CN1879566A - 内窥镜缝合装置 - Google Patents

内窥镜缝合装置 Download PDF

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CN1879566A
CN1879566A CNA2006100879866A CN200610087986A CN1879566A CN 1879566 A CN1879566 A CN 1879566A CN A2006100879866 A CNA2006100879866 A CN A2006100879866A CN 200610087986 A CN200610087986 A CN 200610087986A CN 1879566 A CN1879566 A CN 1879566A
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pin
wobble
endoscopic instrument
stitching
endoscope
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CN1879566B (zh
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迈克尔·J·斯托克斯
马克·S·奥尔蒂斯
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Ethicon Endo Surgery Inc
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Abstract

一种用于连续应用缝合线的内窥镜器械，其包括一个缝合主体，该缝合主体的形状和尺寸设置为适于以可以使其致动的方式连接到可从市场上购买的内窥镜的远端。所述缝合主体包括缝合外壳，在该外壳中容纳有针和驱动组件，用于使针围绕连续的环形路径运动，以利于与针的远端连接的缝合线的应用。所述驱动组件包括一个在驱动索和销的控制下沿着缝合外壳运动的摇摆件，其中所述驱动索和销的致动引起摇摆件选择性地与针接合及脱离接合，从而导致针以连续的方式围绕环形路径运动。

Description

内窥镜缝合装置
技术领域
本发明涉及腹腔镜手术装置。尤其是，本发明涉及一种用于连续缝合应用的内窥镜缝合装置。
背景技术
在过去十年间，内窥镜手术已得到了迅速发展。与需要较大外部开口以暴露出需要修复的内部器官或组织的现有技术相比，这些手术通常可以在最小创伤的条件下进行外科手术。
除了已知的内窥镜手术的许多应用领域以外，内窥镜手术还被发展为用于病理性肥胖的外科手术。病理性肥胖是一种严重的医学状态。事实上，病理性肥胖在美国以及其他国家已经变得非常普遍，并且看上去这种趋势正在向着消极方向发展。与病理性肥胖有关的并发症包括使期望寿命显著缩短的高血压、糖尿病、冠状动脉疾病、中风、充血性心力衰竭、多种整形外科问题以及肺动脉瓣闭锁不全。考虑到这一点，本领域技术人员必然能理解，与病理性肥胖有关的资金和物质成本是巨大的。事实上，据估计，仅在美国涉及肥胖的花费超过1000亿美元。
已经发展了多种外科手术来治疗肥胖。一种手术是鲁氏Y形(Roux-en-Y)胃旁路术(RYGB)。这种手术高度复杂，并且一般用于治疗病理性肥胖的人。仅在美国一个国家，每年进行大约35000例手术。其它形式的肥胖治疗外科手术包括Fobi袋(Fobi pouch)、胆胰转流术(bilio-pancreatic diversion)以及胃成形术或者“胃间隔手术”。此外，已知可植入装置，其限制食物通过胃部的通道并影响饱胀感。
