CN1665449B - 用于夹紧、切割及缝合组织的器械 - Google Patents

用于夹紧、切割及缝合组织的器械 Download PDF

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CN1665449B
CN1665449B CN038155192A CN03815519A CN1665449B CN 1665449 B CN1665449 B CN 1665449B CN 038155192 A CN038155192 A CN 038155192A CN 03815519 A CN03815519 A CN 03815519A CN 1665449 B CN1665449 B CN 1665449B
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clamp
driver
far
surgical instruments
cutting
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CN1665449A (zh
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迈克尔·P·惠特曼
约翰·E·伯班克
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Covidien LP
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • A61B17/07207Surgical 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017Electrical control of surgical instruments
    • A61B2017/00022Sensing or detecting at the treatment site
    • A61B2017/00039Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003Steerable
    • A61B2017/00318Steering mechanisms
    • A61B2017/00323Cables or rods
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00398Details 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00681Aspects not otherwise provided for
    • A61B2017/00734Aspects not otherwise provided for battery operated
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • A61B2017/07214Stapler heads
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2901Details of shaft
    • A61B2017/2905Details of shaft flexible
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2932Transmission of forces to jaw members
    • A61B2017/2943Toothed members, e.g. rack and pinion
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • A61B2017/320052Guides for cutting instruments

Abstract

一种外科器械(11a),包括具有远端(50a、80a)、且相对设置的第一和第二夹钳(50、80),第一夹钳枢轴连接到第二夹钳;偏置元件(82),如弹簧使得第一夹钳远端朝向第二夹钳远端偏置;第二夹钳上与第一夹钳连接的第一驱动器(88),设置为启动其可使第一和第二夹钳分离而打开,启动其可使第一和第二夹钳闭合而闭合;设置于第二夹钳内的切割和缝合元件(104)中的至少之一,优选为可旋转地安装在楔上的刀片;以及第二驱动器(98),设置为使切割和/或缝合元件从第二夹钳远端朝向其近端移动,以至少切割和缝合夹持在第一和第二夹钳间的组织部分。通过将第一和第二夹钳远端朝向彼此偏置,可防止夹持在第一和第二夹钳之间的组织部分从其远端之间漏掉。

Description

用于夹紧、切割及缝合组织的器械
相关申请的交叉引用
本申请要求以下每一个专利申请的优先权,它们的全部内容结合于此处作为参考:2002年6月14日提交的第60/388,644号美国专利申请;2001年11月30日提交的第09/999,546号美国专利申请;2001年6月22日提交的第09/887,789号美国专利申请;2001年4月17日提交的第09/836,781号美国专利申请;2000年11月28日提交的第09/723,715号美国专利申请;1999年6月2日提交的第09/324,451号美国专利申请;1999年6月2日提交的第09/324,452号美国专利申请;1999年7月12日提交的第09/351,534号美国专利申请;以及2001年7月24日提交的第6,264,087号美国授权专利;2000年2月22日提交的第09/510,923号美国专利申请;以及2000年2月22日提交的第09/510,927号美国专利申请。
技术领域
本发明涉及一种外科器械。更具体而言,本发明涉及一种用于夹紧、切割、以及缝合组织的线性夹紧、切割、以及缝合器械。
背景技术
一种外科器械是线性夹紧、切割、以及缝合器械。该器械可以在外科手术过程中用于从胃肠道中切割癌变或异常组织。常用的线性夹紧、切割、以及缝合器械如图1所示。该器械包括手枪握持型结构,该结构包括细长杆和远端。该远端包括一对剪刀形夹持元件,用于夹持结肠的开口端使之闭合。在该器械中,两个剪刀形夹持元件之一,例如砧座部可相对于整个结构移动或枢轴转动,而另一夹持元件则相对于整个结构保持固定。该剪刀形元件的启动,即砧座部的枢轴转动,通过设置在手柄处的夹持扳机来控制。
除该剪刀形器械外,远端还包括缝合机构。剪刀形机构的固定夹持元件包括缝合件仓盒容纳区域,以及用于驱动缝合件向上穿过组织的夹紧端并顶到砧座部上,从而将之前打开的组织端部缝合的机构。该剪刀形元件可与细长杆整体形成,或者也可以是可拆卸地,以便可以互换各种的剪刀和缝合元件。
前述的外科器械,尤其是如图1所示的线性夹紧、切割、以及缝合器械的一个问题在于,夹紧机构的相对的夹钳不能在剪刀形夹持元件的远端提供足够的夹紧力来保证夹持在夹持元件之间的组织部分不会从夹持元件的远端之间挤出去。
发明内容
根据本发明的一个实施例,该外科器械包括具有远端的第一夹钳和具有远端的第二夹钳。第二夹钳相对于第一夹钳设置。第一夹钳枢轴连接到第二夹钳。该外科器械还包括偏置元件,使得第一夹钳远端朝向第二夹钳远端偏置。该偏置元件也可以包括弹簧,以将第一夹钳的近端和第二夹钳的近端相连接。
该外科器械还包括位于第二夹钳中、并连接到第一夹钳的第一驱动器.第一驱动器可以设置为,启动第一驱动器可以使得第一夹钳和第二夹钳分离而打开夹钳,启动第一驱动器使得第一夹钳和第二夹钳闭合而闭合夹钳.当启动所述第一驱动器来闭合所述夹钳时,在所述第一驱动器完全闭合所述夹钳之前,所述偏置元件使得所述第一夹钳的远端接触所述第二夹钳的远端.
该外科器械还包括设置于第二夹钳内的切割和缝合元件中的至少之一,优选地,刀片可旋转地安装在楔上。第二驱动器可以设置为从第二夹钳的远端朝向近端移动该切割元件和/或缝合元件,以至少切割和缝合夹持在第一夹钳和第二夹钳之间的组织部分。
通过将第一夹钳和第二夹钳的远端朝向彼此偏置,根据本发明第一实施例的外科器械可防止被夹持在第一夹钳和第二夹钳之间的组织部分从第一夹钳和第二夹钳之间漏掉。
附图说明
图1为普通线性夹紧、切割、以及缝合器械的立体图;
图2为根据本发明一个实施例的机电外科装置的立体图;
图3(a)至3(d)为根据本发明一个实施例的线性夹紧、切割、以及缝合附件在其运行时的各个阶段的侧视图;
图4(a)至4(d)为根据本发明另一个实施例的线性夹紧、切割、以及缝合附件在其运行时的各个阶段的侧视图;
图5(a)为根据本发明另一个实施例的线性夹紧、切割、以及缝合附件的侧视图;
图5(b)为图5(a)所示的线性夹紧、切割、以及缝合附件的局部俯视图;
图6(a)为用于图5(a)所示的线性夹紧、切割、以及缝合附件中的可替换的缝合元件仓盒的分解视图;
图6(b)为沿图5(b)中的线6-6剖开的线性夹紧、切割、以及缝合附件的截面图;
图7为图5(a)中所示的线性夹紧、切割、以及缝合附件的后视图;
图8为沿图6(b)中的线8-8剖开的线性夹紧、切割、以及缝合附件的截面图;
图9为沿图6(b)中的线9-9剖开的线性夹紧、切割、以及缝合附件的截面图;
图10为沿图9中的线10-10剖开的线性夹紧、切割、以及缝合附件的截面图;
图11为沿图6(b)中的线11-11剖开的线性夹紧、切割、以及缝合附件的截面图;
图12为沿图11中的线12-12剖开的线性夹紧、切割、以及缝合附件的截面图;
图13为沿图6(b)中的线13-13剖开的线性夹紧、切割、以及缝合附件的截面图;
图14为沿图13中的线14-14剖开的线性夹紧、切割、以及缝合附件的截面图;
图15为根据本发明一个实施例的机电外科器械柔性轴的侧视图,其中部分被剖开;
图16为沿图15中的线16-16剖开的柔性轴的截面图;
图17为图15所示的柔性轴的第一联结器的后视图;
图18为图15所示的柔性轴的第二联结器的前视图;
图19为图2所示的机电外科器械的电动机装置的示意图;
图20为图2所示的机电外科器械的示意图;
图21为图15所示的柔性轴的编码器的示意图;
图22为根据本发明一个实施例的线性夹紧、切割、以及缝合器械的存储装置的示意图;
图23为图2所示的机电外科器械的无线远程控制单元的示意图;以及
图24为图2所示的机电外科器械的有线远程控制单元的示意图。
具体实施方式
根据本发明的外科器械的一个实施例如图3(a)到3(d)所示。参见图3(a)到3(d),示出了一个外科器械11a,例如线性夹紧、切割、和缝合器械的实施例。在该实施例中,外科器械11a包括具有远端50a和近端50b的第一夹钳50,以及具有远端80a和近端80b的第二夹钳80。第一夹钳50和第二夹钳80在各自近端50b和近端80b或者接近各自近端而枢轴连接。第一夹钳50的近端50b与第二夹钳80的近端80b通过偏置元件82相互偏置。在这个实施例中,偏置元件82可以是弹簧。外科器械11a包括止动元件,可以限制第一夹钳50的近端50b与第二夹钳80的近端80b相互分离的距离。在根据本发明实施例中,如图3(a)到3(d)所示,止动元件包括靠近第二夹钳80的近端80b设置的销84,该销接合到第一夹钳50的近端50b附近的槽86中,从而通过槽86的上槽面86a接触销84来限制第一夹钳50的近端50b远离第二夹钳80的近端80b的距离。
此外,第一夹钳50与第二夹钳80在各自的远端50a、80a和近端50b、80b之间通过外螺纹杆90连接。在根据本发明的实施例中,如图3(a)到3(d)所示,外螺纹杆90在其下端90a枢轴连接到安装在第一夹钳50上的销92。第一驱动器88与外螺纹杆90连接,因而使外螺纹的螺杆90能够相对第二夹钳80而伸出或者缩回,从而可以相对于第二夹钳80打开或者闭合第一夹钳50。此外,第一驱动器88的第一驱动座654通过第一驱动轴94与第一电动机96连接。下面将做详细解释,当通过第一驱动轴94与第一电动机96连接时,就可以操作第一驱动器88来相对于第二夹钳80打开或者闭合第一夹钳50。
第一夹钳50包括夹紧面108,该夹紧面包括远端108a和近端108b。相类似,第二夹钳80包括夹紧面106,该夹紧面包括远端106a和近端106b。第二夹钳80还包括切割和缝合元件104,该元件可以构成第二夹钳80的夹紧面106的至少一部分。如下所详细描述的,当第一夹钳50和第二夹钳80如图3(d)所示那样完全闭合时,切割和缝合元件104设置用于切割和缝合组织部分,如组织52。第二夹钳80还包括具有第二驱动座694的第二驱动器98,通过第二驱动轴102与第二电动机100连接。当通过第二驱动轴102与第二电动机接合时,可操作第二驱动器98来驱动切割和缝合元件104,从而切割和缝合组织部分52。尽管图中仅示出了两个驱动座,例如,第一驱动座654、第二驱动座694,和两个相应的驱动轴,例如,第一驱动轴94和第二驱动轴102,但是也可以提供任何合适数量的驱动座和驱动轴。例如,可以提供单个驱动轴来操作该外科器械11a。
图3(a)示出了处于完全打开位置的外科器械11a,其中第一夹钳50和第二夹钳80完全分开。在完全分开的位置,第一驱动器88的外螺纹杆90位于相对于第二夹钳80的伸出位置。槽86的上槽面86a与第二夹钳80的销84接触。这样,第一夹钳50的远端50a与第二夹钳80的远端80a处于最大相对距离。第一夹钳50的近端50b与第二夹钳80的近端80b处于最大相对距离。
当第一驱动器88在第一方向驱动时,外科器械11a移动到第一部分闭合位置,如图3(b)所示.在如图3(b)所示的第一部分闭合位置,第一夹钳50和第二夹钳80大致相互平行,例如,第一夹钳50的夹紧面108的远端108a与第二夹钳80的夹紧面106的远端106a之间的距离,与第一夹钳50的夹紧面108的近端108b与第二夹钳80的夹紧面106的近端106b之间的距离相等.如图3(b)所示,外螺纹杆90部分缩回,例如,通过第一驱动器88,缩回到完全伸出位置与完全收缩位置之间的位置.槽86的上槽面86a保持与第二夹钳80的销84接触.这样,当外科器械11a从如图3(a)所示的完全打开位置移动到如图3(b)所示的第一部分闭合位置时,第一夹钳50相对于第二夹钳80围绕止动元件枢转,例如,围绕与上槽面86a接触的销84旋转.在这个实施例中,由于外螺纹杆90缩回,再结合偏置元件82的偏置力,第一夹钳50旋转.相应地,偏置元件82不仅偏置夹钳50的近端50b、夹钳80的近端80b,而且偏置夹钳50的远端50a、夹钳80的远端80a.
