CN101677813B - 手术施夹器 - Google Patents

手术施夹器 Download PDF

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CN101677813B
CN101677813B CN2008800155927A CN200880015592A CN101677813B CN 101677813 B CN101677813 B CN 101677813B CN 2008800155927 A CN2008800155927 A CN 2008800155927A CN 200880015592 A CN200880015592 A CN 200880015592A CN 101677813 B CN101677813 B CN 101677813B
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厄尔·M·策吉贝尔
肯尼思·H·惠特菲尔德
格雷戈里·索伦蒂诺
凯文·罗伯特·斯利特
罗伯托·佩德罗斯
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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
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
    • A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • 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
    • A61B2017/00407—Ratchet means
    • 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
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/038—Automatic limiting or abutting means, e.g. for safety during shipment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0803—Counting the number of times an instrument is used

Abstract

本发明提供了一种手术施夹器，所述手术施夹器包括：壳体；一对手柄；通道组件，其从所述壳体延伸出；夹子载体，其布置在所述通道组件内并且限定了通道和多个窗口；楔形板，其可滑动地布置在所述通道组件内并且通过操作连接到所述手柄上，所述楔形板包括沿其长度形成的多个孔；多个夹子，其可滑动地布置在所述夹子载体的所述通道内；以及夹子输出器，其在所述多个夹子的近侧位置处可滑动地布置在所述夹子载体的所述通道内。所述夹子输出器被配置成并适于与所述夹子载体的所述窗口以及所述楔形板的所述孔选择性地接合，从而在所述楔形板向远侧推进时相对于所述夹子载体向远侧推动所述多个夹子。

Description

手术施夹器
相关申请的交叉引用
本申请要求于2007年4月11日提交的序列号为60/922,946的美国临时申请的权益和优先权，其全部内容通过引用合并于此。
技术领域
本申请涉及手术施夹器，尤其涉及具有多个夹子以在手术程序期间将夹子施加到体组织和脉管上的器械。
背景技术
手术施夹器在本领域中是公知的并且通过提供对体组织和脉管的传统缝合的可选方案已经在外科医生之间更加流行。在格林(Green)等人的专利号为5,030,226的美国专利和伯班克三世(Burbank III)等人的专利号为5,431,668的美国专利中公开了典型的器械。这些器械通常设置多个夹子，这些夹子存储在器械中并且在器械的近端处打开和闭合手柄时被相继地进给到位于器械的远端处的钳口机构。随着手柄闭合，钳口闭合以使定位在钳口构件之间的夹子变形，并且随着钳口打开以松开变形的夹子，新的夹子从序列中被进给到钳口之间的位置。重复此过程直到夹子序列中的所有夹子均已经得到了应用。
本领域中的手术施夹器已知为包括如果器械中不存在夹子则防止手柄闭合并且因此防止钳口闭合的某种类型的闭锁机构。这些闭锁机构防止钳口在组织周围的闭合，当钳口中不存在夹子时，钳口在组织周围的闭合会损伤组织并且可能使组织或脉管受到严重损害。然而，许多现有技术的器械提供了干扰钳口闭合的闭锁机构，并且在对手柄施加足够的力时，闭锁机构可能常常失效。为了防止所述问题，通常提供有复合机构，导致了器械制造的成本增加。
另外，许多现有技术的器械提供了复合机械布置，该布置用于在定位于钳口之间的夹子已经变形然后被松开之后闭合钳口，同时准备将下一个夹子进给到钳口中。这些复合机构，例如在伯班克三世等人的专利号为5,431,668的美国专利中示出的复合机构需要增加制造成本而且增加装配各个器械所花费的时间的多个部件。另外，这些器械通常在一个方向上驱动诸如通道组件的第一部件以闭合钳口，同时在相反方向上拉动夹子推杆(clippusher bar)以准备将一系列夹子中的下一个夹子进给到钳口机构。该布置通常需要额外的运动部件，而且往往增加了制造成本并且增加了装配时间。
因此，对于用于施加手术夹子的器械，存在减少部件的数目并且因此降低器械成本同时减少在制造中装配器械所需的时间量的需求。对于器械，存在这样的特定需求：最小化运动部件的数目并且使运动部件同步以使得它们在手柄打开和闭合时在相同的方向上运动。通过最小化运动部件的数目并且使运动部件的运动方向同步，器械在手术程序期间变得更坚固耐用并且更易于操纵。
对于具有闭锁机构的器械还存在这样的需求：不仅通过提供可靠的闭锁机构(blocking mechanism)来防止钳口闭合，同时提供用于使得器械在手术程序期间器械中所有的夹子均已经被使用之后在将预定力施加到手柄上时不能操作的机构。
发明内容
本公开一般涉及手术施夹器。根据本公开的一个方案，提供了一种手术施夹器，包括：壳体；一对手柄，其可枢转地连接到所述壳体的两侧上；通道组件，其固定在所述壳体上并且从所述壳体延伸出；夹子载体，其布置在所述通道组件内并且限定了通道和多个窗口；楔形板，其可滑动地布置在所述通道组件内，所述楔形板通过操作连接到所述手柄上并且包括沿其长度形成的多个孔；多个夹子，其可滑动地布置在所述夹子载体的所述通道内；以及夹子输出器(clip follower)，其在所述多个夹子的近侧位置处可滑动地布置在所述夹子载体的所述通道内。所述夹子输出器被配置成并适于与所述夹子载体的所述窗口以及所述楔形板的所述孔选择性地接合。所述夹子输出器被配置成并适于在所述楔形板向远侧推进时相对于所述夹子载体向远侧推动所述多个夹子。
