CN103860227A - 与手术装置一起使用的折叠支撑件 - Google Patents
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
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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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07292—Reinforcements for staple line, e.g. pledgets
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07271—Stapler heads characterised by its cartridge
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07285—Stapler heads characterised by its cutter
Abstract
本发明提供了一种与手术装置一起使用的末端执行器，所述末端执行器包括具有限定中心纵向狭槽的组织接触表面的吻合钉钉仓和具有限定中心纵向狭槽的组织接触表面的砧座板。本发明还提供了与手术装置一起使用的折叠的支撑件。折叠的手术支撑件被配置为覆盖在吻合钉钉仓和砧座板的各自组织接触表面上并且被配置为使手术支撑件固持到吻合钉钉仓和砧座板的各自的组织接触表面。手术支撑件具有第一纵向部、第二纵向部以及在第一和第二纵向部之间的中间纵向部，其中中间纵向部被折叠并被配置为安装于吻合钉钉仓和砧座板各自的中心纵向狭槽内。
Description
技术领域
本公开涉及手术吻合装置，所述手术吻合装置包括能够可释放地附接到手术吻合装置上的手术支撑件，并且本公开尤其涉及被折叠和仿形加工为使得保持牢固地附接的手术支撑件。
背景技术
外科医生使用手术吻合装置来顺序地或者同时地施加一排或多排紧固件（例如吻合钉或两部件紧固件）到身体组织以用于将身体组织的多个段连结在一起。所述装置通常包括其间放置有待连结的身体组织的一对钳夹或指状结构。当致动或“发射”吻合装置时，纵向运动的发射杆接触在一个钳夹中的吻合钉驱动构件。吻合钉驱动构件推动手术吻合钉通过身体组织并且进入相对钳夹中的使吻合钉成形的砧座中。如果要移除或分离组织，则可以将刀片设置在所述装置的钳夹中以切割吻合钉线之间的组织。
众所周知，依靠刀片切断手术支撑件的一部分以实现释放。可采用除手术支撑件之外的辅助材料或安装结构（例如缝合线）以提供手术支撑件至手术吻合装置的附接。典型地，随着必须被刀片横切的各个材料的增加而增加发射力以便释放手术支撑件。
令人期望的是提供能够可释放地固定到手术吻合装置的手术支撑件，而不需要辅助材料或安装结构并且不需要刀片来切割辅助材料或安装结构从而将手术支撑件从手术吻合装置释放，从而可以使用更少的材料和更小的发射力。还会令人期望的是，提供具有更高的结构完整性和刚性的手术支撑件而不会有害地影响手术吻合装置的发射顺序。
发明内容
根据本公开的一个方案，本发明提供了一种与手术装置一起使用的末端执行器，其中末端执行器包括：吻合钉钉仓，具有限定中心纵向狭槽的组织接触表面；以及砧座板，具有限定中心纵向狭槽的组织接触表面。折叠的（folded）手术支撑件被配置为覆盖在吻合钉钉仓和砧座板的各自组织接触表面上，并且被配置为使手术支撑件固持到吻合钉钉仓和砧座板的各自的组织接触表面。手术支撑件具有第一纵向部、第二纵向部以及在第一和第二纵向部之间的中间纵向部，其中所述中间纵向部被折叠并被配置为安装于吻合钉钉仓和砧座板的各自的中心纵向狭槽内。优选地，中间纵向部为大体V形。
在一个可选择的实施例中，吻合钉钉仓和砧座板的手术支撑件各自均限定底部表面并且具有带近侧边缘的近侧部，其中近侧部朝底部表面方向折叠使得近侧边缘邻近手术支撑件的底部表面。吻合钉钉仓和砧座板的手术支撑件各自均具有带远侧边缘的远侧部，其中远侧部朝底部表面方向折叠使得远侧边缘邻近手术支撑件的底部表面。
