CN100500104C - 具有电活化聚合物致动的医疗物质投放器的外科缝合器械 - Google Patents

具有电活化聚合物致动的医疗物质投放器的外科缝合器械 Download PDF

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CN100500104C
CN100500104C CNB2005100895192A CN200510089519A CN100500104C CN 100500104 C CN100500104 C CN 100500104C CN B2005100895192 A CNB2005100895192 A CN B2005100895192A CN 200510089519 A CN200510089519 A CN 200510089519A CN 100500104 C CN100500104 C CN 100500104C
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CN1745719A (zh
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弗雷德里克·E·谢尔顿四世
约瑟夫·C·休伊尔
杰罗姆·R·摩根
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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
    • A61B2017/00017—Electrical control of surgical instruments
    • 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
    • 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
    • A61B2017/00831—Material properties
    • A61B2017/00867—Material properties shape memory effect
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00867—Material properties shape memory effect
    • A61B2017/00871—Material properties shape memory effect polymeric
    • 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
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft

Abstract

一种外科缝合和切断器械，它通过具有上部和下部钳口(即砧板和缝合槽)实现微创外科手术，该钳口与细长轴和手柄通过外科开口定位，具体的，所述外科开口是一个套管针的插管。一对液囊(抬升袋)位于缝合槽内，该缝合槽在向近侧突出的杠杆座的下面以使从手柄输送流体导致砧板的闭合和夹紧。双向流体控制可以在手柄处机械产生或由电活化聚合物致动器致动。一旦检测到发射，一个在嵌入到细长轴内的医疗物质注射器中的EAP柱塞就被激活，以用来投放医疗物质(如麻醉剂、粘接材料、烧灼术材料、抗生素等)并沿发射杆引导到E形梁的切割表面上，放置该物质在切断的组织上。

Description

具有电活化聚合物致动的医疗物质投放器的外科缝合器械
相关申请的交叉引用
本申请要求享有系列号为60/591,694、由SheltonIV于2004年7月28日提交的题为“包含电致动关节机构的外科器械”的美国临时申请的权益。本申请涉及共同拥有的系列号为11/082,495、于2005年3月17日提交的、名称为“包含电致动关节机构的外科器械”的美国专利申请，其全部公开内容在此引入作为参考。
技术领域