RYGB涉及使用Roux-en-Y环将空肠移动到较高位置。采用自动吻合装置将胃完全分成两个不相等的部分(一个较小的上部和一个较大的下部胃袋)。通常测得上部袋不到大约1盎司(或者20cc)，而较大的下部胃袋通常保持完整并继续分泌流经肠道的胃液。
然后将一段小肠从下腹部引来并将其与上部袋连接，以形成通过半英寸的开口(也称为人造口)建立的吻合。这段小肠被称为“鲁氏环(Roux环)”，它将食物从上部袋运送到小肠的剩余部分，在那里消化食物。然后将剩余的下部袋以及相连的十二指肠部分重新连接，通常使用钉合器械形成在距离该人造口大约50到150厘米位置处的与Roux环的另一个吻合连接。正是在该连接处来自旁路的胃、胰腺以及肝脏的消化液进入空肠和回肠，辅助食物消化。由于上部袋的尺寸较小，患者被迫以较慢的速率饮食，并更快地感到饱胀。这导致热量摄入的减少。
本领域技术人员当然能够理解，传统的RYGB手术需要大量的手术时间。由于侵入的程度，术后康复时间可能相当长而且非常痛苦。考虑到目前的RYGB手术固有的高度侵入性，已发展了一些其它侵入较小的手术。考虑到这一点，已经发展了一些其它缩小胃部尺寸的手术。最常见的胃缩小手术形式涉及沿着胃应用垂直的钉来形成一个合适的袋。手术通常通过腹腔镜来进行，并同样需要大量的术前、术中和术后资源。
随着内窥镜装置和手术的发展，医生已经开始将内窥镜技术用于胃部手术(例如上面所讨论的那些)，试图将损伤降到最小并缩短手术和康复所需的时间。考虑到前述情况，需要以省时和对患者友好的方式来进行胃部缩小外科手术的手术和器械。
一个没有充分开拓的领域是当进行这些胃以及其它内窥镜手术时对缝合应用的需要。本发明提供了一种适于连续应用缝合线的内窥缝合装置。
发明内容
因此，本发明的一个目的在于提供一种用于连续应用缝合线的内窥镜器械。该器械包括一个缝合主体，其形状和尺寸设置为以可以使其致动的方式连接到可从市场上购买的内窥镜的远端。所述缝合主体包括缝合外壳，在该外壳中容纳有针和驱动组件，用于使针围绕连续的环形路径运动，以便于与针的远端连接的缝合线的应用。该驱动组件包括一个在驱动索和销的控制下沿着缝合外壳运动的摇摆件，其中所述驱动索和销的致动导致摇摆件选择性地与针接合及脱离接合，从而导致针以连续的方式围绕环形路径运动。
本发明还有一个目的是提供一种用于连续应用缝合线的内窥镜。所述内窥镜包括一个内窥镜主体。所述内窥镜还包括一个缝合主体，其形状和尺寸设置为以可以使其致动的方式与所述内窥镜主体的远端连接。所述缝合主体包括缝合外壳，在该外壳中容纳有针和驱动组件，用于使针围绕连续的环形路径运动，以利于与针的远端连接的缝合线的应用。该驱动组件包括一个在驱动索和销的控制下沿着缝合外壳运动的摇摆件，其中所述驱动索和销的致动导致摇摆件选择性地与针接合及脱离接合，从而导致针以连续的方式围绕环形路径运动。
本发明的另一目的在于提供一种用于连续应用缝合线的内窥镜器械。该器械包括一个缝合主体，其形状和尺寸设置为以可以使其致动的方式连接到可从市场上购买的内窥镜的远端。所述缝合主体包括缝合外壳，在该外壳中容纳有针和驱动组件，用于使针围绕连续的环形路径运动，以利于与针的远端连接的缝合线的应用。该驱动组件可施加轴向运动，以导致针围绕连续的环形路径运动。
(1)本发明涉及一种用于连续应用缝合线的内窥镜器械，其包括：
一个缝合主体，其形状和尺寸设置为适于以可以使其致动的方式连接到可从市场上购买的内窥镜的远端；
所述缝合主体包括缝合外壳，在该缝合外壳中容纳有针和驱动组件，用于使针围绕连续的环形路径运动，从而便于与针的远端连接的缝合线的应用；
所述驱动组件包括一个在驱动索和销的控制下沿着缝合外壳运动的摇摆件，其中所述驱动索和销的致动导致摇摆件选择性地与针接合及脱离接合，从而导致针以连续的方式围绕环形路径运动。
(2)按照第(1)项所述的内窥镜器械，其中，一个真空外壳包围所述缝合主体，所述真空外壳的形状和尺寸设置为可与所述内窥镜的真空管线联接。