在本公开的另一个方案中，本发明提供了一种与手术吻合装置一起使用的吻合钉钉仓，所述吻合钉钉仓包括：钉仓主体，其包含限定多个吻合钉固持槽的组织接触表面并且具有中心纵向狭槽；以及吻合钉，其被布置于钉仓主体的每个吻合钉固持槽内。折叠的手术支撑件被配置为覆盖在吻合钉钉仓和砧座板的每个组织接触表面上，并且被配置为使手术支撑件固持到吻合钉钉仓和砧座板的各自的组织接触表面。手术支撑件具有第一纵向部、第二纵向部以及在第一和第二纵向部之间的中间纵向部，其中中间纵向部被折叠并且被配置为安装于吻合钉钉仓和砧座板的各自的中心纵向狭槽内。优选地，中间纵向部为大体V形。
在一个可选择的实施例中，吻合钉钉仓的手术支撑件限定底部表面，并且包含具有近侧边缘的近侧部，其中近侧部朝底部表面方向折叠使得近侧边缘邻近手术支撑件的底部表面。吻合钉钉仓的手术支撑件还包含具有远侧边缘的远侧部，其中远侧部朝底部表面方向折叠使得远侧边缘邻近手术支撑件的底部表面。
在本公开的又一个方案中，本发明提供了一种手术吻合装置，包括壳体以及固定于壳体的末端执行器，该末端执行器包括具有组织接触表面的吻合钉钉仓组件和具有组织接触表面的砧座组件，吻合钉钉仓组件和砧座组件各自均具有中心纵向狭槽。折叠的手术支撑件被配置为覆盖在吻合钉钉仓和砧座板的各组织接触表面上，并且被配置为使手术支撑件固持到吻合钉钉仓和砧座板的各自的组织接触表面。手术支撑件具有第一纵向部、第二纵向部以及在第一和第二纵向部之间的中间纵向部，其中中间纵向部被折叠并被配置为安装于吻合钉钉仓和砧座板中每一个的中心纵向狭槽内。优选地，中间纵向部为大体V形。
附图说明
参照附图，在这里公开了本公开的互锁支撑件固持系统的各种实施例，其中：
图1是根据本公开的实施例的手术吻合装置的立体图；
图2是图1的手术吻合装置的吻合钉钉仓组件的零件分离立体图，图示出根据本公开的一个实施例；
图3是图1的手术吻合装置的砧座组件的零件分离立体图，图示出本公开的一个实施例；
图4A是根据本公开的手术支撑件的可选择实施例的立体图；
图4B是根据本公开的手术支撑件的另一个可选择实施例的立体图；
图4C是根据本公开的手术支撑件的又一个可选择实施例的立体图；
图4D是图4B中描述细节的放大图；
图4E是图4C中描述细节的放大图；
图5是图1的手术吻合装置的绕组织段定位使用的远侧端的立体图；
图6是沿图5的线6-6截取的剖视图；以及
图7是图5的已吻合和已分割的组织段的立体图。
具体实施方式
以下就用于与手术吻合装置一起使用的手术支撑件讨论本公开的多种示例性实施例。在此描述的手术支撑件可用于通过使得在包括至少一个手术支撑件的手术吻合装置的砧座板和吻合钉钉仓之间的创伤组织的边缘接近来封闭伤口。所述至少一个手术支撑件通过被配置为仿形手术吻合装置的形状来可释放地布置在手术吻合装置的组织接触表面上。这允许手术支撑件牢固地保持在组织接触表面上，而不需要额外的紧固件、缝合线或类似结构。手术吻合装置的发射使得至少一个吻合钉的钉腿穿过吻合钉钉仓上的开口、组织以及穿过砧座板上的开口，以使手术支撑件紧固于组织、以使邻近组织彼此紧固，并且封闭组织。吻合钉的发射力从组织接触表面释放手术支撑件。因此，本公开描述手术支撑件、支撑所述手术支撑件的手术吻合装置以及使用它们的方法和机构。
应该理解的是，多种手术吻合装置可与本公开的手术支撑件一起使用。例如，可以使用线性吻合器构造，所述线性吻合器构造例如那些包括可购自Covidien(柯惠)的Tri-Staple technology TM的吻合器，其中Covidien的主要营业场所在555Long Wharf Drive,North Haven,CT06511；以及横向接合吻合器，例如也可购自Covidien的EEATM、CEEATM、GIATM、EndoGIATM和TATM吻合器。还应该理解的是，本公开的原理同样适用于具有替换构造的手术吻合器，所述替换构造例如为：具有环形钉仓和砧座的端对端接合吻合器（参见，例如，名称为“Surgical Fastener Applying Apparatus(手术紧固件施加装置)”的共有美国专利No.5,915,616,该专利的全部内容通过引用结合于此）；腹腔镜吻合器（参见，例如，名称均为“Surgical Stapling Apparatus(手术吻合装置)”的共有美国专利No.6,330,965和No.6,241,139,各专利的全部内容通过引用结合于此）；以及横向接合吻合器（参见，例如，名称均为“Surgical Fastener Applying Apparatus(手术紧固件施用装置)”的共有美国专利No.5,964,394和No.7,334,717，各专利的全部内容通过引用结合于此）。