所述施夹器可以包括钳口组件，所述钳口组件包括从所述通道组件的与所述壳体相反的一端延伸出的一对钳口。所述钳口组件可以适于将夹子容纳在其中并且可以是能够操作的以响应于所述手柄的运动来实现夹子的闭合。
所述施夹器可以包括可滑动地定位在所述壳体和所述通道组件中的至少一个内的夹子推杆，所述推杆具有通过操作连接到所述手柄中的至少一个上的第一端以及限定了靠近所述一对钳口终止的推动器的第二端。所述推杆可以随着所述手柄在第一方向上靠近初始量而朝着所述钳口运动以移动所述钳口之间的所述最远侧夹子。所述推杆可以被配置成并适于随着所述手柄在所述第一方向上靠近额外量而朝着所述壳体运动以移动所述多个夹子中最远侧夹子后方的所述推动器。
所述施夹器可以进一步包括可滑动地布置在所述壳体和所述通道组件中的至少一个内的驱动通道。所述驱动通道可以具有通过操作连接到所述手柄中的至少一个上的第一端以及被配置并尺寸设计为选择性地接合所述一对钳口以实现所述一对钳口的闭合的第二端。所述驱动通道可以随着所述手柄在所述第一方向上运动而朝着所述钳口组件运动以相对于所述钳口移动其所述远端来闭合所述钳口。所述驱动通道可以随着所述手柄在第二方向上运动而离开所述钳口以使其所述远端离开所述钳口从而允许所述钳口打开。
所述施夹器可以进一步包括通过操作连接到所述楔形板上并且能够被所述驱动通道选择性地接合的枢转臂。在使用中，所述枢转臂在所述驱动通道的远侧运动期间的转动导致所述楔形板的近侧运动。
所述施夹器可以进一步包括可枢转地支撑在所述驱动通道上并且能够与其一起运动的推杆凸轮。所述推杆凸轮可以贯穿形成在所述楔形板中的狭槽并且延伸到形成在所述推杆中的窗口中。在使用中，随着所述驱动通道向远侧运动，所述推杆凸轮向远侧移动所述推杆。另外，在所述驱动通道的远侧运动期间，所述推杆凸轮可以相对于所述驱动通道转动以使所述推杆凸轮脱离所述推杆的所述窗口，允许所述推杆向近侧运动。
所述楔形板可以被偏置到远侧位置。所述推杆和/或所述驱动通道可以被偏置到近侧位置。
所述施夹器可以进一步包括棘轮机构。所述棘轮机构可以包括：齿条，其具有多个棘轮齿并且与所述驱动通道关联；以及棘轮爪，其具有至少一个齿并且布置在选择性地接合所述齿条的位置处。所述棘轮爪可以被偏置到与所述齿条接合。在使用中，随着所述驱动通道纵向地往复运动，所述多个齿可以越过所述棘轮爪。所述棘轮爪可以防止所述驱动通道在所述手柄完全致动之前非故意的返回。
所述施夹器可以进一步包括布置在所述通道组件的远端中的闭锁器。在使用中，所述闭锁器在最后一个夹子从所述施夹器中排出时可以由所述夹子输出器致动。所述闭锁器可以由所述夹子输出器推动以延伸越过所述驱动通道的路径，从而防止所述驱动通道向远侧运动。
所述施夹器可以进一步包括驱动销，所述驱动销通过操作被容纳在形成在所述驱动通道中的枢轴点中以在所述手柄运动期间向所述驱动通道传递轴向力。所述枢轴点可以通过至少一个唇缘(lip)与细长狭槽分离。
所述施夹器可以进一步包括运送楔(shipping wedge)，所述运送楔选择性地连接到所述壳体上并且被配置成并适于接合所述手柄中的每一个。
所述施夹器可以进一步包括支撑在所述壳体和所述通道组件中的至少一个中的计数机构。所述计数机构可以被配置成并适于显示所述手柄每次致动时所述施夹器中的变化。
所述驱动通道可以被配置并尺寸设计为至少部分地环绕所述钳口和所述楔形板。所述驱动通道可以包括延伸越过其远端以将所述钳口和所述楔形板保持在所述驱动通道内的带箍(strap)。
根据本公开的另一方案，提供了一种手术施夹器，包括：壳体；一对手柄，其可枢转地连接到所述壳体的两侧上；通道组件，其固定在所述壳体上并且从所述壳体延伸出；夹子载体，其布置在所述通道组件内并且限定了通道；以及驱动通道，其可滑动地布置在所述壳体和所述通道组件中的至少一个内。所述驱动通道具有通过操作连接到所述手柄中的至少一个上的第一端以及被配置并尺寸设计为选择性地接合一对钳口以实现所述一对钳口的闭合的第二端。所述施夹器进一步包括：多个夹子，其可滑动地布置在所述夹子载体的所述通道内；夹子输出器，其在所述多个夹子的近侧位置处可滑动地布置在所述夹子载体的所述通道内；以及闭锁器，其布置在所述通道组件的远端中。在使用中，所述闭锁器在最后一个夹子从所述施夹器中排出时由所述夹子输出器致动。所述闭锁器由所述夹子输出器推动以延伸越过所述驱动通道的路径，从而防止所述驱动通道向远侧运动。
所述施夹器可以进一步包括可滑动地布置在所述通道组件内的楔形板。所述楔形板可以通过操作连接到所述手柄上并且可以包括沿其长度形成的多个孔。所述夹子载体可以限定多个窗口。所述夹子输出器可以被配置成并适于与所述夹子载体的所述窗口以及所述楔形板的所述孔选择性地接合。所述夹子输出器可以被配置成并适于在所述楔形板向远侧推进时相对于所述夹子载体向远侧推动所述多个夹子。
所述施夹器可以进一步包括钳口组件，所述钳口组件包括从所述通道组件的与所述壳体相反的一端延伸出的一对钳口。所述钳口组件可以适于将夹子容纳在其中并且可以是能够操作的以响应于所述手柄的运动来实现夹子的闭合。
所述施夹器可以进一步包括可滑动地定位在所述壳体和所述通道组件中的至少一个内的夹子推杆。所述推杆可以具有通过操作连接到所述手柄中的至少一个上的第一端以及限定了靠近所述一对钳口终止的推动器的第二端。所述推杆可以随着所述手柄在第一方向上靠近初始量而朝着所述钳口运动以移动所述钳口之间的所述最远侧夹子。所述推杆可以被配置成并适于随着所述手柄在所述第一方向上靠近额外量而朝着所述壳体运动以移动所述多个夹子中最远侧夹子后方的所述推动器。
所述施夹器可以进一步包括可枢转地支撑在所述驱动通道上并且能够与其一起运动的推杆凸轮。所述推杆凸轮可以贯穿形成在所述楔形板中的狭槽并且延伸到形成在所述推杆中的窗口中。在使用中，随着所述驱动通道向远侧运动，所述推杆凸轮可以向远侧移动所述推杆。
在操作中，在所述驱动通道的远侧运动期间，所述推杆凸轮可以相对于所述驱动通道转动以使所述推杆凸轮脱离所述推杆的所述窗口，允许所述推杆向近侧运动。
所述施夹器可以进一步包括通过操作连接到所述楔形板上并且能够被所述驱动通道选择性地接合的枢转臂。在使用中，所述枢转臂在所述驱动通道的远侧运动期间的转动可以导致所述楔形板的近侧运动。
所述施夹器还可以进一步包括棘轮机构。所述棘轮机构可以包括：齿条，其具有多个棘轮齿并且与所述驱动通道关联；以及棘轮爪，其具有至少一个齿并且布置在选择性地接合所述齿条的位置处。所述棘轮爪可以被偏置到与所述齿条接合。在使用中，随着所述驱动通道纵向地往复运动，所述多个齿可以越过所述棘轮爪。所述棘轮爪可以防止所述驱动通道在所述手柄完全致动之前非故意的返回。
