CN101011279A - 带可关节运动的端部执行器的电动外科切割和紧固器械 - Google Patents

带可关节运动的端部执行器的电动外科切割和紧固器械 Download PDF

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CN101011279A
CN101011279A CNA2007100069365A CN200710006936A CN101011279A CN 101011279 A CN101011279 A CN 101011279A CN A2007100069365 A CNA2007100069365 A CN A2007100069365A CN 200710006936 A CN200710006936 A CN 200710006936A CN 101011279 A CN101011279 A CN 101011279A
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end effector
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fastening instrument
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CN101011279B (zh
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F·E·谢尔顿四世
C·L·吉勒姆
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Ethicon Endo Surgery Inc
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • 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
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/76—Manipulators having means for providing feel, e.g. force or tactile feedback
    • 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
    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00734—Aspects not otherwise provided for battery operated
    • 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
    • A61B2017/07278—Stapler heads characterised by its sled or its staple holder
    • 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

本发明公开了一种外科切割和紧固器械。根据各实施方式，所述器械包括端部执行器，所述端部执行器包括可动切割器械。所述器械还包括用于致动所述端部执行器中的所述切割器械的主动轴组件。所述器械还包括手柄，所述手柄包括连接到所述主动轴组件的齿轮传动系，用于致动所述齿轮传动系的电动机，在其回缩时使所述端部执行器夹钳定位于其中的物体的闭合触发器，与所述闭合触发器分开、用于在击发触发器回缩时致动电动机的击发触发器。所述器械还包括用于使所述端部执行器进行关节运动的部件。

Description

带可关节运动的端部执行器的电动外科切割和紧固器械
相关申请的交叉引用
本申请涉及下列同时提交的美国专利申请，它们的内容均通过引用包含在本申请中：
--MOTOR-DRIVEN SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH USER FEEDBACK SYSTEM；发明人：Frederick E.Shelton，IV，John Ouwerkerk and Jerome R.Morgan(代理卷号No.050519/END5687USNP)
--MOTOR-DRIVEN SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH LOADING FORCE FEEDBACK；发明人：Frederick E.Shelton，IV，John N.Ouwerkerk，Jerome R.Morgan和Jeffrey S.Swayze(代理卷号No.050516/END5692USNP)
--MOTOR-DRIVEN SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH TACTILE POSITION FEEDBACK；发明人：Frederick E.Shelton，IV，John N.Ouwerkerk，Jerome R.Morgan和Jeffrey S.Swayze(代理卷号No.050515/END5693USNP)
--MOTOR-DRIVEN SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH ADAPTIVE USER FEEDBACK；发明人：Frederick E.Shelton，IV，John N.Ouwerkerk和Jerome R.Morgan(代理卷号No.050513/END5694USNP)
--MOTOR-DRIVEN SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH MECHANICAL CLOSURE SYSTEM；发明人：Frederick E.Shelton，IV和Christoph L.Gillum(代理卷号No.050693/END5770USNP)
--SURGICAL CUTTING AND FASTENING INSTRUMENT WITHCLOSURE TRIGGER LOCKING MECHANISM；发明人：Frederick E.Shelton，IV和Kevin R.Doll(代理卷号No.050694/END5771USNP)
--GEARING SELECTOR FOR A POWERED SURGICALCUTTING AND FASTENING STAPLING INSTRUMENT；发明人：Frederick E.Shelton，IV，Jeffrey S.Swayze，Eugene L.Timperman(代理卷号No.050697/END5772USNP)
--SURGICAL INSTRUMENT HAVING RECORDINGCAPABILITIES；发明人：Frederick E.Shelton，IV，John N.Ouwerkerk和Eugene L.Timperman(代理卷号No.050698/END5773USNP)
--SURGICAL INSTRUMENT HAVING A REMOVABLEBATTERY；发明人：Frederick E.Shelton，IV，Kevin R.Doll，Jeffrey S.Swayze和Eugene Timperman(代理卷号No.050699/END5774USNP)
