CN104394791A - 光能封闭、切割和感知手术装置 - Google Patents
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Abstract
本发明涉及一种医疗器械。所述医疗器械包括外壳和操作性地连接至外壳的末端执行器组件。末端执行器组件包括第一和第二夹爪部件,第一和第二夹爪部件均具有组织接触表面,第一和第二夹爪部件中的至少一个能够在第一间隔位置和第二紧邻位置之间移动,其中在第二位置,夹爪部件协作以限定被构造成接收夹爪部件之间的组织的空腔。末端执行器还包括耦合至第一和第二夹爪部件中的至少一个的至少一个发光元件,所述至少一个发光元件适合于向第一和第二夹爪部件之间抓取的组织输送光能以治疗组织。
Description
技术领域
本发明涉及具有用以治疗和/或监视被治疗组织的部件的手术钳。更特别地,本发明涉及利用光能来治疗(例如封闭、切割等)和/或感知组织性质的开腹或内窥手术钳。
背景技术
在很多手术过程中,人体脉管例如血管、导管、粘连组织、输卵管或类似物被封闭,以使所述脉管失去功能或闭合所述脉管。传统上,一直使用卡钉、夹子或缝合线来闭合人体脉管。但是,这些传统程序经常会在患者体内留下异物材料。在致力于减少异物材料留在患者体内并更加有效地封闭人体脉管的过程中,已经采用了通过加热组织来实施封闭的能量技术。
内窥钳或开腹钳特别适用于封闭,这是因为钳利用机械作用来约束、抓取、剖开和/或夹紧组织。当前的脉管封闭程序利用射频治疗来加热和烘干组织,促使脉管或组织闭合和封闭。虽然在本领域中还已知其它的治疗方法,但是,很少有手术器械具有在不使用额外的手术器械的情况下治疗和监视组织治疗的能力。
发明内容
依照本发明的一个方面,提供了一种医疗器械。该医疗器械包括外壳和操作性地连接至所述外壳的末端执行器组件。末端执行器组件包括第一和第二夹爪部件,第一和第二夹爪部件均具有组织接触表面,第一和第二夹爪部件中的至少一个可以在第一间隔位置和第二紧邻位置之间移动。在所述第二位置,夹爪部件协作以限定被构造成接收夹爪部件之间的组织的空腔。一个或多个光传送元件耦合至第一和第二夹爪部件中的至少一个。所述光传送元件适合于连接至光能量源,并将光能输送至第一和第二夹爪部件之间抓取的组织以治疗组织。
本发明还提供了一种用于治疗组织的系统。该系统包括医疗器械,所述医疗器械包括外壳和操作性地连接至所述外壳的末端执行器组件。末端执行器组件包括第一和第二夹爪部件,第一和第二夹爪部件均具有组织接触表面,第一和第二夹爪部件中的至少一个可以在第一间隔位置和第二紧邻位置之间移动。在所述第二位置,夹爪部件协作以限定被构造成接收夹爪部件之间的组织的空腔。一个或多个光传送元件耦合至第一和第二夹爪部件中的至少一个。所述光传送元件适合于连接至光能量源,并将光能输送至第一和第二夹爪部件之间抓取的组织以治疗组织,以及一个或多个光检测元件,所述光检测元件被构造成测量穿过组织的光能的至少一种性质。该系统还包括耦合至所述光检测元件和所述光能量源的控制器,所述控制器被构造成基于所测量的穿过组织的光能的至少一种性质控制光能量源。
本发明还构思了一种治疗组织的方法。该方法包括:在第一和第二夹爪部件之间抓取组织,第一和第二夹爪部件中的至少一个可以在第一间隔位置和第二紧邻位置之间移动,其中,在所述第二位置,夹爪部件协作以限定被构造成接收夹爪部件之间的组织的空腔;向第一和第二夹爪部件之间抓取的组织施加光能;测量向组织施加的光能的至少一种性质;并基于所测量的光能的至少一种性质控制光能。
参照附图详细描述本公开的手术器械的各个方面,其中同样的参考数字标记类似或相同的元件。在此所使用的术语"远侧"是指远离操作者的那个部分,而术语"近侧"是指靠近操作者的那个部分。在此所使用的术语"治疗"是指对组织进行外科治疗,包括但不限于加热、封闭、切割、感知和/或监视。在此所使用的术语"光能量源"广义上是指包括产生用于医学用途(例如组织治疗)的光的所有类型的装置。这些装置包括激光、发光二极管(LEDs)、灯泡、和在沿着电磁光谱(例如从红外线到紫外线)的适当部分的任何地方产生光装置的其它装置。还应当理解,在此设置的光源可以互换使用,这样,在公开了LED光源的情况下,也可以使用激光源,除非另有说明。