本发明总的涉及能够将多行缝钉合线施加于身体组织，并同时对位于这些切割缝钉线之间身体的组织进行切割的外科缝合器械，更具体地说，涉及有关缝合器械的改进和用于形成这类缝合器械的不同部件的方法的改进。
发明背景
在现有技术中，外科缝合器已经用来同时在组织中形成一个纵向切口并且将多行缝缝合线钉施加在切口的相对侧上。这类器械通常包括一对相配合协同操作的钳口构件，如果打算将该器械用于内窥镜或者腹腔镜的施放器用途，则该对钳口构件可以穿过套管通道。其中一个钳口构件容纳装载一个至少具有两排横向间隔开的缝钉的缝钉匣。另一个钳口构件形成一个具有与缝钉匣中的多排行缝钉对齐的缝钉成形槽的砧板。该器械包括多个往复运动的楔形件，这些楔形件在被向远侧驱动时，穿过缝钉匣上的开口孔并且与支撑缝钉的驱动器接合，以便向砧板发射缝钉。
美国专利No.US5,465,895中描述了适用于内窥镜施放器用途的外科缝合器的一个例子，该缝合器有利地提供不同的闭合和发射动作。由此，医师能够在发射前将钳口构件在组织上闭合以便对组织进行定位。一旦医师确定钳口构件恰当地夹紧住了组织，之后该医师于是就可以发射外科缝合器，由此切割和缝合组织。同时进行切割和缝合组织避免了当用分别只能切割或缝合的不同外科工具来顺序进行这些操作时可能所带来的不便复杂状况。
这些微创外科器械已经得到了广泛的使用并已经证明比传统公开的外科技术有显著的进步。如果还能结合附加的特征和能力则会更好。例如，在国际专利申请WO 03/094743 A1中，描述了一种创口闭合材料施加器组件，当使外科缝合设备的刀具移动以切断组织时，该组件在所述刀具内的针处进行投放。投放是通过由发射手柄或单独注射器压缩的储液器来致动的。
尽管可能需要这样的能力以在同时切断和缝合的情况下在组织上施加医疗物质，相信外科医生不希望施加更大的力量来发射要求的东西，或需要另一个分离的装置被致动。
因此，非常需要有改进能力的外科器械来投放医疗物质。
发明概述
本发明通过提供这样一种外科器械克服了现有技术的上述和其他缺陷，该器械通过具有一个手柄使该器械适合于微创外科手术过程，该手柄经由一个细长轴来穿过外科开口对端部执行器进行定位。穿过细长轴装到端部执行器上的一种电控的医疗物质输送机构，提高了该器械的效用和效力。因此，可以在切割组织时将许多治疗处理精确地应用到组织上，从而缩短术后恢复期且并发症少。
在本发明的一个方面中，端部执行器包括用于夹紧组织的相对的钳口。装有一个发射杆以在细长轴内进行往复的纵向运动，从而从手柄传递发射运动。在远侧装到发射杆上的切割表面由该发射运动所推动，来切断在端部执行器内夹紧的组织。为了促进切断组织的愈合，在发射杆内设纵向上有利地限定一个一直到切割表面的流体通道。一个与该流体通道连通的电流体投放器响应来自控制电路的投放信号，从而沿着流体通道向切割表面投放医疗物质。
在本发明的另一个方面中，外科器械包括一个到端部执行器的流体通道。在外科器械内的一个注射器圆筒具有一个充满医疗物质的内部容积部分。控制电路产生一个投放信号给注射器圆筒内的电活化聚合物柱塞。电活化聚合物柱塞扩张到该内部容积中的通过到端部执行器的流体通道从投放开口投放医疗物质。因此，多个微创外科手术过程可以伴随着在外科处理的部位处同时或选择性的投放医疗物质。此外，电活化聚合物的特性使其自身成为在使用之前具有非常长的保存期的可靠器械。
在本发明的又一个方面中，缝合和切断夹紧的组织外科器械受益于在发射杆的切割表面处同时的医疗物质的电致动投放。因此，通过及时地直接投放到外伤部位上的能力，可以减轻由于切断和缝合导致的组织的外伤。
(1)本发明涉及一种一种外科器械，包括：可操作地构造以产生发射运动的握柄；连接到所述握柄的细长轴；在远端连接到所述细长轴上的端部执行器，它包括用于夹紧组织的相对的钳口；发射构件，它包括一个发射杆，该发射杆被容纳以用于在所述细长轴内往复的纵向运动，从而来传递所述发射运动；一个切割表面，它在远侧连接到所述发射杆上以切断在所述端部执行器中的所述夹紧的组织；以及一个流体通道，它在所述发射杆内纵向形成并到达所述切割表面；控制电路，它可操作地构造以响应发射条件来产生投放信号；以及电流体投放器，它与所述流体通道连通并响应于所述投放信号，来沿着所述流体通道向所述切割表面投放医疗物质，其中，所述电流体投放器还包括一个电活化聚合物致动器。