--ELECTRONIC LOCKOUTS AND SURGICAL INSTRUMENTINCLUDING SAME；发明人：Jeffrey S.Swayze，Frederick E.Shelton，IV，Kevin R.Doll(代理卷号No.050700/END5775USNP)
--ENDOSCOPIC SURGICAL INSTRUMENT WITH A HANDLETHAT CAN ARTICULATE WITH RESPECT TO THE SHAFT；发明人：Frederick E.Shelton，IV，Jeffrey S.Swayze，Mark S.Ortiz和LeslieM.Fugikawa(代理卷号No.050701END5776USNP)
--ELECTRO-MECHANICAL SURGICAL CUTTING ANDFASTENING INSTRUMENT HAVING A ROTARY FIRING ANDCLOSURE SYSTEM WITH PARALLEL CLOSURE AND ANVILALIGNMENT COMPONENTS；发明人：Frederick E.Shelton，IV，Stephen J.Balek和Eugene L.Timperman(代理卷号No.050702/END5777USNP)
--DISPOSABLE STAPLE CARTRIDGE HAVING AN ANVILWITH TISSUE LOCATOR FOR USE WITH A SURGICAL CUTTINGAND FASTENING INSTRUMENT AND MODULAR ENDEFFECTOR SYSTEM THEREFOR；发明人：Frederick E.Shelton，IV，Michael S.Cropper，Joshua M.Broehl，Ryan S.Crisp，Jamison J.Float，Eugene L.Timperman(代理卷号No.050703/END5778USNP)
--SURGICAL INSTRUMENT HAVING A FEEDBACKSYSTEM；发明人：Frederick E.Shelton，IV，Jerome R.Morgan，KevinR.Doll，Jeffrey S.Swayze和Eugene Timperman(代理卷号No.050705/END5780USNP)
技术领域
本发明总的涉及外科切割和紧固器械，更具体涉及电动外科切割和紧固器械。
背景技术
内窥镜手术器械通常比传统的开放式手术装置更受欢迎，因为切口较小，缩短了术后康复时间并减少了并发症。因此，适于精确地将远端执行器通过套管针的插管设置到需要的手术部位的内窥镜外科手术领域已经得到了极大发展。这些远端执行器以多种方式接合组织以获得诊断或者治疗效果(例如，内切割器、抓钳、切割器、缝合器、夹具施放器、进入装置、药物/基因治疗输送装置，以及采用超声波、RF、激光等的能量装置)。
已知的外科缝合器包括同时在组织中形成纵向切口并将钉线施加到切口的相对侧上的端部执行器。端部执行器包括一对协同作用的钳口构件，如果器械用于内窥镜或者腹腔镜应用，这对钳口能够穿过套管通道。一个钳口构件容纳具有至少两排横向间隔设置的钉的钉仓。另一个钳口构件限定了具有与钉仓中的钉排对准的钉形成凹槽的砧座。所述器械包括多个往复的楔形件，当向远端驱动时，这些楔形件穿过钉仓中的开口并接合支撑钉的驱动器，使钉向着砧座击发。
在美国专利US5,465,895中描述了适用于内窥镜应用的外科缝合器的例子，其公开了具有不同闭合和击发动作的内切割器。医生能够使用该装置将钳口构件闭合在组织上在击发前定位组织。一旦医生已经确定钳口构件正确地夹钳了组织，则根据采用的装置医生可使用单击发冲程或多击发冲程击发外科缝合器，从而切割并缝合组织。击发该外科缝合器能够切割并缝合组织。同时切割和缝合避免了当用仅仅分别进行切割或者缝合的不同外科工具顺序地进行所述动作时可能引起的并发症。
能够在击发前闭合在组织上的一个特别的优点是，医生可通过已经到达切割所需部位的内窥镜进行检验，包括足够量的组织已经被夹钳在相对的钳口之间。否则，相对的钳口可能被拉得过于靠近，特别是它们的远端夹紧在一起，从而不能在切割的组织中有效地形成闭合钉。另一个极端是，过量的夹钳组织可引起束缚及不完全击发。
每一代内窥镜缝合器/切割器都在复杂性和功能方面连续增强。这种情形的主要原因之一是要求将击发力(FTF)降低到所有或者绝大多数医生都能操作的水平。一种降低FTF的已知解决方案是使用CO2马达或者电动机。这些装置不是比传统的手动装置击发得更好，而是出于不同原因。医生通常更愿意体验与在形成钉时由端部执行器所受的力成比例的力分布，以确保在绝大多数医生的能力的上限(通常大约15-30lbs)内完成切割/缝合循环。如果在装置的手柄中感受到的力感觉过大或者由于一些其它临床原因，他们还通常需要保持对钉展开的控制并能够在任何时候停止。在现有的电动内切割器中没有充分实现这些用户反馈效果。因此，对于在切割/缝合操作仅仅通过按压按钮来致动的电动内切割器，医生还没有普遍接受。
发明内容
在一种概况中，本发明涉及电动外科切割和紧固器械，其为用户提供了有关端部执行器的位置、力和/或展开的反馈。在各实施方式中，所述器械还允许操作人员控制端部执行器，包括如果需要时能够停止展开。所述器械还可包括位于其手柄中的两个触发器——闭合触发器和击发触发器——具有独立的致动运动。当器械的操作人员回缩闭合触发器时，定位在端部执行器中的组织可由端部执行器夹钳。然后，当操作人员回缩击发触发器时，电动机可借助齿轮传动系为可旋转主动轴组件提供动力，使端部执行器中的切割器械切割被夹钳的组织。
在各实施方式中，所述器械还包括具有加载力反馈和控制器的动力辅助系统，以减小由操作人员施加的所需击发力，从而完成切割操作。在所述实施方式中，击发触发器可啮合到主动轴组件的齿轮传动系中。在这种方式中，操作人员可体验与施加到切割器械的力有关的反馈。也就是说，击发触发器上的加载力可与通过切割器体验的力相关。仍在所述实施方式中，由于击发触发器啮合到齿轮传动系中，由操作人员施加的力可被增加到施加给电动机的力中。
根据各实施方式，当击发触发器被回缩适当的量(例如5度)时，可致动通/断开关，将信号发送到电动机，使其以特定速率旋转，从而开始致动传动轴组件和端部执行器。根据另一些实施方式，可使用比例传感器。比例传感器可将信号发送到电动机，使其以与由操作人员施加到击发触发器的力成比例旋转。在该方式中，击发触发器的旋转位置通常与切割器械位于端部执行器中的位置(例如，完全展开或者完全回缩)成比例。此外，操作人员可在冲程的一些点处停止回缩击发触发器以停止电动机，从而停止切割运动。另外，可使用传感器分别感测端部执行器冲程的开始(例如完全回缩位置)和冲程的结束(例如完全展开位置)。因此，传感器可提供适应控制系统，用于控制端部执行器在电动机、齿轮传动系和端部执行器的封闭环系统之外展开。
在另一些实施方式中，击发触发器可不直接啮合到用于致动端部执行器的齿轮传动系中。在所述实施方式中，可使用第二电动机将力施加到击发触发器，模拟在端部执行器中切割器械的展开。第二电动机可基于由旋转编码器测定的主动轴组件的增量旋转而受到控制。在所述实施方式中，击发触发器的旋转位置的位置可与端部执行器中切割器械的位置相关联。另外，通/断开关或者比例开关可用于控制主电动机(即为主动轴提供动力的电动机)。
在各实现方式中，端部执行器可使用在其基座中的螺旋传动螺杆驱动切割器械(例如刀)。而且，端部执行器可包括用于缝合被切割的组织的钉仓。根据另外的实施方式，也可使用紧固(或者密封)被切割的组织的其它方式，包括RF能量和粘合剂。