现在将参照附图详细描述本公开的手术支撑件和手术吻合装置的实施例，在附图中相同的附图标记表示类似或相同的零件。在下面的讨论中，术语“近侧”和“尾端”可以互换地使用，并应将其理解为是指在正确使用过程中一个结构的更接近临床医生的部分。术语“远侧”和“头侧”也可以互换地使用，并应将其理解为是指在正确使用过程中一个结构的更远离临床医生的部分。如在本文使用的，应将术语“患者”理解为是指人类对象或其他动物，应将术语“临床医生”理解为是指医生、护士或是提供护理的其他人，并且“临床医生”可包括辅助人员。
现在参照图1，其公开了示例性的手术吻合装置或手术吻合器10，用于吻合组织并施加支撑件材料或手术支撑件到组织。美国专利No.7,128,253中公开了这种手术吻合器械的示例，该专利的全部内容通过引用合并于此。
手术吻合装置10通常包括：手柄12，其具有从手柄12向远侧延伸的细长管状构件14。末端执行器组件16安装于细长管状构件14的远侧端18。末端执行器组件16包括第一钳夹或吻合钉钉仓组件200以及第二钳夹或砧座组件300，其中，吻合钉钉仓组件200被配置为在其中容纳吻合钉钉仓32。末端执行器组件16可永久性地固定于细长管状构件14，或可以是可拆卸的并且因此可用新的末端执行器组件16替换。除了可替换的末端执行器组件或作为对此的可选方案，钉仓组件200可被移除并替换。吻合钉钉仓组件200和砧座组件300中的一个可运动地安装于末端执行器组件16的远侧端18，并且能够在彼此远离的打开位置与基本上彼此接近的闭合位置之间运动。砧座组件300支撑砧座板302并且可由金属材料制造，包括但不限于不锈钢、钛、钛合金以及类似材料。吻合钉钉仓32的组织接触表面可由不是金属的材料制造，包括但不限于塑料、热塑性塑料、树脂、聚碳酸酯以及类似材料。
手术吻合装置10进一步包括扳机33，如图1所见，扳机33可运动地安装在手柄12上。扳机33的致动首先操作使第一钳夹和第二钳夹在打开和闭合位置之间运动，并同时致动手术吻合装置10将吻合钉线施加到组织。为了使得末端执行器组件16相对于待吻合的组织正确定向，手术吻合装置10加设安装于手柄12的旋钮34。旋钮34的相对于手柄12的旋转使得细长管状构件14和末端执行器组件16相对于手柄12旋转，以便于末端执行器组件16相对于待吻合组织正确定向。
如图5和图6所示，驱动器36被设置为使第一钳夹或吻合钉钉仓组件200和第二钳夹或砧座组件300从打开位置到闭合位置运动接近。驱动器36运动穿过中心纵向狭槽338（图3），该狭槽338成形于砧座组件300的砧座板302中。随着驱动器36穿过狭槽338，具有刀片31的刀具30关联驱动器36以切断在吻合钉钉仓组件200和砧座组件300之间被捕获的组织。
可参考共同拥有美国专利第5,915,616、6,330,965以及6,241,139号，各个专利的全部内容通过引用并入在此，用于示例性的手术吻合装置10的结构和操作的详述。
吻合钉钉仓组件200和/或砧座组件300可设置有手术支撑件500。手术支撑件500用于通过手术吻合装置10来加强和封闭施加在组织上的吻合钉线。手术支撑件500可被配置为适于配合任何手术吻合、紧固或发射装置的任何形状、大小或尺寸。
在下文以更详述的方式描述吻合钉钉仓组件200设有钉仓支撑件500a并且砧座组件300设有砧座支撑件500b。该支撑件500a、500b可由任何生物相容的天然或合成材料制成。形成该支撑件500a、500b的材料可以是生物可吸收的或非生物可吸收的。应该理解为，天然的（包括由动物获得的材料）、合成的、生物可吸收的和非生物可吸收的材料的任意组合可被用来形成支撑件材料。支撑件500a、500b可以是多孔的或无孔的、多孔与无孔的组合层。无孔的支撑件500a、500b可用于阻碍或防止周围组织的组织向内生长，从而用作粘附屏障并防止形成不想要的疤痕组织。支撑件材料可以是薄膜、泡沫、网织物、纺织物、无纺物或其它材料，以及可以通过模塑、吹塑薄膜工艺、熔喷法和/或纺粘工艺形成。