(3)按照第(1)项所述的内窥镜器械，其中，所述针为弓形的。
(4)按照第(1)项所述的内窥镜器械，其中，所述针包括内表面、外表面以及沿着所述针的外表面形成的凹口，并且所述摇摆件包括凹口，该凹口的形状和尺寸设置为在摇摆件致动过程中与沿着所述针的外表面的凹口接合。
(5)按照第(1)项所述的内窥镜器械，其中，所述摇摆件包括接合构件和凸轮构件，所述凸轮构件与所述销协作来控制所述接合构件的位置，以选择性地与所述针接合。
(6)按照第(5)项所述的内窥镜器械，其中，所述凸轮构件包括一个狭槽，所述销在该狭槽中运动，以使接合构件运动成与所述针接合及脱离接合。
(7)按照第(5)项所述的内窥镜器械，其中，所述摇摆件还包括一个摩擦板，其用于辅助控制所述接合构件的定位。
(8)按照第(5)项所述的内窥镜器械，其中，所述接合构件是弓形的，以与针的形状基本上一致。
(9)本发明还涉及一种用于连续应用缝合线的内窥镜，其包括：
一个内窥镜主体；
一个缝合主体，其形状和尺寸设置为适于以可以使其致动的方式连接到所述内窥镜主体的远端；
所述缝合主体包括缝合外壳，在该缝合外壳中容纳有针和驱动组件，用于使针围绕连续的环形路径运动，以利于与针的远端连接的缝合线的应用；
所述驱动组件包括一个在驱动索和销的控制下沿着缝合外壳运动的摇摆件，其中所述驱动索和销的致动导致摇摆件选择性地与针接合和脱离接合，从而引起针以连续的方式围绕环形路径运动。
(10)按照第(9)项所述的内窥镜，其中，一个真空外壳包围所述缝合主体，所述真空外壳与所述内窥镜的真空管线联接。
(11)按照第(9)项所述的内窥镜，其中，所述针为弓形的。
(12)按照第(9)项所述的内窥镜，其中，所述针包括一个内表面和一个外表面，沿着所述针的外表面形成有凹口，并且所述摇摆件包括凹口，该凹口的形状和尺寸设置为适于在该摇摆件致动过程中与沿着所述针的外表面的凹口接合。
(13)按照第(9)项所述的内窥镜，其中，所述摇摆件包括接合构件和凸轮构件，所述凸轮构件与所述销协作来控制所述接合构件的位置，以选择性地与所述针接合。
(14)按照第(13)项所述的内窥镜，其中，所述凸轮构件包括一个狭槽，所述销在该狭槽中运动，以导致接合构件运动成与所述针接合和脱离接合。
(15)按照第(13)项所述的内窥镜，其中，所述摇摆件还包括一个摩擦板，其辅助控制所述接合构件的定位。
(16)按照第(13)项所述的内窥镜，其中，所述接合构件是弓形的，以与针的形状基本上一致。
(17)本发明还涉及一种用于连续应用缝合线的内窥镜器械，其包括：
一个缝合主体，其形状和尺寸设置为适于以可以使其致动的方式连接到可从市场上购买的内窥镜的远端；
所述缝合主体包括缝合外壳，在该缝合外壳中容纳有针和驱动组件，用于使针围绕连续的环形路径运动，以利于与针的远端连接的缝合线的应用；
所述驱动组件可施加轴向运动，以导致针围绕连续的环形路径运动。
(18)按照第(17)项所述的内窥镜器械，其中，一个真空外壳包围所述缝合主体，所述真空外壳的形状和尺寸设置为适于与所述内窥镜的真空管线联接。
(19)按照第(17)项所述的内窥镜器械，其中，所述针为弓形。
通过结合阐明本发明的一些实施例的附图阅读下列详细描述可以清楚了解本发明的其它优点和目的。
附图说明
图1是本发明的透视图，其中一个真空外壳与其连接。
图2是不带真空外壳的本发明的透视图。
图3到10分别是示出了本发明的操作的剖视透视图。
具体实施方式
这里公开了本发明的详细实施例。然而应理解，所公开的实施例仅仅作为以多种形式体现的本发明的示范性例子。因此，这里所公开的细节并不解释为限制，而仅仅作为权利要求书的基础以及作为教导本领域技术人员如何制造和/或使用本发明的基础。
