CN101069649B - 具有带组织定位器的砧座的一次性钉仓 - Google Patents

具有带组织定位器的砧座的一次性钉仓 Download PDF

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CN101069649B
CN101069649B CN2007100062116A CN200710006211A CN101069649B CN 101069649 B CN101069649 B CN 101069649B CN 2007100062116 A CN2007100062116 A CN 2007100062116A CN 200710006211 A CN200710006211 A CN 200710006211A CN 101069649 B CN101069649 B CN 101069649B
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F·E·谢尔顿四世
M·S·克罗珀
J·M·布罗赫尔
R·S·克里斯普
J·J·弗洛特
E·L·蒂姆珀曼
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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
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A—HUMAN NECESSITIES
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    • 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
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0023—Surgical instruments, devices or methods, e.g. tourniquets disposable
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07285—Stapler heads characterised by its cutter
    • 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
    • A61B17/2812—Surgical forceps with a single pivotal connection
    • A61B17/282—Jaws
    • A61B2017/2825—Inserts of different material in jaws

Abstract

一种用于外科切割和紧固器械的一次性钉仓。各种实施方式包括相对于钉仓体被支撑并在打开和闭合位置之间可移动的一次性砧座。在一次性砧座上设置有至少一个组织挡块用于定向组织并用支撑在钉仓体内的缝钉进行切割和缝合。其它实施方式涉及用于外科切割和紧固器械的端部执行器，它可以与多个钉仓体连接使用，钉仓体具有共同长度但也可以不同长度的缝钉排。

Description

具有带组织定位器的砧座的一次性钉仓
相关申请的相互引用
本申请与以下美国专利申请相关，其全部内容通过引用并入本文：
发明名称为“MOTOR-DRIVEN SURGICAL CUTTING ANDFASTENING INSTRUMENT WITH USER FEEDBACK SYSTEM”，发明人为Frederick E.Shelton，IV，John Ouwerkerk and Jerome R.Morgan的申请(K&LNG 050519/END5687USNP)；
发明名称为“MOTOR-DRIVEN SURGICAL CUTTING ANDFASTENING INSTRUMENT WITH LOADING FORCE FEEDBACK”，发明人为Frederick E.Shelton，IV，John N.Ouwerkerk，Jerome R.Morgan，and Jeffrey S.Swayze的申请(K&LNG 050516/END5692USNP)；
发明名称为“MOTOR-DRIVEN SURGICAL CUTTING ANDFASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK”，发明人为Frederick E.Shelton，IV，John N.Ouwerkerk，Jerome R.Morgan，and Jeffrey S.Swayze的申请(K&LNG 050515/END5693USNP)；
发明名称为“MOTOR-DRIVEN SURGICAL CUTTING ANDFASTENING INSTRUMENT WITH ADAPTIVE USER FEEDBACK”，发明人为Frederick E.Shelton，IV，John N.Ouwerkerk，and Jerome R.Morgan的申请(K&LNG 050513/END5694USNP)；
发明名称为“MOTOR-DRIVEN SURGICAL CUTTING ANDFASTENING INSTRUMENT WITH ARTICULATABLE ENDEFFECTOR”，发明人为Frederick E.Shelton，IV and Christoph L.Gillum的申请(K&LNG 050692/END5769USNP)；
发明名称为“MOTOR-DRIVEN SURGICAL CUTTING ANDFASTENING INSTRUMENT WITH MECHANICAL CLOSURESYSTEM”，发明人为Frederick E.Shelton，IV and Christoph L.Gillum的申请(K&LNG 050693/END5770USNP)；
发明名称为“SURGICAL CUTTING AND FASTENINGINSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM”，发明人为Frederick E.Shelton，IV and Kevin R.Doll的申请(K&LNG050694/END5771USNP)；