本发明还提供了用于通过向组织传送光来治疗组织的系统和方法。这可以通过与目标组织无间隙接触地放置光源来实现。在一些实施例中,可以通过利用设计成从光源向组织传送光的光学系统连接光源与目标组织来实现。任一系统可以包括在光能冲击目标组织并与之相互作用时定形光能的分布的元件。在此使用的术语"发光元件"表示光在与目标组织相互作用之前从其引出的任何装置,包括但不限于:光源;终止于目标组织的光透射系统的末端;折射、衍射、透射或反射光学元件,例如透镜、衍射光栅、窗户和镜子、以及它们的组合。
激光源可以产生波长从大约200nm到大约15,000nm的光,包括但不限于:红宝石激光器、可调钛-蓝宝石激光器、铜蒸汽激光器、二氧化碳激光器、变石激光器、诸如氩氟化物(ArF)准分子激光器、氩-染料激光器的氩激光器、磷酸钛氧钾(KTP)激光器、诸如氟化氪(KrF)准分子激光器的氪激光器、钕:钇-铝-石榴石(Nd:YAG)激光器、钬:钇-铝-石榴石(Ho:YAG)激光器、铒:钇-铝-石榴石(Er:YAG)激光器、二极管激光器、纤维激光器、氙氯化物(XeCl)准分子激光器、可调铊激光器、以及它们的组合。另外的光源类型还包括光纤光源和氘光源。
在本发明的某些方面,光可以用多个波长生成。例如,Nd:YAG和KTP激光器可以是单个光源的一部分,Nd:YAG在组织中具有较大的光深,可用来封闭,KTP带有较短的光深,可用来封闭较小脉管、较薄组织,或者用于切割。在此所使用的术语"接收模块"是指能够接收和/或感知信号(例如光能和热能)并且能够分析所接收的信号以生成控制和/或输出信号(例如对用户生成指令和/或征兆)的部件或设备。应当注意,接收模块也可以向其它适合的用于分析的部件(例如治疗器和/或发生器)传递所接收的信号。
正如下文参照附图更加详细介绍的那样,本发明概括来说涉及包括可以融合(例如封闭)和/或分离(例如切割)组织的末端执行器组件的光能手术装置。本发明还提供了在治疗的各个阶段感知和/或监视组织性质以确定治疗完成的时间、组织封闭的功效和/或测量夹爪压力(例如品质封闭的潜在要求)的一个或多个装置。相对于当前方法,例如电阻抗测量,光感知提供了较好的封闭品质征兆。另外,可以使用用于组织封闭的同一光能装置实现组织分离,消除了传统上用来在夹爪部件中组织分离的独立机械刀片的需要。本发明还提供了用于向用户、发生器和/或控制算法提供有关手术部位处或紧邻手术部位处的温度、夹爪闭合压力、夹爪定位及其它各种反馈信息的反馈的一种或多种方法。
本发明的下列方面及其部件的任何一个都可以互换地与一个或多个其它实施例相组合。例如,夹爪部件的表面上的涂层可以包括在每一个实施例中,各种夹爪部件实施例可以使用所披露的各种监视和控制程序。
附图说明
参照附图,在此描述了本主题器械的各种实施例,其中:
图1A是依照本发明实施例的内窥钳的透视图,所述内窥钳具有附连至其远端的末端执行器组件;
图1B是依照本发明另一实施例的开腹钳的透视图,所述开腹钳具有手柄组件和附连至手柄组件的远端的末端执行器组件;
图1C是依照本发明另一实施例的蓄电池动力内窥钳的透视图1C语言,所述内窥钳具有附连至其远端的末端执行器组件;
图2A是依照本发明实施例的末端执行器组件的横截面侧视图;
图2B是图2A中末端执行器组件的横截面前视图;
图3是依照本发明实施例的末端执行器组件的横截面前视图;
图4A是依照本发明实施例的末端执行器组件的横截面侧视图;
图4B是图4A中末端执行器组件的横截面前视图;
图4C是图4A中末端执行器组件的激光纤维的示意性侧视图;
图5是依照本发明实施例的末端执行器组件的横截面前视图;