所述施夹器可以进一步包括驱动销，所述驱动销通过操作被容纳在形成在所述驱动通道中的枢轴点中以在所述手柄运动期间向所述驱动通道传递轴向力。所述枢轴点可以通过至少一个唇缘与细长狭槽分离。
所述驱动通道可以被配置并尺寸设计为至少部分地环绕所述钳口和所述楔形板。所述驱动通道可以包括延伸越过其远端以将所述钳口和所述楔形板保持在所述驱动通道内的带箍。
附图说明
当结合下列附图考虑时，从下面的详细描述中将更加全面的认识并更容易理解本施夹器，其中：
图1为根据本公开的手术施夹器的立体图；
图2为图1的施夹器的顶视平面图；
图3为图1和图2的施夹器的侧面正视图；
图4为图1至图3的施夹器的部件分离的立体图；
图5为沿图2的5-5截取的图1至图4的施夹器的截面图；
图6为图5的细节表示区域的放大图；
图7为图5的细节表示区域的放大图；
图8为图5的细节表示区域的放大图；
图9为沿图8的9-9截取的图1至图8的施夹器的截面图；
图10为图1至图9的施夹器在上半壳体从其中移走的情况下所示的顶视立体图；
图11为图1至图10的施夹器在上半壳体和计数组件从其中移走的情况下所示的顶视立体图；
图12为图1至图11的施夹器的远端在筒形盖(cartridge cover)从其中移走的情况下所示的顶视立体图；
图13为图1至图12的施夹器在上半壳体、计数组件以及推杆从其中移走的情况下所示的顶视立体图；
图14为图1至图13的施夹器的远端在筒形盖和推杆从其中移走的情况下所示的顶视立体图；
图15为图1至图14的施夹器的远端在筒形盖、推杆以及夹子载体从其中移走的情况下所示的顶视立体图；
图16为图1至图15的施夹器的远端在筒形盖、推杆、夹子载体、一堆夹子以及夹子输出器从其中移走的情况下所示的顶视立体图；
图17为图16的细节表示区域的放大图；
图18为图1至图17的施夹器在上半壳体、计数组件、推杆、夹子载体、一堆夹子、夹子输出器以及楔形板从其中移走的情况下所示的顶视立体图；
图19为图18的细节表示区域的放大图；
图20为图18的细节表示区域的放大图；
图21为图1至图20的施夹器在上半壳体从其中移走的情况下所示的顶视立体图，图示了在手柄的最初挤压期间的施夹器；
图22为图21的细节表示区域的放大图；
图23为在手柄的最初挤压期间的图5的细节表示区域8的放大图；
图24为在手柄的最初挤压期间的图1至图23的施夹器的齿条和棘轮爪组件的放大平面图；
图25为在手柄的最初挤压期间的图5的细节表示区域6的放大图；
图26为图1至图25的施夹器在上半壳体从其中移走的情况下所示的顶视立体图，图示了在手柄的挤压期间的施夹器；
图27为图26的细节表示区域的放大图；
图28为在手柄的挤压期间的图5的细节表示区域7的放大图；
图29为在手柄的挤压期间的图5的细节表示区域8的放大图；
图30为在手柄的挤压期间的沿图2的5-5截取的图1至图29的施夹器的手柄组件的截面图；
图31为图30的细节表示区域的放大图；
图32为在手柄的挤压期间的图1至图31的施夹器的远端在筒形盖从其中移走的情况下所示的顶视立体图；
图33为在手柄的挤压期间的图1至图32的施夹器的远端在筒形盖、推杆以及夹子载体从其中移走的情况下所示的顶视立体图；
图34和图35为图1至图33的施夹器的钳口组件的顶视平面图，图示了在手柄的挤压期间的钳口组件的闭合；
图36为图1至图35的施夹器在上半壳体从其中移走的情况下所示的顶视立体图，图示了听觉/触觉反馈构件以及齿条和棘轮爪组件的致动；
图37为包括施加有手术施夹器的夹子的体脉管的立体图；
图38为在手柄的打开期间的图1至图37的施夹器的齿条和棘轮爪组件的放大平面图；
图39为在手柄的打开期间的图26的细节表示区域的放大图；
图40和图41为在手柄的打开期间的图5的细节表示区域7的放大图；
图42和图43为在手柄的打开期间的图5的细节表示区域8的放大图；
图44为在最后一个夹子已经从施夹器中排出之后的图5的细节表示区域8的放大图；
图45为图1至图24的施夹器在下半壳体从其中移走的情况下所示的底视立体图，图示了在最后一个夹子已经从施夹器中排出之后的正在被挤压的施夹器的手柄；
图46为图45的细节表示区域的放大图；
图47为根据本公开的一个实施方式的与图1至图46的施夹器一起使用的运送楔的后视立体图；
图48为图1至图46的施夹器的立体图，图示了通过操作紧固到其上的图47的运送楔；
图49为一个半壳体从其中移走的图48的施夹器的另一立体图，图示了紧固到其上的运送楔；
图50为根据本公开的另一实施方式的与图1至图49的施夹器一起使用的驱动通道的分解立体图；
图51为示出为处于装配和操作状态下的图50的驱动通道的平面图；
图52为根据本公开的又一实施方式的与图1至图49的施夹器一起使用的驱动通道的分解立体图；以及
图53为示出处于装配和操作状态下的图52的驱动通道的平面图。
具体实施方式
现在将结合附图来详细描述根据本公开的手术施夹器的实施方式，其中，相似的附图标记表示相似或相同的结构元件。如附图所示及以下整个说明书所描述的，依照惯例，当提到手术器械上的相对定位时，术语“近侧”表示装置的较靠近用户的一端，而术语“远侧”表示装置的较远离用户的一端。
现在结合图1至图5，根据本公开的一个实施方式的手术施夹器通常标示为100。手术施夹器100通常包括手柄组件102并且手柄组件102包括壳体104，壳体104具有上半壳体104a和下半壳体104b。手柄组件102进一步包括可枢转地紧固到壳体104上并从其向外延伸出的一对手柄106。通道组件108固定地紧固到壳体104上并从其向外延伸出，在钳口组件110中终止。
如图1至图5所示，施夹器100的半壳体104a和104b通过彼此卡扣配合的接合而固定在一起。壳体104限定了形成在上半壳体104a中用于支撑并显示计数机构的窗口104c，这将在下文中进行更详细地讨论。壳体104可以由合适的塑料形成。
如图4所示，手柄106由手柄枢转柱(handle pivot post)104d紧固到壳体104上，手柄枢转柱104d从下半壳体104b延伸出并延伸到形成在手柄106中的相应孔106a中。手柄组件102包括连杆构件122，连杆构件122在形成在相应的手柄106中的枢轴点106b处可枢转地连接到每个手柄106上。每个连杆构件122的远端122a经由驱动销124枢转地连接到形成在驱动通道140中的枢轴点140a上。驱动销124的每一端被可滑动地容纳在细长通道104e中，细长通道104e形成在相应的上半壳体104a和下半壳体104b中。在使用中，如在下文中将更详细描述的，随着手柄106被挤压，连杆构件122经由驱动销124向远侧推动驱动通道140。