参照图1到图10，公开了一种用于连续应用缝合线12的内窥镜器械10。尽管该器械特别适用于进行内窥镜胃缩小手术，本领域技术人员当然能够理解，该装置可用于广泛的多种应用，而不会背离本发明的精神。
所述器械10包括一个缝合主体14，其形状和尺寸设置为以可使其致动并形成真空的方式与可从市场上购买的内窥镜18的远端16连接。值得注意的是，所述缝合主体14采用本领域技术人员所熟知的已知连接结构固定到内窥镜18。
所述缝合主体14由第一外壳构件20和第二外壳构件22组成，二者连接在一起形成外壳24，在外壳24中容纳本发明器械10的功能元件，以按照本发明进行运动。需要说明的是，所述外壳24包括一个内部第一轨道26，在其中定位针28，用于在驱动组件30的控制下围绕预定的环形路径运动。
所述驱动组件30支撑于围绕内部第一轨道26定位的第二和第三轨道32、34中。所述驱动组件30可施加轴向运动，以导致针28围绕连续的环形路径运动。驱动组件30通常由沿着第二轨道32静止安装的摩擦板36和摇摆件38组成，当销40沿着外侧第三轨道34运动时，所述摇摆件38沿着第二轨道32运动。一根驱动索42与所述销42连接，以下面更详细描述的方式控制其致动。
所述缝合主体14为具有中央开口44的大体C形，在缝合过程中组织定位在所述中央开口中，根据如下更加详细描述的本发明的缝合器械10的操作可以了解这样设置的原因。在其操作过程中，所述缝合主体44的C形使针28可以围绕环形路径运动。
参照图1及图2，本发明的内窥镜缝合器械10通过夹持器17与可从市场上购买的内窥镜18连接。如上所述，所述缝合器械10可以多种方式固定到内窥镜18，而不背离本发明的精神。所述缝合器械10以使用户能保持观察针28和操作范围的方式定向，并且形成小的横截面，以辅助经口插入(当所述器械用于胃部外科手术时)。
一个真空外壳46包围本发明缝合器械10的缝合主体14，从而限定一个腔48，缝合主体14位于所述腔中。该真空外壳46与内窥镜18的真空管线50联接，从而在由真空外壳46限定的腔48以及缝合主体14的中央开口44中形成真空。这样，真空的应用将附近的组织抽吸到缝合主体14的中央开口44中。
如上所述，所述外壳24容纳有针28，其用于将缝合线12应用于抽吸到中央开口44中的组织。如这里所述，根据本发明，缝合线12与针28的远端连接，并且当针28致动时该缝合线被牵引穿过组织。使针28弯曲，以围绕预定的环形路径旋转。针28沿着240度的圆弧延伸，从而形成120度的开口。然而，本领域技术人员能够理解，所述开口可以是变化的，例如，我们可以设想使用提供了140度的开口的针。所述针28包括一个沿着由针28限定的圆弧的内部表面的内表面52，以及一个沿着由针28限定的圆弧的外部表面的外表面54。在针28的外表面54中切割形成一系列凹口56。如同基于下列描述可知的那样，所述凹口56的形状和尺寸设置为在针的夹取、驱动和释放过程中由驱动组件30使用。尽管公开了将沿着针的外表面的凹口用于根据本发明的优选实施例，可以设想，所述针还可形成为不具有凹口，使驱动组件仅仅夹住针的完全平滑的外表面，将其向前驱动。
参照图3到10对驱动组件30的操作和针28的运动进行描述，在图3-10中，外壳24的一半被移除，以露出本发明的缝合装置10的内部元件。驱动索42与销40刚性连接。如同在下面详细描述的那样，驱动索42、销40和摇摆件38被伸出和缩回，以与针28接合和脱离接合，从而使针围绕其环形路径运动。驱动索42的挠性足以使其在外壳24中弯曲并沿着内窥镜18挠曲，但其刚性又足以使其被压缩成将摇摆件38驱动到其初始驱动位置(见图4)。
摇摆件38由弓形接合构件58和凸轮构件60组成，所述凸轮构件60与销40协同操作，用于控制接合构件58的位置，以选择性地与针28接合。接合构件58构造有内部凹口62，所述内部凹口62的形状和尺寸设置为能够与针28接合，以沿着顺时针方向对针进行驱动；但当摇摆件38(也就是接合构件58和凸轮构件60)沿着逆时针方向向着初始驱动位置运动时，可允许针的自由运动。