随着第一驱动器88的进一步接合,外科器械11a移动到如图3(c)所示的第二部分闭合区域。在如图3(c)所示的第二部分闭合区域中,由于偏置元件82,第一夹钳50的夹紧面108的远端108a与第二夹钳80的夹紧面106的远端106a之间的距离,比第一夹钳50的夹紧面108的近端108b与第二夹钳80的夹紧面106的近端106b之间的距离小。如图3(c)所示,外螺纹杆90通过第一驱动器88相对于如图3(b)所示的部分缩回位置继续回缩。槽86的上槽面86a继续与第二夹钳80的销84保持接触。这样,移动外科器械11a从如图3(b)所示的第一部分闭合位置到如图3(c)所示的第二部分闭合位置,第一夹钳50相对于第二夹钳80继续围绕止动元件旋转,例如,围绕与上槽面86a相接触的销84旋转。
随着第一驱动器88的进一步接合,外科器械11a移动到如图3(d)所示的完全闭合位置。在如图3(d)所示的完全闭合位置,第一夹钳50的夹紧面108和第二夹钳80的夹紧面106大致平行。如图3(d)所示,外螺纹杆90通过第一驱动器88相对于如图3(c)所示的部分缩回位置完全缩回。如图3(c)所示,第一夹钳50的夹紧面106的远端106a与第二夹钳80的夹紧面108的远端108a相互接触,外螺纹杆90的进一步缩回使得槽86的上槽面86a与第二夹钳80的销84分离。这样,在移动外科器械11a从如图3(c)所示的第二部分闭合位置到如图3(d)所示的完全闭合位置时,第一夹钳50相对于第二夹钳80围绕第一夹钳50的夹紧面106的远端106a和第二夹钳80的夹紧面108的远端108a旋转,然后,随着远端106a与远端108a围绕组织部分52的逐渐分离。偏置元件82(其被压入如图3(d)所示的位置)继续偏置使得第一夹钳50的近端50b和第二夹钳80的近端80b分离,并且偏置第一夹钳50的远端50a,使其靠近第二夹钳80的远端80a。
图4(a)到图4(c)示出了根据本发明另一实施例的线性夹紧、切割、以及缝合附件的侧视图.具体而言,图4(a)示出了处于打开位置的外科器械11b.图4(b)示出了处于部分闭合位置的外科器械11b,以及图4(c)示出了处于闭合位置的外科器械11b.在根据本发明的实施例中,如图4(a)到图4(c)所示,外科器械11b的第一夹钳50具有曲面1081.更具体而言,第一夹钳50的远端50a朝向第二夹钳80的远端80a弯曲.因此施加到夹于第一夹钳50和第二夹钳80之间的组织部分(未示出)的夹紧力在第一和第二夹钳50、80的远端50a、80a要比在第一和第二夹钳50、80的近端50b、80b大,因此,可以帮助减少组织部分从第一和第二夹钳50、80的远端50a、80a脱离的趋势.根据本发明的一个实施例,外科器械11b的第一夹钳50由弹性的、可变形材料构成,从而当足够的夹紧力施加到第一和第二夹钳50、80的远端50a、80a时,该第一夹钳50可以相对于图4(a)到图4(c)中所示的弯曲位置至少部分是直的.此外,如上所述,为了进一步将第一夹钳50的远端50a朝向第二夹钳80的远端80a偏置,以及在第一和第二夹钳50、80的远端50a、80a提供更大的夹紧力,外科器械11b也可以应用偏置元件,例如,连接到第一和第二夹钳50、80的近端50b、80b的弹簧.
图5(a)到图14示出了根据本发明的另一实施例的线性夹紧、切割、以及缝合附件的不同视图。更具体而言,图5(a)是根据本发明的另一实施例的线性夹紧、切割、以及缝合附件的侧视图。外科器械11设置为尤其适合于将内窥镜通过套管(未示出)插入到病人的身体中。图5(a)示出了与第二夹钳80相应的第一夹钳50。图5(b)是图5(a)所示的外科器械11,特别是第二夹钳80的部分俯视图。
图6(a)是可更换的缝合件仓盒600的分解视图,其可应用于图5(a)到图14中所示的根据本发明的实施例中。该可更换的缝合件仓盒600包括缝合件托架604。缝合件托架604在其近端604d具有槽604i,通过存储模块定位器6042将存储模块6041定位在其中。存储模块6041可如上所述存储信息,例如,在提交于2000年11月28日的第09/723,715号美国专利申请、提交于2001年4月17日的第09/836,781号美国专利申请、提交于2001年6月22日的第09/88,789号美国专利申请、以及提交于2002年3月15日的第10/099,634号美国专利申请中所披露的,上述专利申请的内容全部结合于此作为参考。楔驱动器605设置为可以通过缝合件托架604的中央槽604e可旋转地设置。更具体而言,楔驱动器605具有远端605a,设置为可旋转地安装在缝合件托架604的远端开口604a中。楔驱动器605还包括外螺纹区域605b、旋转地延伸穿过缝合件托架604的近端开口604b中的无螺纹区域605c、以及位于最近端的正齿轮605d。
可更换的缝合件仓盒600还包括具有内螺纹孔603a的楔603。楔驱动器605的外螺纹区域605b设置为延伸穿过楔603的内螺纹孔603a。楔603的内螺纹孔603a的螺纹与楔驱动器605的外螺纹区域605b的螺纹相匹配。如下所述,当楔驱动器605旋转时,楔603通过中央槽604e在缝合件托架604的远端604c和缝合件托架604的近端604d之间移动。
缝合件托架604还包括中央槽604e的相对壁604g上的多个垂直设置的槽604f。在中央槽604e的每一侧上,设置有缝合件推动器607,可以滑动地设置在槽604f中。更具体而言,每一个缝合件推动器607具有顶面607a,在缝合件推动销607c的两排607b之间纵向延伸。缝合件推动销607c设置为:排607b中的与缝合件托架604的壁604g相邻接的每一个缝合件推动销607c被限制在壁604g的相应槽604f中,从而可以在其中垂直滑动。缝合件推动销607c设置在缝合件托架604的槽604h上。缝合件托架604的槽604h中容纳有多个紧固件,例如缝合件606。每一个缝合件606包括一个端面606a以及一对叉脚606b。
楔603还包括一对斜边603b,可以滑动地与缝合件推动器607的各个顶面607a相接合。当楔603通过中央槽604e从缝合件托架604的远端604c向近端604d移动时,楔603的一对斜边603b设置为滑动地与缝合件推动器607的各个顶面607a相接合,从而连续地将缝合件推动器607的缝合件推动销607c推入,从而也把缝合件606推出缝合件托架604的槽604h。筒形顶611设置为安装到缝合件托架604的中央槽604a上,而缝合件定位器610可以设置为覆盖缝合件托架604的夹紧面106。
图6(b)中示出了沿图5(b)中的6-6线获得的线性夹紧、切割、以及缝合附件的横截面图.图6(b)示出了完全处于打开位置的外科器械11,其中外螺纹杆90完全缩回.在图6(b)中,示出了外科器械11,此时在第一和第二夹钳50、80的夹紧面106、108之间没有组织部分,因此,示出了完全处于闭合位置的外科器械11,其中第一夹钳50的夹紧面108的远端108a与第二夹钳80的夹紧面106的远端106a接触.
如图6(b)所示,外科器械11包括设置在第二夹钳80中的切割、以及缝合元件104。根据本发明示出的实施例,切割、以及缝合元件104包括图6(b)中的可更换缝合件仓盒600,其可更换地安装在第二夹钳80中。在图6(a)中分解示出的可更换缝合件仓盒600在图6(b)中示出为组装并安装到第二夹钳80中。
如图6(b)中所示,楔603上设置由具有刀刃51a的刀片51。在另一实施例中,切割和缝合元件可以单独设置。在图6(b)所示的实施例中,外科器械11包括刀片51,刀片51具有具有接触面653的尾部区域654。刀片51围绕枢轴51b可旋转地与楔603连接,从而可使刀片在第一位置和第二位置之间旋转。图6(b)示出了当楔603和刀片51从缝合件托架604的远端604c到近端604d移动时,在几个位置A-E处的楔603和刀片51。
在位置A处,楔603和刀片51设置在缝合件托架604的远端604c处。在位置A处,楔603和刀片51放入了壳体615中,刀片51相对于楔603旋转,从而位于缩回位置,即,刀刃51a面向上方并且未露出。接触面653起初朝向缝合件托架604的近端604d。
在操作的过程中,第二驱动器98通过例如,旋转楔驱动器605使楔603和刀片51前进到位置B。在位置B处,楔603和刀片51设置在缝合件托架604的远端604c近处。更具体而言,在位置B处,楔603和刀片51设置为使得刀片51的接触面653开始接触壳体615的启动凸缘615a。当刀片51的接触面653开始接触壳体615的启动凸缘615a时,刀片51开始相对于楔603旋转。
进一步地操作第二驱动器98,使得楔603和刀片51前进到位置C。在位置C处,楔603和刀片51相对于缝合件托架604的远端604c更近。更具体而言,在位置C处,楔603和刀片51设置为使刀片51的接触面653完全与壳体615的启动凸缘615a接触。当刀片51的接触面653完全接触壳体615的启动凸缘615a时,刀片51完全相对于楔603旋转,从而使得刀片51的刀刃51a在伸出位置,即,刀刃51a朝向缝合件托架604的近端604d。
进一步地操作第二驱动器98,使得楔603和刀片51前进到位置D。在位置D处,楔603和刀片51设置为接近缝合件托架604的远端604c和缝合件托架604的近端604d之间的中点。在位置D处,刀片51保持在伸出位置,刀片51还具有朝向缝合件托架604的近端604d的刀刃51a,从而切割夹在第一夹钳50和第二夹钳80之间的组织部分(未示出)。
进一步操作第二驱动器98,使得楔603和刀片51前进到位置E。在位置E处,楔603和刀片51设置在缝合件托架604的近端604d处,在位置E处,刀片51仍然保持在伸出位置,刀刃51a朝向缝合件托架604的近端604d。但是,此处刀片51包围在壳体616中,从而刀刃51a没有显露。
如图6(b)所示,第一夹钳50包括砧座元件700,相应于第二夹钳80设置。砧座元件700包括夹紧面108,和第二夹钳80的夹紧面106一起夹紧需要切割和缝合的组织部分。
外科器械11还包括偏置元件82,其可以将第一夹钳50的近端50b偏置离开第二夹钳80的近端80b;以及止动元件,可以限制第一夹钳50的近端50b与第二夹钳80的近端80b之间可分离的距离.在如图6(b)所示的根据本发明的实施例中,偏置元件82包括弹簧705,其保持在外科器械11的圆柱形壳体706中.更具体而言,弹簧705的第一端接触第一夹钳50的内表面5010,弹簧705的第二端接触圆柱壳体706的壳体壁708.止动元件707的第一端707a连接到第一夹钳50,并延伸穿过弹簧705的中心以及穿过壳体壁708的开口708a,进入圆柱形的壳体709中.当第一夹钳50和第二夹钳80处于如图6(b)所示的闭合位置时,止动元件707的第二端707b接触第二夹钳80的内表面.止动元件707的第二端707b优选形状为T形,其与圆柱壳体壁709相接触,但是不能延伸穿过开口708a.因此,止动元件707的第二端707b与圆柱壳体壁708接触,限制了第一夹钳50的近端50b与第二夹钳80的近端80b之间的可分离的距离.