通道组件108包括通道或筒形盖130以及外通道132，通道或筒形盖130以及外通道132中的每一个均具有保持在壳体组件102中例如上半壳体104a和下半壳体104b之间的近端。筒形盖130被配置成并尺寸设计为与外通道132卡扣配合地接合。例如，筒形盖130可以包括至少一个保持元件(retention element)130a，保持元件130a被配置成并适于选择性地接合设置在外通道132上的互补或对应保持元件132a。
如图4至图12所示，施夹器100包括可滑动地布置在筒形盖130下方的夹子推杆160。推杆160包括限定了推动器160c的远端160a，推动器160c被配置成并适于选择性地接合/移动存储在手术施夹器100中的最远侧夹子“C1”。推杆160进一步包括近端160b，近端160b在其中限定了近侧窗口160d，近侧窗口160d用于将驱动销124可滑动地容纳在其中。推杆160进一步在其中限定了用于与推杆凸轮162通过操作接合的远侧窗口160e，这将在下文中进行更详细地描述。
施夹器100包括呈拉力弹簧形式的偏置构件164，偏置构件164通过操作紧固到推杆160的近端160b和壳体104上并位于推杆160的近端160b和壳体104之间，趋于将推杆160保持在缩回或最近侧位置。偏置构件164用于在最远侧夹子“C1”推进到钳口120中或钳口120之间之后缩回或有助于缩回推杆162。在一个实施方式中，偏置构件164可滑动地布置在套筒166a内。
施夹器100进一步包括推杆凸轮162，推杆凸轮162通过操作布置在推杆160的下方并且通过操作与推杆160的远侧窗口160e关联。推杆凸轮162包括头部162a和尾部或杆部162b：头部162a通过操作容纳在推杆160的远侧窗口160e内，尾部或杆部162b在朝向下半壳体104b的方向上从头部162a延伸出。如图6所示，杆部162b可滑动地容纳在限定在下半壳体104b中的细长狭槽104f中。推杆凸轮162的作用和操作将在下文中进行更详细地讨论。
施夹器100进一步包括布置在通道组件108内并位于推杆160下方的夹子载体170。夹子载体170通常为盒状结构，其具有限定了贯穿其的通道170d的上壁170a、一对侧壁170b以及下壁170c。夹子载体170包括形成在上壁170a中并且沿其长度纵向延伸的多个间隔开的窗口172。夹子载体170包括形成在下壁170c中并且沿其长度纵向延伸的细长窗口174(参见图9)。
如图4、图7、图14和图15所示，以如下方式被装载和/或保持在夹子载体170的通道170d内：使得一堆手术夹子“C”在通道170d内滑动和/或沿通道170d滑动。通道170d被配置并尺寸设计为以头对尾的方式将一堆或多个手术夹子“C”可滑动地保持在其内。
如图8、图12和图14所示，夹子载体170的远端包括一对间隔开的弹性柄脚(tang)171。柄脚171被配置成并适于选择性地接合保持在载体170内的一堆手术夹子“C”的最远侧手术夹子“C1”的后跨部(backspan)。
如图4、图7、图14和图15所示，施夹器100进一步包括可滑动地布置在夹子载体170的通道170d内的夹子输出器174。如在下文中将更详细讨论的，夹子输出器174定位在一堆手术夹子“C”的后方并且设置为在施夹器100的致动期间向前推动一堆夹子“C”。如在下文中将更详细描述的，夹子输出器174通过楔形板180向前和向后的往复运动而致动。
如图7所示，夹子输出器174包括限定了平面的主体部174a、从主体部174a基本上向后上方延伸的远侧凸起175以及从主体部174a基本上向后下方延伸的近侧凸起176。远侧凸起175包括在由主体部174a限定的平面下方向下延伸的远侧部175a以及在由主体部174a限定的平面上方向上延伸的近侧部175b。
远侧凸起175的近侧部175b被配置并尺寸设计为选择性地接合形成在夹子载体170的上壁170a中的窗口172。在使用中，夹子输出器174的远侧凸起175的近侧部175b在形成于夹子载体170的上壁170a中的窗口172中的接合防止了夹子输出器在近侧方向上行进或运动。
近侧凸起176被配置并尺寸设计为选择性地接合形成在楔形板180中的窗口180b。在使用中，夹子输出器174的近侧凸起176在形成于楔形板180中的窗口180b中的接合允许夹子输出器174在楔形板180向远侧运动时向远侧推进或运动。
如图4和图7至图17所示，施夹器100进一步包括可滑动地布置在手柄组件102和通道组件108内的楔形板180。楔形板180邻近夹子载体170布置。楔形板180包括用于选择性地通过操作插入钳口120之间的基本锥形的远端180a。如图4和图16所示，楔形板180限定了沿其长度纵向延伸的多个间隔开的窗口或孔180b、位于孔180b远侧的远侧窗口或孔180c、位于孔180c近侧的细长纵向延伸狭槽180d以及位于狭槽180d近侧的最近侧横向定向狭槽180e。
如图4、图8、图12和图14至图16所示，施夹器100包括支撑在楔形板180上的远侧闭锁器178。远侧闭锁器178包括尾状物或凸起178a，尾状物或凸起178a基本上向后下方延伸并且被配置并尺寸设计为容纳在楔形板180中的远侧窗口或孔180c中。
如图4、图6、图10、图11、图13和图18所示，施夹器100包括具有枢转地支撑在手柄组件102中的凸台179a的楔形板枢转臂179。特别地，枢转臂179被枢转地支撑在壳体104的下半壳体104b中。枢转臂179包括杆或指部179b，杆或指部179b从枢转臂179延伸出并且被配置成并适于在楔形板180的最近侧狭槽180e中可滑动地接合。在使用中，如在下文中将更详细讨论的，随着驱动通道140向远侧运动，驱动通道140的凸缘或壁140g相对于杆179b接合枢转臂179的凸轮表面179c，使得枢转臂179围绕凸台179a枢转，并且使得杆179b在与驱动通道140相反的方向上移动楔形板180。
施夹器100进一步包括呈拉力弹簧形式的偏置构件184，偏置构件184通过操作紧固到楔形板180的近端和壳体104上并位于楔形板180的近端和壳体104之间，趋于将楔形板180保持在推进或最远侧位置。偏置构件184用于在定位于钳口120之间的夹子“C”形成之后推进或有助于推进楔形板180。随着楔形板180推进，如将在下文中更详细讨论的，楔形板180抵靠钳口120的内表面做凸轮运动，从而使钳口120保持彼此间隔开。
如图4至图20所示，施夹器100包括往复运动地支撑在手柄组件102的壳体104和通道组件108中并在其间延伸的驱动通道140。驱动通道140的近端被支撑在壳体104的上半壳体104a和下半壳体104b之间并且驱动通道140的远端在楔形板180下方的位置处被支撑在通道组件108的筒形盖130和外通道132之间。