(2)根据项目(1)所述的外科器械，其中，所述电流体投放器包括一个部分地填充医疗物质的圆柱体，该圆柱体包括一个柱塞，而该柱塞包括所述电活化聚合物致动器，该电活化聚合物致动器可操作地构造以使所述柱塞延伸进入填充有医疗物质的圆柱体的一部分中。
(3)根据项目(2)所述的外科器械，进一步包括一个从外部可进入的容器，该容器可操作地构造以接收一个充满的圆柱体并拔出用尽的圆柱体。
(4)根据项目(2)所述的外科器械，其中，所述圆柱体位于所述细长轴内。
(5)根据项目(1)所述的外科器械，其中，所述端部执行器包括一个缝合施加组件。
(6)根据项目(1)所述的外科器械，其中，所述流体通道包括一个位于所述发射杆内的侧面凹槽。
(7)根据项目(1)所述的外科器械，其中，所述发射杆包括一个纵向的层压左半部份和右半部份，进一步包括一个在二者之间限定的内部流体通道。
(8)根据项目(1)所述的外科器械，其中，所述电流体投放器进一步包括一个容纳医疗物质的储液器，该医疗物质选自麻醉剂、粘接材料、烧灼术物质、抗生素和凝血剂。
(9)本发明还涉及一种外科器械，其包括：可操作地构造以产生发射运动的握柄；连接到所述握柄的细长轴；在远端连接到所述细长轴上的端部执行器；连接到所述端部执行器的流体通道；圆柱形注射器，包括充满医疗物质的内部容积，一个与所述流体通道连通的投放开口，和一个电活化聚合物柱塞，它可操作地构造以在激活时延伸进入所述内部容积中，通过所述投放开口投放医疗物质；控制电路，它可操作地构造以产生一个投放信号给电活化聚合物柱塞来指令投放。
(10)根据项目(9)所述的外科器械，进一步包括一个从外部可进入的容器，该容器可操作地构造以接收一个充满的圆柱体并拔出用尽的圆柱体。
(11)根据项目(9)所述的外科器械，其中，所述圆柱体位于所述细长轴内。
(12)根据项目(9)所述的外科器械，其中，所述医疗物质选自麻醉剂、粘接材料、烧灼术物质、抗生素和凝血剂。
(13)根据项目(12)所述的外科器械，其中，所述端部执行器可操作地构造以响应使用者的手柄致动对人体组织实施外科治疗，所述控制电路进一步可操作地构造以响应使用者的手柄致动，同时产生投放信号以投放医疗物质。
(14)根据项目(9)所述的外科器械，进一步包括一个用于夹紧、缝合和切断组织的工具。
(15)本发明还涉及一种外科器械，其包括：可操作地构造以产生发射运动的握柄；连接到所述握柄的细长轴；在远端连接到所述细长轴上的端部执行器，它包括用于夹紧组织的相对的钳口；发射构件，它包括一个发射杆，该发射杆被容纳以用于在所述细长轴内往复的纵向运动，从而来传递所述发射运动；一个切割表面，它在远侧连接到所述发射杆上以切断在所述端部执行器中的所述夹紧的组织；以及一个流体通道，它在所述发射杆内纵向限定并到达所述切割表面；缝钉匣，它被容纳在相对的钳口之一内，响应所述发射构件来驱动并穿过所述夹紧的组织形成缝合；控制电路，它可操作地构造以响应与发射构件向远端运动有关的发射条件来产生投放信号；以及电流体投放器，它与所述流体通道连通，并响应所述投放信号，来沿着所述流体通道向所述切割表面投放医疗物质。
(16)根据项目(15)所述的外科器械，其中，所述电流体投放器还包括一个电活化聚合物致动器。
(17)根据项目(16)所述的外科器械，其中，所述电流体投放器包括一个部分地填充医疗物质的圆柱体，该圆柱体包括一个柱塞，而该柱塞包括所述电活化致动器，该电活化致动器可操作地构造以使所述柱塞延伸进入填充有医疗物质的圆柱体的一部分中。
(18)根据项目(17)所述的外科器械，进一步包括一个从外部可进入的容器，该容器可操作地构造以接收一个充满的圆柱体并拔出用尽的圆柱体。
(19)根据项目(17)所述的外科器械，其中，所述圆柱体位于所述细长轴内。
(20)根据项目(15)所述的外科器械，其中，所述流体通道包括一个位于所述发射杆内的侧面凹槽。
(21)根据项目(15)所述的外科器械，其中，所述发射杆包括一个纵向的层压左半部份和右半部份，进一步包括一个在二者之间限定的内部流体通道。
(22)根据项目(15)所述的外科器械，其中，所述电流体投放器进一步包括一个容纳医疗物质的储液器，该医疗物质选自麻醉剂、粘接材料、烧灼术物质、抗生素和凝血剂。