与上述图3(a)到3(d)中讨论的实施例相似,外科器械11的第二夹钳80还包括第一驱动器88,通过第一驱动轴94连接到第一电动机96,从而当通过第一驱动轴94与第一电动机96相啮合时,操作第一驱动器88,使第一夹钳50相对于第二夹钳80打开或者闭合。在图6(b)中示出的实施例中,第一驱动器88包括外螺纹杆90,可在下端90a枢转地连接到第一夹钳50中的销92。外螺纹杆90在上端90b处包括止动件90c。图6(b)示出了锥齿轮螺母617,其构成了第一驱动器88的一部分。锥齿轮螺母617旋转地位于轴承螺母618中。轴承螺母618不可旋转地位于壳体板619的开口中,其可以水平地、及固定地设置在外科器械11中。锥齿轮螺母617具有内螺纹孔617a,外螺纹杆90可以穿过该孔设置,从而锥齿轮螺母617的内螺纹孔617a的螺纹可以与外螺纹杆90的螺纹相匹配。锥齿轮螺母617还包括多个轮齿617b。
图6(b)示出了锥齿轮驱动器620,其也构成了第一驱动器88的一部分。锥齿轮驱动器620在一端具有锥齿轮621,旋转地位于锥齿轮轴承622之中。锥齿轮轴承622非旋转地位于齿轮箱623的开口中,该齿轮箱垂直地并且固定地位于外科器械11中。锥齿轮螺母617的多个轮齿617b与锥齿轮621的多个轮齿621a相啮合。锥齿轮驱动器620还包括第一纵向区域620b以及第二纵向区域620c。锥齿轮驱动器620的第二纵向区域620b延伸通过壳体板624中的开口,其垂直地并且固定地位于外科器械11中。
在该实施例中,齿轮组625也构成了第一驱动器的一部分。齿轮组625具有内中央孔626,锥齿轮驱动器620可穿过该孔延伸。齿轮组625还具有几个纵向设置的区域。齿轮组625的第一区域625a具有横截面为圆形的光滑圆柱外表面。此外,齿轮组625的第一区域625a具有一径向设置的孔6251,销6252穿过该孔设置。销6252穿过齿轮组625的第一区域625a的孔6251,进入到锥齿轮驱动器620的第一纵向区域620b的相应的径向设置的孔6201中,从而使齿轮组625和锥齿轮驱动器620非旋转地连接。齿轮组625的第二区域625b限定出正齿轮627,正齿轮627具有多个圆周设置的正齿轮轮齿6271。齿轮组625的第三区域625c也限定出正齿轮628,正齿轮628具有多个圆周设置的正齿轮轮齿6281。齿轮组625的第四区域625d也限定出正齿轮629,正齿轮629具有多个圆周设置的正齿轮轮齿6291。
此外,在该实施例中,第一驱动器还包括齿轮组630.齿轮组630具有内中央孔630a,齿轮销631可穿过该孔延伸.齿轮销631包括远端631a,该末端部可旋转地容纳于齿轮箱6000的垂直设置的壳体板632的开口632a中,该齿轮箱固定安装在外科器械11上;以及近端631b,其可旋转地延伸通过齿轮箱6000的垂直设置的壳体板635的开口635a.齿轮组630具有几个纵向设置的区域.齿轮组630的第一区域630b限定出正齿轮633,该正齿轮具有多个沿着圆周设置的正齿轮轮齿6331.齿轮组630的第二区域630c限定出正齿轮634,该正齿轮具有多个沿着圆周设置的正齿轮轮齿6341.外科器械11设置为使得齿轮组630的正齿轮633的正齿轮轮齿6331与齿轮组625的正齿轮627的正齿轮轮齿6271相互啮合.同时,齿轮组630的正齿轮634的正齿轮轮齿6341与齿轮组625的正齿轮628的正齿轮轮齿6281相互啮合.
外科器械11还包括盖板组件710,其连接到外科器械11的近端。盖板组件710包括内螺纹孔710a,其与外科器械11的齿轮箱6000的壳体壁711的内螺纹孔相对齐;外螺纹螺栓712(其螺纹与内螺纹孔710a和711a相匹配)穿过盖板组件710和壳体壁711延伸,从而牢牢地将盖板组件710与壳体壁711相连接。盖板组件710还包括快速连接套筒713,该套筒具有快速连接槽713a,可以与柔性驱动轴1620的快速连接元件1664完全接合。为了将柔性驱动轴1620的快速连接元件1664固定在快速连接套筒713的快速连接槽713a中,盖板组件710还包括盖板弹簧714。
图7示出了盖板组件710的附加特征。图7是图5中示出的线性夹紧、切割、以及缝合附件的后视图。参照图7,在盖板组件710和壳体壁711之间设置有止挡板717。止挡板717通过螺纹712固定,并具有开口717a和717b,第一驱动器88的第一驱动座654以及第二驱动器98的第二驱动座694可穿过上述开口延伸。盖板组件710还包括数据接头1272,其包括电触点1276。盖板组件710的数据接头1272通过在其间延伸的柔性数据传输缆(未示出)电性地、逻辑性地连接到容纳在与设置在缝合件托架604的近端604b中的存储模块6041上。
图8为沿图6(b)中的线8-8剖开的线性夹紧、切割、以及缝合附件的截面图。参照图8,砧座元件700包括纵向设置的槽701,该槽从砧座元件700的远端700a延伸到近端700b。槽701与第二夹钳80的刀片51相对齐,从而当刀片从第二夹钳80的远端80a移动到近端80b时,刀片51沿着槽701移动并缩回。砧座元件700包括多个缝合件导向件703的行702。缝合件导向件703设置为当启动外科器械11时,容纳缝合件606的叉脚606b,并弯曲该叉脚606b,从而闭合缝合件606。当外科器械11处于闭合位置时,多个缝合件导向件703的行702与第二夹钳80中的缝合件托架604的槽604h相对齐,从而保持在缝合件托架604的槽604h中的缝合件606与砧座元件700的缝合件导向件703相对应,可以由缝合件推动器607的缝合件推动销607c推入并闭合。
图9为沿图6(b)中的线9-9剖开的线性夹紧、切割、以及缝合附件的截面图。图10为沿图9中的线10-10剖开的线性夹紧、切割、以及缝合附件的截面图。图10示出了构成第一驱动器88的一部分的齿轮组640。齿轮组640具有内部中央孔640a,齿轮销641可从该孔中穿过延伸。齿轮销641具有远端641a,其非旋转地位于齿轮箱6000的壳体板635的开口635a中,还具有近端641b,其旋转地延伸穿过齿轮箱6000的垂直设置的壳体板645a上的开口645a。齿轮组640具有几个纵向设置的区域。齿轮组640的第一区640b限定出正齿轮643,该正齿轮具有多个圆周设置的正齿轮轮齿6431。齿轮组640的第二区640c限定出正齿轮644,该正齿轮具有多个圆周设置的正齿轮轮齿6441。外科器械11设置为使得齿轮组640的正齿轮643的正齿轮轮齿6431与齿轮组625的正齿轮629的正齿轮轮齿6291相啮合。
图10还示出了构成第二驱动器98的一部分的启动轴组件690.如前参照图3(a)至3(d)所述,第二驱动器98与第二电动机100通过第二驱动轴102相互连接,操作用来驱动切割以及缝合元件104来切割和缝合组织部分52.启动轴组件690具有几个纵向设置的区域.启动轴组件690的第一区域690a延伸到齿轮箱6000的垂直设置的壳体板692的孔692a中,并在其中旋转.启动轴组件690的第二区域690b限定出具有多个圆周设置的正齿轮轮齿6911的正齿轮691.启动轴组件690的第三区域690c限定出第二驱动座694.第二驱动座694包括驱动夹6942可插入其中的槽6941.驱动夹6942设置为不可旋转地、可拆卸地连接到第二驱动轴102上,以下将详细说明.
图11为沿图6(b)中的线11-11剖开的线性夹紧、切割、以及缝合附件的截面图。图12为沿图11中的线12-12剖开的线性夹紧、切割、以及缝合附件的截面图。图12示出了构成第一驱动器88的一部分的夹紧轴组件650。夹紧轴组件650具有几个纵向设置的区域。夹紧轴组件650的第一区域650a延伸到齿轮箱6000的垂直设置的壳体板624的开口624a中,并在其中旋转。夹紧轴组件650的第二区域650b限定出具有多个圆周设置的正齿轮轮齿6531的正齿轮653。外科器械11设置为使得夹紧轴组件650的正齿轮653的正齿轮轮齿6531与齿轮组640的正齿轮644的正齿轮轮齿6441相互啮合。夹紧轴组件650第三区域650c限定出直的纵向轴,该轴部分地被齿轮隔板657包围,该齿轮隔板通过紧靠正齿轮653来保持夹紧轴组件650的纵向位置。夹紧轴组件650的第四区域650d限定出第一驱动座654。第一驱动座包括驱动夹6542可插入其中的槽6541。驱动夹6542设置为不可旋转地、可拆卸地连接到第一驱动轴94的互补第一驱动联结器1666上,以下将详细说明。
图13为沿图6(b)中的线13-13剖开的线性夹紧、切割、以及缝合附件的截面图。图14为沿图13中的线14-14剖开的线性夹紧、切割、以及缝合附件的截面图。图14示出了形成第二驱动器98的一部分的梭式空套齿轮660。梭式空套齿轮660具有第一端660a,该第一端延伸到垂直地和固定地设置在外科器械11中的壳体板604l的开口604e中,并在其内可旋转。类似地,梭式空套齿轮660具有第二端660b,其延伸通过齿轮箱6000的垂直设置的壳体板66l的开口604e中,并在其中可旋转地支撑。梭式空套齿轮660还具有中心区域660c,其限定出具有多个圆周设置的正齿轮轮齿6621的正齿轮662。外科器械11设置为使得梭式空套齿轮660的正齿轮662的正齿轮轮齿662l可与正齿轮605d的正齿轮轮齿605l在可替换缝合件仓盒600的楔驱动器605的近端啮合。
图14还示出了构成第二驱动器98的一部分的侧轴组件670。侧轴组件670具有几个纵向设置的区域。侧轴组件670的第一区域670a延伸通过齿轮箱6000的壳体板661的开口661b,并在其中可旋转。此外,第一区域670a限定出具有圆周设置的正齿轮轮齿6721的正齿轮672。该实施例中外科器械11设置为使得侧轴组件670的正齿轮672的正齿轮轮齿6721可与梭式空套齿轮660的正齿轮662的正齿轮轮齿6621相啮合。此外,侧轴组件670的第一区域670a包括轴向锥孔6701,从缝合件托架604的近端604d开始延伸的销6702可插入其中,因此有助于确保缝合件托架600恰好插入到第二夹钳80的第一驱动器88,并且恰好接合。侧轴组件670的第二区域670b限定出直的纵向轴。侧轴组件670的第三区域67c限定出联结器671,即,凸的六边形联结器。
图14还示出了构成第二驱动器98的一个部分的侧轴组件680.侧轴组件680具有几个纵向设置的区域.侧轴组件680的第一区域680a限定出联结器682,即,凹的六边形联结器,其设置为非旋转地连接到侧轴组件670的联结器671.侧轴组件680的第二区域680b限定出直的纵向轴.侧轴组件680的第三区域680c限定出具有多个圆周设置的正齿轮轮齿6811的正齿轮681.外科器械11设置为使得侧轴组件680的正齿轮681的正齿轮轮齿6811与启动轴组件690的正齿轮691的正齿轮轮齿6911相啮合.侧轴组件680的第四区域680d伸入到安装在外科器械11内的导向衬套683的开口683a中,并可在其中旋转.