驱动通道140的远端为基本U形通道，包括一对间隔开的侧壁140b，侧壁140b在离开外通道132并朝向筒形盖130的方向上从其后跨部140c延伸出。驱动通道140进一步限定了形成在后跨部140c中的驱动销凹槽140a，驱动销凹槽140a用于枢转地和/或可滑动地容纳贯穿其的驱动销124。驱动通道140进一步限定了形成在后跨部140c中驱动销凹槽140a的远侧位置处的推杆凸轮孔140e。驱动通道140进一步限定了形成在后跨部140c中推杆凸轮孔140e的远侧位置处的往复运动限定狭槽140f。
施夹器100包括紧固到驱动通道140上的驱动通道带箍143。带箍143被紧固到驱动通道140的直立部140b上以便横跨其延伸。在一个实施方式中，带箍142在往复运动限定狭槽140f的远侧位置处紧固到驱动通道140上。如图8和图14至图16所示，带箍143被紧固到驱动通道140上以使楔形板180在带箍143的下方延伸。
施夹器100进一步包括支撑在驱动通道140上的听觉/触觉指示器148。在使用中，如在下文中将更详细描述的，随着施夹器100被致动以及驱动通道140往复运动，指示器148与设置在施夹器100中的对应互补结构相互作用以向用户产生听觉和/或触觉反馈。
施夹器100进一步包括呈拉力弹簧形式的偏置构件146，偏置构件146通过操作紧固到驱动通道140的近端和壳体104上并位于驱动通道140的近端和壳体104之间，趋于将驱动通道140保持在缩回或最近侧位置。偏置构件146用于在定位于钳口120之间的夹子“C”形成之后缩回或有助于缩回驱动通道140。在一个实施方式中，偏置构件146可滑动地布置在套筒146a内。
驱动通道140的近端包括或限定了齿条140d，齿条140d被配置成并适于与棘轮爪142接合。驱动通道140的齿条140d和棘轮爪142限定了棘轮机构144。在使用中，随着驱动通道140轴向地运动，齿条140d也运动。齿条140d具有这样的长度：随着驱动通道到达最近侧或最远侧位置，当齿条140d在近侧运动和远侧运动之间变化时，其允许棘轮爪142反向并在齿条140d上返回。
在棘轮爪142与齿条140d基本上通过操作接合的位置处，棘轮爪142通过棘轮爪销141枢转地连接到下半壳体104b上。棘轮爪142能够与齿条140d接合以限制齿条140d的纵向运动，从而限制驱动通道140的纵向运动。棘轮机构144进一步包括爪簧145，爪簧145被配置并定位为使棘轮爪142偏置到通过操作与齿条140d接合。爪簧145用于使棘轮爪142的齿与齿条140d的齿保持接合并且使棘轮爪142保持在转动或斜置的位置。
手术施夹器100包括安装在通道组件108的远端上或通道组件108的远端处并且能够由手柄组件102的手柄106致动的一对钳口120。钳口120由诸如不锈钢或钛的合适的生物相容性材料形成。
钳口120经由铆钉122等安装在驱动通道140的远端中，铆钉122等贯穿驱动通道140的往复运动限定狭槽140f以使钳口120相对于外通道132和驱动通道140纵向地固定。
如图8、图12和图14至图17所示，钳口120在其间限定了用于将手术夹子(未示出)容纳在其中的通道120a。
如图1、图2、图4至图6和图10所示，施夹器100进一步包括支撑在手柄组件102的壳体104中的计数机构190。计数机构190包括显示器192、处理器194、致动器196以及呈电池等形式的能源198。
显示器192可以是本领域已知的任何提供事件的指示的器件。所述事件可以涉及施夹器100的程序或操作。显示器192可以是液晶显示器(LCD)、等离子显示器、一个或多个发光二极管(LED)、发光显示器(luminescent display)、彩色显示器、数字显示器、模拟显示器、被动式显示器(passive display)、主动式显示器(active display)、所谓的“扭曲向列(twistednematic)”显示器、所谓的“超扭曲向列”显示器、“双扫描”显示器、反射式显示器、背光式显示器、字母数字显示器、单色显示器、所谓的“低温多晶硅薄膜晶体管(LPTS TFT)”显示器，或者指示与程序或施夹器100相关的参数、信息或者图像的任何其它合适的显示器192。
在一个实施方式中，显示器192是液晶显示器，其可以是向外科医生显示施夹器100的一个或多个操作参数的黑白或彩色显示器。在一个实施方式中，显示的操作参数可以是剩余夹子的数量(amount)或数目(number)、已经使用的夹子的数目、位置参数、手术使用时间或程序的任何其它参数。显示器192可以显示文本、图像或者这两者的组合。
在一个实施方式中，计数机构190可以具有凸片192a，凸片192a优选地由聚酯薄膜(Mylar)或另一种聚合绝缘材料制成，布置在电池或能源198和处理器194的触头(contact)194a之间或处理器194的触头194a之间以防止电池或能源198在存储期间变得耗尽。凸片192a可以延伸出手术施夹器100的壳体104以便允许易于从其中移走该凸片。一旦凸片192a被移走，则电池或能源198与处理器194的触头194a电接触或在处理器194的触头194a之间电接触。
显示器192可以包括用于放大显示在其上的参数的棱镜等。显示器192的棱镜可以将显示器放大至任意希望的尺寸，以允许外科医生易于从远处阅读显示器。
计数机构190的致动器196通过操作连接到驱动销124上，从而驱动销124的往复的轴向运动导致相伴随的致动器196的轴向运动。随着致动器196在远侧方向上运动，致动器196接合触头194a，使得触头194a完成回路并且触发处理器194执行功能(即，使显示器192上出现的数目减小给定的增量或值)。
结合图21至图46，现在将对在诸如脉管的目标组织周围卷曲或形成手术夹子的手术施夹器100的操作进行描述。在施夹器100的手柄106最初挤压之前，驱动销124位于最近侧位置，棘轮爪142位于驱动通道140的齿条140d的近侧，推杆凸轮162位于最近侧位置，并且没有夹子“C”定位在钳口106内。由于驱动销124位于最近侧位置，因此推杆160、驱动通道140以及计数致动器196也位于最近侧位置。而且，在施夹器100的手柄106最初挤压之前，楔形板180位于最远侧位置。
而且，在最初挤压之前，没有夹子“C”出现在钳口120内。在手柄106的最初挤压期间，夹子“C”首先被装载到钳口120中，这将在下文中进行更详细地描述。
现在参考图21至图25，图示了在手柄106的最初挤压期间在上半壳体104a从其中移走的情况下所示的施夹器100。如图21至图25所示，在手柄106的最初挤压期间，使得连杆构件122的远端122a相对于壳体104向远侧运动。随着连杆构件122的远端122a向远侧运动，使得驱动销124向远侧运动从而将远侧轴向运动传递给驱动通道140和计数致动器196。随着驱动通道140向远侧运动，推杆凸轮162向远侧运动，从而由于推杆凸轮162在推杆160的远侧窗口160e中的接合而相伴随地相对于壳体104向远侧移动推杆160。随着驱动通道140和推杆160向远侧运动，相应的偏置构件146、164被伸长(stretch)或拉长(extend)。
