CN103402445B - 具有多速率定向切换机构的外科器械 - Google Patents
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Abstract
本发明公开了一种外科器械，该外科器械具有远程可控用户界面和击发驱动装置。该击发驱动装置能够在远程可控用户界面的第一致动时产生旋转击发运动，并且在远程可控用户界面的另一致动时产生旋转回缩运动。器械包括第一驱动构件和第二驱动构件，其中远程可控用户界面能够与第一驱动构件选择性地接合，其中远程可控用户界面能够与第二驱动构件选择性地接合。器械还包括与第一驱动构件和第二驱动构件可操作地接合的细长轴组件。器械还包括联接到细长轴组件的端部执行器。端部执行器包括能够在其中可操作地支撑钉仓的细长通道、以及可动地联接到细长通道的砧座。端部执行器还包括被可操作地支撑在细长通道内的切割构件，其中该切割构件与细长轴组件可操作地接合。器械使得当远程可控用户界面操作第一驱动构件时，第一致动将切割构件推进第一距离，其中当远程可控用户界面操作第二驱动构件时，另一致动使切割构件回缩第二距离，并且其中第二距离大于第一距离。
Description
相关专利申请的交叉引用
本专利申请为部分继续申请，该部分继续申请要求2007年6月6日提交的名称为“SurgicalInstrumentHavingaMultipleRateDirectionalSwitchingMechanism”的美国专利申请11/810,015的权益；本专利申请涉及下列共同拥有的与本专利申请同时提交的美国专利申请，并且这些专利申请全文以引用方式并入本文：
(1)名称为“SURGICALINSTRUMENTHAVINGADIRECTIONALSWITCHINGMECHANISM”的美国专利申请序列号11/810,016，其美国专利号为7,832,408，公布于2010年11月16日，代理人案卷号为070058/END6088USNP；和
(2)名称为“SURGICALINSTRUMENTHAVINGACOMMONTRIGGERFORACTUATINGANENDEFFECTORCLOSINGSYSTEMANDASTAPLEFIRINGSYSTEM”的美国专利申请序列号11/809,935，其美国专利号为7,819,299，公布于2010年10月26日，代理人案卷号为070060/END6090USNP。
背景技术
1.技术领域
本发明一般涉及外科缝合器械，并且更具体地涉及具有端部执行器闭合系统和用于部署缝钉的击发系统的外科缝合器。
2.相关领域的说明
如本领域所知，外科缝合器常用于将缝钉部署到软组织中，以例如尤其在组织被横切时减少或消除软组织的出血。外科缝合器例如直线切割器常包括端部执行器，该端部执行器能够将软组织固定在第一钳口构件和第二钳口构件之间。第一钳口构件常包括钉仓，该钉仓能够将缝钉可移除地储存在其中，并且第二钳口构件常包括砧座。缝钉通常由驱动器从钉仓部署，该驱动器横贯钉仓中的通道，并且使缝钉抵靠砧座变形，并且将软组织层固定在一起。如本领域所知，常将缝钉以多个缝钉行或排部署，以将组织层更牢靠地固定在一起。端部执行器还可包括例如刀的切割构件，在已将软组织层缝合在一起之后，该切割构件在两排缝钉之间推进以切除软组织。
在已将驱动器和切割构件推进到端部执行器内之后，常需要使驱动器和/或切割构件回缩到它们的起始位置。先前的外科缝合器已包括回位弹簧，在外科缝合器上的释放按钮或切换开关已被外科医生致动之后，该回位弹簧使切割构件相对于钉仓回缩。然而，此类缝合器不能部分地回缩切割构件，因此，切割构件在其可被重新推进之前必须完全回缩。其它先前的外科缝合器已包括多个触发器，该多个触发器与系统可操作地接合，以闭合钳口构件并推进和/或回缩驱动器和切割构件。尽管此类装置适用于它们的预期目的，但是其常要求外科医生释放与闭合系统可操作地接合的触发器，并且重新定位他们的手以抓握与系统可操作地接合的不同触发器，从而推进缝钉驱动器和切割构件。尽管先前的外科缝合器已被开发成具有用于闭合钳口构件以及推进驱动器和切割构件的单个触发器，但是此类装置在触发器的初始致动时执行这两种功能。尽管在一些情况中适用，但是由于需要高度的力以致动触发器，在相同的触发器致动中执行这两种功能的装置常常极其难以操作。此外，由于此类装置在相同触发器致动中闭合钳口构件以及部署缝钉，因此此类装置无法在缝钉被部署到软组织中之前给予外科医生机会以评估闭合钳口构件的位置以及重新定位钳口构件。需要的是对上述情况加以改善。
附图说明
通过结合附图参考本发明实施例的以下说明，本发明的各种实施例的上述和其它特征和优点以及获取它们的方式将变得更加明显，并且将更好地理解发明本身，其中：
图1为根据本发明的实施例的外科器械的透视图；
图2为图1的外科器械的轴部分和端部执行器的分解图；
图3为图1的外科器械的柄部部分的分解图；
图4为移除了外科器械的一些部件的图3的柄部部分的局部侧视图；
图5为移除了外科器械的一些部件的图3的柄部部分的顶视图，其示出了处于如下构型的外科器械，该构型用于在端部执行器中推进切割构件；
图6为移除了外科器械的一些部件的图3的柄部部分的底视图，其示出了处于如下构型的外科器械，该构型用于在端部执行器中推进切割构件；
图7为移除了外科器械的一些部件的图3的柄部部分的局部透视图；
图8为图1的外科器械的透视图，其示出了在触发器的第一致动时外科器械的构型；
图9为处于图8所示的构型的图1的外科器械的局部透视图，其中外科器械的一些部件被移除；
图10为图1的外科器械的端部执行器闭合系统的凸轮的透视图；
图11为图10的凸轮的正视图，其示出了砧座闭合系统的锁的各种相对位置；
图12为图1的外科器械的透视图，其示出了在触发器的第一致动之后触发器已被释放之后外科器械的构型；
图13为图1的外科器械的透视图，其示出了在触发器的第二致动时外科器械的构型；
图14为处于图13中的构型的图1的外科器械的局部透视图；
图15为图1的外科器械的透视图，其示出了在触发器的第三致动时外科器械的构型；
图16为图1的外科器械的透视图，其示出了在触发器的第四致动时外科器械的构型；
图17为图1的外科器械的透视图，其示出了在触发器的第四致动并且外科器械的切换机构已被操作之后在触发器已被释放之后的外科器械的构型；
图18为图1的外科器械的透视图，其示出了在触发器的第七致动时外科器械的构型，其中切割构件完全回缩；
图19为示出处于图18的构型的图1的外科器械的局部正视图，其中外科器械的部件被移除；
图20为图1的外科器械的外壳的局部透视图，其示出了在触发器的第七致动之后击发驱动装置和外壳的相互作用；
图21为根据本发明的可供选择的实施例的用于外科器械的齿轮减速机构的透视图，其中齿轮减速外壳的一部分被拆卸；
图22为图21的齿轮减速机构的分解图；
图23为根据本发明的可供选择的实施例的外科器械的透视图；
图24为图23的外科器械的端部执行器和轴组件的分解图；
图25为图23的外科器械的柄部部分的分解图；
图26为图23的外科器械的分解图，其中外科器械的部件被移除；
图27为图23的外科器械的透视图，其中外科器械的部件被移除；
图28为图23的外科器械的第二透视图，其中外科器械的部件被移除；
图29为能够在端部执行器内推进切割构件的图23的外科器械的侧视图；