本发明的这些和其他目的和优点可以从所附的附图及其说明中显现出来。
附图说明
构成本说明书的一部分的附图示出了本发明的实施方案，其与上述发明概述、即将给出的对实施方案的详细说明一起用来说明本发明的原理。
图1是外科缝合和切断器械的透视图，该器械具有在张开位置的流体致动的上钳口(砧板)和电活化聚合物(EAP)医疗物质投放轴。
图2是图1中外科缝合和切断器械的执行部分的分解透视图。
图3是图1中外科缝合和切断器械的执行部分的左侧正视图，该视图是大致沿纵向长轴的横截面获得的，并且该横截面穿过偏置的EAP注射器和容器，该容器与E形梁发射杆中的投放槽流体连通。
图4是图1中外科缝合和切断器械的执行部分的远侧部分的左侧正视详图，该图是大致沿其纵向长轴的横截面获得的，但示出了打开砧板的横向偏置的液囊致动器。
图5是带有医疗物质导管的E形梁发射杆的左侧详图。
图6是图4中外科缝合和切断器械的执行部分的远侧部分左侧正视详图，该图是在砧板闭合时大致沿其纵向长轴的横截面获得的。
图7是图6中E形梁发射杆左侧详图。
图8是端部执行器的下钳口(缝合槽)与细长轴的连接部分的顶部详图，该视图是沿着通过线8-8的横截面获得的，示出了对E形梁发射杆的引导。
图9是图2中外科缝合和切断器械的执行部分的发射杆引导件的主视图。
图10是沿线9-9的横截面截取的图9所示发射杆引导件左视图。
图11是图3中外科缝合和切断器械的细长轴的主视图，该视图沿穿过EAP医疗物质注射器的远端的线11-11获得。
图12是图11中EAP医疗物质注射器的左视图。
图13是图1中外科缝合和切断器械的执行部分的左视图，将该执行部分部分地切除以示出用于EAP医疗物质注射器近侧安装件。
图14是图13中外科缝合和切断器械的细长轴的EAP医疗物质注射器和容器的左侧详图。
图15是图2中缝合和切断器械的发射杆的俯视图。
图16是层压的发射杆的左视图，图中的虚线示出了用于在图1所示外科缝合和切断器械的剖视图中的内部流体通路。
图17是一个替换的E形梁的左侧详图，图中以虚线示出了剖视图中内部流体通路。
图18是图15所示层压的发射杆的主视图，该视图是沿穿过流体通路的近侧开口槽的线18-18的横截面获得的。
参照附图，其中在几幅图中同样的标号表示同样的零部件，在图1-2中，外科缝合和切断器械10能够实现本发明的独特的益处，既包括端部执行器14的上钳口(砧板)12的流体致动(例如，张开、闭合/夹紧)，又包括将医疗物质投放到正被切开的组织上。端部执行器14的流体致动提供了一定范围的设计方案从而避免了传统机械连接的一些设计局限。例如，可以避免连接或元件失灵的情况。另外，将流体投放到切断的组织上允许施加一定范围的有利的治疗处理，如施加麻醉剂、粘接材料、烧灼术物质、抗生素、凝血剂等。
具体参照图2，外科缝合和切断器械10包括一个执行部分16，该执行部分16由细长轴18和端部执行器14构成，在图中的缝合组件20示出。外科缝合和切断器械10还包括在近侧连接到轴18上的握柄22(图1)。当执行部分16通过外科开口或特别是通过形成气腹来实施微创外科手术的套管针的插管插入时，该握柄22保留在患者的体外。
左和右液囊(抬升袋)24，26被支撑在缝合槽30的后部28内。砧板12包括一对向内的横向枢轴销32，34，它们以可枢转的方式与向外开口的枢轴凹槽36，38接合，该凹槽36，38在缝合槽30上形成，位于后部28的远侧。砧板12包括指向近侧的杠杆座40，该杠杆座40伸入缝合槽30的后部28，高出液囊(抬升袋)24，26且与之接触，从而充填液囊24，26导致砧板12的远侧夹紧段41像跷跷板一样朝被保持在缝合槽30的远侧部分44内的缝钉匣42枢转。液囊24，26的排空和塌陷或端部执行器14的一些其他的弹性特性导致砧板12打开。左、右流体导管46，48分别与左、右液囊24，26连通的双向传送用于致动的流体。应当意识到与本发明一致的应用可以包括在握柄22内的机械致动(如闭合扳柄)(未示出)，其中使用者压下一个控制器，该控制器导致端部执行器14的闭合和夹紧。