在此公开的与手术吻合装置一起使用的手术支撑件500a、500b的另外的示例性材料在共同转让的美国专利号为5,542,594、5,908,427、5,964,774和6,045,560的专利以及共同转让的于2006年4月20日提交的公开号为2006/0085034的美国申请、于2006年6月22日提交的公开号为2006/0135992的美国申请中给出，各个专利的全部内容均通过引用合并于此。支撑件材料可以如在美国申请号13/293,215中所描述的形成，该申请的全部公开通过引用结合于此。
如图2和图3所图示，手术支撑件500可释放地附接到吻合钉钉仓32和/或砧座板302的内表面或组织接触表面220、320。手术支撑件500被折叠并且被配置为仿形吻合钉钉仓32和砧座板302各自的形状。将手术支撑件500配置成采取吻合钉钉仓32或砧座板302的形状，允许手术支撑件500在吻合装置10发射之前固定于相应的组织接触表面。当使用器械以及在抓住组织时操作装置等的时候，该折叠部分也为支撑件提供稳定性。
参考图2，吻合钉钉仓组件200的钉仓支撑件500a可操作地固定于吻合钉钉仓32的组织接触表面220。钉仓支撑件500a具有第一纵向部510、第二纵向部512、以及在第一和第二纵向部510、512之间的中间纵向部514。该中间纵向部514被折叠并且被配置为形状适配地稳固地安装于吻合钉钉仓的中心纵向狭槽238内。在这个实施例中，第一和第二纵向部510、512保持在吻合钉钉仓的组织接触表面220上。中间纵向部514为大体V形或U形，这样纵向间隙沿着由第一和第二纵向部510、512限定的平面存在。换言之，钉仓支撑件500a包括第一状态，其中钉仓支撑件500a大体为平面，以及第二状态，其中平面的钉仓支撑件500a沿它的纵向轴线被折叠以限定大体V形的中间纵向部514，以便于限定中心纵向延伸的突起或翼片。支撑件可使用加热和/或加压被模制成或压制成这个形状。
将钉仓支撑件500a仿形加工为安装于中心纵向狭槽238内，在使用吻合装置10期间，阻止钉仓支撑件500a横向运动。进一步地，中间部分514在吻合钉钉仓32的中心纵向狭槽238内的精确安装提供稳固地将钉仓支撑件500a固定在适当位置的摩擦力。支撑件中一个或多个折叠的形状提供稳定性，并能够被设置在支撑件的中心部分、远侧部、近侧部或侧面。当刀片31远侧平移穿过中心纵向狭槽238时，刀片沿着折叠部分切割钉仓支撑件500a的中间部分514，进一步从吻合钉钉仓32的组织接触表面220释放第一和第二纵向部510、512。
图2和图3图示出支撑件500a、500b的附加特征，用于将支撑件500a、500b固定到各自的组织接触表面220、320。如图2所示，吻合钉钉仓32具有第一外侧表面248a和第二外侧表面248b。钉仓支撑件500a的第一延伸部526从第一纵向部510向下延伸。第一延伸部526可由向吻合钉钉仓32的第一外侧表面248a延伸并且邻近第一外侧表面248a定位的折叠部分成形。相似地，钉仓支撑件500a的第二延伸部528（其也可以是支撑件的折叠部分）由第二纵向部512向下延伸，并且朝吻合钉钉仓32的第二外侧表面248b折叠并邻近第二外侧表面248b定位。第一和第二延伸部526、528允许增加强度以维持钉仓支撑件500a在吻合钉钉仓32的组织接触表面220上的定位。虽然示出了关于钉仓支撑件500a的第一和第二延伸部526和528，但是应当理解的是砧座支撑件500b可包括相似特征。
参考图3，与钉仓支撑件500a相似，砧座支撑件500b可操作地固定于砧座组件300的砧座板302的组织接触表面320。砧座支撑件500b被折叠和仿形加工为使得中间部分514被稳固地定位在砧座板302的中心纵向狭槽338内。砧座板302的第一和第二纵向部510、512保持在砧座板302的组织接触表面320上。换言之，砧座支撑件500b包括第一状态，其中砧座支撑件500b为基本上平面的；以及第二状态，其中平面砧座支撑件500b沿着它的纵向轴线折叠，以限定大体V形的中间纵向部514，以便于限定中心纵向延伸的突起或翼片。
