长轴是柔性的并且被经腔插入。
更具体地说，本发明涉及如下内容：
(1)一种内窥镜缝合装置，包括：
细长轴，具有近端和远端；
端部执行器，连接到所述细长轴的远端，用于接合组织并将至少一个紧固件传递到被接合的组织；
手柄，连接到所述细长轴的近端；以及
致动器，能够可操作地与所述端部执行器和手柄相关联，该致动器具有第一位置和第二位置，在所述第一位置中，该致动器的旋转有效地使所述端部执行器旋转，在所述第二位置中，该致动器的旋转有效地从所述端部执行器击发至少一个紧固件。
(2)如第(1)项所述的装置，其中，所述致动器适于在第一和第二位置之间沿着该细长轴的纵向轴线平移，并且该致动器从第一位置到第二位置的平移能够闭合该端部执行器，以便接合组织。
(3)如第(2)项所述的装置，其中，所述端部执行器包括用于在其间接合组织的相对的钳口，并且所述致动器包括位于其远端的离合器，在所述致动器从第一位置平移到第二位置时，所述离合器适于抵靠形成于至少一个钳口上的凸轮表面，以闭合钳口。
(4)如第(1)项所述的装置，其中，所述致动器包括可操作地与所述手柄和端部执行器相关联的可转动和平移的驱动轴。
(5)如第(4)项所述的装置，其中，所述驱动轴包括位于其远端的离合器。
(6)如第(5)项所述的装置，其中，当致动器处于第一位置时，所述离合器适于与所述端部执行器的外壳接合，从而所述致动器和离合器的旋转能够有效地使端部执行器旋转。
(7)如第(5)项所述的装置，其中，当致动器处于第二位置时，所述离合器适于与齿轮组件接合并使之旋转，所述齿轮组件用于使设置在端部执行器中的驱动器前进，以从所述端部执行器击发至少一个钉。
(8)如第(2)项所述的装置，其中，所述手柄包括适于使所述致动器在第一和第二位置之间平移的平移构件，和适于使所述致动器相对于所述细长轴旋转的可旋转构件。
(9)如第(1)项所述的装置，其中，所述端部执行器包括可拆卸地置于其中的钉仓，所述钉仓容纳用于缝合组织的多个钉和用于切割被缝合组织的刀。
(10)如第(4)项所述的装置，其中，至少一部分所述驱动轴由电活性聚合物材料制成，并且其中所述手柄有效地用于将能量传输到驱动轴，以便使电活性聚合物材料沿轴向收缩并沿径向扩张，由此使驱动轴平移。
(11)如第(1)项所述的装置，还包括设置在所述细长轴的远端上的光学图像收集单元，该光学图像收集单元适于在内窥镜手术过程中采集图像。
(12)如第(11)项所述的装置，还包括图像显示屏，该图像显示屏设置在所述装置的近侧部分上并适于与所述光学图像收集单元通讯，以显示所采集的图像。
(13)复原权利要求1的装置的方法，包括：
拆除并替换可拆卸地设置在端部执行器中的钉仓，以制备重新使用的装置，所述钉仓在其中容纳有多个紧固件。
(14)如第(13)项所述的方法，其中，所述钉仓包括设置于其中用于切割被紧固的组织的刀。
(15)一种内窥镜缝合装置，包括：
细长轴，该细长轴具有连接到其远端的端部执行器，可动地连接到其近端的手柄，以及驱动轴，该驱动轴在操作上与所述手柄和端部执行器相关联，并适于使所述端部执行器相对于所述细长轴转动，以闭合端部执行器来接合组织并从所述端部执行器击发至少一个紧固件。
(16)如第(15)项所述的装置，其中，所述驱动轴可以在第一位置和第二位置之间运动，在所述第一位置中，该驱动轴的旋转在不使所述端部执行器闭合和击发的情况下令其相对于所述细长轴相应地旋转，在所述第二位置中，该驱动轴的旋转在不使所述端部执行器相对于所述细长轴旋转的情况下使所述端部执行器闭合和击发。