应当意识到，在此使用的术语“近侧”和“远侧”是参照紧握器械的握柄的临床医生而言。因此，缝合施加组件20相对于更近侧的握柄22在远侧。还应当意识到，为了方便和清楚起见，在此使用的空间术语如“纵向”和“横向”是相对于附图而言的。但是，外科器械被用于许多方向和位置，而且这些术语并不具有限制性和绝对性。
具体参照图2，细长轴18包括一个框架50，该框架50的近端可旋转地接合握柄22(图1)，从而使旋钮52旋转框架50以及端部执行器14。框架50的远端有侧面凹槽54，该凹槽与缝合槽30的近侧凸缘56接合。框架50包括侧面一个沿横向在中心的、底部发射槽58，该槽沿纵向穿过框架50，用于接收一个两件式发射杆60，该两件式发射杆60包括带有在远侧固定的E形梁64的发射杆62，所述E形梁在缝合施加组件20内平移的切断和缝合组织。框架50的远侧部分包括一个上腔66，该上腔66的远端和近端通过远端和近端孔68，70相连接，在之间有一个横条72，夹具弹簧76的一个远侧突出夹具74在其上与下弹簧弹性臂78接合，向远侧端和向下伸突出穿过上腔66来向下偏压置发射杆62，使之与缝合槽30接合，尤其是在下弹簧臂78遇到发射杆62上的一个凸起部分80时。
通过包括一个在框架50内形成的横向偏置的圆柱形腔90，将医疗物质的投放集成到细长轴18内，该圆柱形腔通过一个矩形孔92沿其纵向长度与外部相通，该孔比电活化聚合物(EAP)注射器100略短，注射器100通过孔92插入圆柱形腔90内。圆柱形腔90的近侧部分包含一个纵向对准的压缩弹簧102，它将EAP注射器100的远侧投放锥体104向远端推动成与框架密封接触，且允许为EAP注射器100的插入和取出平移。电导体106穿过框架50并连接到压缩弹簧102上，该压缩弹簧102也是由导电金属形成的。EAP注射器100的后部是导电的并接触弹簧102以形成被保持在EAP注射器100的近侧部分的EAP致动器110的阴极。应当意识到另一个导体(可能与导体106一同走线)也电连接到EAP致动器110上以作为阳极。
当致动时，EAP致动器110纵向扩张，作为柱塞而通过远端投放锥体104排出在EAP注射器100的远侧部分中的医疗物质112。在EAP致动器110横向缩短以补偿其纵向伸长的情况下，柱塞密封件114保持在EAP注射器100内的横向密封。围绕导体106的通气孔(未示出)在投放时医疗物质112允许空气在柱塞密封件114后面重新填充EAP注射器100。通气孔可以依靠医疗物质112的表面张力来避免泄漏或成为一个单向阀。如下所述，医疗物质112由框架50引导至侧面流体槽120，该流体槽120形成在发射杆62和E形梁中，用于将医疗物质引导到E形梁64的切割表面122。框架槽58的大小要适合密封该侧面流体槽120。位于弹簧夹具76下面的部分侧面流体槽120由发射杆引导件124密封。在图示形成中，外护套130包围框架50以及砧板12的向近侧突出的杠杆座40。顶部远侧开口131允许砧板12闭合。
确定外护套130的一个外部矩形孔132的大小且对其进行纵向定位，以便与在框架50内形成的矩形孔92一致。在一些应用中，外护套130可旋转以有选择地将矩形孔92对准，外部矩形孔132，以用于插入或移出EAP注射器100。应当意识到，在一些应用中，EAP注射器100可以整体地组装进细长轴中，这不允许选择所需的医疗物质。例如，带有整体的缝合夹头和医疗投放储液器的一次性执行部分可由临床医生作为一个单元选择。相信在使用的时候允许插入有一定的优点，包括临床上灵活选择医疗物质(如麻醉剂、粘接材料、抗生素、烧灼术混合物等)和延长储存期限/简化执行部分16的保存和包装。
在图示的形式中，沿纵向排列并设置内许多碟形EAP层构成的细长块以沿其纵向轴线伸长。电活化聚合物(EAPs)是一组导电涂层聚合物，当施加电压时其形状改变。实质上，导电聚合物与某些形式的离子液或凝胶和电极配合。离子从流体/凝胶中流入导电聚合物或者从导电聚合物中流入的流动通过施加的电压引导，并且这种流动引导聚合物的变形。依据所使用的聚合物和离子流体，电压在1V到4KV的范围内。一些EAPs在施加电压时收缩，而一些膨胀。EAPs可以与机械装置配合，比如弹性或柔性盘，来改变施加电压时产生的效果。