发明名称为“GEARING SELECTOR FOR A POWERED SURGICALCUTTING AND FASTENING STAPLING INSTRUMENT”，发明人为Frederick E.Shelton，IV，Jeffrey S.Swayze，Eugene L.Timperman的申请(K&LNG 050697/END5772USNP)；
发明名称为“SURGICAL INSTRUMENT HAVING RECORDINGCAPABILITIES”，发明人为Frederick E.Shelton，IV，John N.Ouwerkerk，and Eugene L.Timperman的申请(K&LNG 050698/END5773USNP)；
发明名称为“SURGICAL INSTRUMENT HAVING A REMOVABLEBATTERY”，发明人为Frederick E.Shelton，IV，Kevin R.Doll，Jeffrey S.Swayze and Eugene Timperman的申请(K&LNG050699/END5774USNP)；
发明名称为“ELECTRONIC LOCKOUTS AND SURGICALINSTRUMENT INCLUDING SAME”，发明人为Jeffrey S.Swayze，Frederick  E.Shelton，IV，Kevin R.Doll的申请(K&LNG050700/END5775USNP)；
发明名称为“ENDOSCOPIC SURGICAL INSTRUMENT WITH AHANDLE THAT CAN ARTICULATE WITH RESPECT TO THESHAFT”，发明人为Frederick E.Shelton，IV，Jeffrey S.Swayze，Mark S.Ortiz，and Leslie M.Fugikawa的申请(K&LNG 050701END5776USNP)；
发明名称为“ELECTRO-MECHANICAL SURGICAL CUTTINGAND FASTENING INSTRUMENT HAVING A ROTARY FIRING ANDCLOSURE SYSTEM WITH PARALLEL CLOSURE AND ANVILALIGNMENT COMPONENTS”，发明人为Frederick E.Shelton，IV，Stephen J.Balek and Eugene L. Timperman的申请(K&LNG050702/END5777USNP)；
发明名称为“SURGICAL INSTRUMENT HAVING A FEEDBACKSYSTEM”，发明人为Frederick E.Shelton，IV，Jerome R.Morgan，Kevin R.Doll，Jeffrey S.Swayze and Eugene Timperman的申请(K&LNG050705/END5780USNP)。
背景技术
本发明总的涉及外科器械，更具体而言，涉及外科切割和紧固器械。
与传统的开放式外科器械相比，内窥镜外科器械更受欢迎，原因是更小的切口往往减少术后恢复时间和并发症。通常，这些内窥镜外科器械包括“端部执行器”、手柄组件和在端部执行器和手柄组件之间延伸的细长轴。端部执行器是器械的被配置成以各种方式接合组织以实现期望诊断或治疗效果的部分(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，和使用超声、RF、激光的能量装置，等等)。
端部执行器和轴部分的尺寸被设定成通过放置在患者体内的套管针插入。细长轴部分能使端部执行器插入到期望深度并且也便于端部执行器的旋转以将其定位在患者体内。在合理放置套管针和例如通过另一套管针使用抓钳的条件下，通常这种定位程度就足够了。外科缝合和切割器械(例如在美国专利No.5,465,895中描述的)是通过插入和旋转成功地定位端部执行器的内窥镜外科器械的一个例子。
医疗构件制造者已使用过两种基本的设计方法在以降低内窥镜外科器械的总成本。然而这两种尝试对于实现使用者至少某些需求是成功的，却不能实现所有的需求。
例如，第一种方法涉及用于击发的一次性端部执行器的使用。该端部执行器是由相对于脆弱的构件制造的，由于端部执行器构件在每次击发后明显变形，因此在配置新端部执行器之前只能被击发一次。这种类型的端部执行器采用“I-梁”特征的刀，以防止砧座在击发过程中偏离钉仓。由于I-梁安座在相对脆弱的砧座构件上，I-梁使得直接位于I-梁特征下的砧座部分变形。这些因素的组合促进了缝钉形成，同时减小了致动器械所需要的力，因为I-梁只是将砧座向下相对于钉仓拉至需要随时形成缝钉正确的位置。
尽管该方法改善了缝钉形成并降低了切割组织和展开缝钉所需的力，它还具有许多缺点。首先，在每次击发后外科医生需要处理整个砧座、通道和钉仓，这增大了的制造花费。第二，由于相对于脆弱的端部执行器以及砧座实际上被夹至组织上，器械常常不能牢固地夹持目标组织。第三个问题是相对于脆弱的端部执行器仅仅可靠地适用于击发中等厚度的组织，而对于很厚的组织则无能为力。
以前曾采用过的第二种设计方法是制造更坚固的可用于多次击发的端部执行器构件。在该方法中，每次击发后仅替换钉仓组件即可。由于端部执行器构件必需耐受多次击发负荷，它们被有意设计成在每次击发后不会变形。这种设计理念在刀上采用了不同类型的特征，使得在展开缝钉以促进缝钉形成的过程中，砧座相对于钉仓保持定位。高刚性端部执行器构件与不同夹钳机理的组合使得这种类型的器械可以可靠地施加高夹钳负荷，这样外科医生可以容易地操作希望的组织。高刚性构件还促成了端部执行器可靠地适用于相对于较厚的组织样品。
但是，该方法的一个缺点是防止砧座偏离钉仓的刀现在需要将很硬的砧座向下拉向钉仓。因此刀试图将整个梁向下拉向钉仓，就像整个缝钉排那样长，而不象以前的器械那样仅将砧座在局部区域向下拉。由于刀上的砧座拖拽负荷提高了，因此该方法通常必须产生更高的展开力。
因此，需要能解决上述问题的用于外科切割和紧固器械的端部执行器配置，其在厚组织中保持相同的缝钉形成质量、夹钳性能以及重复展开缝钉的能力，并减小展开缝钉和刀所需的力。
还需要这样的端部执行器系统，它可以与长度相同但具有不同缝钉排长度的钉仓一起使用。
发明内容