而且，所述器械可包括机械闭合系统。机械闭合系统可包括具有夹钳构件(例如砧座)的细长通道，所述夹钳构件可枢转连接到所述通道以夹钳定位在端部执行器中的组织。用户可通过回缩闭合触发器致动端部执行器的夹钳动作，所述闭合触发器通过机械闭合系统使端部执行器进行夹钳动作。一旦夹钳构件被锁定在位置中，操作人员可通过回缩独立的击发触发器致动切割操作。这可引起切割器械沿着通道纵向行进，以便切割由端部执行器夹钳的组织。
在各种实现方式中，所述器械可包括用于致动端部执行器的可旋转主动轴组件。此外，所述主动轴可包括关节运动接头，其使端部执行器进行关节运动。所述关节运动接头可包括例如锥齿轮组件，万向接头或者能够将扭转力传递到端部执行器的柔性扭索。
本发明的其它方面涉及用于将闭合触发器锁定到手柄的下部的手枪式握把部分的各种机构。所述实施方式将手柄中直接位于触发器上方和后方的空间释放出来，用于器械的其它元件，包括齿轮传动系和机械闭合系统的元件。
更具体地说，本发明涉及如下内容：
(1)一种外科切割和紧固器械，包括：
端部执行器，包括：
细长通道；
以可枢转的方式连接到所述细长通道的夹钳构件；以及
可动切割器械，在所述夹钳构件处于夹钳位置时用于穿过所述通道，以切割由所述夹钳构件夹钳在所述端部执行器中的物体；
用于致动所述端部执行器中的所述切割器械的主动轴组件；
连接到所述主动轴组件的齿轮传动系；
用于致动所述齿轮传动系的电动机；
在回缩时使所述夹钳构件枢转到夹钳位置的闭合触发器；
与所述闭合触发器分开、用于在击发触发器回缩时致动电动机的击发触发器；以及
用于使所述端部执行器进行关节运动的部件。
(2)如第(1)项所述的外科切割和紧固器械，还包括关节运动控制器，用于允许所述器械的操作者控制所述用于进行关节运动的部件。
(3)如第(1)项所述的外科切割和紧固器械，其中，所述用于进行关节运动的部件包括万向接头。
(4)如第(1)项所述的外科切割和紧固器械，其中，所述用于进行关节运动的部件包括锥齿轮组件。
(5)如第(1)项所述的外科切割和紧固器械，其中，所述用于进行关节运动的部件包括扭索。
(6)如第(1)项所述的外科切割和紧固器械，其中，
所述主动轴组件包括近侧传动轴和远侧传动轴；以及
所述用于进行关节运动的部件在所述近侧传动轴和远侧传动轴之间连接到所述主动轴组件。
(7)如第(6)项所述的外科切割和紧固器械，还包括运行电动机传感器，用于感知所述击发触发器的回缩，其中，当通过所述运行电动机传感器感知所述击发触发器的回缩时，发送信号给所述电动机以使其向前旋转，从而用所述切割器械切割定位在所述端部执行器中的物体。
(8)如第(7)项所述的外科切割和紧固器械，其中，所述运行电动机传感器包括比例开关，从而使所述电动机的旋转速度与施加到所述击发触发器上的回缩力成比例。
(9)如第(8)项所述的外科切割和紧固器械，还包括：
反向电动机传感器，用于感知所述切割器械切割冲程结束的条件指示；以及
停止电动机传感器，用于感知所述切割器械回缩的条件指示。
(10)如第(9)项所述的外科切割和紧固器械，其中，所述击发触发器啮合到所述齿轮传动系。
(11)如第(6)项所述的外科切割和紧固器械，还包括机械闭合系统，该机械闭合系统连接到所述闭合触发器和夹钳构件，用于在所述闭合触发器回缩时使所述夹钳构件枢转到夹钳位置。
(12)如第(11)项所述的外科切割和紧固器械，其中，所述机械闭合系统包括：
连接到所述闭合触发器的支架；以及
闭合管组件，其远端连接到所述夹钳构件并且近端置于所述支架中。
(13)如第(6)项所述的外科切割和紧固器械，其中，所述端部执行器包括置于所述细长通道中的钉仓，并且所述夹钳构件包括砧座。
(14)如第(6)项所述的外科切割和紧固器械，还包括锁定机械，用于在回缩时锁定所述闭合触发器。
(15)如第(3)项所述的外科切割和紧固器械，其中，所述端部执行器还包括螺旋传动螺杆，该螺旋传动螺杆的向前旋转使所述切割器械通过沿着所述通道向远侧行进来进行切割冲程，并且螺旋传动螺杆的反向旋转使所述切割器械通过沿着所述通道向近侧行进来回缩。
(16)如第(6)项所述的外科切割和紧固器械，还包括用于将力施加到所述击发触发器的触觉位置反馈系统，从而使该击发触发器的位置与所述端部执行器中的切割器械的位置相关。
(17)一种外科切割和紧固器械，包括：
包括可动切割器械的端部执行器；
用于致动所述端部执行器中的所述切割器械的主动轴组件；
手柄，包括：
连接到所述主动轴组件的齿轮传动系；
用于致动所述齿轮传动系的电动机；
在其回缩时使所述端部执行器夹钳定位于其中的物体的闭合触发器；以及
与所述闭合触发器分开、用于在击发触发器回缩时致动电动机的击发触发器；以及
用于使所述端部执行器进行关节运动的部件。
(18)如第(17)项所述的外科切割和紧固器械，其中，
所述主动轴组件包括近侧传动轴和远侧传动轴；以及
所述用于进行关节运动的部件在所述近侧传动轴和远侧传动轴之间连接到所述主动轴组件。
(19)如第(18)项所述的外科切割和紧固器械，还包括位于所述手柄附近的关节运动控制器，用于允许所述器械的操作者控制所述用于进行关节运动的部件。
(20)一种外科切割和紧固器械，包括：
包括可动切割器械的端部执行器；
通过轴连接到所述端部执行器的手柄，其中所述手柄包括击发触发器和分开的闭合触发器；
在所述闭合触发器回缩时使所述端部执行器夹钳定位于其中的物体的闭合部件；
在致动所述击发触发器时响应于所述击发触发器致动所述切割器械的电动部件；以及
用于使所述端部执行器进行关节运动的部件。
附图说明
下面接合附图通过例子来描述本发明的各种实施方式，其中：
图1和2是根据本发明的各种实施方式的外科切割和紧固器械的透视图；
图3到5是根据本发明的各种实施方式的器械的端部执行器和轴的分解图；
图6是根据本发明的各种实施方式的端部执行器的侧视图；
图7是根据本发明的各种实施方式的器械的手柄的分解图；
图8和9是根据本发明的各种实施方式的手柄的局部透视图；
图10是根据本发明的各种实施方式的手柄的侧视图；
图11是在根据本发明的各种实施方式的器械中使用的电路的示意图；
图12-13是根据本发明的其它实施方式的手柄的侧视图；
图14-22示出了用于锁定根据本发明的各种实施方式的闭合触发器的不同机构；
图23A-B显示了可在根据本发明的各实施方式的器械的关节运动处采用的万向接头(“u-接头”)；
图24A-B显示了可在根据本发明的各实施方式的器械的关节运动处采用的扭索；
图25-31示出了根据本发明的另一种实施方式的具有电力辅助的外科切割和紧固器械；
图32-36示出了根据本发明的又一种实施方式的具有电力辅助的外科切割和紧固器械；
图37-40示出了根据本发明的实施方式的具有触觉反馈的外科切割和紧固器械；以及
图41-42示出了可根据本发明的各实施方式使用的比例传感器。
具体实施方式
图1和2示出了根据本发明的各实施方式的外科切割和紧固器械10。所示实施方式是内窥镜器械，一般来说，本文中描述的器械10的实施方式是内窥镜外科切割和紧固器械。然而应当注意的是，根据本发明的实施方式，所述器械可以是非内窥镜外科切割和紧固器械，例如腹腔镜器械。
图1与2中所示的外科器械10包括手柄6、轴8和在关节运动枢轴14处与轴8枢转连接的关节运动端部执行器12。关节运动控制器16可靠近手柄6设置，以使端部执行器12围绕关节运动枢轴14旋转。在所示的实施方式中，端部执行器12构造为作为用于夹钳、切割及缝合组织的内切割器，尽管在其它实施方式中，也可采用不同类型的端部执行器，例如用于其它类型的外科装置的端部执行器，例如抓钳、切割器、缝合器、夹具施放器、进入装置、药物/基因治疗装置、超声波、RF或激光装置等。