如图3所示，第一延伸部526从第一纵向部510延伸并向砧座支撑件500b的底部表面536折叠。第一延伸部526向底部表面536折叠，以便临近于砧座支撑件500b的第一纵向部510的底部表面536布置。自第二纵向部512延伸的第二延伸部528朝向第二纵向部512的底部表面536折叠，以便临近于砧座支撑件500b的底部表面536布置。这个附加的特征对砧座支撑件500b进行加强，并在拉紧期间阻止砧座支撑件500b撕裂。在支撑件的侧面可以设置折叠部分以提高钉仓和/或砧座构件上的支撑件的稳定性。在这个实施例中，虽然示出了关于砧座支撑件500b的第一和第二延伸部526和528，但应当理解的是，钉仓支撑件500a可包括相似特征。
图4A至图4C图示出可选择的实施例。手术支撑件500包括与吻合钉钉仓32和/或砧座板302的形状一致的形状。为描述目的，仅仅引用钉仓支撑件500a和吻合钉钉仓32，但是，应当理解的是，相似结构用于砧座支撑件500b和砧座板302。在该选择中，砧座支撑件500b可被不同地配置，用于提供稳定性和在砧座板302受到的抗撕裂性。
在图4A中，在这个示例中的手术支撑件500a的中间纵向部514为大体平面的，并被配置为位于吻合钉钉仓32的组织接触表面220上。在这个实施例中，钉仓支撑件500a的第一纵向部510向第一外侧表面248a折叠并且邻近于第一外侧表面248a。相似地，钉仓支撑件500a的第二纵向部512向第二外侧表面248b折叠并且邻近于第二外侧表面248b。第一纵向部510和第一外侧表面248a之间的结合以及第二纵向部512和第二外侧表面248b之间的结合阻止钉仓支撑件500a的横向运动以及使钉仓支撑件500a固定于适当位置。因此，支撑件500a可以具有一个或多个纵向折叠部分。
图4B图示出另一个可选择的实施例，其中钉仓支撑件500a限定底部表面536，并且钉仓支撑件500a包括向底部表面536折叠的近侧部520和远侧部522。钉仓支撑件500a的近侧部520具有向底部表面536折叠的近侧边缘530，以便于邻近于钉仓支撑件500a的底部表面536布置。相似地，钉仓支撑件500a的远侧部522具有向底部表面536折叠的远侧边缘532，以便于邻近于钉仓支撑件500a的底部表面布置。支撑件具有一个或多个折叠的末端。在这个实施例中，近侧部520、远侧部522邻近于吻合钉钉仓32的组织接触表面220。可以构想的是，在此论述的用于吻合钉钉仓32和砧座板302两者的实施例可与在本领域已知的众所周知的缝合固持方法一起使用。例如，如图4B和4D所示，一对凹口538可以布置于近侧部520、远侧部522的各自折叠区域内。一个或多个缝合线部，或一些其他种类的锚固件，可定位于凹口内。可选择地或额外地，能够使用粘合剂或焊接来固定支撑件。
图4C又图示出另一个可选择的实施例，其中，钉仓支撑件500a的第一和第二纵向部510、512向钉仓支撑件500a的底部表面536折叠。以如上所描述的相似方式，第一纵向部510的第一纵向边缘540向底部表面536折叠，以便于邻近于钉仓支撑件500a的底部表面布置。第二纵向部512的第二纵向边缘542向底部表面536折叠，以便于邻近于钉仓支撑件500a的底部表面536布置。在这个实施例中，第一和第二纵向部510、512贴近于吻合钉钉仓32的组织接触表面220。凹口538，如图4E所示，沿折叠区域布置。可以构想的是，凹口538能以各不相同的构造布置，来与本领域众所周知使用的缝合线相关联。在图4B和图4C中所描述的实施例中，对钉仓支撑件500a进行加强并阻止钉仓支撑件500a在拉紧期间撕裂。
在此公开的被用来固持缝合线的凹口538在2012年9月5日提交的共同转让的美国临时专利Nos.61/696906中提出，各个专利的全部内容通过引用并入于此。
组装之前，手术支撑件500a、500b可以加热成形或冷折叠成仿形形状，用于容纳在吻合钉钉仓32和砧座板302各自的中心纵向狭槽238、338内。在组装期间，手术支撑件500a、500b分别放置在吻合钉钉仓组件200和砧座组件300的各个组织接触表面220、320上。可使用在本技术领域众所周知的附加的缝合线或紧固件来进一步将手术支撑件500a、500b附接到每个组织接触表面220、320。另外，在此公开的任何一个实施例中，可使用其它的结合方法如粘合剂、超声焊接、激光焊接、溶剂粘结或热挤压。