(17)如第(16)项所述的装置，其中，所述驱动轴适于相对于所述细长轴的纵向轴线平移，以便在第一和第二位置之间运动，并且该驱动轴从第一位置到第二位置的平移适于闭合该端部执行器的相对钳口。
(18)如第(16)项所述的装置，其中，所述驱动轴的远端能与部分端部执行器接合，从而在所述驱动轴处于第一位置时使所述端部执行器旋转，并且所述驱动轴的远端能与齿轮组件接合，从而在该驱动轴处于第二位置时使所述齿轮组件旋转，所述齿轮组件的旋转有效地用于使设置在所述端部执行器中的驱动器前进，以从该端部执行器击发至少一个钉。
(19)一种用于紧固组织的方法，包括：
将细长轴插入体腔中，以将连接到所述细长轴远端的端部执行器定位在待紧固的组织附近，所述细长轴的近端包括可动地连接到其上的手柄组件；
使在所述手柄组件上处于第一位置的可旋转构件旋转，以便使所述端部执行器围绕所述细长轴的纵向轴线旋转；以及
使在所述手柄组件上处于第二位置的可旋转构件旋转，以便在不使所述端部执行器旋转的情况下击发设置在所述端部执行器中的至少一个钉。
(20)如第(19)项所述的方法，还包括使在所述手柄组件上的平移构件运动，以围绕待紧固组织闭合所述端部执行器的相对钳口。
(21)如第(19)项所述的方法，其中，所述细长轴是柔性的并且被经腔插入。
附图说明
从以下结合附图给出的详细说明可更全面地理解本发明，其中：
图1A是根据本发明的外科缝合装置的一种示例性实施方式的透视图；
图1B是图1A的外科缝合装置的端部执行器的透视图；
图2是图1A的外科缝合装置的部分细长轴的局部切除的透视图，示出了驱动轴延伸穿过细长轴；
图3是图1A的外科缝合装置的端部执行器的侧剖视图；
图4是图1A的外科缝合装置的部分端部执行器的俯视图，示出了离合器与端部执行器接合以使其旋转；
图5A是图1A的部分端部执行器的放大侧剖视图；
图5B是图5A所示端部执行器的侧剖视图，示出了运动到闭合位置的钳口；
图6是图1A的部分端部执行器的侧视图，示出了齿轮和驱动器组件；
图7是图1A的部分端部执行器的透视图，示出了导螺杆被驱动穿过端部执行器以从钉仓击发钉；
图8A是图1A的端部执行器的钉仓的透视图；
图8B是图8A所示钉仓的驱动滑橇的透视图；
图9A是图1A所示装置的手柄的透视图；
图9B是图9A的手柄的透视图，示出了处于第二位置的旋钮；
图10是图1A所示装置的部分细长轴的透视图，示出了光学图像收集单元。
具体实施方式
下面将描述一些示例性实施方式，以便提供此处披露的装置和方法的结构、功能、制造和使用的原理的全面理解。在附图中示出了这些实施方式的一个或多个例子。本领域技术人员将会理解，此处具体描述以及在附图中示出的装置和方法是非限定性实施方式，并且本发明的范围仅由权利要求书限定。结合一种示例性实施方式示出或描述的特征可与其它实施方式的特征结合。旨在将这类变型和改变包括在本发明的精神范围内。
本发明提供用于控制外科缝合装置上的端部执行器的运动(即，旋转)和致动(即，闭合和/或击发)的装置。总的来说，所述外科缝合装置包括细长轴，该细长轴具有带有从其延伸、用于接合组织并将一个或多个紧固件传递到被接合的组织的端部执行器的远端，该细长轴还具有带有手柄的近端，该手柄用于控制该端部执行器的旋转，由此使端部执行器围绕所述细长轴的纵向轴线旋转，该手柄还用于控制该端部执行器的致动，由此使端部执行器闭合和击发，以便传输一个或多个紧固件，并且选择性地切割被紧固的组织。在一种示例性实施方式中，所述装置包括单个致动机构，该单个致动机构被构造成使端部执行器旋转和致动。