器械10的手柄6可包括用于致动端部执行器12的闭合触发器18和击发触发器20。应理解，具有用于不同外科任务的端部执行其的器械可具有不同数目或类型的触发器或者用于操作端部执行器12的其它合适的控制器。所示出的端部执行器12通过优选的细长轴8与手柄6分离。在一种实施方式中，器械10的医生或者操作人员可通过利用关节运动控制器16使端部执行器12相对于轴8进行关节运动，如在由Geoffrey C.Hueil等人于2006年1月10提交的申请号为11/329,020、题为“Surgical Instrument Having An Articulating EndEffector”的美国专利申请中更详细描述的关节运动控制器，其内容通过引用包含于本申请中。
在该例子中，在其它零部件中，端部执行器12包括钉通道22和可枢转平移的夹钳构件，例如砧座24，其以一间距被保持，确保对夹钳在端部执行器12中的组织进行有效缝合及切割。手柄6包括手枪式握把26，由医生向着手枪式握把26可枢转地拉动闭合触发器18可使砧座24向着端部执行器12的钉通道22夹钳或者闭合，从而夹钳定位在砧座24和通道22之间的组织。击发触发器20位于比闭合触发器18更远的外侧。一旦闭合触发器18被锁定在闭合位置(将在下面进一步描述)，击发触发器20可略微向着手枪式握把26旋转，使其可被操作人员使用一只手控制。然后操作人员可向着手枪式握把26枢转地拉动击发触发器20，引起夹钳在端部执行器12中的组织的缝合及切割。在另外的实施方式中，可使用除了砧座24以外的不同类型的夹钳构件，例如诸如相对的钳口等。
应当理解，在本文中使用的术语“近侧”和“远侧”以握持器械10的手柄6的医生为参考。因此，相对于更近的手柄6而言，端部执行器12处于远侧。还应理解，为了方便和清楚起见，在本文中使用的空间术语，诸如“垂直”和“水平”是相对于附图而言。但是，所述外科器械以许多方向和位置被使用，这些术语并不是限定性的和绝对的。
闭合触发器18可首先被致动。一旦医生对端部执行器12的位置感到满意，医生可将闭合触发器18向着靠近手枪式握把26的其完全闭合锁定位置拉回。然后可致动击发触发器20。当医生去掉压力时(将在下面更全面描述)，击发触发器20返回到打开位置(在图1和2中显示)。当压下手柄6上的释放按钮时可释放锁定的闭合触发器18。释放按钮可以各种形式实现，例如诸如在图14中显示的滑动释放按钮160，和/或图16中显示的按钮172。
图3是根据本发明的各实施方式的端部执行器12的分解图。如在示出的实施方式中所示，除了前面提到的通道22和砧座24以外，端部执行器12可包括切割器械32、滑橇33、可拆卸安装在通道22中的钉仓34和螺纹轴36。切割器械32例如可以是刀。砧座24可在与通道22的近端连接的枢轴点25处可枢转地打开和闭合。砧座24还可包括位于其近端的翼片27，其可插入到机械闭合系统(在下面进一步描述)的元件中以打开和闭合砧座24。当闭合触发器18被致动时，也就是说由器械10的用户拉动时，砧座24可围绕枢轴点25枢转进入夹钳或者闭合位置。如果端部执行器12的夹钳是满意的，操作人员可致动击发触发器20，如同将在下面更详细描述的那样，其引起刀32和滑橇33沿着通道22纵向行进，从而切割夹钳在端部执行器12中的组织。滑橇33沿着通道22的运动引起钉仓34的钉被驱动穿过被切割的组织并抵靠闭合的砧座24，所述砧座使钉弯曲以紧固被切割的组织。在各实施方式中，滑橇33可以是美国专利US6,978,921的钉仓34的一体组成元件，该专利题为“Surgicalstapling instrument incorporating an E-beam firing mechanism”，其内容通过引用而包含在本申请中，该专利提供了关于所述两冲程切割和紧固器械的更多细节。滑橇33可以是钉仓34的一部分，当刀32在切割操作之后回缩时，滑橇33不回缩。
应注意的是，尽管这里描述的器械10的实施方式采用缝合切割的组织的端部执行器12，在其它实施方式中也可使用用于紧固或者密封被切割组织的不同技术。例如，也可使用采用RF能量或者粘合剂来紧固被切割组织的端部执行器。Yates等人的题为“ELECTROSURGICAL HEMOSTATIC DEVICE”的美国专利5,709,680，和Yates等人的题为“ELECTROSURGICALHEMOSTATIC DEVICE WITH RECESSED AND/OR OFFSETELECTRODES”的美国专利5,688,270公开了使用RF能量密封被切割组织的内窥镜切割器械，它们的内容都通过引用包含在本申请中。同样通过引用而包含在本申请中的Jerome R.Morgan等人的美国专利申请11/267,811和Frederick E.Shelton，IV等人的美国专利申请11/267,383公开了使用粘合剂来紧固被切割组织的内窥镜切割器械。因此，尽管本文中此处以及下面类似的描述指的是切割/缝合操作，应当认识到，这是典型实施方式而不意味着限制。也可采用其它组织紧固技术。
图4和5是根据各实施方式的端部执行器12和轴8的分解图，图6是根据各实施方式的端部执行器12和轴8的侧视图。如在所示的实施方式中所示，轴8可包括由枢转连接件44可枢转连接的近侧闭合管40和远侧闭合管42。远侧闭合管42包括开口45，砧座24上的翼片27插入其中以便打开和闭合砧座24(将在下面进一步描述)。近侧脊管46设置在闭合管40、42内部。设置在近侧脊管46内部的是主旋转(或者近侧)传动轴48，其借助锥齿轮组件52与次级(或远侧)传动轴50连接。次级传动轴50与传动齿轮54连接，所述传动齿轮54与螺纹轴36的近侧传动齿轮56接合。垂直锥齿轮52b可安放在近侧脊管46的远端中的开口57中并在其中枢转。远侧脊管58可用于包围次级传动轴50和传动齿轮54、56。共同地，主动轴48、次级传动轴50和关节运动组件(例如锥齿轮组件52a-c)有时在本文中称为“主动轴组件”。
定位在钉通道22的远端的轴承38容纳螺旋传动螺杆36，允许螺旋传动螺杆36相对于通道22自由旋转。螺旋传动螺杆轴36可连接刀32的带螺纹的开口(未显示)，使轴36的旋转引起刀32经过钉通道22向远侧或者近侧(取决于旋转方向)平移。因此，当主动轴48被击发触发器20致动引起旋转(将在下面更详细解释)时，锥齿轮组件52a-c引起次级传动轴50旋转，进而由于传动齿轮54、56的接合引起螺纹轴36旋转，引起刀驱动构件32沿着通道22纵向行进切割夹钳在端部执行器中的任何组织。滑橇33例如可由塑料制成，并可具有倾斜的远侧表面。当滑橇33穿过通道22时，向前倾斜的表面可向上推动或者驱动钉仓中的钉穿过夹钳的组织并抵靠砧座24。砧座24使钉弯曲，从而缝合切割的组织。当刀32回缩时，刀32和滑橇33可脱离接合，从而将滑橇22留在通道22的远端。
如上所述，由于缺乏对于切割/缝合操作的用户反馈，对于仅仅通过按压按钮来致动切割/缝合操作的电动内切割器，医生还没有普遍接受。相反，本发明的实施方式提供了具有端部执行器中切割器械的展开、力和/或位置的用户反馈的电动内切割器。
图7-10示出了电动内切割器特别是其手柄的示例性实施方式，其提供了有关端部执行器中切割器械的展开和加载力的用户反馈。另外，该实施方式可在回缩击发触发器20时使用由用户提供的电源为装置供电(所谓的“电力辅助”模式)。如在所示的实施方式中所示，手柄6可包括外部下侧件59、60和外部上侧件61、62，它们配合在一起总地形成手柄6的外部形状。电池64，例如Li离子电池可设置在手柄6的手枪式握把26的上部。电池64为设置在手柄6的手枪式握把26部分的上部中的电动机65供电。根据各实施方式，电动机65可以是大约具有5000RPM最大旋转的DC电刷驱动电动机。电动机65可驱动90°锥齿轮组件66，其包括第一锥齿轮68和第二锥齿轮70。锥齿轮组件66可驱动行星齿轮组件72。行星齿轮组件72可包括与传动轴76连接的小齿轮74。小齿轮74可驱动配合的环形齿轮78，所述环形齿轮78经传动轴82驱动螺旋齿轮鼓轮80。环84可与螺旋齿轮鼓轮80螺纹接合。因此，当电动机65旋转时，通过介于其间的锥齿轮组件66、行星齿轮组件72和环形齿轮78使环84沿着螺旋齿轮鼓轮80行进。