图30为能够在端部执行器内回缩切割构件的图23的外科器械的侧视图；
图31为根据本发明的可供选择的实施例的定向切换机构的透视图，其中一些部件被拆卸，并且其它部件以横截面示出；
图32为图31的定向切换机构的平面图，其中一些部件被移除，并且其它部件以横截面示出；并且
图33为根据本发明的可供选择的实施例的双稳态柔性机构的图解。
贯穿多个视图，对应的参考符号指示对应的部件。本文示出的范例以一种形式示出本发明的优选实施例，并且不应将此类范例理解为以任何方式限制本发明的范围。
具体实施方式
现在将描述某些示例性实施例，以提供对本文所公开的装置和方法的结构、功能、制造和用途的总体理解。这些实施例的一个或多个实例示于附图中。本领域的那些普通技术人员将理解，本文具体描述和在附图中示出的装置和方法为非限制性的示例性实施例，并且本发明的各种实施例的范围仅由权利要求书限定。结合一个示例性实施例示出或描述的特征可与其它实施例的特征组合。此类修改形式和变型旨在包括在本发明的范围内。
在各种实施例中，根据本发明的外科器械可包括例如用于将外科缝钉插入软组织中的系统。在至少一个实施例中，外科器械可包括能够将缝钉可移除地储存在其中的钉仓、以及当缝钉从钉仓部署时使缝钉变形的砧座。为了部署缝钉，外科器械可包括能够横贯钉仓的缝钉驱动器、以及用于在钉仓内推进缝钉驱动器的击发驱动装置。在各种实施例中，击发驱动装置可包括驱动棒，该驱动棒由与其可操作地接合的触发器在基本线性的方向上平移。在其它实施例中，击发驱动装置可包括由触发器旋转的驱动轴。在此类实施例中，外科器械可包括轴组件，该轴组件可将驱动轴的旋转运动转变成线性运动，并且使缝钉驱动器在钉仓内平移。尽管图1-20中所示的以及下文所述的示例性实施例包括具有旋转驱动轴的击发驱动装置，但是本发明并不局限于此。此外，尽管下文提供了具有旋转驱动轴的击发驱动装置的总体描述，但是其它此类装置在2006年6月27日提交的名称为“MANUALLYDRIVENSURGICALCUTTINGANDFASTENINGINSTRUMENT”的共同拥有的共同未决的美国专利申请序列号11/475,412中被更详细地描述和示出，该专利申请的全部公开内容以引用的方式并入本文。
参见图1，外科器械50可包括柄部部分52、触发器54、细长轴组件56和端部执行器58。在各种实施例中，端部执行器58可包括砧座62和钉仓通道64，其中通道64能够容纳钉仓66，并且砧座62可被可枢转地连接至通道64。在至少一个实施例中，砧座62和通道64中的至少一者可操作地连接至触发器54，使得在触发器54的致动时，砧座62可被旋转为如图8中所示的闭合位置。在各种实施例中，参见图2-4，触发器54可与闭合驱动系统可操作地接合，该闭合驱动系统能够使砧座62和通道64两者相对于细长轴组件56的外部护套57平移。首先参见图4，闭合驱动装置可包括与触发器54可操作地接合的凸轮68，使得触发器54的第一致动可使凸轮68围绕销70旋转，并且在基本线性的方向上驱动闭合连杆72。更具体地，触发器54可包括从其延伸的提升销55（图3）。该提升销能够接触凸轮68的表面71并且将凸轮68提升为图8中所示的位置。凸轮68还可包括凸轮槽69。当凸轮68从图4中所示的其位置旋转至图8中所示的其位置时，凸轮槽69的侧壁可接合闭合连杆销76，并且在本实施例中使闭合连杆72在由箭头A(图4)所示的方向上滑动。
参见图2和4，外科器械50还可包括细长轴组件56（图1）内的脊组件，其中脊组件可包括近侧通道部分78和远侧通道部分80。在各种实施例中，通道部分78和80可通过突出部或舌状物84和沟槽86的协同接合而互连。更具体地，参见图2，在各种实施例中，近侧通道部分78可包括能组装到远侧通道部分80的第一半77和第二半79，使得突出部84被固定在沟槽86内。在至少一个实施例中，近侧通道部分的两半77和79可包括突出部81和/或孔83，该突出部和/或孔能够在近侧通道部分的两半77和79之间提供扣合接合或压合接合。在各种其它实施例中，通道部分78和80可通过任何合适的装置互连，并且在至少一个实施例中，尽管未示出，但是部分78和80可整体成型。与上文类似，参见图2，远侧通道部分80可包括能够连接至钉仓通道64的远端88。更具体地，远侧通道部分80和钉仓通道64可包括例如协同舌状物和沟槽结构，该结构可在其间提供压合互连或扣合互连，尽管可使用其间的任何其它合适的互连。
参见图4，通道部分78的近端82可通过销53联接到闭合连杆72，使得当闭合连杆72由凸轮68平移时，通道部分78在细长轴组件56内平移。在至少一个实施例中，通道部分78还可包括从其延伸的突出部87，该突出部能够在外壳部分90中的凹槽85（图3）内滑动，并且基本上限制通道部分78沿轴线的平移。由于钉仓通道64经由远侧通道部分80连接至近侧通道部分78，当凸轮68如上所述由触发器54旋转时，通道64以及可枢转地连接至所述通道的砧座62可在方向A上运动。在至少一个实施例中，参见图2，当通道64和砧座62相对于护套57平移时，砧座62的近端63能够邻接细长轴组件56的外部护套57。在砧座62的近端63接触外部护套57之后，砧座62能够朝通道64和钉仓66旋转以闭合砧座62，如图8中所示。在各种实施例中，参见图2，通道64可包括其中的槽65，该槽能够在砧座62相对于通道64枢转时引导砧座62。一旦砧座62闭合，外科器械还可包括将砧座62保持在其闭合位置的锁。在各种实施例中，参见图9-11，外科器械50可包括安装到外壳90的弹簧锁92，其中弹簧锁92能够将凸轮68可释放地保持在适当位置，因此将闭合连杆72、通道部分78和80、通道64和砧座62锁定在适当位置，直到外科医生期望打开砧座62，如下文所进一步详述。
在各种实施例中，在砧座62已置于其闭合位置之后，触发器54可被第二次致动以操作击发驱动装置，该击发驱动装置在端部执行器58内推进切割构件96。在至少一个实施例中，击发驱动装置可在触发器54的第一致动之前与触发器54脱离。在此类实施例中，触发器54的第一致动可使触发器54与击发驱动装置可操作地接合，和/或释放击发驱动装置的部件，使得击发驱动装置与触发器54可操作地接合。在所示实施例中，参见图3和4，击发驱动装置可包括从触发器54延伸的触发器齿轮部分100、齿轮系102、齿轮滑架130以及可旋转的驱动轴106，该击发驱动装置能够在端部执行器58内推进切割构件96，如下文所更加详述。如图3-7中所示，齿轮系102可包括棘轮齿轮108、主传动齿轮110、锥传动齿轮112和锥齿轮114，其中在触发器54的第一致动之前，凸轮68能够将棘轮齿轮108偏置成不与主传动齿轮110接合。更具体地，参见图3，棘轮齿轮108可包括轴116和衬圈118。其中凸轮68能够接触衬圈118并将棘轮齿轮108偏置成远离主传动齿轮112，使得棘轮齿轮108上的棘轮面109不与主传动齿轮110上的棘轮面111接合。