图14还示出了柔性数据传输缆1278。如前所述,该柔性数据传输缆1278电性地、逻辑性地连接到将定位在缝合件托架604的的近端604d的槽604i中的存储模块6041连接到盖板组件710的数据接头1272上。方便地,在这个实施例中,柔性数据传输缆1278是平的数据缆,该数据缆沿着第二夹钳80的内表面8010延伸,并且具有最小的截面积,这样可以避免与上述的各种齿轮装置接触。
根据本发明的一个实施例,外科器械11可形成为连接到机电外科装置,如机电驱动装置1510上,或与其形成整体。在另一实施例中,外科器械11也可形成为连接到纯粹的机械装置的驱动装置上,例如图1所示的驱动装置。
图2为根据本发明的机电驱动器元件1610的一个实施例的立体图。该机电外科装置在美国专利申请第09/723,715、美国专利申请第09/836,781、以及美国专利申请第09/887,789中有所描述,其全部内容结合于此作为参考。该机电驱动器元件1610包括,如,远程电力控制台1612,其包括具有前面板1615的壳体1614。显示装置1616和指示器1618a、1618b安装在该前面板1615上。柔性轴1620从壳体1614伸出,并通过第一联结器1622可拆卸地连接到该壳体。柔性轴1620的远端1624可包括第二联结器1626,适用于将如上述的外科器械11可拆卸地连接到柔性轴1620的远端1624上。第二联结器1626还可用于连接不同的外科器械或外科附件。在另一实施例中,柔性轴1620的远端1624可固定地连接到外科器械或与其形成为一体。
参照图15,示出了柔性轴1620的侧向局部视图。根据一个实施例,柔性轴1620包括管状外壳1628,该外壳包括涂层或其他的密封设置来密封其内部通道1640和外界环境之间。外壳1628可以成形为一种组织相容、可以杀菌的材料。外壳1628由组织相容的、无菌弹性材料形成。放置在柔性轴1620的内部通道1640中,并且沿着整个长度延伸的可以是第一旋转驱动轴94、第二可旋转驱动轴102、第一操纵缆1634、第二操纵缆1635、第三操纵缆1636、第四操纵缆1637、和数据传输缆1638。图16为沿图15中的线16-16剖开的柔性轴的截面图,并且进一步示出了几条缆94、102、1634、1635、1636、1637、和1638。每一个操纵缆1634、1635、1636、1637、1638的远端固定到柔性轴1620的远端1624。每一个缆94、102、1634、1635、1636、1637、和1638可以被容纳各个壳体中。
第一旋转驱动轴94和第二旋转驱动轴102可设置为高度柔性轴,例如,编织的或螺旋的驱动缆.可以理解,该高度柔性驱动缆可具有受限的扭矩传递特性和能力.也可以理解,外科器械11或其他连接在柔性轴1620上的附件需要高于驱动轴94、102所能传递的扭矩的较高扭矩输入.驱动轴94、102也可被设置为传递低扭矩和高速率,通过设置在如,外科器械或附件和/或远程电力控制台1612上的驱动柔性轴1620的远端和/或近端上的齿轮装置,高速率/低扭矩可转换为低速率/高扭矩.可以理解,这样的齿配装置可以沿着壳体1614上的电动机和连接到柔性轴1620上的外科附件或其他附件之间的动力链设置在任意位置.该齿轮装置可包括,例如,正齿轮、行星齿轮、谐波齿轮、摆线驱动装置、以及行星驱动装置等.
现在参照图17,示出了第一联结器1622的后视图。第一联结器1622包括第一接头1644、第二接头1648、第三接头1652、和第四接头1656,每一个接头都可旋转地固定到第一联结器1622。每一个接头1644、1648、1652、1656都包括各自的槽1646、1650、1654、1658。如图17所示,每一个槽1646、1650、1654、1658可以是六边形的。可以理解,每一个槽1646、1650、1654、1658可以设置用于将接头1644、1648、1652、1656非旋转地和刚性地连接到壳体1612中容置的电动机装置的各个驱动轴上的任意的形状和结构。可以理解,可以在电动机的各个驱动轴上设置互不突起,以驱动柔性轴1620上的驱动元件。也可以理解,槽可以设置在驱动轴上以及互补突起可设置在接头1644、1648、1652、1658上。也可设置其他的连接装置和结构,用于非旋转地和可拆卸地连接各个接头1644、1648、1652、1656和电动机装置的驱动轴。
接头1644、1648、1652、1656中的一个不可旋转地固定到第一驱动轴94,接头1644、1648、1652、1656中的另外一个不可旋转地固定到第二驱动轴102。接头1644、1648、1652、1656中的剩余两个与传送元件接合,该传送元件形成为在操纵缆1634、1635、1636、1637上施加张力,因此可操纵柔性轴1620的远端1624。数据传输缆1638电性地和逻辑性地与数据接头1660连接。数据接头1660包括,例如,电触点1662,与数据缆1638中容耐的缆线相对应并且数量相等。第一联结器1622包括键结构1642,以将第一联结器1622正确地定位到相匹配和互补的壳体1612上设置的联结器装置。键结构1642可以设置在第一联结器1622上,也可设置在壳体1612上的匹配和互补的联结器装置上,或者设置在其两者上。第一联结器1622包括快速连接型接头,其通过简单的推进运动可将第一联结器1622连接到壳体1612。几个接头1644、1648、1652、1656、1660中的任何一个均可结合密封件使用,以在第一联结器1622的内部与外部环境之间形成密封。
参照图18,示出了柔性轴1620的第二联结器1626的前视图。在该实施例中,第二联结器1626包括第一接头1666和第二接头1668,每一个接头可旋转地固定到第二联结器1626,并且每一个接头不可旋转地连接到第一驱动轴94和第二驱动轴102的远端。快速连接型的配合件1664设置在第二联结器1626上,以可拆卸地固定在器械11上。该快速连接型的配合件1664可以是,例如,旋转的快速连接型配合件、卡口型配合件等,也可以是与图6(b)所示的盖板组件710的快速连接套筒713互补的配合件。键结构1674可设置在第二联结器1626上,并用于将外科器械11正确地对齐到第二联结器1626。键结构或者其他可将外科器械11对齐到柔性轴1620上的装置可设置在第二联结器1626或外科器械11上,或设置在上述两者上。另外,键结构可以设置在器械11上,如图6(b)所示的快速连接套筒713的槽713a。具有电触点1672的数据接头1670也可设置在第二联结器1626上。类似于第一联结器1622的数据接头1660,第二联结器1626的数据接头1670包括触点1672,其电性地和逻辑性地连接到数据传输缆1638的各个缆线和数据接头1660的触点1662上。接头1666、1668、1670上可结合设置密封件,以在第二联结器1626的内部和外部环境之间形成密封。
机电驱动元件设置在远程电力控制台1612的壳体1614中,该机电驱动元件形成为驱动驱动轴94、102和操纵缆1634、1635、1636、1637,从而操纵连接到第二联结器1626上的机电驱动器元件1610和外科器械11.在图19所示的实施例中,通过电源来操纵的五台电动机96、100、1684、1690、1696放置在远程电力控制台1612中.可以理解,可是设置任何合适数量的电动机,也可通过电池电源、线电流、直流电源、电控直流电源等来操纵各台电动机.可以理解,电动机可以连接到直流电源上,其依次连接到线电流并给电动机提供工作电流.
图19示意性地示出了一种可能的电动机装置。第一电动机96的输出轴1678与第一联结器1622的第一接头1644接合,此时,第一联结器1622和柔性轴1620与壳体1614接合从而驱动第一驱动轴94和第二联结器1626的第一接头1666。相类似,当第一联结器1622和柔性轴1620与壳体1614接合从而驱动第二驱动轴102和第二联结器1626的第二接头1668时,第二电动机100的输出轴1682与第一联结器1622的第二接头1648接合。当通过第一滑轮装置1688使得第一联结器1622和柔性轴1620与壳体1614接合从而驱动第一和第二操纵缆1634、1635时,第三电动机1684的输出轴1686与第一联结器1622的第三接头1652接合。当通过第二滑轮装置1694使得第一联结器1622和柔性轴1620与壳体1614接合从而驱动第三和第四操纵缆1636,1637时,第四电动机1690的输出轴1692与第一联结器1622的第四接头1656相接合。第三和第四电动机1684、1690可以被固定在仓壳1100上,其通过第五电动机1696的输出轴1698在第一位置和第二位置之间可选择地滑动,以通过各自的滑轮装置1688、1694与第三和第四电动机1684、1690选择性地接合和断开,从而使得柔性轴1620根据需要变得张紧地、可操纵地、或柔软地,通过让位于第一位置和第二位置之间的第五电动机的输出轴1698与第三和第四电动机1684,1690啮合或者不啮合而让仓壳可选择地移动。可以理解,其他机械的、电子的和/或机电的机构均可被用于有选择地与操纵机构接合和断开。如上所述,电动机可形成为如美国专利第09/510,923,名为“用于控制柔性轴内操纵线缆机构的仓盒组件”中所述,其全部内容结合于此作为参考。
可以理解,电动机96、100、1684、1690、1696可以是高速率/低扭矩、低速率/高扭矩电动机等。如上所述,第一旋转驱动轴94和第二可旋转驱动轴1902可以用于传递高速率和低扭矩。因此,第一电动机96和第二电动机100可以为高速率/低扭矩电动机。可选择地,第一电动机96和第二电动机100可以为低速率/高扭矩电动机,其中减扭矩/增速齿轮装置设置在第一电动机96和第二电动机100之间,以及第一旋转驱动轴94和第二旋转轴102之间。该扭矩递减/速度递增齿轮装置可包括,例如正齿轮、行星齿轮、谐波齿轮、摆线驱动装置、行星齿轮驱动装置等。可以理解,任何一种这样的齿轮装置均可以设置在远程电力控制台1612中或者在柔性轴1620的近端,例如,第一联结器1622。可以理解,齿轮装置可以设置在第一旋转驱动轴94和/或第二可旋转驱动轴102的远端和/或近端,以防止其卷曲和破裂。
参照图20,示意性地示出了机电驱动元件1610的示意图.控制器1122设置在远程电力控制台1612的壳体1614中,并且设置为可用来控制机电驱动器元件1610、以及线性夹紧、切割、以及缝合器械11或连接到柔性轴1620上的其他外科器械或附件的所有功能和操作.设置有存储单元1130,其包括存储装置,如,ROM元件1132、RAM元件1134等.ROM元件1132电性地和逻辑性地与控制器1122通过线1136导通,而RAM元件1134通过线1138与控制器1122电性地和逻辑性地导通.RAM元件1134包括任何一种随机访问存储器,如,磁存储装置、光存储装置、磁光存储装置、电存储装置等.类似地,ROM元件1132包括任何只读存储器,如,可擦写存储介质,如PC卡或PCMCIA型装置.可以理解,ROM元件1132和RAM元件1134可以设置为单独元件也可设置为分开的元件,以及ROM元件1132和/或RAM元件1134可设置为PC卡或PCMCIA型装置.