图6是依照本发明实施例的末端执行器组件的横截面侧视图;
图7A和图7B是依照本发明实施例的末端执行器组件的横截面侧视图;
图8A是依照本发明实施例的末端执行器组件的横截面侧视图;
图8B和8C是图8A所示的末端执行器的俯视图;
图9是依照本发明实施例的末端执行器组件的横截面侧视图;
图10是依照本发明实施例的末端执行器组件的横截面侧视图;
图11是依照本发明实施例的末端执行器组件的横截面侧视图;
图12A是图11所示的末端执行器组件的横截面前视图;
图12B是图11所示的末端执行器组件抓取组织的横截面前视图;
图13是依照本发明实施例的末端执行器组件的横截面侧视图;
图14是依照本发明实施例的图13所示的末端执行器组件的夹爪部件的俯视图;
图15A是依照本发明实施例的内窥钳的侧视图,显示了外壳、轴、末端执行器组件和位于第一位置的触发组件;
图15B是依照本发明实施例的沿图15A的线15B-15B剖取的放大横截面;
图15C是依照本发明实施例的图15A的触发组件的放大侧视图;
图15D是图15中的末端执行器组件实施例的放大侧视图,显示了依照本发明实施例的光解剖元件从末端执行器组件的远端部的相对延伸;
图16和图17是依照本发明实施例的用于从末端执行器组件的远端延伸光解剖元件的触发组件的侧视图;
图18A是依照本发明实施例的夹爪部件的俯视图,所述夹爪部件包括设置在其外周上的光解剖元件;
图18B是依照本发明实施例的夹爪部件的前横截面,所述夹爪部件包括设置在其外周上的光解剖元件;
图19是依照本发明实施例的末端执行器组件的横截面侧视图;
图20是依照本发明实施例的末端执行器组件的横截面侧视图;
图21是图20中末端执行器的顶部夹爪部件的横截面俯视图;
图22是依照本发明实施例的图20的末端执行器组件的横截面前视图;
图23是依照本发明实施例的图20的末端执行器组件的横截面前视图;
图24是依照本发明实施例的图20的末端执行器组件的底部夹爪部件的横截面前视图;
图25是依照本发明的手术系统的示意图;
图26是组织成分的吸收系数与波长的曲线图;以及
图27是组织成分和激光源的吸收系数与波长的曲线图。
具体实施方式
现在参照图1A和1B,分别显示了内窥手术钳10和开腹钳10'。对于这里的目的,在此所述的末端执行器组件的任意实施例都可以利用内窥器械或开腹手术器械中的任一个。应当注意,不同的电连接、光连接和机械连接及其它考虑可以适用于每个特定类型的器械。但是,有关末端执行器组件及其工作特性的新颖性方面不管对于内窥设计还是对于开腹手术设计基本上都保持一致。还应当注意,下述的任何实施例都可以被构造成海包括传统的脉管封闭能力。
本发明提供了用于利用光能封闭组织的设备、系统和方法。由于光吸收作用,使用光(例如从大约200nm到大约11,000nm)来加热组织。光能量的吸收、透射和散射能量取决于组织、组织状态(例如水合作用、疾病状态、治疗阶段等等)和光波长。本发明利用这些因素,基于对波长的适当选择,控制能量在组织内的分布。更具体地说,被组织强力吸收的波长靠近组织表面沉积能量,而被组织微弱吸收的波长用来在组织较深处沉积较大部分的入射能量。尤其是,由于组织在某些红外波长相对可透光,红外频率的光能可以被用来较深的能量沉积。
在图1A中,钳10耦合至用于生成适合于治疗组织的光能的光能量源(例如发生器40)。发生器40被构造成输出各种能量,例如波长从大约200nm到大约11,000nm的光能。钳10经由索缆34耦合至发生器40,所述索缆34适合于在其间输送光能和控制信号。下面将更详细地讨论利用上述光能的钳10的各种实施例。
钳10被构造成支撑末端执行器组件(例如末端执行器组件100)。钳10包括外壳20、手柄组件22、触发组件25和转动组件28,这些部件能够使钳10和末端执行器组件100相互协作以抓取、封闭、分割和/或感知组织。钳10通常包括外壳20和手柄组件22,手柄组件22包括可动手柄24和固定手柄26,固定手柄26与外壳20一体化形成。手柄24相对于固定手柄26可动,以经由驱动组件(未显示)致动末端执行器组件100,从而抓取组织。