在触发器54的第一致动时，如上所述，凸轮68可被旋转到图8中所示的位置，并且由于此类旋转，凸轮68中的沟槽120（图4和5）能够释放棘轮齿轮108。更具体地，参见图5-7，可将沟槽120的尺寸设定成使得当凸轮68的旋转使沟槽120与衬圈118对齐时，衬圈118可滑过凸轮68，并且允许棘轮弹簧122将棘轮齿轮108偏置成与主传动齿轮110可操作地接合。其后，触发器54可由触发器弹簧124释放并随后返回到其起始位置，其中触发器弹簧124可被连接至从外壳90延伸的销126以及从触发器54延伸的销128。值得注意的是，尽管触发器54可返回到其起始位置，但是凸轮68可保持被锁92锁定在其第二位置，如上所述，从而使沟槽120和衬圈118之间保持对齐。现将棘轮齿轮108与传动齿轮110可操作地接合，触发器54的第二致动可在端部执行器58内推进切割构件96和缝钉驱动器。
首先参见图3和4，触发器54的致动可使触发器齿轮部分100围绕由销70限定的轴线旋转。触发器齿轮部分100可包括沿其周边延伸的齿轮齿，参见图5和6，该齿轮齿可例如与棘轮齿轮108的围绕圆周延伸的齿轮齿接合。因此在使用中，触发器54的致动或旋转可使棘轮齿轮108围绕由轴116和销117（图3）限定的轴线旋转。如上所述，参见图5和6，棘轮齿轮108可包括棘轮面109，该棘轮面能够与主传动齿轮110的棘轮面111接合。在至少一个实施例中，棘轮面109和111能够在触发器54的第二致动或其它后续致动时将触发器54的旋转运动传递到主传动齿轮110，而且当触发器54被释放并返回到其未致动位置时，棘轮面109和111允许在其间的相对滑动运动。实际上，当棘轮齿轮108在一个方向上旋转时，棘轮面109和111能够将旋转运动传递到主传动齿轮110，但当棘轮齿轮108在相对方向上旋转时，棘轮面109和111不将旋转运动传递到主传动齿轮110。尽管本文描述并示出了棘轮机构，但是可使用用于在触发器54和主传动齿轮110之间传递运动的任何其它合适的机构。此外，尽管触发器54已被描述并示出为杠杆，但是可使用任何其它合适的装置来激发本文所述的击发驱动装置和闭合驱动装置。
首先参见图5-7，主传动齿轮110可包括例如围绕其圆周延伸的齿轮齿，该齿轮齿可与围绕例如锥传动齿轮112的周边延伸的齿轮齿接合。因此在使用中，从棘轮齿轮108传递到主传动齿轮110的旋转运动例如可被传递到锥传动齿轮112。在各种实施例中，锥传动齿轮112可被安装到轴113或与轴113整体成型，其中轴113可限定被锥传动齿轮112围绕旋转的轴线。在至少一个实施例中，参见图3，外科器械50还可包括托架115，锥传动齿轮112和轴113可围绕该托架旋转。如下文所更加详述，托架115还可包括能够滑动地支撑齿轮滑架130的至少一部分的支撑件119。在各种实施例中，参见图5-7，锥齿轮114可附接到锥传动齿轮112，或者作为另外一种选择，锥齿轮114可被安装到轴113或与轴113整体成型。在任一种情况下，传递到锥传动齿轮112的旋转运动可被传递到锥齿轮114。
在各种实施例中，尽管未示出，锥齿轮114可经由协同工作的锥齿轮齿与传动轴106直接接合。在至少一个此类实施例中，锥齿轮114可使传动轴106例如在顺时针方向上旋转，并且如下文所述在端部执行器58内推进切割构件96。在此类实施例中，触发器54的致动可在端部执行器58内推进切割构件96，然而，切割构件96将必须手动地或经由附加的回缩系统来回缩。在本发明的所示实施例中，参见图3和5-7，外科器械50还可包括切换机构，该切换机构可允许驱动轴106在顺时针或逆时针方向上旋转，并且相应地使切割构件96经由触发器54的致动被推进或回缩。在各种实施例中，首先参见图5和6，切换机构可包括可在第一位置和第二位置之间移动的齿轮滑架130。在第一位置，锥齿轮114的旋转运动使驱动轴106在例如顺时针方向上旋转，在第二位置，锥齿轮114的旋转运动使驱动轴106在例如逆时针方向上旋转。
在各种实施例中，参见图5-7，齿轮滑架130可包括外壳132、正向齿轮134和反向齿轮136，其中正向齿轮134和反向齿轮136可旋转地安装到外壳132。在至少一个实施例中，驱动轴106可包括例如基本上六角形的末端107，该末端可容纳于正向齿轮134和反向齿轮136中的孔（未示出）内，使得齿轮134和134与驱动轴106可旋转地接合。在其它各种实施例中，末端107可包括任何其它合适的形状或构型，使得齿轮134和136与驱动轴106可旋转地接合。在任一种情况下，参见图5，齿轮滑架130可沿末端107滑动，使得正向齿轮134或反向齿轮136可与锥齿轮114接合。在使用中，当正向齿轮134与例如锥齿轮114接合时，锥齿轮114的旋转运动可被传递到正向齿轮134，并且由于末端107和正向齿轮134中的孔的协同的几何形状，齿轮134的旋转运动可被传递到驱动轴106。为了使驱动轴在相对的方向上旋转，齿轮滑架130可朝近侧或向后滑动，使得反向齿轮136接合锥齿轮114。下文进一步描述了用于以此方式激发齿轮滑架130的机构。
在各种实施例中，如图5中所示，当正向齿轮134与锥齿轮114接合时，反向齿轮136可与锥齿轮114脱离，使得反向齿轮136随驱动轴106自由旋转。在至少一个实施例中，齿轮滑架130还可包括垫片135。该垫片能够可旋转地支撑齿轮134和136并使齿轮134和136对齐，还允许齿轮134和136彼此独立地旋转。在一些实施例中，可将齿轮滑架130置于向前和向后位置中间的位置，使得齿轮134和136两者接合锥齿轮114并将驱动轴106保持在锁定状态，使得触发器54不能被致动。在其它各种实施例中，可将齿轮滑架130置于中间位置，使得齿轮134和136两者均不接合锥齿轮114。在此类实施例中，击发驱动装置处于“自由”状态，并且锥齿轮114的旋转运动不被传递到驱动轴106。
在各种实施例中，首先参见图2，驱动轴106还可包括螺纹驱动部分138，该螺纹驱动部分可与击发螺母140可操作地接合。在至少一个实施例中，螺纹驱动部分138能够响应于驱动轴106的旋转运动可滑动地推进和/或回缩击发螺母140。更具体地，击发螺母140可包括能够通过螺纹来容纳螺纹驱动部分138的螺纹孔141，使得驱动轴106的旋转产生将击发螺母140朝远侧推进的反应力。在至少一个实施例中，击发螺母140可包括从其延伸的突出部142。该突出部能够延伸穿过限定于近侧通道部分的两半77和79之间的槽，以便约束击发螺母140沿轴线的运动。实际上，槽可防止击发螺母140随驱动轴106旋转，并且当将击发螺母140在通道部分78内平移时，槽可限定突出部142的路径。
在各种实施例中，参见图2，切割构件96可与击发螺母140可操作地接合，使得如上所述的击发螺母140的平移可导致切割构件96在端部执行器58内平移。在至少一个实施例中，外科器械50还可包括连接至击发螺母140的击发连杆144、连接至切割构件96的驱动棒146、以及能够将驱动棒146连接至击发连杆144的适配器148。在各种实施例中，击发连杆144可包括近端145，该近端可包括能够以压合方式容纳击发螺母140的至少一部分的孔。在至少一个实施例中，击发连杆144的近端145可包括可变形构件147，在可变形构件147已朝凹槽143向内压下或变形之后，该可变形构件能够接合击发螺母140中的凹槽143。在任一种情况下，击发连杆144还可包括例如能够以压合方式容纳插头150的远端149。其中插头150可包括从其延伸的突出部152，该突出部可容纳于适配器148中的槽154内。在各种实施例中，适配器148还可包括槽151，其中槽151能够容纳驱动棒146的连接器插片154，使得当适配器148由击发连杆144平移时，驱动棒146可在远侧保持器部分80内平移。在至少一个实施例中，驱动棒146还可包括远端156，该远端能够接合切割构件96中的凹槽97，并且在端部执行器58内推进和/或回缩切割构件96。如上所述，切割构件96可包括刀99，当切割构件96在端部执行器58内被推进时，该刀能够切割定位在砧座62和钉仓66之间的组织。另外，如上所述，切割构件96可包括部分95，其中部分95能够在钉仓66内推动缝钉驱动器（未示出），以部署可移除地储存在其中的缝钉（未示出）。