控制器1122还连接到壳体1614的前面板1615上,特别是通过线1154连接到限制装置1616上,以及通过线1156、1158连接到指示器1618a、1618b上。线1116、1118、1124、1126、1128电性地和逻辑性地将控制器1122分别连接到第一、第二、第三、第四、第五电动机96、100、1684、1690、1696上。有线远程控制单元(“RCU”)1150通过线1152电性地和逻辑性地连接到控制器1122上。还设置有无线RCU1148,并通过无线链接1160与通过线1144连接到收发器1140上的接收/发送单元1146连通。收发器1140通过线1142电性地和逻辑性地连接到控制器1122上。无线链接1160可以是如红外链接的光链接、电波链接、或者任何其他形式的无线通信链接。
开关装置86可以通过线1188连接到控制器1122,该开关装置可以包括例如一组DIP开关。开关装置1186可以被设置为例如用来选择显示装置1616上显示信息和提示所使用的多种语言。这些信息和提示可以与机电驱动器元件1610和/或连接到其上的外科器械11的操作和/或状态。
根据本发明的实施例,第一编码器1106设置在第二联结器1626上,并且形成为响应和根据第一驱动轴94的旋转而输出信号。第二编码器1108设置在第二联结器1626上,并且设置响应和根据第二驱动轴102的旋转而输出信号。各编码器1106、1108的信号输出表示各自的驱动轴94、102的旋转位置及其旋转方向。编码器1106、1108可包括如霍耳效应器件、光学器件等。尽管编码器1106、1108被描述为设置在第二联结器1626中,但是也可以理解,编码器1106、1108可设置在电动机装置和外科器械11之间的任何位置。可以理解,在第二联结器1626或柔性轴1620的远端可以设置编码器1106、1108,以精确地确定驱动轴的旋转方向。如果编码器1106、1108可设置在柔性轴1620的近端,第一和第二可旋转驱动轴94、102的卷曲可能会导致测量误差。
图21示出了编码器1106、1108的示意图,其包括霍耳效应器件。具有N极1242和S极1244的磁铁1240不可旋转地安装到驱动轴94、102上。编码器1106、1108还包括第一传感器1246和第二传感器1248,其相对于驱动轴94、102的纵向或旋转轴线间隔90度设置。传感器1246、1248输出是连续,并且传感器感测到的磁场范围的极性改变时,该传感器也随之改变其状态。这样,基于编码器1106、1108的输出信号,驱动轴94、102的角度位置在四分之一的转速范围内可被检测到,并且驱动轴94、102的旋转方向也可被确定。通过数据传输缆1638中相应的线缆1110、1112,每一个编码器1106、1108的输出都被传送到控制器1122。根据编码器1106、1108的输出信号来监测驱动轴94、102的角位置和旋转方向,因此控制器1122可以判断连接到机电驱动元件1610上的外科器械的元件的位置和/或状态。也即,通过计算驱动轴94、102的转数,控制器1122可以判断出连接到机电驱动元件1610上的外科器械的元件的位置和/或状态。
例如,第一夹钳50相对于第二夹钳80的前进距离和楔603的前进距离可以根据各个驱动轴94、102的旋转度数来计算和确定.通过根据编码器1106、1108的输出信号和外螺纹杆90和楔驱动器605的已知节距,来及时确定第一夹钳50和楔603在某一点的绝对位置以及第一夹钳50和楔603的相对位移,从而可以用于确定第一夹钳50和楔603在随后所有时间内的绝对位置.当外科器械11初始与挠性轴1620连接时可以确定第一夹钳50和楔603的绝对位置.可选择地,根据编码器1106、1108的输出信号,可以确定第一夹钳50和楔603相对于,例如第二夹钳80的相对位置.
结合以上参照图7所述,外科器械11可以包括其尺寸和结构可适用于与第二联结器1626的接头1670电性地和逻辑形地连接的数据接头1272。在该实施例中,数据接头1272包括与接头1670的触点数量相等的触点。存储模块6041电性地和逻辑地与数据接头1272相连。存储模块6041可以是,例如,EEPROM、EPROM等形式,并且可以容纳在例如,外科器械11的第二夹钳80的可被替换的缝合件仓盒600的缝合件托架604中,如图6(a)所示。
图22示意性地示出了存储模块6041。如图22所示,数据接头1271包括触点1276,其均电性地和逻辑性地通过各自的线,即,柔性数据缆1278连接到存储模块6041。存储模块6041可被用于存储,例如,序列号数据1180、附件类型数据(ID)1182、和使用数据数据1184。存储模块6041还可以额外存储其他数据。序列号数据1180和ID数据1182可以是只读数据。序列号数据1180和/或ID数据1182可以存储在存储模块6041的只读部中。在一个实施例中,序列号数据1180可以是唯一识别特定外科器械的数据,而ID数据1182可以是识别附件类型的数据,例如,连接到机电驱动器元件1610上的其他类型的外科器械或附件。使用数据1184表示特定附件的使用,例如,外科器械11的第一夹钳15已经打开或者闭合的次数,或者外科器械11的楔603已经前进的次数。使用数据1184可以存储在存储模块6041的读/写部。
需要指出的是,连接到柔性轴1620的远端1624的附件,例如外科器械11可以设计和形成为可使用一次或者多次。附件也可以设计和形成为可使用特定的次数。因此,使用数据1184可以用于确定外科器械是否已经使用过,以及是否使用的次数已经超过了允许使用的最大次数。如下所述,在达到使用次数的最大数值之后,任何试图使用该外科器械都将会产生“错误”状态。
参照图20,当外科器械11初始连接到柔性轴1620时,控制器1122形成为可从外科器械11的存储模块6041中读取ID数据1182.存储模块6041通过数据传输缆1683的线1120电连地和逻辑地连接到控制器1122.基于读取的ID数据1182,控制器1122形成为从存储单元1130读取或者选择对应于连接到柔性轴1620上的外科器械或者附件的操作程序或者算法.存储单元1130形成为存储对应于每个外科器械或者附件的操作程序或者算法,控制器1122根据从每个连接的外科器械或者附件的存储模块6041中读取的ID数据1182,从存储单元1130中选择和/或读取操作程序或者算法.如上所述,存储单元1130还包括可移除的ROM元件1132和/或RAM元件1134.因此,存储在存储单元1130中的操作程序或算法可以被更新、增加、删除、改进、或者根据需要进行修正.存储在存储单元1130中的操作程序或者算法例如可以根据用户的特殊要求进行定制化.数据输入装置,例如,键盘、鼠标、指示器、触摸屏等可通过数据接口连接到存储单元1130,以方便操作程序或者算法的定制化.可选择地以及另外地,操作程序或者算法可以定制和预编程到远离机电驱动器元件1610的存储模块130中.可以理解,序列号数据1180和/或使用数据1184也可以用于确定从存储单元1130中读取或者选择多个操作程序或者算法中的确切的那个.还可以理解,操作程序或者算法也可选择存储到外科器械11的存储模块6041中并通过数据传输缆1638传输到控制器1122.一旦控制器1122读取或者选择或者被传输入恰当的操作程序或者算法,控制器1122将使操作程序或者算法通过用户经由RCU1150和/或RCU1148执行的操作而进行工作.如上所述,控制器1122通过各线缆1116、1118、1124、1126、1128而电性地和逻辑性地连接到第一电动机96、第二电动机100、第三电动机1684、第四电动机1690、第五电动机1696,并形成为根据各线缆1116、1118、1124、1126、1128读取、选择、或者传输的操作程序或者算法控制该电动机96、100、1684、1690、1696.
参照图23,图中示意性地示出了无线RCU1148。无线RCU1148包括操纵控制器1300,该操纵控制器具有多个开关1302、1304、1306、1308,设置在四位摇杆1310下方。通过摇杆1310操作开关1302、1304可以通过第三电动机1684控制第一和第二操纵缆1634、1635。同样,通过摇杆1310操作开关1306、1308可以通过第四电动机1692控制第三和第四操纵缆1636、1637。可以理解,摇杆1310和开关1302、1304、1306、1308设置为使得开关1302、1304的操作可以控制柔性轴1620在南北方向的移动,而开关1306、1308的操作可以控制柔性轴1620在东西方向的移动。此处的东南西北是相对于坐标系而言的。可选择地,数字操纵杆、模拟操纵杆等可取代摇杆1310和开关1302、1304、1306、1308的设置。也可以采用电位计或者其他类型的启动器来代替开关1302、1304、1306、1308。
无线RCU1148还包括操纵接合/断开开关1312,其用来控制第五电动机696来选择性地接合和断开该操纵机构。无线RCU1148还包括两位摇杆1314,其包括可操作的第一开关1316和第二开关1318。操作这些开关1316、1318可以根据对应于连接器械的操作程序或者算法,来控制机电驱动器元件1610和其他连接到柔性轴1620的外科器械或者附件,例如外科器械11的某些功能。例如,操作两位摇杆1314可以控制外科器械11的第一夹钳50和第二夹钳80的打开或者闭合。无线RCU1148也设置有另外的开关1320,其可以根据对应于连接的器械的操作程序或者算法控制机电驱动器元件1610的以及连接到柔性轴1620的其他器械的运行。例如,操作开关1320可以启动外科器械11的楔603,使之前进。
无线RCU1148还包括控制器1322,其通过线缆1324电性地和逻辑性地连接到开关1302、1304、1306、1308上;通过线缆1326连接到开关1316、1318上;通过线缆1328连接到开关1312上;以及通过线缆1330连接到开关1320上。无线RCU1148还包括对应于前面板1615的指示器1618a、1618b的指示器1618a′、1618b′;以及对应于前板1615的显示装置1616的显示装置1616′。如果设置有上述指示器和显示装置,则指示器1618a′、1618b′分别通过线缆1332、1334电性地和逻辑性地连接到控制器1322,而显示装置1616′通过线缆1336电性地和逻辑性地连接到控制器1322上。控制器1322通过线1340电性地和逻辑性地连接到收发器1338,而收发器1338通过线缆1344电性地和逻辑性地连接到接收器/发射器1342。电源,例如电池可以设置在无线RCU1148中进行供电。因此,无线RCU1148用于通过无线链接1160控制机电驱动器元件1160和连接到柔性轴1620上的器械11的运行。
无线RCU1148也可以包括通过线缆1348连接到控制器1322的开关1346.操作开关1346可以将数据信号通过无线链接1160传输到发射器/接收器1146中.数据信号包括仅用于识别无线RCU1148的识别数据.控制器1122使用该识别数据来防止未授权人员操作该机电驱动器元件1610以及防止通过另外一个无线RCU干涉该机电驱动器元件1610.无线RCU1148和机电外科器械610之间的后续通信可包括识别数据.因此,控制器1122可以区别无线RCU,并且只允许一个可识别的无线RCU1148控制机电驱动器元件1610和连接到柔性轴1620的外科器械11的运行.