本发明的一方面涉及用于外科切割和紧固器械的一次性钉仓，其包括可操作地支撑其内多个缝钉的钉仓体。本发明的各种一次性钉仓还包括相对于所述钉仓体可支撑的一次性砧座元件，使得砧座元件可以在闭合位置和打开位置之间移动，在闭合位置时砧座元件的底面与钉仓体顶面邻接，在打开位置时砧座元件的底面与钉仓体顶面间隔开使得组织被插入所述底面与所述顶面之间。至少一个组织挡块位于砧座元件上，用于与插入在砧座元件的底面和钉仓体顶面之间的组织相接触，从而相对于支撑在所述钉仓体内的缝钉定向组织。
本发明的另一方面涉及一种用于外科切割和紧固器械的端部执行器，各种实施方式的端部执行器包括细长通道，其近端连接到外科切割和紧固器械的一部分上。细长通道还具有远端，并被配置成支撑其内的一次性钉仓。端部执行器还包括具有近端和远端的刚性顶端砧座板。其该近端枢转地连接到细长通道的近端上，并且可分别响应于由支撑在外科切割和紧固器械中的驱动系统施加的打开和闭合力在打开位置和闭合位置之间选择性地枢转，在打开位置时，顶端砧座板的远端远离细长通道的远端使得一次性钉仓安座在细长通道内，在闭合位置时，顶端砧座板与安座在细长通道内的钉仓邻接。刚性顶端砧座板配置成与一次性砧座板相配合，其中一次性砧座板与安座在细长通道内的一次性钉仓关联。刀组件被可操作地支撑在所述通道内并被连接到外科切割和紧固器械的驱动系统上，用以将刀组件从细长通道的近端驱动至所述远端并将刀组件返回细长通道的近端。楔形滑块与刀组件相关联并与其一起行进。当所述刀组件从细长通道的近端被驱动至细长通道的远端时，楔形滑块被定向成致动安座在细长通道中的一次性钉仓中的缝钉驱动器。
本发明的又一方面还涉及一种用于外科切割和紧固器械的一次性钉仓。在各种实施方式中，所述钉仓包括可操作地支撑其内多个缝钉的钉仓体。一次性缝钉形成装置被连接至钉仓体上，使得一次性缝钉形成装置可在闭合位置和打开位置之间移动，在闭合位置时一次性缝钉形成装置的底面与钉仓体顶面邻接，在打开位置时一次性缝钉形成装置的底面与所述钉仓体的顶面间隔开，使得组织被插入所述底面与所述顶面之间。组织挡块装置位于一次性缝钉形成装置上，用于与插入在一次性缝钉形成装置的底面和钉仓体顶面之间的组织相接触，相对于支撑在所述钉仓体内的缝钉定位组织。
本发明的再一方面还涉及一种用于外科切割和紧固器械的端部执行器，其结构适合于与多个相同长度钉仓体中的至少一个联用。各个钉仓体内可操作地支撑多个排列成至少第一缝钉排的缝钉，并具有与其关联地至少一个组织挡块。端部执行器的结构还适合与另一多个其它钉仓体的至少一个其它钉仓体一起使用，该另一多个其它钉仓体的长度与相同长度钉仓体的长度相同，并且其内可操作地支撑多个其它缝钉，所述其它缝钉排列成至少一个其它缝钉排，其它缝钉的其它排比钉仓体中的缝钉排长。各种实施方式的端部执行器包括连接至外科切割和紧固器械一部分的细长通道。细长通道配置成支撑其内的任一钉仓体和其它钉仓体。顶端砧座板被端枢转地连接到细长通道上，并且可分别响应由支撑在外科切割和紧固器械中的驱动系统施加其上的打开和闭合的力在打开位置和闭合位置之间移动。顶端砧座板具有至少一个与其相关联的顶端组织挡块，并且至少一个顶端组织挡块被配置成当钉仓体安座在细长通道中以相对于其内的缝钉排定位组织时，与至少一个与钉仓体关联的组织挡块协作。至少一个顶端组织挡块进一步被配置成当所述其它钉仓体安座在细长通道时，定位夹持在顶端砧座和其它钉仓体之一之间的组织，使得至少一个顶端组织挡块相对于在其它钉仓体中的至少另一排其它缝钉定位组织。刀和缝钉驱动器组件被可操作地支撑在所述细长通道中，并配置成接收来自外科切割和紧固器械驱动系统的向前驱动运动以及相反的运动，当所述刀和缝钉驱动器组件被向前驱动时，夹持在端部执行器中的组织被切割并被安座在细长通道中的钉仓所支撑的缝钉缝合。
本发明具体涉及如下方面：
(1)一种用于外科切割和紧固器械的一次性钉仓，所述钉仓包括：
钉仓体，其可操作地在内部支撑多个缝钉；
相对于所述钉仓体支撑的一次性砧座，使得所述一次性砧座可以在闭合位置和打开位置之间移动，在闭合位置时，所述一次性砧座的底面与所述钉仓体的顶面邻接，在打开位置时，所述一次性砧座的底面与所述钉仓体的顶面间隔开，从而允许组织被插入在所述底面和所述顶面之间；以及
至少一个组织挡块，其位于所述一次性砧座上，用于与插入在一次性砧座的底面和所述钉仓体顶面之间的组织相接触，从而相对于支撑在所述钉仓体内的缝钉定向组织。
(2)如第(1)项所述的一次性钉仓，其中，所述一次性砧座由可偏转的板材制造。
(3)如第(1)项所述的一次性钉仓，其中，在所述一次性砧座的所述底面形成与在所述钉仓体中的所述多个缝钉对应的多个缝钉形成凹窝。
(4)如第(1)项所述的一次性钉仓，其中，所述一次性砧座的近端通过至少一个弹簧连接到所述钉仓体的近端上。
(5)如第(1)项所述的一次性钉仓，其中，所述至少一个组织挡块包括从所述一次性砧座的一个侧面向下突出的第一组织挡块和从所述一次性砧座的第二侧面向下突出的第二组织挡块。
(6)如第(1)项所述的一次性钉仓，其中，所述一次性砧座的所述顶面适于相配地接合外科切割和紧固器械上的刚性顶端砧座板。
(7)如第(6)项所述的一次性钉仓，还包括沿所述一次性砧座的每个侧面延伸的加强杆。
(8)如第(1)项所述的一次性钉仓，其中，所述一次性砧座具有沿纵向延伸的槽部，使得外科切割和紧固器械的刀组件的一部分能够通过所述槽部分伸出，当刀组件被驱动穿过所述钉仓体和所述一次性砧板上的所述纵向延伸的槽时，在刀组件上侧向延伸的导向突起用于向所述钉仓体的所述顶面偏压一次性砧座。
(9)如第(1)项所述的一次性钉仓，其中，所述一次性砧座由金属片材制造。
(10)如第(1)项所述的一次性钉仓，还包括可操作地支撑在所述钉仓体中的多个缝钉驱动器，每个所述缝钉驱动器上支撑至少一个缝钉，并可动地支撑在所述钉仓体中，使得每个所述缝钉驱动器在被外科切割和紧固器械的驱动楔形凸轮接触到时，驱动其上支撑的缝钉与所述一次性砧座形成接触。
(11)一种用于外科切割和紧固器械的端部执行器，所述端部执行器包括：
通道，其近端连接到外科切割和紧固器械的一部分上，所述通道还具有远端，并被配置成支撑其内的一次性钉仓；
具有近端和远端的刚性顶端砧座板，所述近端枢转地连接到所述通道的所述近端上，并且可分别响应于由支撑在外科切割和紧固器械中的驱动系统施加的打开和闭合的力在打开位置和闭合位置之间选择性地枢转，在打开位置时，所述顶端砧座板的所述远端远离所述通道的所述远端使一次性钉仓座能安座在所述通道内，在闭合位置时，所述顶端砧座板与安座在通道内的钉仓邻接，所述刚性顶端砧座板被配置成与一次性砧座板相配合，所述一次性砧座板于安座在通道内的一次性钉仓相关联；