在各种实施例中，外科器械能够在触发器54的单次致动时将切割构件96推进期望的距离，触发器54的单次致动即实施例中触发器54的第二次总体致动，其中触发器54的第一致动如上所述闭合砧座62。然而在其它实施例中，触发器54的多于一次致动可用于将切割构件96推进期望的距离。在至少一个此类实施例中，参见图12-16，触发器54可被致动三次，以将切割构件96从端部执行器58的近端59推进到远端61。然而在其它实施例中，此类致动的数量将主要取决于切割构件96将移动的总体距离，以及每次致动导致的切割构件96的位移。值得注意的是，在触发器54的第二致动之前，可将切割构件96定位在端部执行器58的近端59，并且可将击发螺母140定位在其最近侧位置。在触发器54的第二致动时，参见图13和14，切割构件96可在近端59和远端61之间推进大约三分之一的距离，并且类似地，可将击发螺母140沿驱动轴106朝远侧推进。其后，参见图15，切割构件可在触发器54的第三致动时在近端59和远端61之间被推进附加的三分之一距离，并且类似地，参见图16，切割构件96可在触发器54的第四致动时被推进到端部执行器58的远端61中。
在各种实施例中，为了辅助外科医生监视触发器54已被致动的次数，外科器械50可包括计数机构。该计数机构能够显示触发器54已被致动的次数和/或剩余的致动次数，以在钉仓中部署所有的缝钉。在任一种情况下，首先参见图3和9，计数机构170的一个实施例可包括外壳90中的指示器螺母172、指示器板174和指示器窗171（图1）。在至少一个实施例中，指示器板174可包括其上的标记，该标记可向外科医生传达触发器54已被致动的次数以推进切割构件96。在此类实施例中，指示器板174可包括在触发器54的第一致动之前和之后通过窗171可见的空白部分173，触发器54的第一致动即如上所述闭合砧座62的触发器54的致动。在触发器54的第二致动时，驱动轴106的旋转可朝远侧推进指示器螺母172和安装到指示器螺母172的指示器板174，使得可通过指示器窗171看到指示器板174上的数字“1”或其它适当标记。因此，此类标记可向外科医生指示切割构件96已通过触发器54的一次致动被推进。类似于击发螺母140，指示器螺母172可包括可通过螺纹与驱动轴106的螺纹部分176接合的螺纹孔，使得驱动轴106的旋转向指示器螺母172施加反应力，并且朝远侧将其推进。触发器54的后续致动可使数字“2”和“3”在指示器窗171下方移动。
如上所述，为了回缩切割构件96，齿轮滑架130可被移动，使得正向齿轮134与锥齿轮114脱离，并且参见图17和18，反向齿轮136与锥齿轮114接合。其后，触发器54的后续致动可使驱动轴106在相对的方向上旋转，并且使击发螺母140朝近侧平移。更具体地，由于击发螺母140与驱动轴106的螺纹部分138之间的螺纹接合，轴106在相对方向上的旋转向击发螺母140施加反应力，该反应力使击发螺母140在近侧方向上移动。因此，击发连杆144、驱动棒146、以及如上所述连接至击发螺母140的切割构件96也在近侧方向上移动，从而在端部执行器58内回缩切割构件96。类似地，轴106在相对方向上的旋转可使指示器组件170的指示器螺母172也朝近侧移动。更具体地，齿轮滑架130已被移动之后的触发器54的第一致动，即触发器54的第五次总体致动，可导致驱动轴106向指示器螺母172施加反应力，并使螺母172朝近侧运动。在此类情况下，指示器螺母172可使指示器板174相对于窗171运动，使得可通过指示器窗171可见数字“2”，该数字“2”可提醒外科医生需要触发器54的另外两次致动以完全回缩切割构件96。
尽管在本实施例中触发器54被致动三次以推进和/或回缩切割构件96，但是在其它实施例中，推进切割构件96所需的致动可不同于回缩切割构件96所需的致动。下文进一步详述了包括用于推进和回缩切割构件96的结构的示例性实施例。此外，在至少一个实施例中，切割构件96的部分95可与缝钉驱动器接合，使得切割构件96的回缩同样回缩缝钉驱动器。然而在其它实施例中，缝钉驱动器可被遗留在钉仓中，并且仅切割构件96被回缩。可利用此类实施例，在此类实施例中，用尽的钉仓组件被新的钉仓组件替换，新的钉仓组件在其中包括它自己的缝钉驱动器。因此，期望将经使用的缝钉驱动器留在用尽的钉仓内是可取的。
为了如上所述激发齿轮滑架130，参见图3-5，外科器械50可包括切换机构160。在至少一个实施例中，切换机构160可包括轴切换162、从其延伸的移位器柄部164、以及移位器连杆166，其中移位器连杆166可经由移位器销169连接至轴162，并且经由销168连接至齿轮滑架外壳132。为了如上所述使齿轮滑架130相对于驱动轴106滑动，移位器164能够使轴162旋转，使得从轴162延伸的曲柄臂163移动移位器连杆166，并且沿驱动轴106的轴线105驱动齿轮滑架130。在所示实施例中，当移位器柄部164在基本上向下的方向上取向时，如图8中所示，曲柄臂163在基本上向上的方向上取向。在此构型中，参见图5，齿轮滑架130被定位在其最向后或近侧位置，使得正向齿轮134与锥齿轮114可操作地接合。为了使外科器械50移动到使切割构件96回缩的构型中，移位器柄部164可如图17中所示向上旋转，以使曲柄臂163向前或朝远侧旋转。相应地，曲柄臂163能够使连杆臂166朝远侧移动，并且将齿轮滑架130牵拉到其最远侧的位置中，从而使反向齿轮136与锥齿轮114接合。如果在至少部分回缩切割构件96之后外科医生期望推进切割构件96，则外科医生可向下旋转移位器柄部164，并使正向齿轮134与锥齿轮114重新接合。
在各种实施例中，参见图3和5，外科器械50还可包括用于将切换机构160偏置到如下构型中的双稳态柔性机构，在该构型中，齿轮134或136之一与锥齿轮114接合。换句话讲，当外科医生仅部分地旋转移位器柄部164时，双稳态柔性机构可导致切换机构160变得动态不稳定。在这种情况下，双稳态柔性机构可将切换机构160偏置到稳定的两种构型之一中，这两种构型即正向构型和反向构型。在各种实施例中，首先参考图3，双稳态柔性机构180可包括接收器182、弹簧184、柱塞186和倒头销188。在至少一个实施例中，倒头销188可将柱塞186连接至切换轴162，并且接收器182可连接至从外壳90延伸的突出部183。在使用中，弹簧184能够经由柱塞186向轴162施加偏置力，并且如果轴162在其正向方向和反向方向之间仅部分地旋转，则弹簧184能够使轴162旋转。