如图22所示，在手柄106的最初挤压期间，听觉/触觉指示器148用于产生可听到的卡搭声和/或可触知的振动，从而指示用户手术施夹器100的手柄106已经通过至少部分行程。特别地，随着手柄106被致动，听觉/触觉指示器148的臂148a在凸耳104g上方和/或沿着凸耳104g行进并因此弯曲，凸耳104g形成在上半壳体104a和下半壳体104b中的至少一个中。随着听觉/触觉指示器148的臂148a到达凸耳104g的一端，臂148a卡合在凸耳104g的所述一端上并且与上半壳体104a和/或下半壳体104b的表面104h接触，从而随着臂148a与表面104h接触而产生可听到的声音和可触知的振动。在一个实施方式中，听觉/触觉指示器148向用户指示夹子“C”已经被适当地发射。
如图23所示，同样在手柄106的最初挤压期间，随着推杆160在远侧方向上运动，其推动器160c接合最远侧夹子“C1”的后跨部并且开始将最远侧夹子“C1”向远侧移动或推动出夹子载体170并且进入钳口120中。随着最远侧夹子“C1”向远侧运动，夹子载体170的柄脚171被偏转或者由凸轮带动地脱离与最远侧夹子“C1”的接合并且返回至其未偏转或者未被凸轮带动的状态以抓取一堆夹子“C”中随后的夹子。在手柄106的最初挤压期间，推杆160被推进了足以将最远侧夹子“C1”放置在钳口120的通道120a中的量。
如图24所示，同样在手柄106的最初挤压期间，随着驱动通道140在远侧方向上运动，棘轮机构144的齿条140d向远侧运动，使得齿条140d的齿运动到与棘轮爪142的齿接合并且越过或者跨过棘轮爪142的齿。一旦棘轮机构144的齿条140d运动到与棘轮爪142接合，则在齿条140d已经离开棘轮爪142之前，驱动通道140不能返回至原位置或者最近侧位置。在手柄106的最初挤压期间，如图26和图27所示，驱动通道140向远侧运动，直到驱动通道140的凸缘或壁140g紧靠或接合枢转臂179的凸轮表面179c。
如图25所示，在手柄106的最初挤压期间，推杆凸轮162随着驱动通道140向远侧运动，使得推杆160与其一起运动，如上所述，直到推杆凸轮162的杆部162b接合或紧靠形成在下半壳体104b的细长狭槽104f中的凸耳104i。当推杆凸轮162的杆部162b接合凸耳104i时，推杆凸轮162在驱动通道140的窗口140e处转动，从而使得头部162a开始脱离或者开始旋转出推杆160的远侧窗口160e。
继续结合图25，在手柄106的最初挤压期间，在凸片192a移走的情况下，计数致动器196运动至与处理器194的触头194a接合，从而完成回路并且使得处理器194执行功能，如上所述。
现在参考图26至图37，图示了在手柄106的进一步挤压期间在下半壳体104b从其中移走的情况下所示的施夹器100。如图26至图37所示，在手柄106的进一步挤压期间，使得连杆构件122的远端122a相对于壳体104进一步向远侧运动。随着连杆构件122的远端122a进一步向远侧运动，使得驱动销124进一步向远侧运动从而将远侧轴向运动传递给驱动通道140和计数致动器196。
如图26和图27所示，随着驱动通道140进一步向远侧运动，驱动通道140的凸缘或壁140g抵靠枢转臂179的凸轮表面179c做凸轮运动，使得枢转臂179围绕凸台179a转动。随着枢转臂179围绕枢转凸台179a转动，枢转臂179的杆179b在与凸轮表面179c的运动方向相反的方向上运动。随着枢转臂179的杆179b运动，杆179b在楔形板180的最近侧狭槽180e内可滑动地做凸轮运动，使得楔形板180在近侧方向上运动。如图27所示，随着楔形板180在近侧方向上运动，偏置构件184被伸长或拉长。
如图28、图29和图31所示，随着楔形板180在近侧方向上运动，楔形板180相对于夹子输出器174向近侧运动从而相对于夹子输出器174的近侧凸起176向近侧移动其窗口180b。而且，随着楔形板180在近侧方向上运动，其远端180a从钳口120之间撤回，从而允许钳口120最终闭合或接近。
如图31和图32所示，随着驱动通道140进一步向远侧运动，推杆凸轮162以上述方式进一步向远侧运动，直到其杆162b越过形成在下半壳体104b的细长狭槽104f中的凸耳104i并且使推杆凸轮162的头部162a旋转出与推杆160的远侧窗口160e的接合。一旦推杆凸轮162的头部162a脱离或旋转出推杆160的远侧窗口160e，则推杆160由于伸长的偏置构件164施加在其上的弹簧弹力而撤回至最近侧位置。
如图32和图33所示，随着驱动通道140进一步向远侧运动，在推杆160的推动器160c和楔形板180的远端180a从钳口120之间移走的情况下，驱动通道140的远侧边缘和/或驱动通道带箍143接合钳口120的凸轮表面120b，从而使得钳口120朝向彼此接近并且形成插入其间的手术夹子“C1”。由于驱动通道带箍143被固定在驱动通道140上并且与其一起运动，因此驱动通道带箍143用于覆盖驱动通道140以便在钳口120的接近期间将钳口120保持在驱动通道140内，并且在施夹器100的操作期间将楔形板180保持在驱动通道140内。如图37所示，手术夹子“C1”可以形成或卷曲在脉管“V”或任何其它生物组织上。
而且，随着驱动通道140完全地向远侧推进，如图36所示，棘轮机构144的齿条140d向远侧运动到超过棘轮爪142，使得齿条140d的齿向棘轮爪142的齿的远侧运动从而使得齿条140d和棘轮爪142彼此脱离。这样，允许驱动通道140返回至原位置或者最近侧位置。
如上所述并且如图36所示，随着驱动通道140向远侧运动，听觉/触觉指示器148的臂148a卡合在凸耳104g的一端上并且接触上半壳体104a和/或下半壳体104b的表面104h，从而随着臂148a接触表面104h产生可听到的声音和/或可触知的振动。听觉/触觉反馈可以向外科医生指示夹子已经适当地形成并且施夹器100已经经过了容许行程。
现在参考图38至图43，图示了在手柄106的整个行程或者挤压之后以及在手柄106打开期间的施夹器100。在手柄106的打开或松开期间，使得连杆构件122的远端122a相对于壳体104向近侧运动。随着连杆构件122的远端122a向近侧运动，使得驱动销124向近侧运动从而将近侧轴向运动传递给驱动通道140和计数致动器196。偏置构件146的收缩有助于驱动通道140的近侧运动。可选择地，手柄106的松开导致偏置构件146在近侧方向上撤回驱动通道140。