可操作地支撑在所述通道内的刀组件，其被连接到外科切割和紧固器械的驱动系统上，用以将所述刀组件从所述通道的所述近端驱动至所述远端并使所述刀组件返回所述通道的所述近端；以及
与所述刀组件相关联并与其一起行进的楔形滑块，当所述刀组件从所述通道的所述近端被驱动至所述通道的所述远端时，所述楔形滑块被定向成致动安座在通道中的一次性钉仓中的缝钉驱动器。
(12)如第(11)项所述的端部执行器，其中，所述刚性顶端砧座板上形成有至少一个顶端组织挡块，用以将夹紧在一次性砧座板与安座在所述通道中的一次性钉仓之间的组织相对于支撑在一次性钉仓内的缝钉定位。
(13)如第(12)项所述的端部执行器，其中，一次性砧座元件上形成有至少一个底部组织挡块，所述至少一个顶端组织挡块之一分别对应于一次性砧座板上的底部组织挡块，并且当一次性钉仓和一次性砧座板收纳在所述通道内时所述至少一个顶端组织挡块之一与一次性砧座板上的底部组织挡块抵接。
(14)如第(11)项所述的端部执行器，其中，当一次性砧座板处于闭合位置并且所述刀组件被从所述通道的所述近端驱动至所述通道的所述远端时，所述刀组件的一部分从安座在所述通道内的一次性钉仓中的细长槽穿出，并且所述刀组件的另一部分从与一次性钉仓相关联的一次性砧座板中的另一细长槽穿出。
(15)如第(14)项所述的端部执行器，还包括在所述刀组件的所述另一部分上的至少一个偏转器突起，当刀组件被从所述近端驱动至所述远端时，每个所述偏转器突起将一次性砧座板压向一次性钉仓。
(16)如第(11)项所述的端部执行器，其中，所述刚性顶端砧座板的大小适于保持装配在一次性砧座板上的加强脊之间。
(17)一种用于外科切割和紧固器械的一次性钉仓，所述钉仓包括：
可操作地支撑其内的多个缝钉的钉仓体；
一次性缝钉形成装置，其连接至所述钉仓上，使得一次性缝钉形成装置可在闭合位置和打开位置之间移动，在闭合位置时，所述一次性缝钉形成装置的底面与所述钉仓体的顶面邻接，在打开位置时，所述一次性缝钉形成装置的底面与所述钉仓体的顶面间隔开，使得组织能被插入在所述底面与所述顶面之间；以及
在所述一次性缝钉形成装置上的组织挡块装置，用于与插入在一次性缝钉形成装置的底面和所述钉仓体的顶面之间的组织相接触，从而相对于支撑在所述钉仓体内的缝钉向定组织。
(18)如第(17)项所述的一次性钉仓，其中，所述一次性缝钉形成装置包括可变形的砧座板。
(19)如第(18)项所述的一次性钉仓，其中，所述可变形的砧座板内具有与钉仓内的缝钉相对应的缝钉形成凹窝。
(20)如第(17)项所述的一次性钉仓，其中，所述一次性缝钉形成装置通过至少一个将所述一次性缝钉形成装置偏压至打开位置的偏置元件连接至所述钉仓体上。
(21)一种用于外科切割和紧固器械的端部执行器，其被构造成适于与多个相同长度钉仓体中的至少一个联用，其中，每个钉仓体内可操作地支撑多个排列成至少一排即第一缝钉排的缝钉，并具有与其关联的至少一个组织挡块，所述端部执行器还被构造成适于与另一多个钉仓体的至少一个其它钉仓体联用，所述另一多个钉仓体的长度与所述相同长度钉仓体的长度相同，并且其内可操作地支撑多个其它缝钉，所述其它缝钉排列成至少一排其它排，其它缝钉的所述其它排比钉仓体中的缝钉排长；所述端部执行器包括：
可连接至外科切割和紧固器械的一部分上的细长通道，所述细长通道被配置成支撑其内的任一钉仓体和其它钉仓体；
顶端砧座板，其被枢转地连接到所述细长通道上，并且可分别响应由支撑在外科切割和紧固器械中的驱动系统施加的打开和闭合的力在打开位置和闭合位置之间移动，所述顶端砧座板具有与其相关联的至少一个顶端组织挡块，所述至少一个顶端组织挡块被配置成当所述其它钉仓体安座在所述细长通道中以相对于其内的缝钉排定位组织时，与至少一个与钉仓体关联的组织挡块协作，所述至少一个顶端组织挡块还被配置成当所述其它钉仓体安座在所述细长通道时，定位夹紧在顶端砧座和其它钉仓体之一之间的组织，使得所述至少一个顶端组织挡块相对于在所述其它钉仓体中的至少另一排其它缝钉定位组织；以及
刀和缝钉驱动器组件，其被可操作地支撑在所述细长通道中，并配置成接收来自外科切割和紧固器械驱动系统的向前驱动运动以及相反运动，从而当所述刀和缝钉驱动器组件被向前驱动时，夹紧在端部执行器中的组织被切割并被支撑于钉仓中的缝钉缝合，所述钉仓安装在细长通道中。
附图说明
以下将通过实施例并参考附图，描述本发明的各种实施方式，相同的标号表示相同的部件，其中：
图1是可采用本发明各种实施方式的端部执行器以及钉仓的外科切割和紧固器械的透视图；
图2是根据本发明实施方式的端部执行器的分解组装图；
图3是其中支撑本发明钉仓实施方式的本发明端部执行器实施方式的截面图，为清楚起见，省略了一些构件；
图4是本发明钉仓实施方式的局部俯视图；
图5是本发明的钉仓实施方式与端部执行器的局部截面图，图解说明缝钉被击发进入夹在端部执行器中的组织内；
图6是根据本发明端部执行器实施方式以及钉仓实施方式的底部透视图，其中移除了细长通道；
图7是本发明端部执行器实施方式以及钉仓实施方式的局部透视图；
图8是安装在本发明的端部执行器实施方式中的本发明的钉仓实施方式的透视图，其中钉仓处于打开位置；
图9是图8所示的端部执行器以及钉仓的截面图；
图10是图8和9中所示的端部执行器以及钉仓的透视图；
图11是本发明各种实施方式的钉仓和端部执行器的截面图，其处于夹持一片组织前的打开位置；
图12是本发明另一实施方式的钉仓和端部执行器处于闭合状态的透视图；
图13是图12的实施方式中钉仓和端部执行器的另一透视图，图解说明其底部砧座板在从端部执行器移出之前的位置；
图14是图12和13的钉仓和端部执行器处于打开状态的透视图；
图15是图14中所示的钉仓和端部执行器的截面图；
图16是本发明各种实施方式的钉仓和端部执行器处于打开状态的局部放大截面图；
图17是本发明各种实施方式的端部执行器和钉仓组件处于闭合状态的截面图；
图18是图17的端部执行器和钉仓的局部放大截面图；
图19是本发明各种实施方式的远端驱动轴部分的透视图；
图20是图19的远端驱动轴部分的截面图；
图21是本发明各种实施方式的渐细的夹合元件(渐细的夹合元件)的透视图；
图22是图21的渐细的夹合元件的截面图；
图23是本发明各种实施方式的夹合板的透视图；
图24是图23的夹合板的截面图；