在各种实施例中，一旦切割构件96已被完全回缩，则端部执行器闭合系统和缝钉击发系统可被复位，使得用尽的钉仓从外科器械50移除，新的钉仓66可被定位在钉仓通道64内，并且外科器械50可如上所述被用于进一步缝合和切割组织。在所示实施例中，凸轮68可从锁92被释放，以打开砧座62并使端部执行器闭合系统复位。类似地，棘轮齿轮108可与主传动齿轮110脱离，以使触发器54与齿轮系102脱离并且使缝钉击发系统复位。在至少一个实施例中，凸轮68和棘轮齿轮108可被手动复位，然而，首先参见图3-5、9、10、19和20，外科器械50可包括复位系统，该复位系统可自动复位上述端部执行器闭合系统和缝钉击发系统。在各种实施例中，触发器54的最终返回致动可使这些系统复位，如下文所详述。
如上所述，触发器54的第一致动可使凸轮68旋转到图8中所示的位置中，并且当击发驱动装置由触发器54的后续致动来操作时，弹簧锁92能够将凸轮68保持在适当位置。还如图8中所示，外科器械50还可包括凸轮弹簧67，该凸轮弹簧能够将凸轮68向下偏置，并且参见图9和10，能够抵靠弹簧锁92而保持从凸轮68延伸的凸轮锁臂73。在此类实施例中，凸轮锁臂73可包括能够容纳弹簧锁92的至少一部分的凹槽74。为了辅助凸轮弹簧67阻止凸轮68在触发器54的后续致动期间向上提升并且变得与凸轮弹簧92脱离，指示器螺母174能够接触凸轮导轨75并且抵靠弹簧锁92保持凸轮锁臂73。更具体地，当指示器螺母174朝远侧推进时，如上所述，指示器螺母174可沿提供前挡块的接触导轨75滑动，凸轮68不能抵靠该前挡块旋转。然而，一旦指示器螺母174返回到其最近侧的位置，则指示器螺母174可变得与斜坡89对齐。因此，触发器54的第三返回致动可导致凸轮68略微向上旋转，从而使锁臂73与弹簧锁92脱离，如图10中所示。
在凸轮68已从锁92被释放后，凸轮返回弹簧67能够使凸轮68向下旋转并且使其返回至其原始位置。当凸轮68向下旋转时，凸轮槽69的壁能够朝远侧驱动闭合连杆72，并且相应地也朝远侧驱动通道部分78和80以及钉仓通道64。在至少一个实施例中，端部执行器58还可包括弹簧（未示出）。当钉仓通道64朝远侧滑动，即远离细长轴组件56的外部护套57滑动时，该弹簧能够将砧座62向上偏置。在其它各种实施例中，尽管未示出，外科器械50还可包括致动器，外科医生可在所述致动器中操作以将砧座62牵拉或推动到打开位置中。在任一种情况下，在至少一个实施例中，凸轮返回弹簧67可对凸轮68施加足够的力以使棘轮齿轮108移动成不与主传动齿轮110接合，并且因此使击发驱动装置复位。在其它各种实施例中，凸轮返回弹簧67可能不够强效而无法用足够的力向下牵拉凸轮68以使棘轮齿轮108与主传动齿轮110脱离。在至少一个此类实施例中，参见图3-5和19，外科器械50还可包括切换开关组件，该切换开关组件可选择性地将棘轮齿轮108偏置成远离主传动齿轮110。
在各种实施例中，首先参见图3、4和9，切换开关组件190可包括安装到驱动轴106的切换致动器192，其中切换致动器192可包括从其延伸的切换臂193。在触发器54的最终返回致动时，在至少一个实施例中，指示器螺母172可接触切换致动器192并使其围绕驱动轴106旋转，使得切换臂193朝棘轮齿轮108旋转。在至少一个此类实施例中，参见图9，指示器螺母172还可包括斜坡179。该斜坡能够接合从切换致动器192延伸的突出部191，并且使切换致动器192围绕驱动轴106顺时针旋转。在各种实施例中，切换臂193能够在其围绕驱动轴106旋转时接触棘轮齿轮108，并且使棘轮齿轮108远离主传动齿轮110移动。在至少一个实施例中，棘轮齿轮108可远离传动齿轮110充分移动，以允许凸轮返回弹簧67将凸轮68邻近衬圈118定位。其后，凸轮68可将棘轮齿轮108保持在该位置，直到凸轮68如上所述向上旋转。
尽管上述机构可使凸轮68和棘轮齿轮108复位至它们的初始位置中，但是至少在所示实施例中，切换致动器192的切换臂193可保持抵靠棘轮齿轮108的衬圈118定位。因此，即使凸轮68向上旋转成使得沟槽120在触发器54的第一致动时与衬圈118对齐，棘轮齿轮108也可能不会被释放以如上所述接合主传动齿轮110。据此，在至少一个实施例中，外科器械50可包括用于使切换臂193旋转成不与棘轮齿轮108接合的复位机构。在各种实施例中，此类机构可例如响应于触发器54的致动而被手动操作和/或自动操作。在至少一个实施例中，如图20种所示，外壳90可包括从其延伸的突出部91，该突出部能够使切换致动器192围绕驱动轴106旋转，并且使其返回至其原始的未致动位置，如图9中所示。更具体地，在各种实施例中，当齿轮滑架130从其远侧位置运动到其近侧位置时，突出部91能够接合切换连杆194（图3）。在远侧位置中，反向齿轮136与锥齿轮114接合；在近侧位置，正向齿轮134与锥齿轮114接合。当移位器柄部164向下旋转以使齿轮滑架130朝近侧运动并且将外科器械50置于其上述“推进”构型时，此类运动可能受切换机构160的影响。由于切换连杆194和突出部91之间的接触，切换连杆194可围绕销195旋转，使得切换连杆194接触致动臂193，并且使切换致动器192围绕驱动轴106逆时针旋转。在各种实施例中，切换开关组件190还可包括双稳态柔性机构196，该双稳态柔性机构可有助于确保切换开关组件190不陷入中间构型。
如上所述，根据本发明的外科器械可包括用于致动端部执行器闭合系统和缝钉击发系统两者的单一触发器。尽管上述结构结合此类单一触发器外科器械进行了描述，但是上述结构中的多个可用于具有第一触发器和第二触发器的外科器械中。所述第一触发器用于致动端部执行器闭合系统，所述第二触发器用于致动缝钉击发系统。参见例如图23-30，外科器械200可包括用于致动端部执行器闭合系统的触发器201以及用于致动缝钉击发系统的触发器204。在各种实施例中，参见图25，端部执行器闭合系统可包括经由销209与闭合触发器201可操作地接合的闭合连杆203。端部执行器闭合系统还可包括滑块205和闭合管207（图23），其中闭合管207可经由滑块205和销211可操作地连接至闭合连杆203。更具体地，参见图29，闭合管207可包括在其最近端处的凸缘213，该凸缘能够被容纳在滑块205中的槽215内，使得滑块205的滑动运动被传递到闭合管207。
在使用中，首先参见图29和30，触发器201的致动可使闭合连杆203朝远侧平移，并且相应地使滑块205和闭合管207也朝远侧平移。在各种实施例中，闭合管207可包括与砧座62协同接合的结构，使得闭合管207的平移导致砧座62朝钉仓通道64旋转。更具体地，参见图24，砧座62可包括从其延伸的突出部51，该突出部可容纳于闭合管207的孔217内，使得孔217的侧壁可邻接突出部51并使砧座62向下旋转。为引导砧座62，如上所述，钉仓通道64可包括槽65。当砧座62被旋转时，该槽为砧座62限定路径。外科器械200还可包括能够将触发器201保持在致动位置的锁219，从而将砧座62保持在闭合位置。为打开砧座62，锁219（图28）可与触发器201脱离，使得触发器201可返回至其未致动位置。当触发器201返回至其未致动位置时，触发器201可朝近侧驱动滑块205和闭合管207，并且由于突出部51和孔217之间的操作接合而使砧座62向上旋转。