手柄6还可包括与击发触发器20通讯的运转电动机传感器110，以便检测何时击发触发器20已经由操作人员向着手柄6的手枪式握把部分26拉近(或者”闭合”)，从而致动端部执行器12的切割/缝合操作。所述传感器110可以是比例传感器，例如诸如变阻器或者可变电阻器。当击发触发器20被拉近时，传感器110检测运动并发送有关供给到电动机65的电压(或者动力)的电信号指示。当传感器110是可变电阻器或其类似物时，电动机65的旋转通常可与击发触发器20的运动量成比例。也就是说，如果操作人员仅仅以很小的力拉动或者闭合击发触发器20，电动机65的旋转相对较慢。当击发触发器20被完全拉近(或者处于完全闭合位置)时，电动机65以其最大速度旋转。换言之，用户拉动击发触发器20越困难，施加到电动机65上的电压越高，引起的旋转速度越快。
手柄6可包括靠近击发触发器20上部的中间手柄件104。手柄6还包括连接在中间手柄件104和击发触发器20的支柱之间的偏压弹簧112。偏压弹簧112可将击发触发器20偏压到其完全打开位置。在该方式中，当操作人员释放击发触发器20时，偏压弹簧112将击发触发器20向着其打开位置拉动，由此除去传感器110的致动，从而使电动机65停止旋转。而且，借助于偏压弹簧，任何时候用户闭合击发触发器20，用户将受到对于闭合操作的阻力，从而为用户提供有关由电动机65施加的旋转量的反馈。此外，电动机可停止回缩击发触发器20，从而除去来自传感器200的力，由此停止电动机65。这样，用户可停止展开端部执行器12，从而为操作人员提供切割/紧固操作的控制手段。
螺旋齿轮鼓轮80的远端包括驱动与小齿轮124配合的环行齿轮122的远侧传动轴120。小齿轮124与主动轴组件的主动轴48连接。这样，电动机65的旋转引起主动轴组件旋转，这引起端部执行器12的致动，如上所述。
螺纹连接在螺旋齿轮鼓轮80上的环84可包括设置在带槽的臂90的槽88中的支柱86。带槽的臂90具有开口92，其相对的一端94容纳连接在手柄外侧件59、60之间的枢轴销96。枢轴销96还经过开口100设置在击发触发器20中并经过开口102设置在中间手柄件104中。
另外，手柄6可包括反向电动机传感器(或者冲程结束传感器)130和停止电动机(或者冲程开始)传感器142。在各实施方式中，反向电动机传感器130可以是设置在螺旋齿轮鼓轮80的远端的限制开关，当环84到达螺旋齿轮鼓轮80的远端时，使螺纹连接在螺旋齿轮鼓轮80上的环84与反向电动机传感器130接触并使之启动。当致动时，反向电动机传感器130发送信号到电动机65，使其反向旋转，从而在切割操作之后缩回端部执行器12的刀32。
停止电动机传感器142例如可以是正常闭合的限制开关。在各实施方式中，其可以设置在螺旋齿轮鼓轮80的近端，当环84到达螺旋齿轮鼓轮80的近端时，由环84启动开关142。
在操作中，当器械10的操作人员向后拉动击发触发器20时，传感器110检测击发触发器20的展开并发送信号到电动机65，引起电动机65以例如与操作人员向后拉动击发触发器20的困难程度成比例的速度向前旋转。电动机65向前旋转进而引起行星齿轮组件72远端的环行齿轮78旋转，从而引起螺旋齿轮鼓轮80旋转，引起以螺纹方式接合在螺旋齿轮鼓轮80上的环84沿着螺旋齿轮鼓轮80向远侧行进。螺旋齿轮鼓轮80的旋转还驱动上述主驱动器轴组件，所述主驱动器轴组件进而引起刀32在端部执行器12中展开。也就是说，引起刀32和滑橇33纵向穿过通道22，从而切割端部执行器12中夹钳的组织。而且，在使用缝合型端部执行器的实施方式中，进行端部执行器12的缝合操作。
在端部执行器12的切割/缝合操作完成的时刻，螺旋齿轮鼓轮80上的环84将到达螺旋齿轮鼓轮80的远端，从而使反向电动机传感器130启动，发送信号到电动机65引起电动机65反转其旋转方向。这又使刀32回缩，并引起螺旋齿轮鼓轮80上的环84向后运动到螺旋齿轮鼓轮80的近端。
中间手柄件104包括与带槽的臂90接合的后侧肩106，参见图8和9中最好地显示的。中间手柄件104还具有与击发触发器20接合的向前运动止动件107。带槽的臂90的运动受到电动机65的旋转的控制，如上所述。在环84从螺旋齿轮鼓轮80的近端向远端行进、带槽的臂90逆时针旋转时，中间手柄件104将被释放以逆时针旋转。因此，当用户拉动击发触发器20时，击发触发器20将接合中间手柄件104的向前运动止动件107，引起中间手柄件104逆时针旋转。但是，由于后侧肩106接合带槽的臂90，只要带槽的臂允许，中间手柄件104将仅仅能够逆时针旋转。这样，如果电动机65由于一些原因停止旋转，带槽的臂90将停止旋转，用户将不能进一步拉动击发触发器20，因为由于带槽的臂90使中间手柄件104不能自由逆时针旋转。
图41和42示出了可用作根据本发明的各实施方式的运行电动机传感器110的可变传感器的两种状态。传感器110可包括面部分280，第一电极(A)282，第二电极(B)284以及位于电极282、284之间的可压缩电介质材料286(例如EAP)。传感器110可设置成在回缩时使面部分280接触击发触发器20。因此，当击发触发器回缩时，电解质材料286被压缩，如图42中所示，使电极282、284更接近在一起。电极282、284之间的距离“b”直接关系到电极282、284之间的阻抗，距离越大阻抗越大，距离越小阻抗就越小。这样，由于击发触发器20的回缩而压缩电介质286的量(在图42中以力“F”表示)与电极282、284之间的阻抗成比例，可用于按比例控制电动机65。
在图7-10中显示了用于通过回缩闭合触发器18来闭合(或夹钳)端部执行器12的砧座24的典型闭合系统的元件。在所示的实施方式中，闭合系统包括通过销251与闭合触发器18连接的轭形件250，所述销251经过闭合触发器18和轭形件250中都对准的开口插入。枢轴销252经过闭合触发器18中的与销251插入穿过闭合触发器18的地方错位的另一个开口插入，闭合触发器18围绕所述枢轴销252枢转。因此，闭合触发器18的回缩引起闭合触发器18的上部逆时针旋转，轭形件250经销251与所述闭合触发器的上部连接。轭形件250的远端经销254连接第一闭合支架256。第一闭合支架256连接到第二闭合支架258。共同地，闭合支架256、258限定一个开口，近侧闭合管40(见图4)的近端安放并保持在所述开口中，从而使闭合支架256、258的纵向运动通过近侧闭合管40引起纵向运动。器械10还包括设置在近侧闭合管40内部的闭合杆260。闭合杆260可包括窗口261，位于一个手柄外部件(例如在所示的实施方式中的外部下侧件59)上的支柱263设置在该窗口261中，将闭合杆260固定连接到手柄6。在该方式中，近侧闭合管40能够相对于闭合杆260纵向运动。闭合杆260还可包括远侧卡圈267，其配合在近侧脊管46中的空腔269中并由帽271限制在其中(见图4)。
在操作过程中，当轭形件250由于闭合触发器18的回缩而旋转时，闭合支架256、258引起近侧闭合管40向远端运动(即远离器械10的手柄端)，引起远侧闭合管42向远端运动，引起砧座24围绕枢轴点25旋转到夹钳或者闭合位置中。当闭合触发器18没有锁定在锁定位置中时，引起近侧闭合管40向近端滑动，引起远侧闭合管42向近端滑动，借助被插入到远侧闭合管42中的翼片27引起砧座24围绕枢轴点25旋转到打开或者未夹钳位置中。在该方式中，通过回缩并锁定闭合触发器18，操作人员可将组织夹钳在砧座24和通道22之间，并可在切割、夹钳操作之后通过打开闭合触发器20从锁定位置释放夹钳的组织。