图25是本发明各种实施方式的闭合螺母的透视图；
图26是图25中闭合螺母的截面图；
图27是远端驱动轴部分和闭合螺母的截面图，其中闭合螺母处于打开状态；以及
图28是远端驱动轴部分和闭合螺母的截面图，其中闭合螺母处于闭合状态。
具体实施方式
图1所示为能够实现本发明的端部执行器配置和/或钉仓配置的外科切割和紧固器械10。图1中所示的外科器械10包括手柄6、轴组件8和关节运动的端部执行器300，其中端部执行器300在关节运动枢轴14处枢转地连接至轴组件8上。在各种实施方式中，控制手柄中容纳有驱动电动机600和总体用610表示的控制器系统，用于控制端部执行器300的打开和闭合，以及控制对其内夹持组织的切割和缝合。关节运动控制器16可以设置成与手柄6邻接，以执行端部执行器绕关节运动枢轴14旋转。器械10的手柄6可以包括闭合扳机18和击发扳机20用于使端部执行器300关节运动。所示的端部执行器300优选通过细长轴8与手柄6隔开。在一个实施方式中，器械10的医生或操作者可以通过利用关节运动控制器16相对于轴8使端部执行器300关节运动，如GeoffreyC.Hueil等人于2006年1月10日提交的发明名称为“urgical InstrumentHaving An Articulating End Effector”的未决美国专利申请No.11/329,020号中所详细记载的那样，其全部内容通过引用并入本文。也可以采用其它的关节运动设置。
如下面所进一步详细阐述的，各种端部执行器的实施方式包括可枢转地移动的砧座组件，其被保持的间距能确保有效地缝合与切割夹持在端部执行器300中的组织。在各种示例性的实施方式中，手柄6可以包括手枪式握把26，医生向握把枢转地拉动闭合扳机18，使得顶部砧座板340朝向安座在端部执行器300的细长通道302中的钉仓500夹钳或闭合，从而夹持位于顶部砧座板340和钉仓500中的组织。击发扳机20可以位于闭合扳机18外侧更远的位置。在各种实施方式中，如下文中所述，一旦闭合扳机18被锁定在闭合位置，则击发扳机20可以稍微向手枪式握把26转动，这样操作者使用单手就可以够到。然后操作者可以朝向手枪式握把26枢转地拉动击发扳机20，从而缝合和切割端部执行器300中的组织。本领域技术人员很容易理解，在不背离本发明的范围与实质的基础上，其它手柄以及驱动系统配置可以成功地与本文中记载的各种实施方式及其等同结构联合使用。
应理解，这里使用的术语“近端”和“远端”是相对握持器械10的手柄6的医生而言的。因此，端部执行器300相对于更近端的手柄6处于远端。还应理解，为了方便和简明起见，这里使用的空间术语例如“垂直”和“水平”是相对附图而言的。然而，外科器械可以以各种朝向和位置使用，这些术语并不是想要对其进行限制和绝对化。
图2-11图解说明了本发明各种实施方式的独特和新颖的端部执行器300。如具体实施方式所阐述的，应理解附图中的端部执行器300可以容纳不同的钉仓500。例如，端部执行器300可以容纳具有相同长度钉仓体的45mm和60mm的一次性钉仓。这样的钉仓体及其操作是已知的，因而本文中不再详述。例如，发明名称为“Surgical Stapling InstrumentIncorporating an E-beam Firing Mechanism，”的美国专利No.6,978,921提供了关于这些钉仓结构的详细记载，其全部通过引用并入本文。
一般而言，各个钉仓500包括钉仓体502，钉仓体502被从钉仓体502的近端向其渐细的外部尖端延伸的中央细长槽508分开。参见图2。钉仓体502可以由聚合材料制造并被连接到金属钉仓盘510上。在各种设置中，例如用于45mm钉仓的钉仓体502可具有与用于60mm钉仓的钉仓体502的长度“L”相同的长度。多个缝钉接收凹窝512形成于钉仓体205内，并排布成横向间隔的六纵行或“排”缝钉514、516、518、520,522、524。参见图5。在各种实施方式中，用于45mm钉仓的缝钉排的长度“L”会短于在605mm钉仓中的排的长度“L”。本领域技术人员很容易理解，这里所用的45mm和60mm大小的钉仓仅仅是作为例子。其它具有不同排缝钉的钉仓尺寸也包括在本发明的各种实施方式中。
缝钉-支撑驱动器532定位在凹窝512内，驱动器532上支撑有缝钉534。根据缝钉接收凹窝512的位置(排)，缝钉支撑驱动器532其上可以支撑一个或两个缝钉530。钉仓体502还包括从其近端504向其渐细的外尖端506延伸的四个纵向槽503、505、507、509，用以接收在端部执行器300中的楔形滑块326上形成的滑块凸轮328，其结构及操作将在下面详细说明。参见图3。当滑块凸轮342通过钉仓体502中其相应的槽503、505、507、509从近端向远端506行进时，接触到与这些槽关联的缝钉支撑驱动器532，并推动缝钉支撑驱动器532和其支撑的缝钉534从钉仓体502向上伸出。参见图6。当缝钉534的臂536的端部接触到形成于底部砧座板350中的凹窝358时，它们被折叠使缝钉534闭合。
如具体实施方式中所描述的，本领域技术人员还可以理解，本发明各种实施方式的各种独特新颖的方面使得许多端部执行器构件可以由金属片制造以降低端部执行器的总成本。其它端部执行器构件可以包括机加工零件。
本发明的各种端部执行器包括细长通道302，其大小适合可移出地接收和支撑一次性钉仓500的钉仓体502。应当理解，在各种实施方式中，细长通道302被配置成支撑任一大小相同的钉仓体，无论其内支撑的缝钉排的长度如何。刀螺杆304被可转动地支撑在细长通道302中。刀螺杆304具有远端306，其上连接有远端推力轴承308，推力轴承308被细长通道302的远端303中形成的远端轴承壳体310可转动地支撑。参见图2。刀螺杆304具有中心驱动部件312，其上形成有螺旋线。刀螺杆304还具有光滑的延伸部分314以及形成于其上或者连接于其上的刀螺杆齿轮316。近端推力轴承318形成刀螺杆304或连接于其上。近端推力轴承318可转动地被容纳于支撑在远端中心管部分58中的近端轴承壳体319内。参见图9。远端中心管部分58具有一对在其远端形成的柱59，其适于被接纳在细长通道302的近端305形成的垂直槽307中。柱59可以通过摩擦、粘合剂或通过长轴管9的远端被保留在细长通道302中的槽307内。参见图1。