如上文所述，根据本发明的外科器械可包括击发驱动装置，该击发驱动装置能够例如以第一速率推进切割构件，并且以不同的速率回缩切割构件。在各种实施例中，参见图23-30，外科器械200可包括击发驱动装置202。该击发驱动装置可包括触发器204、驱动轴206、第一棘轮组件210和第二棘轮组件212。在至少一个实施例中，棘轮组件210和212能够使驱动轴206分别在顺时针和逆时针方向上旋转，以便在端部执行器58内推进或回缩切割构件96。在各种实施例中，参见图25，触发器204可与棘轮组件210和212选择性地接合，使得当触发器204被致动时，仅棘轮组件210和212之一被触发器204驱动。在至少一个此类实施例中，触发器204可为沿销214可滑动的，以便使触发器204与棘轮组件210和212之一接合。在所示实施例中，销214可被可旋转地容纳于外壳部分218中的孔216中，并且为触发器204提供旋转轴线。
在各种实施例中，参见图27，触发器204可被定位成使得可枢转地安装到触发器204的制转杆220与棘轮222接合，并且在触发器204被致动时，棘轮222围绕销214由制转杆220旋转。在触发器204被释放时，制转杆220可滑过棘轮222的棘轮齿224，从而允许在其间的相对运动。在至少一个实施例中，棘轮组件210还可包括制转杆弹簧（未示出），该制转杆弹簧能够将制转杆220偏置成与棘轮齿224接合，并且当触发器204被重新致动时，使制转杆220与棘轮齿224重新接合。为了将棘轮222的旋转传递至驱动轴206，驱动轴206可包括连接至其的正向齿轮226。更具体地，在至少一个实施例中，棘轮222还可包括与正向齿轮226可操作地接合的齿轮齿228，使得棘轮222的旋转使正向齿轮226和驱动轴206围绕轴线230（图25）旋转。在各种实施例中，正向齿轮226可例如压合到驱动轴206上，或者在其它各种实施例中，正向齿轮226可与驱动轴206整体成型。
在各种实施例中，类似于上述外科器械，参见图24，驱动轴206可与击发螺母140可操作地接合，以使击发螺母140在近侧保持器部分232内平移。还如上所述，击发螺母140的平移可经由驱动棒146被传递到切割构件96，以在端部执行器58内推进切割构件96。为了在端部执行器58内回缩切割构件96，在至少一个实施例中，触发器204可被滑动成与第二棘轮组件212接合，使得当触发器204被致动时，驱动轴206在相对的方向上旋转。类似于棘轮组件210，参见图28，棘轮组件212可包括棘轮234和制转杆236。其中制转杆236可被可枢转地安装到触发器204并且可经由棘轮齿238与棘轮234可操作地接合。类似于棘轮222，棘轮234可包括与安装到驱动轴206的反向齿轮242可操作地接合的齿轮齿240。当棘轮222和234在基本上相对侧上接合驱动轴206时，棘轮222和234可使驱动轴206在相对的方向上旋转，即分别在顺时针方向和逆时针方向上旋转。因此，为了选择是在端部执行器58内推进还是回缩切割构件96，触发器204可被滑动成与第一棘轮组件210或第二棘轮组件212可操作地接合。
在各种实施例中，尽管未示出，但是第一棘轮222和第二棘轮234可具有基本上相同的直径或节距半径。换句话讲，棘轮的中心或旋转轴线和棘轮的齿轮齿之间的距离可为相同的。在此类实施例中，触发器204的每次致动所推进的切割构件96的距离与触发器204的每次致动所回缩的切割构件96的距离将为基本上相同的。尽管适用于一些情况中，但是此类实施例可能要求外科医生在完全回缩切割构件96之前多次致动触发器204。根据以上所述，在各种实施例中，第一棘轮222可具有不同于第二棘轮234的节距半径的节距半径。在至少一个实施例中，第二棘轮234可具有比第一棘轮222更大的节距半径，使得触发器204的每次致动所回缩的切割构件96的距离大于触发器204的每次致动所推进的切割构件96的距离。换句话讲，至少在这些实施例中，第二棘轮组件212可以大于其被推进的速率回缩切割构件96。在此类实施例中，第一棘轮组件210由于更低的推进速率可向切割构件96提供更大的扭矩或推进力，而第二棘轮组件212由于更快的回缩速率可减少外科医生回缩切割构件所需的时间。
尽管如上所用的术语“速率”被用于描述切割构件96在触发器204的每次致动时可被推进或回缩的距离，但是术语“速率”并不局限于此。在至少一个实施例中，术语“速率”可被用于描述切割构件运动的速度和/或加速度。在此类实施例中，期望具有这样的切割构件可为可取的，其以更低的速度和/或加速度被推进以更好地控制切割构件，并且以更大的速度和/或加速度回缩以减少回缩切割构件所需的时间。此外，尽管所示实施例包括用于提供不同的推进和回缩速率的棘轮组件，但是本发明并不局限于此。相反，设想其它实施例，其包括正齿轮系、锥齿轮、和/或其它运动传递装置。
在各种实施例中，根据本发明的外科器械可包括用于增加或减小驱动轴的旋转速度的齿轮箱。在至少一个实施例中，参见图25，外科器械200还可包括齿轮箱250。该齿轮箱可被可操作地定位在驱动轴206以及棘轮组件210和212中间。在各种实施例中，齿轮箱250可被用于“减慢”驱动轴206的速度，使得轴206以比如果不利用齿轮箱250更慢的速度转动。在可供选择的实施例中，齿轮箱可用于“加快”驱动轴206的速度，使得驱动轴206以更快的速度转动。在至少一个实施例中，齿轮箱250可包括用于改变驱动轴206的速度的至少一组行星齿轮。在其它各种实施例中，齿轮箱诸如图21和22中所示的齿轮箱252可包括外壳253、安装到输入轴256的输入齿轮254、小齿轮258、以及安装到输出轴262的输出齿轮260。在此类实施例中，由于输入齿轮254和输出齿轮260的不同节距半径，输入轴256和输出轴262将以不同的速度旋转。为有利于齿轮254、258和260在外壳253内的旋转运动，齿轮箱252还可包括如图22中所示的各种支撑板264、垫片266和销268。除了上文所述之外，齿轮箱252还可被用于例如将输入轴256的顺时针运动转变成输出轴262的逆时针运动。
在上述各种实施例中，外科器械200的触发器204可在其与第一棘轮组件210可操作地接合的第一位置和其与第二棘轮组件212可操作地接合的第二位置之间滑动。在至少一个实施例中，在第二制转杆236与第二棘轮234接合之前，击发驱动装置202能够使得例如第一制转杆220与第一棘轮222脱离。在此类实施例中，触发器204可被定位在中间位置。在该中间位置，其不与第一棘轮组件210或第二棘轮组件212可操作地接合。因此在各种实施例中，击发驱动装置202可处于“自由”状态。在该“自由”状态下，触发器204的致动不导致驱动轴206的旋转。在可供选择的实施例中，在第一制转杆220与第一棘轮222可操作地脱离之前，击发驱动装置202能够使得例如第二制转杆236与第二棘轮234接合。在此类实施例中，触发器204可被定位在中间“锁定”状态。在该“锁定”状态下，触发器204不能被致动，从而指示外科医生触发器204未与棘轮组件中的任一者完全接合，并且触发器204需要被进一步调整。