随着驱动通道140向近侧运动，驱动通道140的远侧边缘和/或驱动通道带箍143脱离钳口120的凸轮表面120b，从而随着楔形板180重新插入钳口120之间而使钳口120彼此分离，并且将另一个手术夹子“C”容纳在钳口120之间。
如图39所示，随着驱动通道140向近侧运动，驱动通道140的凸缘或壁140g脱离枢转臂179的凸轮表面179c，允许偏置构件184收缩并且向远侧方向移动楔形板180。随着楔形板180向远侧方向运动，楔形板180的远端180a被重新插入或重新引入钳口120之间，从而使钳口120张开，如图43所示。
如图40和图41所示，随着楔形板180向远侧运动，夹子输出器174的近侧凸起176在楔形板180的窗口180b中接合从而向远侧推动给定的距离。随着夹子输出器174向远侧推动，一堆夹子“C”也向远侧推动。如图41所示，当楔形板180到达最远侧位置时，夹子通道(clip channel)170紧靠、接合、推动或者用凸轮带动远侧凸起175的近侧部175b直到楔形板180的网状物(web)180f基本上位于远侧凸起175的远侧部175a的下方。在这种情况下，远侧凸起175的近侧部175b运动至延伸到夹子通道170的递增地较远侧窗口172中。
如图42和图43所示，随着夹子输出器174向前推动，向前移动一堆夹子“C”，最远侧夹子“C1”通过在推杆160的推动器160c的下方做凸轮运动来移动推动器160c的远端，直到最远侧夹子“C1”被施夹器170的柄脚171挂住。
暂时转向图38，随着驱动通道140在近侧方向上运动，听觉/触觉指示器148的臂148a卡合回到凸耳104g上并且使听觉/触觉指示器148复位以用于手柄106的下一个发射行程或者挤压。
如上所述，随着驱动通道140在近侧方向上运动，驱动销124在近侧方向上使计数致动器196移动出与处理器194的触头194a的接合。
现在转向图44，图示了在手柄106的整个行程或者挤压之后以及在最后一个夹子已经从其中排出之后的施夹器100的远端。在最后一个夹子被发射之后，如图44所示，夹子输出器的近侧凸起176布置在楔形板180的孔180b中的最远侧孔或者窗口内。这样，随着楔形板180在夹子被发射之后向远侧运动，夹子输出器174也以上述方式向远侧运动。然而，在本布置中，随着夹子输出器174向远侧运动，其远侧凸起175运动到夹子载体170的窗口172的最远侧窗口的远侧。这样，远侧凸起175的近侧部175b接合夹子载体170的顶壁的内表面并且被向下用凸轮带动或者推动。
随着远侧凸起175的近侧部175b被向下用凸轮带动或者推动，远侧凸起175的远侧部175a接合闭锁器178的凸起178a的上表面并且向下用凸轮带动或者推动闭锁器178的凸起178a，跨过支撑在驱动通道140上的带箍143的路径，并且进入楔形板180的远侧窗口180c中。这样，如果驱动通道140向远侧推进，则带箍143将以上述方式紧靠闭锁器178的凸起178a并且防止或者阻止带箍143向远侧运动，从而防止或者阻止驱动通道140向远侧运动。目前，棘轮爪142位于停歇处，即齿条140d的远端，并且手柄106设置在完全打开的位置并且因此不能更大程度地打开。在该配置中，施夹器被闭锁而不能再使用。
如图45和图46所示，如果外科医生试图通过在其手柄106上施加过大的力(即，比预定极限值大的力)来突破施夹器100的闭锁配置，则驱动销124将被推动越过限定了驱动通道140的枢轴点140a的唇缘140j，并且进入细长狭槽140k中。细长狭槽140k将具有足以基本上容纳驱动销124的全部行进距离的长度。
现在转向图47至图49，施夹器100可以包括支撑在壳体104上并插入手柄106之间的运送楔200。运送楔200用于在施夹器100的运送和/或存储期间使手柄106保持间隔开或未挤压。在一个实施方式中，计数机构190的凸片192a连接到运送楔200上，从而从施夹器100移走运送楔200导致了凸片192a的移走，如上所述。
如图47至图49所示，运送楔200包括呈凸边形式的主体部202，主体部202限定了通道204，通道204被配置并尺寸设计为将壳体104的一部分容纳在其中。运送楔200包括从主体部202的两侧向外延伸并被配置为将手柄106容纳在其中的直立部206。运送楔200进一步包括从主体部202的两侧向内延伸并且与直立部206基本对齐的凸起208。运送楔200的凸起208被配置并尺寸设计为在运送楔200被适当地紧固到施夹器100上时与壳体104的外表面接合。
运送楔200包括紧固构件210，紧固构件210从运送楔200延伸出，用于接合壳体104并且将运送楔200保持在相对于施夹器100适当的位置。紧固构件210可以被配置成并适于与壳体104卡扣配合地接合或者与设置在壳体104上的互补结构卡扣配合地接合。
现在转向图50和图51，根据本公开的另一实施方式的与施夹器100一起使用的驱动通道通常标示为240。驱动通道240用于适应以下情况：第二夹子被施加在之前施加的现有的夹子上，或者夹子被施加在诸如骨骼的硬质/密致材料上。如果夹子正在被施加在现有的夹子上或硬质材料上，则施夹器尤其是驱动通道希望完成向前或远侧行程，以便棘轮机构的齿条离开棘轮爪并且允许驱动通道返回至最近侧位置。
因此，如图50和图51所示，驱动通道240包括彼此轴向地可滑动地关联的远侧驱动通道242和近侧驱动通道244。远侧驱动通道242限定了形成在其用于接合和容纳从近侧驱动通道244向远侧延伸的凸起244a的后跨部中的窗口242a。驱动通道240包括插入远侧驱动通道242和近侧驱动通道244之间的压缩构件246。特别地，压缩构件246被支撑在近侧驱动通道244的凸起244a上并且能够与远侧驱动通道242的近侧表面242b以及近侧驱动通道244的远侧表面244b接合。压缩构件246可以由橡胶构成并且具有给定或已知的硬度计(durometer)以及给定的未压缩宽度。
在使用中，随着驱动通道240在远侧方向上运动，近侧驱动通道244接合/挤压压缩构件246从而接合/挤压远侧驱动通道242。压缩构件246的构造材料被选择为使得在施夹器100发射以将夹子施加到体组织上期间显示对压缩构件246的宽度基本上没有压缩。然而，如果夹子正在被施加在另一个夹子上或硬质材料上，则远侧驱动通道242的远侧运动被阻止。由于棘轮机构的齿条已经接合棘轮爪，因此近侧驱动通道244在其完成其远侧行程之前不能够返回至最近侧位置。因此，为了使近侧驱动通道244返回至原位置或最近侧位置，手柄106被进一步挤压，将近侧驱动通道244推动到压缩构件246中，使得压缩构件246压缩足以使棘轮机构的齿条离开并脱离棘轮爪的量，从而允许近侧驱动通道244返回至原位置或最近侧位置。
随着近侧驱动通道244正在返回至原位置或最近侧位置，近侧驱动通道244的凸起244a接合远侧驱动通道242并且在近侧方向上拉动远侧驱动通道242。