图11是根据本发明的各实施方式的器械10的电路的示意图。在锁定闭合触发器18之后当操作人员开始在击发触发器20中拉动时，启动传感器110，允许电流流过。如果通常断开的反向电动机传感器开关130断开(意味着端部执行器冲程的结束还没有到达)，电流将流到单刀双掷继电器132。由于反向电动机传感器开关130没有闭合，继电器132的感应器134将不被供给能量，使继电器132处于其非供能状态。所述电路还包括钉仓锁定传感器136。如果端部执行器12包括钉仓34，传感器136将处于闭合状态，允许电流流动。相反，如果端部执行器12不包括钉仓34，传感器136将断开，从而防止电池64为电动机65供电。
当钉仓34存在时，传感器136闭合，为单刀单掷继电器138提供能量。当继电器138被提供能量时，电流经过继电器136流动，从而为电动机65供电，允许其沿着向前的方向旋转。
当端部执行器12到达其冲程末端时，反向电动机传感器130将被致动，从而闭合开关130并为继电器134提供能量。这引起继电器134采取其供能状态(在图13中未显示)，引起电流绕过钉仓锁定传感器136和可变电阻器110，不是引起电流流到通常闭合的双刀双掷继电器142并返回到电动机65，而是经过继电器140使电动机65反转。
由于停止电动机传感器开关142是通常闭合的，电流将回流到继电器134以保持其闭合，直到开关142断开。当刀32完全回缩时，停止电动机传感器开关142被致动，引起开关142断开，从而从电动机65除去电力。
在另外的实施方式中，与比例型传感器110不同，可使用通断型传感器。在所述实施方式中，电动机65的旋转速度将不再与操作人员施加的力成比例。而是，电动机65一般将以稳定速度旋转。但是因为击发触发器20与齿轮传动系接合，操作人员仍将感受到反馈的力。
图12是根据另一种实施方式的电力辅助电动内切割器的手柄6的侧视图。图12的实施方式类似于图7-10的实施方式，但在图12的实施方式中，没有与以螺纹方式接合在螺旋齿轮鼓轮80上的环84连接的带槽的臂。相反，在图12所示的实施方式中，环84包括传感器部分114，当环84在螺旋齿轮鼓轮80上向下(并向后)行进时其随着环84一起运动。传感器部分114包括切口116。反向电动机传感器130可设置在切口116的远端，并且停止电动机传感器142可设置在切口116的近端。当环84在螺旋齿轮鼓轮80上向下(并向后)运动时，传感器部分114随着其一起运动。而且，如图12所示，中间件104可具有延伸到切口12中的臂118。
在操作时，当器械10的操作人员向着手枪式握把26回缩击发触发器20时，运行电动机传感器110检测到运动并发送信号给电动机65供电，这引起螺旋齿轮鼓轮80旋转。当螺旋齿轮鼓轮80旋转时，以螺纹方式接合在螺旋齿轮鼓轮80上的环84行进(或者回缩，取决于旋转)。而且，由于击发触发器20的拉动，由于与击发触发器20接合的向前运动止动件107，引起中间件104与击发触发器20一道逆时针旋转。中间件104的逆时针旋转引起臂118随着环84的传感器部分114一起逆时针旋转，使臂118保持设置在切口116中。当环84到达螺旋齿轮鼓轮80的远端时，臂118将接触并由此启动反向电动机传感器130。类似地，当环84到达螺旋齿轮鼓轮80的近端时，臂接触并由此启动停止电动机传感器142。所述动作可分别反转并停止电动机65，如上所述。
图13是根据另一实施方式的电力辅助电动内切割器的手柄6的侧视图。图13的实施方式类似于图7-10的实施方式，但在图13的实施方式中，臂90中没有槽。相反，在图12所示的实施方式中，以螺纹方式接合在螺旋齿轮鼓轮80上的环84包括垂直通道126。作为槽的替代，臂90包括设置在通道126中的支柱128。当螺旋齿轮鼓轮80旋转时，以螺纹方式接合在螺旋齿轮鼓轮80上的环84行进(或者回缩，取决于旋转)。当环84由于设置在通道126中的支柱128而行进时，臂90逆时针旋转，如图13所示。
如上所述，在使用两冲程电动器械时，操作人员首先向后拉动并锁定闭合触发器18。图14和15显示了将闭合触发器18锁定到手柄6的手枪式握把部分26的方式的一种实施方式。在所示的实施方式中，手枪式握把部分26包括钩状件150，其由扭转弹簧152偏压以围绕枢轴点151逆时针旋转。而且，闭合触发器18包括闭合杆154。当操作人员拉动闭合触发器18时，闭合杆154接合钩状件150的倾斜部分156，从而向上(或者图12-13中的顺时针)旋转钩状件150，直到闭合杆154完全通过倾斜部分156、进入钩状件150的凹陷的切口158中，将闭合触发器18锁定在位置中。操作人员可通过推下手枪式握把部分26的后侧或者对侧上的滑动按钮脱扣160释放闭合触发器18。推下滑动按钮脱扣160使钩状件150顺时针旋转，使闭合杆154从凹陷的切口158释放。
图16显示了根据本发明的各实施方式的另一种闭合触发器锁定机构。在图16的实施方式中，闭合触发器18包括具有箭头部分161的楔形件160。箭头部分161由板簧162向下(或者顺时针)偏压。楔形件160和板簧例如可由模制塑料制成。当闭合触发器18回缩时，箭头部分161可经过手柄6的手枪式握把部分26中的开口164插入。箭头部分161的下斜切表面166接合开口164的下侧壁168，迫使箭头部分161逆时针旋转。最终，下斜切表面166完全穿过下侧壁168，除去箭头部分166上的逆时针力，引起下侧壁168滑动到位于箭头部分161后面的切口170中的锁定位置。
为了解锁闭合触发器18，用户按下闭合触发器18的对侧上的按钮172，引起箭头部分161旋转逆时针并允许箭头部分161滑出开口164。
图17-22显示了根据本发明的各实施方式的另一种闭合触发器锁定机构。如该实施方式所示，闭合触发器18包括具有从其上延伸的横向销178的柔性纵臂176。臂176和销178例如可由模制塑料制成。手柄6的手枪式握把部分26包括具有设置在其中的横向延伸的楔形件182的开口180。当闭合触发器18回缩时，销178接合楔形件182并且销178被楔形件178的下表面184向下促动(即臂176顺时针旋转)，如图17和18所示。当销178完全穿过下表面184时，臂176上的顺时针力使销178停置在楔形件182后面的切口186中，如图19所示，从而锁定闭合触发器18。销178进一步通过从楔形件184延伸的柔性止动件188保持在锁定位置中。
为了解锁闭合触发器18，用户可进一步按压闭合触发器18，引起销178接合开口180的倾斜后壁190，促使销178向上穿过柔性止动件188，如图20和21所示。销178然后在开口180中自由行进到上部通道192外，使闭合触发器18不再锁定手枪式握把部分26，如图22所示。
图22A-B显示了万向接头(“u-接头”)195。u-接头195的第二件195-2在水平面中旋转，第一件195-1位于所述水平面中。图23A以线性(180°)朝向显示u-接头195，图23B以大约150°朝向显示u-接头195。u-接头195可用于在主动轴组件的关节运动接头14处代替伞形齿轮52a-c(例如见图4)，使端部执行器12进行关节运动。图24A-B显示扭索197，其可用于伞形齿轮52a-c和u-接头195两种场合，实现端部执行器12的关节运动。
图25-31示出了根据本发明的另一种实施方式的电力辅助的电动双冲程外科切割和紧固器械10的另一种实施方式。图25-31的实施方式类似于图6-10的实施方式，但替代了螺旋齿轮鼓轮80，图23-28的实施方式包括作为替代的齿轮驱动组件。图25-31的实施方式包括变速箱组件200，其包括一些设置在机架201中的齿轮，其中啮合在行星齿轮72和传动轴48的近端处的小齿轮124之间。如同将在下面进一步详细解释的那样，变速箱组件200经击发触发器20为用户提供有关端部执行器12的展开和加载力反馈。而且，用户可通过变速箱组件200为系统提供电力，帮助端部执行器12展开。在这种意义上，与上述实施方式相同，图23-32的实施方式是另一种电力辅助的电动器械10，其为用户提供有关通过切割器械感受的加载力的反馈。