在各种实施例中，外科器械200可包括将触发器204偏置成与第一棘轮组件210和第二棘轮组件212之一接合的装置。在至少一个实施例中，参见图33，外科器械200还可包括双稳态柔性机构270。该双稳态柔性机构可将触发器204偏置出上述中间位置，并且偏置成与第一棘轮组件210或第二棘轮组件212接合。在各种实施例中，双稳态柔性机构270可包括弹簧272和连杆274。其中弹簧272可经由连杆274向触发器204施加偏置力，使得偏置力用于使触发器204运动出图33中所示的其中间位置，并且运动成与第一棘轮222或第二棘轮234接合。更具体地，当触发器204被定位在其中间位置时，弹簧272可被拉伸到长度X1，并且由于弹簧272的回弹力，弹簧272可试图将其自身缩短至其未被拉伸的长度，或至少比X1更短的长度，例如长度X2。为了使弹簧272将其自身缩短至长度X2，弹簧272可使连杆274围绕销275旋转。其中销275可从外科器械外壳218延伸并将连杆274可枢转地安装到外科器械外壳218。更具体地，当将弹簧272的第一末端安装到从外壳218延伸的销276，并且将弹簧272的第二末端安装到从连杆274延伸的销277时，弹簧272可通过使销277运动成更靠近销276而将其自身缩短，这最容易通过使连杆274围绕销275旋转来实现。当连杆274围绕销275旋转时，连杆274中槽278的侧壁能够接合从触发器204延伸的销279，并且使触发器204滑动成与第一棘轮222或第二棘轮234接合。实际上，图33中所示的触发器204的中间位置表示动态不稳定位置，并且与棘轮222和234接合的触发器204的位置表示击发驱动系统的动态稳定位置。
在各种实施例中，如上所述，根据本发明的外科器械可包括用于使驱动轴在例如第一方向和第二方向上旋转的装置。在第一方向上，驱动轴在端部执行器内推进切割构件，在第二方向上，驱动轴回缩切割构件。在至少一个实施例中，参见图31和32，外科器械可包括例如传动装置280。该传动装置可允许外科医生选择是使驱动轴推进还是回缩切割构件。在各种实施例中，传动装置280可包括外壳282、内部输入轴284、外部输入轴285、输出驱动轴286和切换机构288。其中切换机构288能够选择性地使内部输入轴284和外部输入轴285与输出轴286接合。尽管未示出，但是外科器械还可包括例如触发器，该触发器与外部驱动轴285可操作地接合，以便使驱动轴285围绕轴线287在例如顺时针方向上旋转。在至少一个实施例中，传动装置280可包括旋转地安装在外壳282内的小齿轮292、固定地安装到外部输入轴285的输入齿轮293、以及安装到输出驱动轴286的输出齿轮294，其中输入齿轮293可与小齿轮292的外齿轮齿290可操作地接合，使得外部轴285的旋转被传递到小齿轮292。
在传动装置280的第一构型中，输出齿轮294可与小齿轮292的内齿轮齿291可操作地接合，使得小齿轮292的旋转被传递到输出驱动轴286。更具体地，输出齿轮294可经由花键配合末端296与输出驱动轴286可操作地接合，使得输出齿轮294围绕轴线287驱动输出驱动轴286。在该第一构型中，例如外部输入轴285的顺时针旋转可被转变为输出驱动轴286的逆时针运动。在传动装置280的第二构型中，输出齿轮294可与小齿轮292脱离，使得外部输入轴285的旋转不经由小齿轮292被传递到输出驱动轴286。为了使输出齿轮294与小齿轮292脱离，内部驱动轴284可相对于外部驱动轴285滑动，使得输入齿轮297接触输出齿轮294中的凹槽298，并且推动输出齿轮294远离小齿轮292。在至少一个实施例中，凹槽298可包括与内部输入轴284的输入齿轮297可操作地接合的齿299，使得内部输入轴284的旋转被传递到输出驱动轴286。在传动装置280的第二构型中，内部输入轴284的顺时针旋转可被直接传递到输出驱动轴286，使得输出轴286也在顺时针方向上旋转。为了使输出齿轮294与小齿轮292重新接合，内部输入齿轮284可与输出齿轮294脱离，以允许弹簧281沿花键配合末端296来使输出齿轮294滑动。
在上述实施例中，外科医生可选择性地使内部输入轴284相对于外部输入轴285运动，以将传动装置280置于正向构型或反向构型中。在各种实施例中，为了使输入轴284运动，外科器械还可包括能够平移内部输入轴284的致动器或触发器。在至少一个实施例中，外科器械可包括用于使外部输入轴285旋转的第一致动器或触发器、以及用于使内部轴284相对于外部轴285平移的第二致动器或触发器。在此类实施例中，内部输入轴284可包括可与外部输入轴285滑动接合的花键283，使得外部轴285的旋转被传递到内部轴284，但是允许在其间的滑动运动。在至少一个实施例中，传动装置280还可包括可旋转地支撑输入齿轮293的轴承300，并且当被压缩在输入齿轮293和外壳282之间时，该轴承提供偏置力以使输入齿轮293与小齿轮292保持可操作地接合。在各种实施例中，输出轴286可包括从其延伸的构件302。该构件能够被容纳于外壳282的凹槽301内，以便减少或甚至消除输出轴286和外壳282之间的相对运动。在至少一个实施例中，尽管未示出，传动装置280可能仅具有一个小齿轮292，但仍然以上述方式运行。
在各种实施例中，传动装置280还能够例如以不同于回缩切割构件96的速率来推进切割构件96。在至少一个实施例中，参见图31和32，内部输入轴284和输出轴286之间的操作接合可被用于推进切割构件96，并且由于输入齿轮297和输出齿轮294之间的直接接合，内部输入轴284和输出轴286可以1：1比率旋转，即内部输入轴284每旋转一次，输出轴286就旋转一次。在各种实施例中，外部输入轴285和输出轴286之间的操作接合可被用于回缩切割构件96，并且由于输入齿轮293和输出齿轮294的不同节距半径以及它们与小齿轮292的操作接合，外部输入轴285和输出轴286可以不同于1:1的比率旋转。在所示实施例中，当它们经由小齿轮292配合时，输出轴286可以比外部输入轴285更快的速度旋转。因此在各种实施例中，当外部输入轴285与输出轴286可操作地接合时，切割构件96可以比当内部输入轴284与输出轴286可操作地接合时更快的速率平移。
上述发明还对机器人外科系统具有适用性。此类系统在本领域中为人们所熟知并且包括购自IntuitiveSurgical,Inc.（Sunnyvale,CA）的那些。实例还公开于美国专利6,783,524；7,524,32；和7,824,401中。所有上述专利据此以引用的方式并入本文。
一般来讲，机器人外科系统具有远程可控用户界面和远程可控臂，该远程可控用户界面和远程可控臂能够与外科器械和系统交接并操作外科器械和系统。臂可使用一个或多个电子控制系统来控制，该电子控制系统通常适于本地化控制台，以供用户与该本地化控制台交接。器械可由外科系统在本地提供动力，或者具有与机器人总体控制相分离的动力系统。
机器人外科系统包括致动组件、监视器、机器人和附接到机械臂的至少一个牢靠地附接的加载单元。该机械臂具有至少一个外科器械以执行至少一项外科任务，并且该外科器械能够可释放地附接到臂的远端。
在另一个实施例中，机器人外科系统包括处理器、至少一个编码器以确定至少一个马达驱动接头的位置、用于接收从缝合单元传输的电信号并且控制其运动的接收器。
与机器人一起使用的示例性一次性加载单元在授予Tovey等人的美国专利6,231,565中有所公开。具有外科医生比例控制的示例性外科机器人在授予Smith等人的美国专利5,624,398中有所公开。
在本发明的另一个方面中，机器人系统具有框架、相对于框架可动的机械臂，并且具有细长管的缝合组件，该细长管将缝合组件连接至机械臂。具有缝合组件的细长管和缝合组件自身这两者均可释放地附接到并且可操作地联接到机械臂。缝合组件的一种构型可被移除，并且不同的构型可被附接并且被操作。