本发明的各种实施方式还包括刀组件320，其具有在刀螺杆304的螺纹部分312上螺纹形成的刀/滑块轴承322。刀组件320支撑垂直延伸的刀片324以及支撑四个滑块凸轮328的锲形滑块326。读者会理解，当刀螺杆304沿顺时针方向转动时，刀组件320和锲形滑块326向细长通道302的远端303(方向“A”)前进，并且当刀螺杆304沿逆时针方向转动时，刀组件320和锲形滑块326向通道元件302的近端305(方向“B”)移动。如图9中所示，在各种实施方式中，刀组件320其上具有扁平轴承部分322，用于在细长通道302底部的内表面上滑动，并且当刀组件320和锲形滑块326在细长通道302中前进时提供对它们的支撑。此外，刀组件320具有一对从其中伸出侧向延伸的偏转器突起330，其目的将在下文中说明。
在本发明的各种实施方式中，顶端砧座板340通过一对转轴式销342被枢转地接合至通道元件302的近端305，其中转轴式销342的大小可以容纳于贯穿通道元件302的侧壁309设置的椭圆形枢轴孔中。在各种实施方式中，顶端砧座板350由刚性材料制造以在使用过程中使顶端砧座元件的偏转或翘曲最小化。顶端砧座板340被设计成与通过至少一个、优选两个弹簧352连接至钉仓500的近端504上的底部砧座板350相接合。在各种实施方式中，各个弹簧352的一部分353通过粘合剂、槽、机械紧固件等被连接至钉仓体502上。各个弹簧352的其它部分354通过粘合剂、槽、机械紧固件等被连接至底部砧座板350的底面356。参见图2。如图8中所示，底部砧座板350的底面356具有的缝钉形成凹窝358形成于其中。应当理解，在各种实施方式中，底部砧座板350可以被连接至钉仓体502上使得缝钉形成凹窝358对准钉仓体502中的相应缝钉接收凹窝512。可以理解，缝钉形成凹窝358用于当缝钉臂536的端部被压迫接触缝钉534时靠近缝钉534。参见图6。而且，在各种实施方式中，可以在顶端砧座板340的底面341中形成类似的缝钉凹窝(未示出)。随着对具体实施方式的进一步描述，应理解，这样的顶端砧座板构造会使得端部执行器300能够有效地与不具有与其关联的底端砧座的钉仓500、以及具有这种与其连接或关联的底端砧座的钉仓500一起使用。
在各种实施方式中，底部砧座板350可以被直接连接至钉仓体302上并与其组合。但是，在其它实施方式中，底部砧座板350可以在使用者使用前，单独地组合或安装在钉仓500上。例如，可以在钉仓体502的顶面503上设置一对槽或其它保留形状，用于在其中保留弹簧352的部分353。在其它实施方式中，例如底部砧座板350可以通过搭扣等被连接至顶端砧座板上。这样，就会理解，在本发明的各种实施方式中，部砧座板350并不需要必须连接在钉仓体502上。底部砧座板350只是不得不与特定的相应钉仓“相关联”。如本文中所用的，术语“相关联”指底端砧座350板被设置成与特定的钉仓对准，当钉仓中的缝钉被展开进入底部砧座板350中时，底部砧座板350导致缝钉534以预期的方式成形，并包括其中底部砧座板350直接接合到临时连接在顶端砧座板340的钉仓体502上的那些设置，以及在缝钉534被展开进入夹持在端部执行器300的组织中的过程中，其中底部砧座板350另外被保持对准在顶端砧座板340和钉仓体502之间的钉仓体502的那些设置。
在各种实施方式中，例如，在底部砧座板350上设置一对沿底部砧座板350的侧边缘延伸的加强杆360，使得当在细长通道302中安装通常标为370的钉仓/底部砧座板组件时，顶端砧座板340被容纳在加强杆360之间形成砧座组件372。读者会理解，加强杆360用于加强砧座组件并用于搭扣地将底部砧座板350连接到顶端砧座板340上。在各种实施方式中，底部砧座板350可以由金属片、或类似材料或薄的可偏转板材冲压、或者折叠或者形成。这样使用后，它与钉仓体502一起被弃去。因此，对于本发明的各种实施方式，底部砧座板350可以在本文中被称作“一次性砧座板”或“一次性砧座”。
此外，纵向槽362可以设置通过底部砧座板350的中央用于从中容纳刀组件320的上端。在底部砧座板350的上表面357与顶端砧座板340的底面341之间可以提供充足的空间，使得当组件320和锲形滑块326被驱动穿过钉仓520以切割组织和展开缝钉534时，在刀组件320的上端上形成的侧向延伸的导向突起330能够座靠在底部砧座板357的上表面，将底部砧座板350向钉仓体502迫近。此外，纵向槽343可以设置在顶端砧座板340的底面341中以在其中容纳刀组件320的顶端。
本发明的另一个独特而新颖的方面是各种端部执行器的实施方式能够有效地与具有不同缝钉排长度“L”的缝钉仓连接使用。例如本发明的各种实施方式在底部砧座板350上采用组织挡块364。此外，如图8-11中所示，当钉仓组件500被安装在通道中时，为了支撑在砧座板350上的这些“第一”组织挡块364，在顶端砧座板340形成一对顶端组织挡块344以支持和抵靠第一组织挡块364(或者“与其协作”)。本领域技术人员可以理解，在底部砧座板350上的第一组织挡块364的位置可以特定地与连接在在一次性钉仓500上最内侧的缝钉接收凹窝512的位置相适应。如以下将进一步详细讨论的，本发明的这一独特新颖的方面使得能够在端部执行器中使用具有不同长度“L”缝钉排(例如45mm、60mm等)的各种不同的钉仓。
在顶端砧座板340的底面341没有缝钉形成凹窝形成的其它实施方式，底部砧座板350可以采用上述用于那些具有长排缝钉的钉仓500的那些，其只是依靠在顶部组织挡块344上以定位组织，自始至终地防止组织回到砧座/钉仓设置中导致组织被切割但却未被缝合。因此，如图15-19中所示。为了从通道302中移出废钉仓500，下压底部砧座板350，将钉仓和底部砧座板350从长通道302的远端303取出。参见图13。
现在将参照图2以及图18-29，描述用于操作各种实施方式的端部执行器300的驱动组件。如图2以及17-19中所示，远端驱动轴部分402延伸通过在远端中心管58中的驱动轴孔61。远端驱动轴部分402可以直接延伸至在控制手柄6中的驱动电动机设置，或者它可以关节运动使得端部执行器300相对于将端部执行器300连接至控制手柄6的轴或闭合管组件而枢转运动。尽管这些方面并不是本发明公开的主要焦点，以下将简略描述各种替代设置。