该致动机构在操作上与所述手柄和端部执行器相关联，并且它具有第一位置和第二位置，在第一位置，该致动机构有效地用于在不使端部执行器致动的情况下令其旋转，在第二位置，该致动机构有效地用于在不使端部执行器旋转的情况下从其击发至少一个紧固件。该致动机构还能被如此构造，从第一位置到第二位置的运动有效地用于闭合端部执行器，以接合组织。还设置各种其它元件来便于该装置的使用。本领域技术人员将会理解，端部执行器的具体构造可以是变化的，此处所描述的各种控制技术可用在多种外科器械上。
图1A示出了内窥镜外科装置的一种示例性实施方式，该内窥镜外科装置为用于将线性的多排钉应用到组织上并切割已缝合组织的线性缝合和切割装置10的形式。如图所示，装置10总的包括细长轴12，该细长轴12具有带有连接到其上的手柄14的近端12a，以及带有连接到其上或形成与其上的端部执行器16的远侧工作端12b。该细长轴12可具有各种构造。例如，它可以是实心的或者中空的，并且它可由单个元件或者多个部分形成。如图1A所示，细长轴12是中空的，并且由多个连接部分形成，以允许细长轴12挠曲。轴12的柔性以及相对较小的直径允许轴12用于内窥镜手术中，由此使该装置通过天然孔口经腔插入。该端部执行器16也可具有各种构造，但是在所示出的实施方式中，如图1B更详细地显示的，该端部执行器16包括相对的第一钳口18和第二钳口20，它们以可枢转的方式彼此连接并适于在其间容纳组织。第一钳口18适于容纳钉仓，该钉仓具有设置在其中并将被驱动进入组织的多个钉，而第二钳口20形成用于使钉变形的砧座。可使用各种技术将端部执行器16连接到细长轴的远端，但是在一种示例性实施方式中，该端部执行器16以可旋转的方式连接到细长轴，从而该端部执行器16能够围绕细长轴的轴线旋转。该端部执行器16还可以可枢转的方式连接到细长轴的远端，或者它可以包括形成于其上的柔性颈26，以允许端部执行器相对于细长轴进行角运动。
尽管不是本发明的必不可少的元件，图1A还示出了手柄14，它能够在操作上与端部执行器16相关联，从而手柄14的枢转运动可由端部执行器16模仿，由此可采用手柄14使端部执行器16在多个平面中进行关节运动。在下述于同一天提交的美国专利申请中更详细地描述了实现模仿运动的具体机构：Mark S.Ortiz，Frederick E.Shelton IV，James Spivey(代理卷号No.100873-32(END5568USANP1))的“Methods and Devices for ControllingArticulation，”；James Spivey，Mark S.Ortiz，Frederick E.Shelton IV(代理卷号No.100873-105(END5568USANP2))的“Articulating Endoscopic Accessory Channel，”；以及Mark S.Ortiz，Frederick E.Shelton IV(代理卷号No.100873-109(END5568USANP3))的“Surgical Fastener and Cutter with MimickingEnd Effector”，其中的每一篇文献都通过参考结合入本文中。