有两种基本类型的EAPs并且每种有多种构造。该两种基本类型是纤维束和层压形式。纤维束包括大约在30-50微米的纤维。这些纤维可以织成非常类似于织物的束并且因此常称为EAP纱线。这种类型的EAP在施加电压时收缩。电极通常由芯线和导体外壳组成以便还用来包含围绕纤维束的离子液。一种可以买到的纤维EAP材料是由Santa Fe Science and Technology生产并且以商标PANIONTM纤维出售并且在美国专利6,667,825中有描述，其内容在此全部引人以供参考。
另一种类型是层压结构，其由一EAP聚合物层、一离子凝胶层和两个连接到所述的层压层的每一侧的柔性板。当施加电压时，正方形的层压板沿一个方向膨胀并且沿垂直方向收缩。一种可以买到的层压(板形)EAP材料来自于Artificial Muscle Inc，其为SRI实验室的一个部门。板形EAP材料还可以从日本的EAMEX得到，其成为薄膜EAP。
应当注意的是，EAPs在被激励时，体积不变；它们仅仅是沿一个方向膨胀或收缩而在横向上与之相反。层压形式可以通过将一侧包含到刚性结构上并将另一侧如活塞似的使用而以其基本形式使用。层压形式还可以粘结到柔性板的任意侧。当柔性板EAP的一侧被激励时，其沿相反方向扩张柔性板。依据受激励侧的不同，这允许该板在任意方向弯曲。
由EAP致动器通常由许多层或者纤维束一起组成以便配合工作。EAP的机械构造确定由EAP致动器和其运动的能力。EAP可以形成长绳并且围绕单中心电极缠绕。柔性外部外套管将为致动器形成另一个电极并且装有该装置的功能所需的离子液。在这种结构中，当将电场加到电极上时，EAP绳缩短。由EAP致动器的这种结构称为纤维由EAP致动器。同样，可以将层压结构在柔性板的每一侧放置多层或者仅仅在其自身上放置多层以增加其性能。典型的纤维结构具有2-4％的有效张力，在典型的层压形式中使用更高的电压可获得20-30％。
例如，层压EAP材料可以由连接到EAP层上的正板电极层形成，该EAP层又连接到离子细胞层，离子细胞层又连接到负板电极层。多层EAP材料可以通过它们之间的粘合层大量固定以形成EAP板致动器。可以理解的是相对的由EAP致动器可以形成为在任意方向可以选择性地弯曲。
收缩EAP纤维致动器可以包括长的铂阴极线，该阴极线穿过绝缘的聚合物近端帽，该近端帽穿过长形的圆柱形腔体，该圆柱形腔体形成于经导电涂层以作为正极使用的塑料圆柱形壁内。铂电极线的远端嵌入绝缘聚合物远端帽内。许多收缩聚合物纤维与电极线平行地并且围绕电极线设置并且使它们的端部嵌入到各自的端帽中。塑料圆柱形壁沿圆周围绕各个端帽连接以便闭合圆柱形腔体来将填充到收缩聚合纤维和电极线之间的空间内的离子液或凝胶密封。当将电压穿过圆柱形壁(正极)和电极线施加时，离子液进入收缩纤维内，使它们的外径膨胀，同时长度相应缩短，由此使各端帽彼此拉动。
回到图1，握柄22控制砧板12的闭合，两件式发射杆60(图2)的发射和医疗物质的投放。在图示的形式中，可抓住手枪式扳把140和在需要时压下的拇指按钮142以控制砧板12的闭合。拇指按钮142提供比例电信号给类似于EAP注射器100的EAP投放致动器(未示出)，以经过导管46，48输送流体到液囊24，26从而闭合砧板12(图2)。当充分压下拇指按钮142时，机械式节闭锁(未示出)接合的保持拇指按钮142向下，直到完全压下释放了该肘节闭锁来释放拇指按钮142。这样，当拇指按钮142保持压下时，外科医生有可视的指示来闭合和夹紧端部执行器14，通过EAP投放致动器的连续起作用或通过锁定该端部执行器机构维持在这个位置上。例如，控制电路可感知应拇指按钮142的运动，使通常关未闭合的EAP截流关断阀(未示出)打开，以在EAP投放致动器和导管46，48之间形成连通。一旦运动停止，允许EAP截流关断阀允许重新关闭，保持砧板12的位置。另外，可结合手动释放来消除这样的闭锁，从而打开砧板12。
作为一种选择，可包括闭合扳柄(未示出)或其他致动器以可包括双向输送流体到液囊24，26，如在2005年2月18日提交的、，由Kenneth Wales和Chad Boudreaux所申请的、，共同所有的美国专利申请11/061,908中所述，该申请题为“包含结合了流体输送控制的关节连接机构的外科器械”，其全部内容在此引入作为参考。描述了多个这样的用于枢轴的连接的流体致动器，它们适合于闭合砧板12。充分利用几个这样形式的这些版本描述的不同流流体输送器，应当意识到，可将一个相对的反向抬升袋(未示出)放在可代替上述砧板12的杠杆座40上方，从而当左、右液囊(抬升袋)24，26塌陷时维持张开力。