如图20、21、28和29中所示，远端驱动轴部分402具有夹合-接受部分404以及在其上形成的闭合螺纹406。夹合组件410可滑动地容纳在驱动轴部分402的夹合-接受部分404上。如图2、22和23中所示，夹合组件410包括夹头样渐细夹合元件412，其具有在其近端143上一体形成的驱动齿轮414。驱动齿轮414与传动齿轮450啮合，传动齿轮450依次与刀螺杆齿轮316啮合。参见图2、6和7。因此，夹合组件410驱动地与远端驱动轴部分402相接合。驱动齿轮414转动传动齿轮450，后者又转动刀螺杆齿轮316。
在渐细的夹合元件412的远端415上形成一连串的4个渐细部分416。在渐细部分416的内部形成一连串凸花键418。参见图22和23。如以下将详细说明的凸花键418适合选择性地与在远端驱动轴部分402上形成的凹花键部分408相接合。参见图20和21。夹合组件410还包括接纳在渐细的夹合元件412的渐细部分41上的夹合板420。如图24和25中所示，夹合板420具有近端毂部分422和被凸缘部分426隔开的远端毂部分424。圆柱形远端孔部分428延伸通过远端毂部分424，并且渐细的近端孔430延伸通过凸缘部分426和近端毂部分422。参见图25。孔部分428、430使得夹合板420被可滑动地容纳在驱动轴402上并在渐细的夹合元件412上滑动。在渐细的夹合元件412上形成的凸缘部分417与夹合板420的凸缘部分426之间设置夹合打开弹簧，并且推力轴承434还被轴颈连接(journaled)在与夹合板420相邻的夹合-接受部分404a上。参见图2、17和19。
在各种实施方式中，闭合螺母440被接收在远端驱动轴部分402上。如图27-29中所示，闭合螺母440具有于其中部分地延伸的螺纹孔部分442使得它可以被螺接到远端驱动轴部分402的闭合螺纹406上。如这些图中进一步可看到的，闭合螺母具有突出的直立闭合斜面444。闭合斜面444的顶部终止于向直立的闭合突起448延伸的圆角部分446，闭合突起448适合与在顶端砧座板340的近端345上形成的向下突出的闭合钩346相接合。
更具体地说，参照图17和19，顶端砧座板340的近端345具有从近端突出的砧座闭合臂部分347，终止于向下延伸的闭合钩346。如这些图中所示，砧座闭合臂347的底面上具有突起缓冲槽348，用于当闭合螺母440向器最远端的位置前进时接纳闭合突起348(如图17和28中所示)。在各种实施方式中，闭合锁定弹簧460通过机械紧固件装置或粘合剂被连接在通道元件302的底部。闭合锁定弹簧460具有上部462，其终端在直立的保持器凸缘464上。此外，纵向延伸的保持器臂被刚性连接到闭合锁定弹簧460的上部462。
以下将参照图9、11、17-19和28-29，描述本发明各种实施方式。图9、11和17所示为处于打开状态的端部执行器。如这些图中所示，当处于打开位置时，顶端砧座板340的闭合钩臂346骑靠在闭合螺母440的倾斜部分444上。当处于该位置时，顶端砧座板340臂被枢转转动到打开位置。同样当处于该位置时，连接到闭合锁定弹簧460上的保持器臂466的端部与在刀组件320的近端上形成的倾斜表面321相接触。当刀组件320向近端移动时，保持器臂466的端部接触到在刀组件320近端上的倾斜表面321并使得保持器臂466将闭合锁定弹簧460的上部462朝向细长通道302的底部向下偏压。当刀组件320从保持器臂466向远端移动时，锁定弹簧460的上部462能够向上弹起使得保持器凸缘464与闭合螺母440相接合，如下文中将进一步讨论的。如图中所示，当处于打开位置时，闭合突起448位于顶端砧座板340底面上的突起缓冲槽348内。
读者可以理解，当如图9、11和17中所示，端部执行器300处于打开位置时，使用者可以在细长元件302中安装一次性钉仓组件500。当远端驱动轴部分402沿第一方向转动时，其上的闭合螺纹406沿近端方向螺纹地驱动闭合螺母440(图28中的方向“A”)直至闭合螺纹406与闭合螺母440中的螺纹孔脱离。参见图29。当闭合螺母440被向近端驱动时，在砧座闭合臂347上的闭合钩346向上拱起闭合螺母440的斜面444直至它拱入圆角部分446并接触闭合突起448。闭合螺母440的这种运动能够将砧座组件372(顶端砧座板240和底部砧座板350)“拉”至闭合位置，如图18和19中所示。
闭合螺母440被沿近端方向驱动时，闭合螺母440的近端449接触到推力轴承434，推力轴承434将夹合板420沿近端方向压迫抵抗夹合打开弹簧432的力。闭合螺母440向近端的进一步移动将夹合板420推动到渐细的夹合元件412的渐细部分416上，使得其中的凸花键418与远端驱动轴部分402上的凹花键408相接合。渐细的夹合元件412中的凸花键418同远端驱动轴部分402上的凹花键之间的这种接合导致渐细的夹合元件412和驱动齿轮414与远端驱动轴部分402一起转动。驱动齿轮414又转动引起刀螺杆转动的刀螺杆齿轮316并向远端驱动刀组件(“B：方向”)。
当刀组件320被向远端驱动时，侧向延伸的导向突起330与底部砧座板350的顶面相接合，并向下拉动底部砧座板350以进一部分夹持位于底部砧座板350和钉仓体502之间的组织。刀组件320上的刀片324切割组织，锲形滑块326上的凸轮328能够向上驱动将缝钉向底部砧座板350驱动的缝钉支撑驱动器532。当缝钉534的臂536臂驱动进入底部砧座板350中的相应缝钉形成凹窝358时，它们被折叠。参见图6。其中在底部砧座板360上形成至少一个组织挡块364的那些实施方式中，组织挡块364同在顶端砧座板340上的顶端组织挡块344协作以防止组织延伸地太远进入最内侧缝钉之外的钉仓/砧板装置，从而防止将不会被缝合的组织被切割。类似地，也具有形成在顶端砧座板340底面的缝钉形成凹窝并且不采用底部砧座板的那些端部执行器方案中，顶端组织挡块344具有足够的刚性以实现上述的功能，确保未被切割的组织不会被缝合。对于采用未配置组织挡块的底部砧座板350’的那些端部执行器实施方式300’(图12-16)，将依靠在顶端砧座板340上的顶端组织挡块344相对于钉仓500中的缝钉将组织定向，从而防止将不会被缝合的组织被切割。