装置10还包括用于控制端部执行器16的运动和致动的致动机构。运动可包括端部执行器16围绕细长轴12的纵向轴线A的旋转以及端部执行器的致动，由此闭合钳口18、20来接合组织，并使钉从端部执行器被击发入已接合的组织中。致动还包括切割已钉合的组织。在一种示例性实施方式，单个致动机构在操作上与所述手柄和端部执行器相关联，从而使端部执行器旋转和致动。尽管所述致动机构可具有各种构造，但是在所示出的实施方式中，该致动机构为驱动轴28的形式，如图2所示，该驱动轴28延伸穿过部分细长轴12。该驱动轴28可以为细长索(cable)、多绕索或者编织索、杆或者轴的形式，并且它优选是柔性的，以便在该装置10的柔性轴12通过弯弯曲曲的路径经腔插入时能够弯曲。驱动轴28包括近端和远端，如在下面将要详细讨论的那样，它们分别连接到手柄14和端部执行器16的不同部分。在使用过程中，驱动轴28被构造成相对于细长轴12旋转和平移(滑动)，以使端部执行器16旋转和致动。
在图3中更详细地示出了驱动轴28的远端28b和端部执行器16，如图所示，驱动轴28的远端28b从细长轴12向远侧延伸并延伸进入端部执行器16的近端。驱动轴28的远端28b优选地被构造成在驱动轴28处于第一位置时使端部执行器16旋转，并在驱动轴28处于第二位置时击发端部执行器16。驱动轴28从第一位置到第二位置的运动还能有效地使端部执行器16的钳口18、20闭合。尽管可采用各种技术使驱动轴28令端部执行器16旋转、闭合和击发，在所示出的实施方式中，驱动轴28的远端28b包括形成于其上或者可伸缩地配合到其上的离合器30。该离合器30可具有各种形状和尺寸，但是它优选为不对称的，以允许该离合器30接合端部执行器16内的各种机构，如下面将要讨论的。在所示出的实施方式中，该离合器30具有六边形形状。当该离合器30处于第一位置、即图3中所示的远侧位置时，它能够与端部执行器16接合，从而驱动轴28和离合器30的旋转能够使端部执行器16旋转。更具体地说，如图4所示，第一钳口18的相对的内壁包括形成于其上的相对凸起(在图4中只示出了一个凸起18a)，这些凸起被构造成在其间与离合器30接合。因此，当该离合器30位与这些凸起之间时，离合器30的旋转有效地使端部执行器16围绕其纵向轴线相对于细长轴12旋转。
一旦端部执行器16旋转到所需位置，使驱动轴28和离合器30相对于细长轴12沿轴向运动，以便使该离合器30从第一钳口18中的凸起之间移开。在一种示例性实施方式中，驱动轴28和离合器30沿着细长轴12沿近侧方向平移，以使驱动轴28并由此使离合器30定位在第二位置。随着驱动轴28和离合器30向近侧运动，驱动轴28和离合器30可有效地使端部执行器16的钳口18、20闭合。具体地说，如图5所示，第二钳口、即砧座20包括近端20a，该近端20a具有形成于其上并延伸到离合器30的运动路径中的倾斜表面20r。砧座20上的倾斜表面20r位于砧座20连接到第一钳口18的枢轴点近侧。随着离合器30与驱动轴28一起向近侧运动，该离合器30抵靠该倾斜表面20r，从而推动该表面向上离开第一钳口18。结果，砧座20将枢转到闭合位置，如图5B所示，以便接合定位在钳口18、20之间的组织。当驱动轴28和离合器30处于第二近侧位置时，第二钳口或砧座20将保持闭合，因为离合器30将防止第二钳口或砧座20的近端20a返回到其初始位置。