具体参见图3，握柄22包括发射扳柄150(图1)，它被朝向手枪式把扳140向近端拉动以使发射杆152在细长轴18的近侧部分154内向远侧移动。发射杆152的远侧托架156接合发射杆62的向上近侧的钩子158。框架50内的动态密封件160密封在发射杆152上，从而当插入注气的腹部时，执行部分16是靠压缩空气密封的。
可有利地包括用于手柄22的发射杆152的防倒退机构170，其包括多冲程发射扳柄150和连接到发射杆152(未示出)上的回缩偏压的发射机构。具体的说，防倒退锁定板172使发射杆152通过一个紧配合的通孔(未示出)，该孔当回缩的发射杆152如图所示地使锁定板172向后倾时，与锁定板172在框架50内保持在适当的位置上的底部连接。防倒退凸轮套管174位于防倒退锁定板172的远侧位置上并由更远侧的压缩弹簧176推入接触状态，发射杆152穿过所述压缩弹簧，而且该弹簧在框架50内受压缩。应当意识到，握柄22内的机构可以手动释放防倒退机构170以便缩回发射杆152。
在图4-5中，在图示形式中是缝合施加组件20的端部执行器14是如下所述地打开的，即使液囊24的变扁，拉下砧板12的杠杆座40，该砧板12绕销32枢转，抬高远侧夹紧段41，从而允许将身体组织180定位在砧板12和缝合夹头42之间。E形梁64有上部销182，它置于砧板槽184内，允许重复开启和闭合砧板12。当砧板12闭合并使两件式发射杆60向远侧前进时，沿砧板12的长度形成的砧板槽186接收上部销182中间销188在位于缝合槽30之上的缝合夹头42内滑动，与沿着缝合槽30的底部表面滑动的底部销或底脚190相对。
在图6-7中，通过膨胀液囊(抬升袋)24、抬高砧板12的杠杆座40直到与外护套130平齐而使缝合施加组件20闭合，而且允许杠杆座40的近侧向上的弯曲尖端192进入顶部的远端侧口131。该弯曲尖端192与开口131结合，既有利地允许砧板12有更大的径向行程，又对下面的液囊24提供一抵邻接表面，而不是刺破尖端。当砧板12闭合时，上部销182对准砧板槽186以发射，并且使组织180变平到适合切断和缝合的厚度。
在图7-8中，E形梁64被去除以示出其得到沿向下开口的横向扩宽的凹槽200运动的底脚190，该凹槽与窄的纵向狭槽202相通连接，通过槽202E形梁64的垂直部分204可穿过该狭槽202。通向窄的纵向狭槽202的近侧端孔206为底脚190提供了一个组件入口。底部突出部缘208位于发射杆62上，以在发射行程的初始部分、在弹簧弹性夹具76(图6)的振动作用下落入近侧端孔206，该弹簧夹具弹性夹76紧靠发射杆62的抬高部分80，用来正确接结合和能够与端部执行器发射锁定机构(未示出)相互作用。并且，这个位置允许端部执行器14被压紧闭合，从而便于通过外科进入点如套管针的插管(未示出)插入。参照图8-10，发射杆引导件124横向接触发射杆62的一部分，以封闭侧面流体凹槽120的对应部分。在图11中，圆柱形腔90中的EAP注射器100的远侧投放锥体104与在框架50内形成的径向流体通道220连通，该通道220又与侧面流体凹槽120连通。在图12中，在安装于外科缝合和切断器械10中之前，可以有利地用一次性盖230密封EAP注射器100。在图13-14中，示出的EAP注射器100没有一次性盖230，且由弹簧102向远侧振动以使远侧投放锥体104与径向流体通道220接合并连通。
应当意识到，外科缝合和切断器械10中的一个和多个传感器可以检测发射条件(如发射杆或连接到发射杆上的机构的运动，发射扳柄的位置，单独使用者控制投放等)和并激活投放控制电路来实现投放。