在所示的实施方式中，击发触发器20包括两个元件：主体部分202和硬化部分204。主体部分202例如可由塑料制成，硬化部分204可由更具刚性的材料制成，例如金属。在所示的实施方式中，硬化部分204与主体部分202相邻，但根据另外的实施方式，硬化部分204可设置在主体部分202内部。枢轴销209可经过击发触发器元件202、204中的开口插入，并可以是击发触发器20围绕其旋转的接头。另外，弹簧222可偏压击发触发器20沿着逆时针方向旋转。弹簧222可具有与销224连接的远端，所述销224与击发触发器20的元件202、204连接。弹簧222的近端可与手柄外部下侧件59、60中的一个连接。
在所示的实施方式中，主体部分202和硬化部分204在它们的上端部分(分别)包括齿轮部分206、208。齿轮部分206、208接合变速箱组件200中的齿轮(将在下面解释)，以驱动主动轴组件并为用户提供有关端部执行器12的展开。
如图所示，在所示的实施方式中，变速箱组件200可包括六(6)个齿轮。变速箱组件200的第一齿轮210接合击发触发器20的齿轮部分206、208。另外，第一齿轮210接合更小的第二齿轮212，更小的第二齿轮212与大的第三齿轮214共轴。第三齿轮214接合更小的第四齿轮216，更小的第四齿轮与第五齿轮218共轴。第五齿轮218为90°伞形齿轮，其接合与小齿轮124连接的匹配的90°伞形齿轮220(如图31最清楚显示的)，所述小齿轮124驱动主动轴48。
在操作时，当用户回缩击发触发器20时，运行电动机传感器(未显示)被致动，其可为电动机提供信号，使其以与操作人员回缩击发触发器20的程度或者力成比例的速度旋转。这引起电动机65以与来自传感器的信号成比例的速度旋转。在该实施方式中没有显示传感器，但它可以类似于上述运行电动机传感器110。传感器可设置在手柄6中，当击发传感器20回缩时使其压缩。而且，作为比例型传感器的替代，可使用通/断型传感器。
电动机65的旋转引起伞形齿轮68、70旋转，这引起行星齿轮72旋转，经过传动轴76引起环形齿轮122旋转。环形齿轮122与连接到主动轴48的小齿轮124接合。因此，小齿轮124的旋转驱动主动轴48，引起端部执行器12的切割/缝合操作的致动。
小齿轮124的向前运动又引起伞形齿轮220旋转，通过变速箱组件200中的其它齿轮引起第一齿轮210旋转。第一齿轮10接合击发触发器20的齿轮部分206、208，当电动机65为端部执行12提供向前的驱动时，由此引起击发触发器20逆时针旋转(并且当电动机65反向旋转以回缩端部执行器12时逆时针旋转)。这样，用户通过其握持击发触发器20来感受有关端部执行器12的加载力和展开的反馈。因此，当用户回缩击发触发器20时，操作人员将通过端部执行器12感受与感受到的加载力有关的阻力。类似地，在切割/缝合操作之后当用户释放击发触发器20使其返回到其初始位置时，用户将感受来自击发触发器20的顺时针旋转力，该力一般与电动机65的反向速度成比例。
还应注意的是，在该实施方式中用户可施加力(或者在来自电动机65的力的情况下或者除了该力之外的力的情况下)，通过回缩击发触发器20致动主动轴组件(由此致动端部执行器12的切割/缝合操作)。也就是说，击发触发器20的回缩引起齿轮部分206、208逆时针旋转，引起变速箱组件200的齿轮旋转，从而引起小齿轮124旋转，引起主动轴48旋转。
尽管在图25-31中没有显示，器械10还可包括反向电动机和停止电动机传感器。如上所述，反向电动机和停止电动机传感器可分别检测切割冲程的结束(刀/滑橇驱动构件32完全展开)和回缩操作的结束(刀/滑橇驱动构件32完全回缩)。与上述图11相关联的类似电路可用于为电动机65适当供电。
图32-36示出了根据另一种实施方式的具有电力辅助的双冲程电动外科切割和紧固器械10。图32-36的实施方式类似于图25-31的实施方式，但在图32-36的实施方式中，击发触发器20包括下部228和上部230。两部分228、230都与经过每个部分228、230设置的枢轴销207连接并围绕其枢转。上部230包括与变速箱组件200的第一齿轮210接合的齿轮部分232。弹簧222与上部230连接，使上部被偏压沿着顺时针方向旋转。上部230还可包括下臂234，其与击发触发器20的下部228的上表面接触，当使上部230顺时针旋转时使下部228也顺时针旋转，并且当使上部230逆时针旋转时下部228也逆时针旋转。类似地，下部228包括旋转止动件238，其接合上部230的下肩。这样，当使上部230逆时针旋转时下部228也逆时针旋转，当使下部228顺时针旋转时上部230也顺时针旋转。
所示的实施方式还包括为电动机65输送信号的运行电动机传感器110，在各实施方式中，当回缩击发触发器20时，其可使电动机65以与由操作人员施加的力成比例的速度旋转。传感器110例如可以是变阻器或者一些其它可变电阻传感器，如本文所述。另外，器械10可包括反向电动机传感器130，当由击发触发器20的上部230的前表面242接触时使其启动或者转换。当致动时，反向电动机传感器130发送信号到电动机65以使其反转。而且，器械10可包括停止电动机传感器142，当由击发触发器20的下部228接触时使其启动或者转换。当致动时，停止电动机传感器142发送信号以停止电动机65的反向旋转。
在操作过程中，当操作人员将闭合触发器18回缩到锁定位置中时，(通过本领域、包括Frederick Shelton，IV等人的美国专利US6,978,921和Jeffery S.Swayze等人的美国专利US6,905,057中已知的机构，它们的内容都通过引用包含在本申请中)击发触发器20被略微回缩，使用户可握持击发触发器20，以开始切割/缝合操作，如图32和33中所示。在这一点，如图33所示，击发触发器20的上部230的齿轮部分232运动成与变速箱组件200的第一齿轮210接合。当操作人员回缩击发触发器20时，根据各实施方式，在启动运行电动机传感器110之前，击发触发器20可旋转很小的量，例如5度，如图34中所示。传感器110的致动引起电动机65以与由操作人员施加的力成比例的速度向前旋转。如上所述，电动机65向前旋转引起主动轴48旋转，使端部执行器12中的刀32展开(即开始穿过通道22)。与主动轴48连接的小齿轮124的旋转引起变速箱组件200的齿轮210-220旋转。由于第一齿轮210与击发触发器20的上部230的齿轮部分232接合，使上部232逆时针旋转，引起下部228同样逆时针旋转。
当刀32被完全展开时(即处于切割冲程的末端)时，上部230的前表面242启动反向电动机传感器130，所述传感器将信号发送到电动机65，使其反方向旋转。这引起主动轴组件反方向旋转，回缩刀32。主动轴组件反转引起变速箱组件200的齿轮210-220反转，引起击发触发器20的上部230顺时针旋转，引起击发触发器20的下部228顺时针旋转，直到当刀32被完全回缩时下部228启动或者致动停止电动机传感器142，刀32完全回缩，使电动机65停止。这样，用户通过其握持击发触发器20感受有关端部执行器12展开的反馈。因此，当用户回缩击发触发器20时，操作人员将感受与端部执行器12的展开有关的阻力，特别是与刀32感受的加载力有关的阻力。类似地，在切割/缝合操作之后当操作人员释放击发触发器20使其回复到其初始位置时，用户可感受到来自击发触发器20的顺时针旋转力，其通常与电动机65的反向速度成比例。
还应注意的是，在该实施方式中用户可施加力(或者在来自电动机65的力的情况下或者除了该力之外的力的情况下)，通过回缩击发触发器20致动主动轴组件(由此致动端部执行器12的切割/缝合操作)。也就是说，击发触发器20的回缩引起上部230的齿轮部分232逆时针旋转，引起变速箱组件200的齿轮旋转，从而引起小齿轮124旋转，引起主动轴48旋转。