一旦驱动轴28和离合器30处于第二位置，驱动轴28和离合器30的旋转可有效地从钳口18、20击发至少一个紧固件。特别是，离合器30可被构造成与有效地用于使驱动器前进穿过端部执行器16的齿轮组件接合。图6示出了该齿轮组件，其包括第一(上)传动齿轮32和第二(下)传动齿轮34，它们为具有在其周围形成的齿的圆柱形构件的形式。第一传动齿轮32包括形成于其中的槽窝32a(如图5A和5B所示)，该槽窝32a的形状与离合器30的一部分的形状互补，从而该槽窝32a能够容纳和接合位于驱动轴28上的离合器30。特别是，离合器30包括形成于其上并被构造成容纳于该槽窝32a中的第二六边形构件30a(图4)。第二传动齿轮34定位在第一传动齿轮32附近，并且与之接合。结果，当使驱动轴28和离合器30旋转时，第一传动齿轮32将会旋转，以便使第二传动齿轮34旋转。第二传动齿轮34又包括从其向远侧延伸并且固定地连接到其上的轴或导螺杆36。该导螺杆36具有在其外表面上形成的螺纹(未示出)，导螺母38旋到该导螺杆36上。在第二传动齿轮34和导螺杆36旋转时，导螺杆36保持在固定的轴向位置，即，它不沿纵向平移，由此使导螺母38向远侧运动穿过端部执行器16，如图7所示。该导螺母38又连接到驱动滑橇40的近端，或与之抵靠，该驱动滑橇40可有效地从设置在第一钳口18中的钉仓42驱动一个或多个钉。因此，在驱动轴28和离合器30旋转时，第一传动齿轮32将会旋转，以便使第二传动齿轮34和与之相连的导螺杆36旋转。在导螺杆36旋转时，导螺母38在端部执行器16中向远侧运动，由此使驱动滑橇40在端部执行器16中向远侧运动。该驱动滑橇40将迫使一个或多个紧固件穿过形成于钉仓42中的一个或多个紧固件接收狭槽。所述紧固件将延伸穿过接合在钳口18、20之间的组织，并抵靠砧座20变形，以便紧固组织。驱动滑橇40还包括形成于其上并被构造成切割正被紧固的组织的刀。
尽管驱动滑橇40和钉仓42的具体构造根据端部执行器16的具体构造而改变，在一种示例性实施方式中，如图8A所示，钉仓42被构造为施加线性的多排钉，并且形成在成排钉之间延伸的切口，以分开缝合的组织。特别是，钉仓42为大致细长外壳形式，其可拆卸地设置在形成于第一钳口18中的通道内。该外壳包括形成于其中的线性的数排(例如六排)钉容纳狭槽44，并且每个狭槽在其中容纳钉。在钉下面定位数个驱动器(未示出)，用于支撑钉并使钉前进穿过钉容纳狭槽44。在图8B中更详细地示出了驱动滑橇40，其包括形成于其上并具有楔形构造的数个(例如四个)竖直构件41a、41b、41c、41d。随着驱动滑橇40向远侧前进穿过钉仓42，竖直构件41a、41b、41c、41d将抵靠驱动构件，从而使它们朝着砧座20向上运动，由此朝着砧座20驱动钉。驱动滑橇40还包括中央构件，该中央构件延伸穿过钉仓的中间并且具有形成于其上的刀40b，用于切割已缝合的组织。
在使用过程中，钉仓42和与其相连的驱动滑橇40可被设置在端部执行器16中，用于单次使用应用。一旦钉从钉仓42击发，可将具有新的驱动滑橇40的新钉仓置于钳口18中。在下述情况中这种构造是特别有利的，即，在每次使用时不是像驱动滑橇和刀被设置在端部执行器的钳口中的大部分缝合装置那样，不是与钉仓一起拆除，而是可以更换刀40b。本领域技术人员将会理解，实际上在本领域已知的任何钉仓都可与此处公开的各种装置一起使用，并且所示出的钉仓42仅仅是钉仓的一种示例性实施方式。