当刀组件320向远端移动时，保持器臂466不再与刀组件320的倾斜表面321相接触，使得保持器臂466和闭合锁定弹簧460的上部462向上弹起，进一步导致闭合锁定弹簧460上的保持器凸缘464与闭合螺母440的远端保持地接合，以防止其向远端移动。参见图17和18。由于其与与推力轴承434接触的闭合螺母440相接触，保持器凸缘464保持夹合组件410与远端驱动轴部分402相接合，直至刀组件320再次返回接触到保持器臂464。当刀组件320被驱动至其最终的远端位置，如图17中所示，其触发装配在细长通道302中的常规传感器或接触器313，并信号通知控制器电动机停止驱动驱动轴402。参见图2。本领域技术人员将会理解，可以使用各种不同的控制器装置来控制驱动轴402。例如，当刀组件310到达其最远端位置并触发传感器313，容纳在手柄6中的控制器系统610会自动地将其中的驱动电动机反向，并使得驱动轴部分402和刀螺杆反向(例如沿近端“A”方向移动)。在各种其它实施方式中，控制器系统610可以简单地将驱动电动机600停止，然后要求医生触发按钮30使得马达600反向。在其它设置中，控制器系统610可以在触发反向传感器313的时刻与将电动机600反向的时刻之间设定预置的定时延迟。
当刀组件320在刀螺杆304向近端方向移动时，驱动轴402上的闭合螺纹406开始旋回进闭合螺母440中的螺纹孔部分。在该过程中，刀组件320的倾斜表面321再次接触到能够将闭合锁定弹簧460向细长通道302的底部偏压的保持器臂466的端部，使保持器凸缘464与闭合螺母440的远端脱离，从而容许夹合打开弹簧432向远端偏压夹合组件410和闭合螺母440。当闭合螺母440向远端移动时，在顶端砧座板上的闭合钩346将闭合螺母440上的斜面444向上拱，直至闭合螺母440到达打开的位置，其中闭合突起448接触到顶端砧座板中的突起缓冲槽348，并且闭合螺母440推动砧座组件372至打开位置。在细长通道302的近端部分305装配用于感应的第二常规传感器和接触器315，当闭合螺母440处于打开位置时能够感应，并与电动机相通使其停止。参见图2。
如上所述，可以采用各种不同的电动机/控制器装置来向驱动轴部分402提供动力。例如，在各种实施方式中，当开动闭合扳机18，即，被器械10的使用者拉拽，电动机600则可以开始上述闭合过程。可以在细长通道元件302中使用第三传感器315’，用于当闭合螺母404已移动至闭合位置(如图所示)时能够感应。当第三传感器315’感应到闭合螺母440正处于那样的位置，传感器315’可以使得电动机停止转动。因此，如果医生对于在端部执行器300中夹持组织感到满意的话，医生可以触发击发扳机20或其它触发装置，从而以上述方式开动电动机600以转动驱动刀螺杆304的驱动轴402。
从上述讨论中可以理解，本发明的各种实施方式与现有技术外科切割和紧固器械的端部执行器以及这种器械一起使用的钉仓相比，体现出了巨大的进步。尤其是，本发明的各种实施方式能够在同一端部执行器中使用不同的钉仓设置。本发明至少某些实施方式的其它特征涉及提供制造更经济的钉仓，而且其仅要求切割和缝合组织的器械产生较低的击发力。而且，本发明的各种实施方式的另一特征在于所提供的端部执行器可以利用低于至少某些现有技术端部执行器设置的击发力反复地将缝钉展开进入厚组织。
通过引用而全部或者部分并入本文中的任何专利、公开出版物或者其它公开的材料，仅限于不会与在本申请中公开的定义、陈述或者其它公开的材料相矛盾的部分。如此一来，必要时这里明显阐述的公开内容替代任何通过引用而并入本文中的相矛盾的材料。
要求保护的本发明并不仅限于所公开的具体实施方式。这些实施方式是为了示例性地说明而并不限制本发明。在不偏离本发明的实质可以进行各种变通及改变。因此，可以理解，所有这些落在权利要求所限定的本发明范围和精神内的等同方式、变通及改变都在本发明的范围内。

Claims (10)

1.一种用于可再次使用的外科切割和紧固器械的一次性钉仓，所述钉仓包括：
一次性钉仓体，其可操作地在内部支撑多个缝钉，使得所述缝钉能够被所述外科切割和紧固器械的可轴向运动的驱动部分随后从所述钉仓体击发，所述钉仓体的尺寸为在使用过程中可移出地支撑在所述外科切割和紧固器械的细长通道内，在使用后能够从所述细长通道移出；
相对于所述钉仓体支撑的一次性砧座，使得当所述一次性砧座被安座在所述细长通道内时所述一次性砧座能够在闭合位置和打开位置之间移动，在闭合位置时，所述一次性砧座的底面与所述钉仓体的顶面邻接，在打开位置时，所述一次性砧座的底面与所述钉仓体的顶面间隔开，从而允许组织被插入在所述底面和所述顶面之间，所述一次性砧座具有顶面，当所述一次性钉仓体被安座在所述细长通道中时，所述砧座的顶面能够与所述外科切割和紧固器械上的顶端砧座板接合和脱离，并且，当所述一次性钉仓体从所述细长通道被移出时，所述一次性砧座与所述一次性钉仓保持在一起，而且所述顶端砧座板与所述可再次使用的外科切割和紧固器械保持在一起；以及
至少一个组织挡块，其位于所述一次性砧座上，用于与插入在一次性砧座的底面和所述钉仓体顶面之间的组织相接触，从而相对于支撑在所述钉仓体内的缝钉定向组织。
2.如权利要求1所述的一次性钉仓，其特征为，所述一次性砧座由可偏转的板材制造。
3.如权利要求1所述的一次性钉仓，其特征为，在所述一次性砧座的所述底面形成与在所述钉仓体中的所述多个缝钉对应的多个缝钉形成凹窝。
4.如权利要求1所述的一次性钉仓，其特征为，所述一次性砧座的近端通过至少一个弹簧连接到所述钉仓体的近端上。
5.如权利要求1所述的一次性钉仓，其特征为，所述至少一个组织挡块包括从所述一次性砧座的一个侧面向下突出的第一组织挡块和从所述一次性砧座的第二侧面向下突出的第二组织挡块。
6.如权利要求1所述的一次性钉仓，其特征为，所述可再次使用的外科切割和紧固器械上的所述顶端砧座板是刚性的，所述一次性砧座的所述顶面适于相配地接合所述可再次使用的外科切割和紧固器械上的刚性顶端砧座板。
7.如权利要求6所述的一次性钉仓，还包括沿所述一次性砧座的每个侧面延伸的加强杆。
8.如权利要求1所述的一次性钉仓，其特征为，所述一次性砧座具有沿纵向延伸的槽部，使得外科切割和紧固器械的刀组件的一部分能够通过所述槽部分伸出，当刀组件被驱动穿过所述钉仓体和所述一次性砧板上的所述纵向延伸的槽时，在刀组件上侧向延伸的导向突起用于向所述钉仓体的所述顶面偏压一次性砧座。
9.如权利要求1所述的一次性钉仓，其特征为，所述一次性砧座由金属片材制造。
10.如权利要求1所述的一次性钉仓，还包括可操作地支撑在所述钉仓体中的多个缝钉驱动器，每个所述缝钉驱动器上支撑至少一个缝钉，并可动地支撑在所述钉仓体中，使得每个所述缝钉驱动器在被外科切割和紧固器械的驱动楔形凸轮接触到时，驱动其上支撑的缝钉与所述一次性砧座形成接触。
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