根据连接到柔性轴1620的外科器械的元件的位置,如根据编码器1106、1108的输出信号所确定的位置,控制器1122可以根据对应于连接的器械的操作程序或者算法选择性地启动或不启动机电驱动器元件1160的功能。例如,对于外科器械11而言,开关1320的操作而控制的启动功能可以丧失,除非在第一夹钳50和第二夹钳80之间的间隔或者距离确定在可接收的范围里。
参照图24,示意性地示出了有线RCU1150。在该实施例中,有线RCU1150基本包括与无线RCU1148相同的控制元件,因此将省略对这些元件的进一步描述。与上述相同的元件在图24中同样示出。可以理解,机电驱动器元件1610和连接到柔性轴1620上的器械,如外科器械11可以由有线RCU1150和/或无线RCU1148控制。在无线RCU1148中电池无法发挥作用时,可使用有线RCU1150来控制机电驱动器元件1610和连接到柔性轴1620上的外科器械11的功能。
如上所述,壳体1614的前面板1615包括显示装置1616和指示器1618a、1618b。显示装置1616可以包括α-数字显示装置,例如LCD显示装置。显示装置1616还可包括声音输出装置,例如,扬声器、蜂鸣器等。根据与连接到柔性轴1620的器械,如外科器械11相对应的操作程序或者算法可以由控制器1122操作和控制显示装置1616。如果没有连接外科器械或者附件,可以由控制器1122读取或者选择或者被传输缺省的操作程序或者算法,从而控制显示装置1616的运行以及机电驱动器元件1610的其他方面和功能。如果将外科器械11连接到柔性轴1620,显示装置1616将显示,例如根据编码器1106、1108的输出信号所确定的表示第一夹钳50和第二夹钳80之间的间隔的数据,如上详细所述。
与此相同,可以根据与连接到柔性轴1620的器械例如外科器械11相对应的操作程序或者算法,由控制器1122操作和控制指示器1618a、1618b。指示器1618a和/或1618b也可以包括声音输出装置,例如扬声器、蜂音器等和/或视觉显示装置,例如,LED、指示灯、光源等。如果外科器械11连接到柔性轴1620,则指示器1618a可以指示,例如机电驱动器元件1610处于电源“开”状态,以及指示器1618b还可指示,例如第一夹钳50和第二夹钳80之间的间隔是否在可接收的范围内。可以理解,尽管仅描述了两个指示器1618a、1618b,但是可以根据需要设置任何数量的附加指示器。此外,尽管只描述了一个显示装置1616,但是也可以根据需要设置任何数量的其他显示装置。
有线RCU1150的显示装置1616′和指示器1618a′、1618b′,以及无线RCU1148的显示装置1616″和指示器1618a″、1618b″可以通过各自的控制器1322、1322′,根据与连接到柔性轴1620的器械的操作程序和算法进行操作和控制。
如前所述,外科器械11可以用于夹紧、切割、以及缝合组织部分.该外科器械11的操作将结合去除病人肠道中的癌变或者异常组织进行说明,当然,外科器械11仅用于一种组织或者一种类型的外科手术.通常,在手术过程中,当胃肠道中存在癌变或者异常组织时,初始保持在如图3(a)中所示闭合位置的外科器械11例如通过套管(未示出)插入到病人腹部.优选地,外科器械11具有预装在第二夹钳80中的缝合件托架604.利用机电驱动器元件1610的远程启动,第一驱动器88接合,以驱动外科器械11的第一夹钳50相对于第二夹钳80进入打开位置.临近癌变组织的组织部分位于打开的第一夹钳50和第二夹钳80之间.再次通过远程启动,第一驱动器88反向接合,从而使第一夹钳50和第二夹钳80相对闭合,夹紧位于其间的组织.一旦充分夹紧组织部分,通过远程控制使得第二驱动器98接合,从而使楔603从缝合件托架604的远端604c移动到其近端604d,从而切割和缝合组织部分.根据本发明的一个实施例,第二驱动器98然后反向接合,使得楔603从缝合件托架604的近端604d缩回到远端604c.然后外科器械11从病人腹部移出来.一旦移动,第一驱动器88根据本发明的一些实施例重新接合,将驱动外科器械11的第一夹钳50相对于第二夹钳80处于打开位置,使可更换缝合件仓盒600从外科器械11的第二夹钳80去除,将新的可更换的缝合件仓盒600插入到第二夹钳80中,然后在癌变组织的其他侧重复上述步骤,因此,可以移除癌变组织部分,并将其两端缝合,以防止肠中的物质落入到腹中.但是需要注意的是,也可以是本发明的另外一种实施例,其中,外科器械11和/或机电驱动器元件1610可以只允许单独使用外科器械11,如上所述.
根据本发明的另一实施例,外科器械11连接到机电驱动器元件1610的第二联结器1626中,从而第一驱动座654与机电驱动器元件1610的第一驱动轴94相接合,第二驱动座694和机电驱动器元件1610的第二驱动轴102相接合。因此,通过通过机电驱动器元件1610的第一驱动轴94的旋转而旋转的第一驱动座654,可旋转第一驱动器88。可以根据第一电动机96来顺时针旋转或者逆时针旋转。同样通过机电驱动器元件1610的第二驱动轴102的旋转而旋转的第二驱动座694,可旋转第二驱动器98。同样可以根据电动机100来顺时针旋转或者逆时针旋转。
一旦外科器械11插入到病人的身体中,与第一驱动轴94相对应的第一电动机96启动,其在夹紧轴组件650的近端与第一驱动座654相接合,从而使得夹紧轴组件650在第一方向,如顺时针方向旋转.由于夹紧轴组件650的正齿轮653的正齿轮轮齿6531与齿轮组640的正齿轮644的正齿轮轮齿6441相啮合,因此,夹紧轴组件650的旋转可使得齿轮组640在第一方向,如逆时方向旋转,其与夹紧轴组件650的旋转方向相反.同样,由于齿轮组640的正齿轮643的正齿轮轮齿6431与齿轮组630的正齿轮629的正齿轮轮齿6291相啮合,因此,齿轮组640的旋转使得齿轮组630在第一方向,如顺时方向旋转,其与夹紧轴组件650的旋转方向相反.同时,由于齿轮组630的正齿轮633的正齿轮轮齿6331与齿轮组625的正齿轮627的正齿轮轮齿6271啮合,并且由于齿轮组630的正齿轮634的正齿轮轮齿6341与齿轮组625的正齿轮628的正齿轮轮齿6281啮合,齿轮组630的旋转使得齿轮组625在第一方向,如逆时针方向旋转,其与夹紧轴组件650的旋转方向相反.齿轮组625的旋转使得锥齿轮621(如齿轮组625一样,也安装到锥齿轮驱动器620上)在第一方向旋转,如,逆时针方向旋转,其与齿轮组625的旋转方向相同.因为斜齿轮621的斜齿轮轮齿621a与斜齿轮螺母617的斜齿轮轮齿617b啮合,因此斜齿轮621的旋转使得斜齿轮螺母617在斜齿轮轴承622中旋转,例如在第一顺时针方向旋转(从上面看).斜齿轮螺母617的内螺纹孔617a的螺纹与外螺纹螺杆90的螺纹相啮合,这样斜齿轮螺母617的旋转将导致外螺纹螺杆并不围绕其轴线旋转,而是向下移动,例如,使得外螺纹螺杆90上端90b的止动元件90c远离第二夹钳80的表面8010.由于外螺纹螺杆90在其下端90a通过销92连接到第一夹钳50上,因此第一夹钳50将与第二夹钳80分离.以这种方式连续操作第一电动机96,使得外科器械11处于完全打开的状态,例如,外螺纹螺杆90相对于第二夹钳80处于完全伸出的位置,因此通过弹簧705使得止动元件707的第二端707b偏置,以与圆柱形壳体708接触.在该完全打开的位置,如图3(a)所示,第一夹钳50和第二夹钳80之间形成一个空间.
然后一部分组织被夹在第一夹钳50与第二夹钳80之间。之后,第一电动机96反向操作,使得第一驱动轴94与第一驱动座654相接合使得夹紧轴组件650在第二方向,例如,逆时针方向旋转。夹紧轴组件650的旋转使得齿轮组640在第二方向,例如,顺时针方向旋转,顺次使得齿轮组630在第二方向,例如,顺时针方向旋转。齿轮组630的这种旋转使得齿轮组625在第二方向,例如顺时针方向旋转,顺次使得锥齿轮621在第二方向,例如顺时针方向旋转。锥齿轮621的旋转使得追齿轮螺母617在锥齿轮轴承622中旋转,在第二方向。例如,逆时针方向(从上方看时)旋转,这样使得外螺纹螺杆90向上移动并且使得第一夹钳50向第二夹钳80移动。当外螺纹螺杆90慢慢缩回到完全回缩位置时,例如,外螺纹螺杆90的止动元件90c的点接触到第二夹钳80的上表面,外科器械11首先慢慢地被移动到如图3(b)所示的部分闭合位置,然后移动到如图3(c)所示的部分闭合位置,最后移动到如图3(d)所示的完全闭合位置。这样,以这种方式连续操作第一电动机96最终使得该外科器械11处于如图3(d)所示的完全闭合位置。
接下来,操作者确定开始安切割合缝合手术是安全的和/或适合的.为了开始缝合和切割手术,需要启动对应于第二驱动轴102的机电驱动器元件1610的第二电动机100,其在启动轴组件690的近端的第二驱动座694相接合,因此使得启动轴组件690在第一方向,例如,顺时针旋转.因为启动轴组件690的正齿轮691的正齿轮轮齿6911与侧轴组件680的正齿轮681的正齿轮轮齿6811啮合,从而使得启动轴组件690的旋转使得侧轴组件680在与启动轴组件690的旋转方向相反的方向旋转,例如,逆时针旋转方向.由于侧轴组件680的凹的六角形联结器682不可旋转地链接到链接到侧轴组件670的凸的六角形联结器671,因此侧轴组件680在该方向,例如,逆时针方向旋转时,将使得侧轴组件670也随着侧轴组件680的旋转在相同的方向,例如,逆时针方向旋转.由于侧轴组件670的正齿轮672的正齿轮轮齿6721与梭式空套齿轮660的正齿轮662的正齿轮轮齿6621啮合,因此侧轴组件670的旋转使得梭式空套齿轮660在与侧轴组件670相反的方向旋转,例如,逆时针方向.而且,由于梭式空套齿轮660的正齿轮662的正齿轮轮齿6621在可更换的缝合件仓盒600的楔驱动器605的近端位置与正齿轮605d的正齿轮轮齿6051啮合,梭式空套齿轮660的旋转使得楔驱动器605在与梭式空套齿轮660相反的方向旋转,例如,逆时针方向.优选地,如该实施例所述,当可更换的缝合件仓盒600一开始就被插入到外科器械11的第二夹钳80中时,楔603和与其相连的刀片51位于缝合件托架604的远端604c位置.由于楔603的内螺纹孔603c的内螺纹与楔驱动器605的外螺纹相啮合,因此楔驱动器605的旋转使得楔603经过缝合件托架604的中央孔604e从缝合件托架604的远端604c朝向近端604d移动.以该方式连续操作第二电动机100,将使得楔603完全通过中央孔604e.如前参照图6(b)所述,刀片51一开始的位置使得刀刃51a位于缩回位置.当楔603通过中央孔604e接近时,刀片51的接触面653与壳体615的启动凸缘615a接触,使得刀片51相对于楔603旋转.最终,刀片51相对于楔603旋转使得刀片51的刀刃51a位于伸出位置.例如,刀刃51a面向缝合件托架604的近端604d.刀片51保持在这个位置直到楔603已经移动到缝合件托架604的近端604d的位置,刀刃51a已经切割了部分组织.当楔603朝向着缝合件托架604的近端604b移动时,楔603的斜边603b被推动到各自的缝合件推动器607的顶面607a上,这样使得缝合件推动器607的缝合件推动销607c将缝合件606推出槽604h外,该缝合件最初位于各缝合件托架604的槽604h中.缝合件606的叉脚606b被推动通过被夹持的组织并且靠近砧座元件700的缝合件导向件703,其弯曲并闭合缝合件606来缝合组织部分.当楔603几乎完全通过缝合件托架604的中央孔604e时,所有的缝合件606都被推动经过缝合件托架604,并且这样闭合.