如图5所图示的，在使用手术吻合装置10期间，在其上装载有手术支撑件500a、500b（如上所述）的第一钳夹或吻合钉钉仓组件200以及第二钳夹或砧座组件300被放置在手术部位的任一侧上。吻合钉钉仓组件200和砧座组件300的组织接触表面220、320邻近待彼此紧固的组织“T”的层定位。
如图6所示，吻合钉钉仓组件200包括手术吻合钉50，手术吻合钉50定位在吻合钉钉仓32的单独的吻合钉固持槽52内。吻合钉50为常规类型并包括钉冠54，钉冠54具有从钉冠54延伸的一对钉腿56和58。钉腿56和58分别终止于组织穿透末端60和62。推动器64位于吻合钉固持槽52内并且定位于吻合钉50和驱动杆66的轨道之间。
在所图示的实施例中，初始时，手术吻合装置10通过扳机33相对于手柄12的运动而被致动（图1），引起驱动器36在箭头“A”（图5）的方向上运动并且抵靠砧座板302的斜边21，由此引起砧座组件300相对于吻合钉钉仓组件200运动至闭合位置。随着驱动杆66在吻合钉钉仓32内向远侧推进，驱动杆66推动推动器64向上抵靠吻合钉50的钉冠54，驱动吻合钉50的钉腿56和58穿过钉仓支撑件500a、组织“T”和砧座支撑件500b，朝向砧座组件300的砧座板302中的吻合钉成形凹部68。吻合钉钉腿56和58的组织穿透末端60和62在砧座板302中的吻合钉成形凹部68内成形，钉冠54使手术支撑件500抵靠组织“T”而固定。
在手术吻合装置10的完全致动时，可以使用与手术吻合装置10相关联的并由驱动器36承载的刀具30（图6）来切割组织“T”以及在现在成形的吻合钉50排之间的手术支撑件500a、500b。在砧座组件300运动至与吻合钉钉仓组件200间隔开的打开位置时，支撑件500a、500b被从相应的吻合钉钉仓组件200和砧座组件300的各自组织接触表面220、320拉开和释放。
在图7中图示出分开的和由吻合钉50闭合吻合的组织“T”。具体地，手术支撑件500a、500b通过吻合钉50的钉腿56、58和钉冠54抵靠组织“T”而固定。因此，手术支撑件500a、500b被吻合到组织“T”，从而封闭并加强由吻合钉50产生的吻合钉线。
本领域的技术人员理解的是，在此具体描述并图示在附图中的装置和方法为非限制性的示例性实施例，并且描述、公开以及附图应该仅仅构成特定实施例的示例。因此应当理解的是，本公开不限于所描述的精确实施例，本领域的技术人员在不偏离本公开的范围或精神的前提下能够实现多种其它的改变和修改。另外，能想到的是，关于一个示例性实施例所说明或描述的元件和特征可以与另一示例性实施例的元件和特征进行组合而不偏离本公开的范围，而这种修改和变型也被有意包括在本公开的范围内。因此，除了由所附的权利要求书所指明的之外，本公开的主题不受已经具体示出和所描述的内容限制。
Claims (6)
1.一种与手术装置一起使用的末端执行器，所述末端执行器包括：
吻合钉钉仓，其具有限定中心纵向狭槽的组织接触表面；
砧座板，其具有限定中心纵向狭槽的组织接触表面；以及
折叠的手术支撑件，其被配置为覆盖在所述吻合钉钉仓和所述砧座板的各自组织接触表面上并且被配置为使所述手术支撑件固持到所述吻合钉钉仓和所述砧座板各自的组织接触表面，所述手术支撑件限定底部表面并且包含具有近侧边缘的近侧部和具有远侧边缘的远侧部，
其中所述近侧部和远侧部中的至少一个相对于所述底部表面被折叠。
2.根据权利要求1所述的末端执行器，其中所述手术支撑件具有第一纵向部、第二纵向部以及在第一和第二纵向部之间的中间纵向部，
其中所述中间纵向部被折叠并被配置为安装于所述吻合钉钉仓和砧座板各自的中心纵向狭槽内。
3.根据权利要求2所述的末端执行器，其中所述中间纵向部为大体V形。
4.一种与手术吻合装置一起使用的吻合钉钉仓，所述吻合钉钉仓包括：
钉仓主体，其包含限定多个吻合钉固持槽的组织接触表面并且具有中心纵向狭槽；
吻合钉，其被布置于所述钉仓主体的每个吻合钉固持槽内；以及
折叠的手术支撑件，其被配置为覆盖在吻合钉钉仓的每个组织接触表面上并且被配置为使所述手术支撑件固持到所述吻合钉钉仓的组织接触表面，所述手术支撑件限定底部表面，并包含具有近侧边缘的近侧部和具有远侧边缘的远侧部，
其中所述近侧部朝底部表面方向折叠使得所述近侧边缘临近手术支撑件的所述底部表面，
其中所述远侧部朝底部表面的方向折叠使得所述远侧边缘临近手术支撑件的所述底部表面。