上述实施方式采用电力辅助用户反馈系统，具有或者不具有用于双冲程电动外科切割和紧固器械的适应控制器(例如，使用设置在电动机、齿轮传动系和端部执行器的闭合环系统外部的传感器110、130和142)。也就是说，在回缩击发触发器20时用户施加的力可通过被(直接或者间接)接合到电动机65和主动轴48之间的齿轮传动系中的击发触发器20加入到由电动机65施加的力。在本发明的其它实施方式中，用户可被提供有关端部执行器中刀32的位置的触觉反馈，但没有使击发触发器20接合到齿轮传动系中。图37-40示出了具有这样的触觉位置反馈系统的电动外科切割和紧固器械。
在图37-40所示的实施方式中，击发触发器20包括下部228和上部230，类似于图32-36中显示的器械10。但是与图32-36的实施方式不同的是，上部230不具有与部分齿轮传动系配合的齿轮部分。相反，该器械包括具有以螺纹方式接合在其中的螺纹杆266的第二电动机265。当电动机265旋转时，螺纹杆266纵向往复进出(取决于旋转的方向)电动机265。器械10还包括编码器268，其响应于主动轴48的旋转将主动轴48(或者主动轴组件的其它元件)的增量角运动转化成例如对应的一系列数字信号。在所示的实施方式中，小齿轮124包括与编码器268连接的近侧传动轴270。
器械10还包括控制电路(未显示)，其可使用微控制器或者一些其它类型的集成电路来实现，从编码器268接收数字信号。基于来自编码器268的信号，控制电路可计算端部执行器12中刀32展开的阶段。也就是说，控制电路可计算是否刀32完全被展开、完全回缩或者在中间阶段。基于端部执行器12的展开的阶段的计算，控制电路可将信号发送到第二电动机265，控制其旋转，从而控制螺纹杆266的往复运动。
在操作过程中，如图37所示，当闭合触发器18没有被锁定在夹钳位置中时，击发触发器20旋转离开手柄6的手枪式握把部分26，使击发触发器20的上部230的前面242不与螺纹杆266的近端接触。当操作人员回缩闭合触发器18并将其锁定在夹钳位置中时，击发触发器20略微向着闭合触发器18旋转，使操作人员可握持击发触发器20，如图38所示。在该位置中，上部230的前面242接触螺纹杆266的近端。
当用户然后回缩击发触发器20时，在初始旋转量(例如5度的旋转)之后致动运行电动机传感器110，如上所述，使传感器110将信号发送到电动机65，引起其以与由操作人员施加到击发触发器20的回缩力的量成比例的向前速度旋转。电动机65的向前旋转经过齿轮传动系引起主动轴48旋转，引起刀32和滑橇33沿着通道22向下行进，并切割夹钳在端部执行器12中的组织。控制电路接收来自编码器268的有关主动轴组件的增量旋转的输出信号，并发送信号到第二电动机265，引起第二电动机265旋转，引起螺纹杆266回缩到电动机265中。这允许击发触发器20的上部230逆时针旋转，这使击发触发器的下部228也逆时针旋转。这样，由于螺纹杆266的往复运动与主动轴组件的旋转相关，器械10的操作人员能够通过他/她握持击发触发器20来感受有关端部执行器12的位置的触觉反馈。但是，由用户施加的回缩力没有直接影响主动轴组件的驱动，因为击发触发器20没有接合到该实施方式中的齿轮传动系中。
借助通过来自编码器268的输出信号对主动轴组件的增量旋转进行追踪，控制电路可计算何时刀32完全展开(即完全延伸)。在这一点，控制电路可发送信号到电动机65以使其反转，引起刀32回缩。电动机65的反转引起主动轴组件的反转，这也由编码器268检测。基于由编码器268检测的反转，控制电路发送信号到第二电动机265，引起其反转，使螺纹杆266开始从电动机265纵向延伸。这种运动促使击发触发器20的上部230顺时针旋转，引起下部228顺时针旋转。这样，操作人员可感受来自击发触发器20的顺时针力，为操作人员提供了关于刀32在端部执行器12中的回缩位置的反馈。控制电路可确定何时刀32完全回缩。在这一点，控制电路可发送信号到电动机65以使其停止旋转。
根据不使用控制电路确定刀32的位置的其它实施方式，可使用反向电动机和停止电动机传感器，如上所述。另外，与使用比例传感器110控制电动机65的旋转不同，可使用通/断开关或者传感器。在这样的实施方式中，操作人员不能控制电动机65的旋转速度。而是，其可以预编程速度旋转。
已经结合切割型外科器械对本发明的各实施方式进行了描述。但是应当注意的是，在其它实施方式中，本文中公开的创造性外科器械不必是切割型外科器械。例如，它可以是非切割型内窥镜器械，抓钳，缝合器，夹具施放器，进入装置，药物/基因治疗输送装置，使用超声、RF、激光等的能量装置。
虽然在本文中已经结合一些公开的实施方式对本发明进行了描述，但是可以实现对于那些实施方式的许多修改和变化。例如，可采用不同类型的端部执行器。而且，在公开的用于一些元件的材料的地方，可使用其它材料。前述说明书和下列权利要求书试图覆盖所有这些修改和变化。
通过引用包含在本申请中的任何专利、公开出版物或者其它公开的材料，全部或者部分，均仅仅包含到所包含的材料不与在本公开内容中阐释的现有定义、陈述或者其它公开材料相矛盾的程度。这样并且到必要的程度，在本文中作为清楚阐释的所公开内容取代任何通过引用包含在本申请中的矛盾的材料。通过引用包含在本申请中，但是与本文中阐释的现有定义、陈述或者其它公开材料相矛盾的任何材料，或者其部分，将仅仅被包含到不引起所包含的材料与在本公开内容中现有的公开材料相矛盾的程度。

Claims (10)

1.一种外科切割和紧固器械，包括：
端部执行器，包括：
细长通道；
以可枢转的方式连接到所述细长通道的夹钳构件；以及
可动切割器械，在所述夹钳构件处于夹钳位置时用于穿过所述通道，以切割由所述夹钳构件夹钳在所述端部执行器中的物体；
用于致动所述端部执行器中的所述切割器械的主动轴组件；
连接到所述主动轴组件的齿轮传动系；
用于致动所述齿轮传动系的电动机；
在回缩时使所述夹钳构件枢转到夹钳位置的闭合触发器；
与所述闭合触发器分开、用于在击发触发器回缩时致动电动机的击发触发器；以及
用于使所述端部执行器进行关节运动的部件。
2.根据权利要求1所述的外科切割和紧固器械，还包括关节运动控制器，用于允许所述器械的操作者控制所述用于进行关节运动的部件。
3.根据权利要求1所述的外科切割和紧固器械，其中，所述用于进行关节运动的部件包括万向接头。
4.根据权利要求1所述的外科切割和紧固器械，其中，所述用于进行关节运动的部件包括锥齿轮组件。
5.根据权利要求1所述的外科切割和紧固器械，其中，所述用于进行关节运动的部件包括扭索。
6.根据权利要求1所述的外科切割和紧固器械，其中，
所述主动轴组件包括近侧传动轴和远侧传动轴；以及
所述用于进行关节运动的部件在所述近侧传动轴和远侧传动轴之间连接到所述主动轴组件。
7.根据权利要求6所述的外科切割和紧固器械，还包括运行电动机传感器，用于感知所述击发触发器的回缩，其中，当通过所述运行电动机传感器感知所述击发触发器的回缩时，发送信号给所述电动机以使其向前旋转，从而用所述切割器械切割定位在所述端部执行器中的物体。
8.根据权利要求7所述的外科切割和紧固器械，其中，所述运行电动机传感器包括比例开关，从而使所述电动机的旋转速度与施加到所述击发触发器上的回缩力成比例。
9.根据权利要求8所述的外科切割和紧固器械，还包括：
反向电动机传感器，用于感知所述切割器械切割冲程结束的条件指示；以及
停止电动机传感器，用于感知所述切割器械回缩的条件指示。
10.根据权利要求9所述的外科切割和紧固器械，其中，所述击发触发器啮合到所述齿轮传动系。
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