现在转向图52和图53，根据本公开的另一实施方式的驱动通道通常标示为340。驱动通道340与驱动通道240基本相似因此在此将仅在配置和操作上需要区分差异的范围内进行详细地讨论。
如图52和图53所示，一对臂344b从远侧驱动通道344的凸起344a的两侧延伸出。远侧驱动通道342包括一对间隔开的相对侧壁342b。臂344b在基本近侧的方向上相对于驱动通道340的纵轴成一角度。近侧驱动通道344的臂344b具有这样的非偏转条件：其中，臂344b延伸超过远侧驱动通道342的侧壁342b。近侧驱动通道344的臂344b具有这样的偏转条件：其中，臂344b在远侧驱动通道342的侧壁342b之间弯曲。
在使用中，随着驱动通道340在远侧方向上移动，近侧驱动通道344的臂344b接合/挤压远侧驱动通道342的侧壁342b。近侧驱动通道342的臂344b的构造的尺寸和材料被选择为使得在施夹器100发射以将夹子施加到体组织上期间显示臂344b基本上没有偏转。然而，如果夹子正在被施加在另一个夹子上或硬质材料上，则远侧驱动通道342的远侧运动被阻止。由于棘轮机构的齿条已经接合棘轮爪，因此近侧驱动通道344在其完成其远侧行程之前不能够返回至最近侧位置。因此，为了使近侧驱动通道344返回至原位置或最近侧位置，手柄106被进一步挤压，向远侧推动近侧驱动通道344，从而使得其臂344b由远侧驱动通道342的侧壁342b用凸轮带动或偏转，使得近侧驱动通道344向远侧运动足以使棘轮机构的齿条离开并脱离棘轮爪的量，从而允许近侧驱动通道344返回至原位置或最近侧位置。
应当理解的是，上述描述仅仅是本公开的示例。本领域技术人员能够想出在不背离本公开的情况下的各种可选方案和改进。因此，本公开旨在涵盖所有这些可选方案、改进和变化。结合附图所描述的实施方式仅仅呈现为证明本公开的特定实例。与上述和/或随附的权利要求中的那些无实质上不同的其它元件、步骤、方法和技术也被认为是包含在本公开的范围内。

Claims (16)

1.一种手术施夹器，包括：
壳体；
一对手柄，其可枢转地连接到所述壳体的两侧上；
通道组件，其固定在所述壳体上并且从所述壳体延伸出；
夹子载体，其布置在所述通道组件内并且限定了通道和多个窗口；
楔形板，其可滑动地布置在所述通道组件内，所述楔形板通过操作连接到所述手柄上并且包括沿其长度形成的多个孔；
多个夹子，其可滑动地布置在所述夹子载体的所述通道内；以及
夹子输出器，其在所述多个夹子的近侧位置处可滑动地布置在所述夹子载体的所述通道内，所述夹子输出器被配置成并适于与所述夹子载体的所述窗口以及所述楔形板的所述孔选择性地接合，其中，所述夹子输出器被配置成并适于在所述楔形板向远侧推进时相对于所述夹子载体向远侧推动所述多个夹子。
2.根据权利要求1所述的施夹器，进一步包括钳口组件，所述钳口组件包括从所述通道组件的与所述壳体相反的一端延伸出的一对钳口，所述钳口组件适于将夹子容纳在其中并且是能够操作的以响应于所述手柄的运动来实现夹子的形成。
3.根据权利要求2所述的施夹器，进一步包括可滑动地定位在所述壳体和所述通道组件中的至少一个内的夹子推杆，所述推杆具有通过操作连接到所述手柄中的至少一个上的第一端以及限定了靠近所述一对钳口终止的推动器的第二端，所述推杆在所述手柄在第一方向上的最初挤压期间朝着所述钳口运动以移动所述钳口之间的最远侧夹子，并且所述推杆被配置成并适于在所述手柄在所述第一方向上的进一步挤压期间朝着所述壳体运动以移动所述多个夹子中最远侧夹子后方的所述推动器。
4.根据权利要求3所述的施夹器，进一步包括可滑动地布置在所述壳体和所述通道组件中的至少一个内的驱动通道，所述驱动通道具有通过操作连接到所述手柄中的至少一个上的第一端以及被配置并尺寸设计为选择性地接合所述一对钳口以实现所述一对钳口的闭合的第二端，所述驱动通道随着所述手柄在所述第一方向上运动而朝着所述钳口组件运动以对着所述钳口移动其远端来闭合所述钳口，所述驱动通道随着所述手柄在第二方向上运动而远离所述钳口以使其所述远端离开所述钳口从而允许所述钳口打开。
5.根据权利要求4所述的施夹器，进一步包括通过操作连接到所述楔形板上并且能够被所述驱动通道选择性地接合的枢转臂，其中，所述枢转臂在所述驱动通道的远侧运动期间的转动导致所述楔形板的近侧运动。
6.根据权利要求4所述的施夹器，进一步包括可枢转地支撑在所述驱动通道上并且能够与其一起运动的推杆凸轮，所述推杆凸轮贯穿形成在所述楔形板中的狭槽并且延伸到形成在所述推杆中的窗口中，其中，随着所述驱动通道向远侧运动，所述推杆凸轮向远侧移动所述推杆。
7.根据权利要求6所述的施夹器，其中，在所述驱动通道的远侧运动期间，所述推杆凸轮相对于所述驱动通道转动以使所述推杆凸轮脱离所述推杆的所述窗口，允许所述推杆向近侧运动。
8.根据权利要求1所述的施夹器，其中，所述楔形板被偏置到远侧位置。
9.根据权利要求4所述的施夹器，其中，所述推杆和所述驱动通道中的至少一个被偏置到近侧位置。
10.根据权利要求4所述的施夹器，进一步包括棘轮机构，所述棘轮机构包括：
齿条，其具有多个棘轮齿并且与所述驱动通道关联；以及
棘轮爪，其具有至少一个齿并且布置在选择性地接合所述齿条的位置处，其中，所述棘轮爪被偏置到与所述齿条接合，其中，随着所述驱动通道纵向地往复运动，所述多个齿越过所述棘轮爪，并且其中，所述棘轮爪防止所述驱动通道在所述手柄完全致动之前非故意的返回。
11.根据权利要求1所述的施夹器，进一步包括布置在所述通道组件的远端中的闭锁器，其中，所述闭锁器在最后一个夹子从所述施夹器中排出时由所述夹子输出器致动。
12.根据权利要求11所述的施夹器，其中，所述闭锁器由所述夹子输出器推动以延伸越过所述驱动通道的路径，从而防止所述驱动通道向远侧运动。
13.根据权利要求4所述的施夹器，进一步包括驱动销，所述驱动销通过操作被容纳在形成在所述驱动通道中的枢轴点中以在所述手柄运动期间向所述驱动通道传递轴向力，其中，所述枢轴点通过至少一个唇缘与细长狭槽分离。
14.根据权利要求1所述的施夹器，进一步包括运送楔，所述运送楔选择性地连接到所述壳体上并且被配置成并适于接合所述手柄中的每一个。
15.根据权利要求1所述的施夹器，进一步包括支撑在所述壳体和所述通道组件中的至少一个中的计数机构，其中，所述计数机构被配置成并适于显示所述手柄每次致动时所述施夹器的变化。
16.根据权利要求4所述的施夹器，其中，所述驱动通道被配置并尺寸设计为至少部分地环绕所述钳口和所述楔形板，其中，所述驱动通道包括延伸越过其远端以将所述钳口和所述楔形板保持在所述驱动通道内的带箍。
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