完成切割和缝合组织部分之后,外科器械11再一次通过套管从病人体中移出。根据本发明的具体实施例,楔603和刀片51可以回到其初始的位于缝合件托架604的远端604c的位置。可选择地,也可不首先将楔603和刀片51缩回而将缝合件仓盒600从第二夹钳80移出,这样可在第二夹钳上放置新的缝合件仓盒600,或者外科器械11可与柔性驱动轴1620分离,以更换新的外科器械11,如前所述。在前述实施例中,例如,楔603和刀片51缩回到缝合件托架604的远端604c的初始位置,机电驱动器单元1610的第二电动机100反向接合,使得第二驱动轴102通过第二驱动座694使得启动轴组件690在第二方向旋转,例如,逆时针方向。启动轴组件690的旋转使得侧轴组件680在第二方向旋转,例如,顺时针方向,顺次使得侧轴组件670在相同的方向,如顺时针方向旋转。该侧轴组件670的旋转使得梭式空套齿轮660在第二方向旋转,例如,逆时针方向,顺次使得楔驱动器605在第二方向旋转,例如,顺时针方向。楔驱动器605的旋转使得楔603通过缝合件托架604的中央孔604e从缝合件托架604的近端604d朝向远端604c移动。以这种方式连续操作第二电动机100将楔603完全通过缝合件托架604的中央孔604e并且返回到缝合件托架604的远端604c。
当外科器械11从病人体内移出时,根据本发明的具体实施例,第一驱动器88可以再次接合以驱动与第二夹钳80相对的外科器械的第一夹钳50,使其进入打开位置,从而使得用过的缝合件仓盒600从外科器械11的第二夹钳80上去除,并且新的可更换的缝合件仓盒600插入到第二夹钳80中。这些步骤,例如,将外科器械11插入到病人体内,打开第一和第二夹钳,将第一和第二夹钳夹住部分组织,切割和缝合部分组织,将楔和刀片返回到其初始位置并且从病人体内移出外科器械,被重复在癌变组织其他侧面执行,因而切除癌变组织,并将该组织两端缝合来防止肠道中的物质溅出到腹腔中。
如上所述的外科器械的重新加载能力,允许操作者在操作外科器械11时可执行有用的步骤。例如,一旦外科器械11最初置于打开位置时,缝合件仓盒600可以让操作者接近并且被检查以确定缝合件606是否已经准备好进行操作和/或是否需要用更加适合的缝合件仓盒600来替换该缝合件仓盒600。类似地,一旦夹紧、切割、以及缝合操作已经执行并且缝合件606已经被使用,则缝合件仓盒600可以再次被操作者接近来用另一个新的缝合件仓盒600来替换该缝合件仓盒600,或者将另一组缝合件606插入到旧的缝合件仓盒600中。方便地,当上夹钳80和下夹钳50位于打开位置时,可替换缝合件仓盒600可拆卸,这样可以防止缝合件仓盒600在上夹钳80和下夹钳50夹持到要切割和缝合的组织时不经意地移动。
根据本发明的一个可选择的实施例,外科器械11是不可重新加载的,例如,缝合件仓盒600不可由操作者从第二夹钳80中拆卸.这样,一旦启动外科器械11以使用缝合件仓盒600中的缝合件606来缝合组织部分之后,外科器械11不能够被再次启动来使用新的缝合件606或新的缝合件仓盒600来缝合其他的组织部分.通过将外科器械11设置为不可重新加载的,由于外科器械11不可有意地或无意地用于两个不同的病人,也不可在同一病人身上重复使用,因而可降低该外科器械被污染和感染的危险.一旦第一外科器械11已经被使用,则该第一外科器械11可从机电驱动器单元1610上分离,并且由第二外科器械11来取代,从而在不同的组织部分执行相同的夹紧、切割、和缝合步骤,例如,在异常或者癌变组织的不同侧面上进行.一旦肠部的第二端也被夹紧、切割、以及缝合,第二外科器械11可以从机电驱动元件1610上分离,并且操作着可以丢弃该器械.在一个可选择的实施例中,缝合件仓盒600被设置为,当缝合件仓盒600中的第一套缝合件606被使用后,操作者可以在同一个缝合件仓盒600中更换缝合件606,并且再次使用相同的缝合件仓盒600.
根据本发明的另一个实施例,外科器械11可以提供有限的可加载性,例如,外科器械11可以被设置为仅允许缝合件仓盒600被替换一次,这样使得夹紧、切割、和缝合操作可在一个病人身上执行两次,例如,在癌变组织的相对两侧执行,但是不允许缝合件仓盒600被更换超过两次。根据本发明的另一个实施例,外科器械11可以被设置为,在缝合件仓盒600中具有两套缝合件606,第一套用在癌变组织的一个侧面上,而第二套用在癌变组织的另一个侧面上。可以理解,外科器械11可以被设置为可使用任意预设次数,其取决于使用数据1184。
根据本发明的另一个可选择的实施例,外科器械11可以被设置具有多个操作范围。这一特性使得具有不同厚度的组织部分能与外科器械11恰当地配合。例如,根据本发明的一个实施例,当外科器械11处于闭合位置时,外科器械11可以被设置为来改变第一夹钳50和第二夹钳80之间的间距,或者改变楔603在第二夹钳80中移动以使得楔603完全达到伸出位置的距离。根据一个实施例,外科器械11可以被重新加载以使用两种或者多种不同尺寸的缝合件仓盒,例如,缝合件仓盒可具有不同的厚度,或容置具有具有不同长度的缝合件606。在该实施例中,操作者可以选择使用设置在其内的两种或者多种不同缝合件仓盒600中的一个。相应地,存储模块6401可包括可由控制器1122读取的数据,因而控制器1122可以识别特定尺寸的缝合件仓盒600。然后在操作过程中控制器1122可以改变第一驱动轴94的旋转次数,从而当外科器械11移动到与要切割合缝合的组织厚度相对应的闭合位置时,第一夹钳50与第二夹钳80之间的距离相应变化。类似地,控制器1122可以改变运行时第二驱动轴102的旋转次数,因而当移动到对应于要切割和缝合的组织厚度的伸出位置时,从而楔603和刀片51的位置可以改变。根据另一个实施例,不同尺寸的不可加载的外科器械11可以被使用,其中不可加载的外科器械11的不同尺寸对应于要切割合缝合的组织厚度。在该实施例中,外科器械11的存储模块6401可以包括由控制器122可读取的数据,以使得控制器1122可以根据与要切割和缝合的组织厚度识别外科器械11。在本发明的另一个实施例中,控制器1122可设置为可提供多个操作范围,使得操作者可根据要切割和缝合的组织厚度来选择设定。例如,根据一个实施例,为了夹紧两个夹钳之间的组织部分,控制器1122可以启动第一驱动轴94,以在第一位置使得与第二夹钳80相对的第一夹钳50闭合。操作者可以选择是否启动第二驱动轴102来切割和缝合组织,或者是否再次启动第一驱动轴94在第一位置使得与第二夹钳80相对的第一夹钳50闭合。该实施例具有在要切割和缝合的组织露出以及其厚度确定之前,不需预先选择外科器械11的特定尺寸、或不需预先选择外科器械11的可更换仓盒的优点。这样可以防止操作者预先选择错误的尺寸,或者需要准备多个备用尺寸清单。
如前所述,通常的切割和缝合器械的问题在于,在操作该器械的过程中,该器械的相对夹钳不能充分地放置夹持在其间的组织部分从夹钳的末端之间漏掉。这主要是因为如图1所示的普通夹紧、切割、和缝合器械的剪刀形的夹持元件相对彼此围绕着夹持元件的近端的枢轴点旋转。这样,由于夹持元件之间的距离通常在夹持元件的近端小于夹持元件的远端处,因此放置在夹持元件之间的组织部分上的夹紧力在靠近夹持元件的近端处最大,然后向着夹持元件的远端方向逐渐减小。夹持元件的近端处的相对高的夹紧力和夹持元件的远端处的相对低的夹紧力使得组织部分被向前推动,并且最终从夹持元件的远端之间离开。这样,组织部分不能被充分地被切割和缝合,并且不能充分地切割和缝合组织末端,因而可能使得其部分组织溅出到病人腹腔中,增加感染和其他并发症的可能性。
相反地,如前面参照图3(a)至3(d)所述,根据本发明各实施例的外科器械11设置有偏压元件,该偏压元件在外科器械11的操作过程中,将第一夹钳50的远端50a和第二夹钳80的远端80a朝向彼此偏压。特别地,根据本发明的实施例,外科器械11在该外壳器械11的近端设置有弹簧82,该弹簧在操作外科器械11时,将第一夹钳50的远端50a和第二夹钳80的远端80a朝向彼此偏压。这样,第一夹钳50的远端50a和第二夹钳80的远端80a之间的夹紧力比通常的夹紧、切割、和缝合器械的夹钳远端的夹紧力更大。第一夹钳的远端50a和第二夹钳80的远端80a之间的夹紧力的增大可以防止位于第一夹钳50和第二夹钳80之间的组织部分从第一夹钳50的远端50a和第二夹钳80的远端80a之间漏掉。
以上所述仅为本发明的优选实施例而已,并不用于限制本发明,对于本领域的技术人员来说,本发明可以有各种更改和变化。凡在本发明的精神和原则之内,所作的任何修改、等同替换、改进等,均应包含在本发明的保护范围之内。

Claims (48)

1.一种外科器械,包括:
包括远端和近端的第一夹钳;
包括远端和近端的第二夹钳,其中所述第二夹钳相对于所述第一夹钳设置,以及所述第一夹钳枢轴连接到所述第二夹钳;
偏置元件,其将所述第一夹钳的近端远离所述第二夹钳的近端偏置,所述偏置元件设置在所述第一夹钳和所述第二夹钳之间;以及
设置于所述第二夹钳上并连接到所述第一夹钳的第一驱动器,所述第一驱动器设置为:当启动所述第一驱动器来打开所述夹钳时,所述第一驱动器将使得所述第一夹钳和所述第二夹钳分开;当启动所述第一驱动器来闭合所述夹钳时,所述第一驱动器将使得所述第一夹钳和所述第二夹钳闭合,
其中,当启动所述第一驱动器来闭合所述夹钳时,在所述第一驱动器完全闭合所述夹钳之前,所述偏置元件使得所述第一夹钳的远端接触所述第二夹钳的远端。
2.根据权利要求1所述的器械,其中,所述偏置元件是弹簧。
3.根据权利要求1所述的器械,其中,作为偏置元件的弹簧设置在所述第一夹钳的近端和所述第二夹钳的近端之间。
4.根据权利要求1所述的器械,还包括止动元件,其通过所述偏置元件限制了所述第一夹钳的近端与所述第二夹钳的近端之间的分开距离。
5.根据权利要求4所述的器械,其中,所述第一夹钳可相对于所述第二夹钳围绕所述止动元件枢轴转动。
6.根据权利要求5所述的器械,其中,当闭合所述夹钳时,所述第一夹钳起初相对于所述第二夹钳围绕所述止动元件枢轴转动,最后相对于所述第二夹钳围绕除所述止动元件之外的点枢轴转动。