关于图23和24。机器人系统包括联接构件，该联接构件可释放地附接到闭合管207的近端并且径向联接到驱动轴206的近端。
可将本发明所公开的装置设计为单次使用后即进行处理，或者可将它们设计为可多次使用。然而，在任一种情况下，所述装置均可重新调理，以在至少一次使用后再次使用。重新调理可包括如下步骤的任何组合：拆卸该装置、接着清洁或置换特定部分、以及后续组装。具体地，所述装置可被拆卸，并且可以任何组合选择性地置换或移除该装置任何数目的特定零件或部分。清洁和/或置换特定部分后，该装置可以在重新调理设施处重新组装以供后续使用，或者在即将进行外科手术之前由外科手术团队重新组装。本领域的技术人员将会知道，装置的重新调理可利用多种用于拆卸、清洁/置换和重新组装的技术。此类技术的使用以及所得的重新调理的装置均在本发明的范围内。
优选地，将在手术前处理本文所述的发明。首先，获取新的或经使用的器械，并在必要时对其进行清洁。然后对器械进行消毒。在一种消毒技术中，将该器械置于闭合并密封的容器中，例如塑性袋或TYVEK袋中。然后将容器和器械置于可穿透该容器的辐射区中，例如γ辐射、x-射线、或高能电子。辐射将器械上和容器中的细菌杀死。然后将灭菌的器械储存在无菌容器中。该密封容器将器械保持无菌，直到在医疗设施中将其打开。
尽管已将本发明作为示例性设计进行了描述，但还可以在本公开的实质和范围内对本发明进行修改。因此本专利申请旨在涵盖采用本发明一般原理的任何变型、用途或适应型式。此外，本专利申请旨在涵盖本发明所属领域中出自已知或惯有实践范围内的背离本公开的型式。
Claims (1)
1.一种外科器械，包括：
远程可控用户界面；
击发驱动装置，所述击发驱动装置能够在所述远程可控用户界面的第一致动时产生旋转击发运动，并且在远程可控用户界面的另一致动时产生旋转回缩运动；
第一驱动构件，其中远程可控用户界面能够与所述第一驱动构件选择性地接合；和
第二驱动构件，其中所述远程可控用户界面能够与所述第二驱动构件选择性地接合；
细长轴组件，所述细长轴组件能够与所述第一驱动构件和所述第二驱动构件操作地接合；和
联接到所述细长轴组件的端部执行器，所述端部执行器包括：
能够在其中可操作地支撑钉仓的细长通道；
可动地联接到所述细长通道的砧座；和
被可操作地支撑在所述细长通道内的切割构件，其中所述切割构件与所述细长轴组件可操作地接合，其中当所述远程可控用户界面操作所述第一驱动构件时，所述第一致动将所述切割构件推进第一距离，其中当所述远程可控用户界面操作所述第二驱动构件时，所述另一致动使所述切割构件回缩第二距离，并且其中所述第二距离大于所述第一距离。
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| US13/037,409 US8534528B2 (en) | 2007-06-04 | 2011-03-01 | Surgical instrument having a multiple rate directional switching mechanism |
| US13/037,409 | 2011-03-01 | ||
| PCT/US2012/026995 WO2012118842A1 (en) | 2011-03-01 | 2012-02-28 | Surgical instrument having a multiple rate directional switching mechanism |
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| CN103402445A CN103402445A (zh) | 2013-11-20 |
| CN103402445B true CN103402445B (zh) | 2016-03-30 |
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| CN201280011067.4A Active CN103402445B (zh) | 2011-03-01 | 2012-02-28 | 具有多速率定向切换机构的外科器械 |
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| US (1) | US8534528B2 (zh) |
| EP (1) | EP2680760A1 (zh) |
| JP (1) | JP2014514012A (zh) |
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| BR (1) | BR112013022119A2 (zh) |
| CA (1) | CA2828714C (zh) |
| RU (1) | RU2628048C2 (zh) |
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- 2012-02-28 EP EP12707966.3A patent/EP2680760A1/en not_active Withdrawn
- 2012-02-28 CA CA2828714A patent/CA2828714C/en not_active Expired - Fee Related
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- 2012-02-28 CN CN201280011067.4A patent/CN103402445B/zh active Active
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Also Published As
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|---|---|
| JP2014514012A (ja) | 2014-06-19 |
| CA2828714A1 (en) | 2012-09-07 |
| US20110155786A1 (en) | 2011-06-30 |
| AU2012223478B2 (en) | 2016-09-01 |
| BR112013022119A2 (pt) | 2016-12-06 |
| EP2680760A1 (en) | 2014-01-08 |
| RU2628048C2 (ru) | 2017-08-14 |
| US8534528B2 (en) | 2013-09-17 |
| RU2013143950A (ru) | 2015-04-10 |
| WO2012118842A1 (en) | 2012-09-07 |
| CA2828714C (en) | 2019-03-12 |
| CN103402445A (zh) | 2013-11-20 |
| AU2012223478A1 (en) | 2013-08-22 |
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