5.一种手术吻合装置，包括：
壳体；以及
根据权利要求4所述的吻合钉钉仓。
6.一种手术吻合装置，包括：
壳体；
末端执行器，其被固定到所述壳体，所述末端执行器包括具有组织接触表面的吻合钉钉仓组件和具有组织接触表面的砧座组件，吻合钉钉仓组件和砧座组件各自具有中心纵向狭槽；以及
折叠的手术支撑件，其被配置为覆盖在吻合钉钉仓和砧座板的每个组织接触表面上，并且被配置为使手术支撑件固持到吻合钉钉仓和砧座板的各自的组织接触表面，所述手术支撑件具有第一纵向部、第二纵向部以及在第一和第二纵向部之间的中间纵向部，所述手术支撑件限定底部表面，并包含具有近侧边缘的近侧部和具有远侧边缘的远侧部，
其中所述近侧部朝底部表面方向折叠使得所述近侧边缘邻近所述手术支撑件的底部表面，
其中所述远侧部朝底部表面方向折叠使得所述远侧边缘邻近所述手术支撑件的底部表面。
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2012
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2013
- 2013-11-13 AU AU2013257439A patent/AU2013257439A1/en not_active Abandoned
- 2013-12-04 CN CN201310646606.8A patent/CN103860227B/zh active Active
- 2013-12-10 JP JP2013254704A patent/JP2014117603A/ja active Pending
- 2013-12-12 EP EP13196816.6A patent/EP2742872A1/en not_active Withdrawn
- 2013-12-12 CA CA2836440A patent/CA2836440A1/en not_active Abandoned
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2016
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2019
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| CN110461250A (zh) * | 2017-02-17 | 2019-11-15 | 爱惜康有限责任公司 | 具有用于与附属物配合的延伸特征部的端部执行器 |
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| CN109316218B (zh) * | 2018-11-07 | 2021-05-04 | 成都颐合恒瑞医疗科技有限公司 | 外科吻合器及其钉仓组件 |
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|---|---|
| AU2013257439A1 (en) | 2014-07-03 |
| CA2836440A1 (en) | 2014-06-13 |
| US20160367257A1 (en) | 2016-12-22 |
| US20140166721A1 (en) | 2014-06-19 |
| CN103860227B (zh) | 2017-12-08 |
| US20190290280A1 (en) | 2019-09-26 |
| US11026688B2 (en) | 2021-06-08 |
| US20210251629A1 (en) | 2021-08-19 |
| US9402627B2 (en) | 2016-08-02 |
| US11806018B2 (en) | 2023-11-07 |
| US10349942B2 (en) | 2019-07-16 |
| JP2014117603A (ja) | 2014-06-30 |
| EP2742872A1 (en) | 2014-06-18 |
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