如上所述，驱动轴28的近端连接到手柄14的如下各部分，它们有效地旋转处于第一位置的驱动轴28，以便由此使端部执行器16旋转，将驱动轴28沿轴向平移到第二位置，由此闭合钳口18、20，以及旋转处于第二位置的驱动轴28，以便从端部执行器16中的钉仓42击发钉。尽管可使用现有技术已知的各种技术来使驱动轴28旋转和平移，在一种示例性实施方式中，手柄14包括可旋转和平移旋钮50，用于使驱动轴28相对于该装置10的细长轴12旋转和平移。在图9A和9B中更详细地显示了手柄14的旋钮50，如图所示，旋钮50仅仅是一个圆柱形构件，该圆柱形构件设置于手柄14的最近端并且连接到驱动轴28的近端。图9A示出旋钮50处于第一位置，在该位置中，旋钮50将驱动轴28旋转，并由此使端部执行器16旋转。图9B示出旋钮50向近侧运动到第二位置，即，相对于细长轴12缩回，以由此闭合钳口18、20。可通过简单地拉动旋钮50来实现其运动，或者可选择的是，装置10包括形成于手柄14上并连接到驱动轴28的单独的平移构件55，以使驱动轴28以及由此使旋钮50在第一和第二位置之间运动。在一种示例性实施方式中，如图所示，平移构件55被成形为配合在使用者的手掌中。肘节连杆或者偏心(over-center)连杆在平移构件55和手柄14之间延伸，用于控制平移构件55相对手柄的运动。在使用过程中，可以挤压平移构件55以使之闭合，由此将指向近侧的力施加到驱动轴28，使驱动轴28运动到第二位置，如图9B所示。处于第二位置中的旋钮50的旋转将有效地使钉从钉仓42击发，如前所述，由此缝合接合在钳口之间的组织。可以在击发钉的同时或者随后切割组织。本领域技术人员将会理解，旋钮的具体位置和构造或者用于使驱动轴28旋转和平移的其它构件可以是变化的。
尽管图9A-9B示出了可旋转和平移旋钮，在其它实施方式中，用于使端部执行器16旋转和致动的驱动轴28可选择地由电活性聚合物形成。电活性聚合物(EAP)，也称作人造肌肉，是能够响应于电场或机械场而展示压电、热电或者电致伸缩特性的材料。具体地说，EAP是一组在被施加电压时改变形状的导电掺杂聚合物。该导电聚合物可配对成某些形式的离子流体或凝胶以及电极，从导电聚合物流进或流出的流体/凝胶的离子流包括聚合物的形状变化。通常，取决于所使用的具体聚合物和离子流体或凝胶可以施加范围在大约1V至4kV的电势。特别需要注意的是，EAP在被供能时不会改变体积，它们仅仅是沿着一个方向扩张并沿着横向收缩。因此，此前披露的驱动轴28可由EAP致动器取代，并且手柄14可被构造成启动外部或内部能量源，以选择性地将能量传输给EAP索，使EAP索轴向收缩，将离合器30从第一位置运动到第二位置。然后例如使用旋钮使EAP索旋转，以从端部执行器16击发一个或多个钉。当终止能量输送时，EAP索将沿轴向扩张，从而使离合器30返回第一位置。
此处披露的各种装置还包括便于使用的其它元件。例如，装置10可包括光学图像收集单元，该光学图像收集单元设置在细长轴12的远端或端部执行器16上，并且被构造成在内窥镜手术过程中采集图像。尽管该单元的位置可变，但图10示出了斜面状外壳60，该外壳60从位于细长轴12上的连接件63的外表面凸出并且在其中容纳所述光学图像收集单元。在外壳60的面向远侧的表面上形成有视窗62，以允许该单元采集端部执行器16和周围外科手术部位的图像。来自该光学图像收集单元的图像可被传送给外部图像显示屏，或者可选择的是，装置10可包括设置在该装置的近侧部分或者连接到其上的图像显示屏。图9A-9B示出了从手柄14向外凸出的图像显示屏70的一种实施方式。
本发明还提供了用于紧固和可选择地切割组织的示例性方法。在一种示例性实施方式中，外科缝合和切割装置(诸如图1A的装置10)的细长轴可被经腔(即，经口或者经肛门)插入到体腔中，以将连接到细长轴12的远端12b的端部执行器16定位在待紧固的组织附近。然后可操作端部执行器16来将待紧固的组织定位在钳口18、20中，并且可使旋钮50如前所述地运动，以旋转端部执行器16，闭合钳口18、20并击发钉。