7.根据权利要求6所述的器械,其中,所述第一夹钳最后相对于所述第二夹钳枢轴转动时所围绕的除所述止动元件之外的所述点是所述第一夹钳的远端和所述第二夹钳的远端相接触的点。
8.根据权利要求6所述的器械,其中,所述第一夹钳最后相对于所述第二夹钳枢轴转动时所围绕的除所述止动元件之外的所述点是夹持于所述第一夹钳和所述第二夹钳之间的组织部分。
9.根据权利要求1所述的器械,其中,所述第一夹钳的近端枢轴连接到所述第二夹钳的近端,并且当闭合所述夹钳时,所述第一夹钳起初围绕所述第二夹钳的近端枢轴转动,最后相对于所述第二夹钳在所述第一夹钳的远端和近端之间的位置枢轴转动。
10.根据权利要求1或9所述的器械,其中,所述第一驱动器包括外螺纹杆,所述第一夹钳与所述第二夹钳在各自的远端和近端之间通过所述外螺纹杆连接,所述第一驱动器使所述外螺纹杆能够相对所述第二夹钳而伸出或者缩回,从而相对于所述第二夹钳打开或者闭合所述第一夹钳。
11.根据权利要求10所述的器械,其中,所述外螺纹杆连接到一对可旋转锥齿轮的第一个锥齿轮上,所述一对可旋转锥齿轮的第二个锥齿轮连接到多个正齿轮中的一个上,所述多个正齿轮依次设置并相互啮合,所述第一锥齿轮的旋转使得所述第一和第二夹钳相互运动。
12.根据权利要求11所述的器械,其中,所述第一驱动器包括连接到多个正齿轮中的一个上的第一驱动座,其中,所述第一驱动座在第一方向旋转以打开所述夹钳,以及在与所述第一方向相反的第二方向旋转来闭合所述夹钳。
13.根据权利要求12所述的器械,其中,所述第一驱动座用于连接机电驱动器的第一旋转驱动轴,所述机电驱动器用于旋转所述第一旋转驱动轴。
14.根据权利要求1或9所述的器械,还包括:
设置于所述第二夹钳中的切割元件;以及
第二驱动器,用于从所述第二夹钳的远端朝向其近端移动所述切割元件,以切割夹持于所述第一和第二夹钳之间的组织部分。
15.根据权利要求1或9所述的器械,还包括:
设置于所述第二夹钳中的缝合元件;以及
第二驱动器,用于从所述第二夹钳的远端朝向其近端移动所述缝合元件,以缝合夹持于所述第一和第二夹钳之间的组织部分。
16.根据权利要求1或9所述的器械,还包括:
设置于所述第二夹钳中的切割和缝合元件;以及
第二驱动器,用于从所述第二夹钳的远端朝向其近端移动所述切割和缝合元件,以切割和缝合夹持于所述第一和第二夹钳之间的组织部分。
17.根据权利要求16所述的器械,其中所述切割和缝合元件包括上面设置有刀片的楔。
18.根据权利要求17所述的器械,其中,所述刀片安装在所述楔上,从而当所述切割和缝合元件移近时,所述刀片从第一位置移动到第二位置。
19.根据权利要求17所述的器械,其中,所述刀片可旋转地安装到所述楔上,从而当所述楔和所述刀片移近时,所述刀片从所述刀片的刀刃未露出的第一位置移动到所述刀片的刀刃露出的第二位置。
20.根据权利要求1所述的器械,还包括:
第二驱动器,用于从所述第二夹钳的远端朝向其近端移动切割元件和缝合元件中的至少一个,以对夹持于所述第一和第二夹钳之间的组织部分进行切割和缝合中的至少之一;以及机电驱动器,包括用于驱动所述第一驱动器的第一旋转驱动轴,和用于驱动所述第二驱动器的第二旋转驱动轴。
21.根据权利要求20所述的器械,其中,所述机电驱动器包括至少一个电动机装置,用于驱动所述第一和第二旋转驱动轴。
22.根据权利要求20所述的器械,其中,所述机电驱动器包括用于驱动第一旋转驱动轴的第一电动机装置,和用于驱动第二旋转驱动轴的第二电动机装置。
23.根据权利要求1所述的器械,还包括:
第二驱动器,用于从所述第二夹钳的远端朝向其近端移动切割元件和缝合元件中的至少一个,以对夹持于所述第一和第二夹钳之间的组织部分进行切割和缝合中的至少之一;以及
机电驱动器,用于驱动所述第一驱动器和所述第二驱动器。
24.根据权利要求23所述的器械,其中,所述机电驱动器用于独立地驱动所述第一驱动器和所述第二驱动器.
25.根据权利要求1所述的器械,其中,所述第一夹钳是弯曲的,从而使得所述第一夹钳的远端朝向所述第二夹钳的远端弯曲。
26.一种机电外科装置,包括:
细长轴;
设置于所述细长轴上的轴向旋转的第一驱动轴;
可拆卸地连接到所述细长轴远端上的外科器械,所述外科器械包括:
包括近端和远端的第一夹钳;
包括近端和远端的第二夹钳,其中所述第二夹钳相对于所述第一夹钳设置,以及所述第一夹钳枢轴连接到所述第二夹钳;
偏置元件,其将所述第一夹钳的近端远离所述第二夹钳的近端偏置,其中所述偏置元件被定位在所述第一夹钳的近端与所述第二夹钳的近端之间并连接到所述第一夹钳的近端与所述第二夹钳的近端;以及
设置于所述第二夹钳上并连接到所述第一夹钳的第一驱动器,所述第一驱动器设置为:当启动所述第一驱动器来打开所述夹钳时,所述第一驱动器将使得所述第一夹钳和所述第二夹钳分开;当启动所述第一驱动器来闭合所述夹钳时,所述第一驱动器将使得所述第一夹钳和所述第二夹钳闭合,
其中,当启动所述第一驱动器来闭合所述夹钳时,在所述第一驱动器完全闭合所述夹钳之前,所述偏置元件使得所述第一夹钳的远端接触所述第二夹钳的远端,
以及用于驱动所述第一驱动轴的电动机装置。
27.根据权利要求26所述的机电外科装置,其中,所述外科器械还包括止动元件,其通过所述偏置元件限制了所述第一夹钳的近端与所述第二夹钳的近端之间的分开距离。
28.根据权利要求27所述的机电外科装置,其中,所述第一夹钳可相对于所述第二夹钳围绕所述止动元件枢轴转动。
29.根据权利要求28所述的机电外科装置,其中,当闭合所述夹钳时,所述第一夹钳起初相对于所述第二夹钳围绕所述止动元件枢轴转动,最后相对于所述第二夹钳围绕除所述止动元件之外的点枢轴转动。
30.根据权利要求29所述的机电外科装置,其中,所述第一夹钳最后相对于所述第二夹钳枢轴转动时所围绕的除所述止动元件之外的所述点是所述第一夹钳的远端和所述第二夹钳的远端相接触的点。
31.根据权利要求29所述的机电外科装置,其中,所述第一夹钳最后相对于所述第二夹钳枢轴转动时所围绕的除所述止动元件之外的所述点是夹持于所述第一夹钳和所述第二夹钳之间的组织部分。
32.根据权利要求26所述的机电外科装置,其中,所述第一夹钳的近端枢轴连接到所述第二夹钳的近端,并且当闭合所述夹钳时,所述第一夹钳起初围绕所述第二夹钳的近端枢轴转动,最后相对于所述第二夹钳在所述第一夹钳的远端和近端之间的位置枢轴转动。
33.根据权利要求26所述的机电外科装置,其中,所述第一驱动器包括外螺纹杆,所述第一夹钳与所述第二夹钳在各自的远端和近端之间通过所述外螺纹杆连接,所述第一驱动器使所述外螺纹杆能够相对所述第二夹钳而伸出或者缩回,从而相对于所述第二夹钳打开或者闭合所述第一夹钳.
34.根据权利要求26所述的机电外科装置,其中,所述外科器械还包括:
设置于所述第二夹钳中的切割元件;以及
第二驱动器,用于从所述第二夹钳的远端朝向其近端移动所述切割元件,以切割夹持于所述第一和第二夹钳之间的组织部分。
35.根据权利要求26所述的机电外科装置,其中,所述外科器械还包括:
设置于所述第二夹钳中的缝合元件;以及
第二驱动器,用于从所述第二夹钳的远端朝向其近端移动所述缝合元件,以缝合夹持于所述第一和第二夹钳之间的组织部分。
36.根据权利要求26所述的机电外科装置,其中,所述外科器械还包括:
设置于所述第二夹钳中的切割和缝合元件;以及
第二驱动器,用于从所述第二夹钳的远端朝向其近端移动所述切割和缝合元件,以切割和缝合夹持于所述第一和第二夹钳之间的组织部分。
37.根据权利要求26所述的机电外科装置,还包括壳体,其中所述细长轴的近端从所述壳体中伸出。
38.根据权利要求37所述的机电外科装置,还包括用于控制所述电动机装置的控制装置。
39.根据权利要求38所述的机电外科装置,其中所述控制装置设置于壳体中。
40.根据权利要求39所述的机电外科装置,还包括用于与所述控制装置通信的远程控制单元,以通过所述控制装置控制所述电动机装置。
41.根据权利要求40所述的机电外科装置,其中,所述远程控制单元包括有线远程控制单元和无线远程控制单元中的至少之一。
42.根据权利要求38所述的机电外科装置,还包括对应于所述第一驱动轴的传感器,所述传感器根据并对应于所述第一驱动轴的转速而输出信号。
43.根据权利要求42所述的机电外科装置,其中,所述控制装置用于根据所述传感器的输出信号确定所述第一驱动轴的旋转位置和旋转方向中的至少之一。
44.根据权利要求38所述的机电外科装置,其中,所述控制装置包括第一存储单元。
45.根据权利要求44所述的机电外科装置,其中,所述第一存储单元用于存储多个操作程序,至少一个所述操作程序与连接到所述细长轴远端的外科器械相对应。
46.根据权利要求45所述的机电外科装置,其中,所述控制装置用于识别连接到所述细长轴远端的外科器械为切割和缝合元件,其中所述切割和缝合元件是连接到所述细长轴远端上的多种类型的外科器械中的一种,所述控制装置用于从所述第一存储单元中至少读取和选择对应于所述切割和缝合元件的操作程序。
47.根据权利要求46所述的机电外科装置,其中,根据从设置到所述外科器械中的第二储存单元中读取的数据,所述控制装置用于识别所述外科器械为连接到所述细长轴上的外科器械的类型。
48.根据权利要求47所述的机电外科装置,还包括设置于所述细长轴上的数据缆,所述数据缆电性地和逻辑性地连接到所述控制装置,并且被电性地和逻辑性地连接到所述第二存储单元。
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US8056786B2 (en) 2011-11-15
AU2003239988A1 (en) 2003-12-31
EP1515651A2 (en) 2005-03-23
EP1515651B1 (en) 2006-12-06
AU2003239988A8 (en) 2003-12-31
US8540733B2 (en) 2013-09-24
CN101803938A (zh) 2010-08-18
PT1515651E (pt) 2007-03-30
CN101803938B (zh) 2012-06-20

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