摇摆件38的接合构件58设计为在外壳24中向着和远离针28的方向径向平移，以及围绕由外壳24所限定的圆弧顺时针和逆时针成弓形地平移。这可通过由凸轮构件60、销40和接合构件58之间的相互作用提供的凸轮作用来实现。凸轮构件60与接合构件58刚性连接，凸轮构件60的径向位置根据其与销40的相互作用而改变，使接合构件58运动造成与针28接合或者与针脱离接合。还可以设想，可采用弹性元件来迫使摇摆件元件38抵靠着针28。
更特别地，当驱动索42受压(也就是向前压缩)以沿着逆时针方向运动摇摆件38时，销40在凸轮构件60内形成的狭槽64中滑动，从而迫使接合构件58和凸轮构件60逆时针运动，同时从针28处向外运动。当摇摆件38沿着逆时针方向运动时，摩擦板36辅助迫使接合构件58从针28向外运动。
当将张力施加到驱动索42并最终施加到销40上时，销40在凸轮构件60中滑动，从而将压力施加到接合构件58和凸轮构件60上，由于由销40与凸轮构件60中的狭槽64的相互作用产生的凸轮运动，导致接合构件58和凸轮构件60向内运动成与针28的外表面54接触。当张力持续施加到驱动索42上时，沿着接合构件58的内表面形成的凹口62卡入在针28的外表面54中切割形成的凹口56内，从而引起针28顺时针旋转，直到摇摆件38运行到外壳24中，并且手术必须开始。
随着达到行程极限，由于销40在狭槽64中滑动，从而引起接合构件58和凸轮构件60向外沿逆时针方向运动，操作人员压缩驱动索42，通过由销40在凸轮构件60的槽64中的相互作用所产生的凸轮性质导致接合构件58与针28脱离接合。在驱动索42上的压缩持续到摇摆件38逆时针运动到外壳24的相对端。然后再次施加张力使针28沿着顺时针方向运动，重复该过程直到针行进360度。
尽管已经显示并描述了优选实施例，应理解，并不是想要通过这些描述对本发明进行限制，而是想要覆盖落入本发明的精神和范围的所有修改和改变的结构。

Claims (8)

1.一种用于连续应用缝合线的内窥镜器械，其包括：
一个缝合主体，其形状和尺寸设置为适于以可以使其致动的方式连接到可从市场上购买的内窥镜的远端；
所述缝合主体包括缝合外壳，在该缝合外壳中容纳有针和驱动组件，用于使针围绕连续的环形路径运动，从而便于与针的远端连接的缝合线的应用；
所述驱动组件包括一个在驱动索和销的控制下沿着缝合外壳运动的摇摆件，其中所述驱动索和销的致动导致摇摆件选择性地与针接合及脱离接合，从而导致针以连续的方式围绕环形路径运动。
2.按照权利要求1所述的内窥镜器械，其中，一个真空外壳包围所述缝合主体，所述真空外壳的形状和尺寸设置为可与所述内窥镜的真空管线联接。
3.按照权利要求1所述的内窥镜器械，其中，所述针为弓形的。
4.按照权利要求1所述的内窥镜器械，其中，所述针包括内表面、外表面以及沿着所述针的外表面形成的凹口，并且所述摇摆件包括凹口，该凹口的形状和尺寸设置为在摇摆件致动过程中与沿着所述针的外表面的凹口接合。
5.按照权利要求1所述的内窥镜器械，其中，所述摇摆件包括接合构件和凸轮构件，所述凸轮构件与所述销协作来控制所述接合构件的位置，以选择性地与所述针接合。
6.按照权利要求5所述的内窥镜器械，其中，所述凸轮构件包括一个狭槽，所述销在该狭槽中运动，以使接合构件运动成与所述针接合及脱离接合。
7.按照权利要求5所述的内窥镜器械，其中，所述摇摆件还包括一个摩擦板，其用于辅助控制所述接合构件的定位。
8.按照权利要求5所述的内窥镜器械，其中，所述接合构件是弓形的，以与针的形状基本上一致。
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