在另一种实施方式中，此处披露的各种装置(包括其各部分)可被设计为在一次使用后丢弃，或者它们可被设计为可多次使用。在任何一种情形中，所述装置在至少使用一次后可被复原(recondition)再使用。复原包括以下步骤的任意组合，即，拆分装置，然后清洗或者替换具体的零件，之后重新组装。举例来说，可从端部执行器上拆除包括驱动滑橇的钉仓，并用在其中容纳有一个或多个紧固件的新钉仓替代。所述钉仓还优选地容纳形成于驱动滑橇上的刀，以切割被紧固的组织。装置的各个其它部分也可被移除和替换。在具体零件的清洗和/或替换后，该装置可以在复原设备或者正好在外科手术之前由外科组重新组装，以用于随后的使用。本领域技术人员将会理解，可采用各种拆分、清洗/替换和重新组装技术来使装置复原。这类技术的使用以及最终的复原的装置都在本申请的范围内。
本领域技术人员将会理解基于上述实施方式的本发明的其它特征和优点。因此，本发明不由已经具体示出和描述的内容限制，只由所附权利要求指明。此处引用的所有出版物和参考文献的全文通过引用结合入本文。

Claims (10)

1.一种内窥镜缝合装置，包括：
细长轴，具有近端和远端；
端部执行器，连接到所述细长轴的远端，用于接合组织并将至少一个紧固件传递到被接合的组织；
手柄，连接到所述细长轴的近端；以及
致动器，能够可操作地与所述端部执行器和手柄相关联，该致动器具有第一位置和第二位置，在所述第一位置中，该致动器的旋转有效地使所述端部执行器旋转，在所述第二位置中，该致动器的旋转有效地从所述端部执行器击发至少一个紧固件。
2.如权利要求1所述的装置，其中，所述致动器适于在第一和第二位置之间沿着该细长轴的纵向轴线平移，并且该致动器从第一位置到第二位置的平移能够闭合该端部执行器，以便接合组织。
3.如权利要求2所述的装置，其中，所述端部执行器包括用于在其间接合组织的相对的钳口，并且所述致动器包括位于其远端的离合器，在所述致动器从第一位置平移到第二位置时，所述离合器适于抵靠形成于至少一个钳口上的凸轮表面，以闭合钳口。
4.如权利要求1所述的装置，其中，所述致动器包括可操作地与所述手柄和端部执行器相关联的可转动和平移的驱动轴。
5.如权利要求4所述的装置，其中，所述驱动轴包括位于其远端的离合器。
6.如权利要求5所述的装置，其中，当致动器处于第一位置时，所述离合器适于与所述端部执行器的外壳接合，从而所述致动器和离合器的旋转能够有效地使端部执行器旋转。
7.如权利要求5所述的装置，其中，当致动器处于第二位置时，所述离合器适于与齿轮组件接合并使之旋转，所述齿轮组件用于使设置在端部执行器中的驱动器前进，以从所述端部执行器击发至少一个钉。
8.如权利要求2所述的装置，其中，所述手柄包括适于使所述致动器在第一和第二位置之间平移的平移构件，和适于使所述致动器相对于所述细长轴旋转的可旋转构件。
9.如权利要求1所述的装置，其中，所述端部执行器包括可拆卸地置于其中的钉仓，所述钉仓容纳用于缝合组织的多个钉和用于切割被缝合组织的刀。
10.如权利要求4所述的装置，其中，至少一部分所述驱动轴由电活性聚合物材料制成，并且其中所述手柄有效地用于将能量传输到驱动轴，以便使电活性聚合物材料沿轴向收缩并沿径向扩张，由此使驱动轴平移。
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