在图15-18中，由纵向的层压左半个和右半个发射杆部分302，304形成一个替代的两件式发射杆300，这两个半部形成击发杆305并连接到E形梁309上。因此，可以进一步限制在发射杆300下面的流体输送器。具体的说，在左半个发射杆部分302中的左侧流体凹槽310在远侧转接到一对分别在左、右半个发射杆部分302，304的中对准的内部流体凹槽312，314，限定了一个内部流体通道316。由于E形梁309横向较厚并且纵向长度短，在其中于切割表面322和被对准的与内部流体通道316连通的后缘之间形成一个钻孔流体通道320。
尽管通过几个实施例对本发明进行了阐述，并且尽管所示的实施例已经相当详细地进行了描述，但是本发明的意图不是限制或以任何方式对所附权利要求的范围限制到如此详细。其它的优点和改进对于本领域技术人员来说是显而易见的。
例如，尽管为了清楚起见，描述了非铰接轴，但应当知道，医疗物质投放可以被结合到铰接轴中。另外，还可以包括流体导管以穿过轴的铰接点到达闭合端部执行器的液囊致动器。
作为另一个例子，尽管在此说明了医疗物质投放和流体致动的砧板闭合，但与本发明的各方面一致的应用可以包括这些特征中的任意一个。另外，对于其中投放粘接材料和/或烧灼术医疗物质的应用，应当知道可以省去诸如缝钉的一些特征。
作为又一个例子，尽管在此图文说明了缝合施加组件20，但应当知道其他端部执行器(抓钳、切割器等)可以受益于流体控制的闭合和医疗物质投放二者之一或者这二者。
作为再一个例子，用于EAP注射器的容器可以在握柄中形成，而不是在细长轴中形成。
作为另一个附加的例子，可在细长槽内形成用于第二EAP注射器的对称结构，从而两种医疗物质可以在发射期间同时投放。
作为进一步的例子，尽管缝合施加装置提供了一个示例性实施例，但应当知道，其他内窥镜器械可以受益于在或接近其远侧投放流体的能力。有益的器械的例子可以包括但不限于消融设备，抓钳，烧灼术工具、吻合环导入设备、外科缝合器、线性缝合器等。即便如此，那些没有使用发射杆的器械可以用到适当位置的导管或流体导管来代替，该发射杆在此用作通向切割表面的方便的流体通道。
尽管电活化聚合物柱塞有多种优点，但应当知道，可以采用其他类型的电致动装置来通过细长轴向端部执行器投放医疗物质。

Claims (8)

1.一种外科器械，包括：
可操作地构造以产生发射运动的握柄；
连接到所述握柄的细长轴；
在远端连接到所述细长轴上的端部执行器，它包括用于夹紧组织的相对的钳口；
一个发射构件，它包括一个发射杆，该发射杆被容纳以用于在所述细长轴内往复的纵向运动，从而来传递所述发射运动；一个切割表面，它在远侧连接到所述发射杆上以切断在所述端部执行器中的所述夹紧的组织；以及一个流体通道，它在所述发射杆内纵向形成并到达所述切割表面；
控制电路，它可操作地构造以响应发射条件来产生投放信号；以及
电流体投放器，它与所述流体通道连通并响应于所述投放信号，来沿着所述流体通道向所述切割表面投放医疗物质，其中，所述电流体投放器还包括一个电活化聚合物致动器。
2.如权利要求1所述的外科器械，其中所述电流体投放器包括一个部分地填充医疗物质的圆柱体，该圆柱体包括一个柱塞，而该柱塞包括所述电活化聚合物致动器，该电活化聚合物致动器可操作地构造以使所述柱塞延伸进入填充有医疗物质的圆柱体的一部分中。
3.如权利要求2所述的外科器械，进一步包括一个从外部可进入的容器，该容器可操作地构造以接收一个充满的圆柱体并拔出用尽的圆柱体。
4.如权利要求2所述的外科器械，其特征为，所述圆柱体位于所述细长轴内。
5.如权利要求1所述的外科器械，其特征为，所述端部执行器包括一个缝合施加组件。
6.如权利要求1所述的外科器械，其特征为，所述流体通道包括一个位于所述发射杆内的侧面凹槽。
7.如权利要求1所述的外科器械，其特征为，所述发射杆包括一个纵向的层压左半部份和右半部份，进一步包括一个在二者之间限定的内部流体通道。
8.如权利要求1所述的外科器械，其特征为，所述电流体投放器进一步包括一个容纳医疗物质的储液器，该医疗物质选自麻醉剂、粘接材料、烧灼术物质、抗生素和凝血剂。
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US20060022015A1 (en) 2006-02-02
US7143925B2 (en) 2006-12-05
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