在某些实施例中,触发组件25可以被构造成致动钳10或另一部件的切割功能,正如下文更详细地描述的那样。钳10还包括具有远侧部分16和近侧部分14的轴12,所述远侧部分16机械地接合末端执行器组件100,所述近侧部分14机械地接合紧邻转动组件28的外壳20。转动组件28与轴12机械相联,以便将转动组件28的转动运动赋予给轴12类似的转动运动,轴12反过来则带动末端执行器组件100转动。
末端执行器组件100包括两个夹爪部件110和120。一个或两个夹爪部件110和120可绕销19枢转,并且一个或两个夹爪部件110和120可从第一位置移动到第二位置,在所述第一位置,夹爪部件110和120彼此间隔开,在第二位置,夹爪部件110和120闭合而抓取其间的组织。
每个夹爪部件110和120均包括分别设置在其面向内的表面上的组织接触表面112和122(参见图2B)。在从发生器40施加能量时,组织接触表面112和122协作以抓取和封闭期间保持的组织。组织接触表面112和122连接至发生器40,这样,光能可以被传送到和/或穿过其间保持的组织。
第一和第二开关组件30和32被构造成有选择地向末端执行器组件100提供光能。更特别地,第一开关组件30可以被构造成执行第一类型的手术过程(例如封闭、切割和/或感知),第二开关组件32可以被构造成执行第二类型的手术过程(例如封闭、切割和/或感知)。应当注意,本公开的实施例可以包括很多适合的开关组件30和32,不仅仅局限于开关组件30和32。也应当注意,本公开的实施例可被构造成执行很多适合的手术过程,不仅仅局限于封闭、切割和感知。
手柄组件20还包括一个或多个光传送元件,例如连接钳10和发生器40的索缆34。索缆34可以包括用以穿过各种路径输送光能并最终到达末端执行器组件100和一个或多个光纤的多个光纤。
第一和第二开关组件30和32也可以与控制器42(例如逻辑电路、计算机、治疗器、字段可编程门阵列等等)协作,所述控制器42在检测到一个或多个参数或阈值的同时,自动触发其中一个开关,以在第一模式(例如封闭模式)和第二模式(例如切割模式)之间变化。在一些实施例中,控制器42还被构造成接收各种传感器反馈,并基于传感器反馈控制发生器40。本发明的实施例允许夹爪部件110和120使用光能封闭和/或切割组织。在一些实施例中,控制器42可以包括反馈回路,所述反馈回路基于下列参数中的一个或多个指示何时完成组织封闭:组织温度、光学感知、组织阻抗随时间的变化和/或向组织施加的光功率或电功率或电流随时间的变化、这些性质的变化率、以及它们的组合。可以采用听觉或视觉反馈监视器向外科医生输送有关总体封闭品质或有效组织封闭完成的信息。
现在参见图1B,描绘了钳10',其包括附连至手柄组件22'的末端执行器组件100(类似于钳10),手柄组件22'包括一对细长轴部分12a'和12b'。每个细长轴部分12a'和12b'分别具有近端14a'和14b'以及远端16a'和16b'。末端执行器组件100包括分别耦合至轴12a'和12b'的远端16a'和16b'的夹爪部件110和120。夹爪部件110和120绕枢轴销19'连接,所述枢轴销19'允许夹爪部件110和120彼此相对地从第一位置枢转到第二位置,以便治疗组织(如上所述)。组织接触表面112和122连接至相对的夹爪部件110和120。
每个轴12a'和12b'包括分别设置在其近端14a'和14b'上的手柄17a'和17b'。手柄17a'和17b'有利于轴12a'和12b'相对于彼此的运动,这反过来又使夹爪部件110和120从打开位置枢转到夹紧或闭合位置,在打开位置,夹爪部件110和120设置为彼此相对间隔开的关系,在夹紧或闭合位置,夹爪部件110和120协作以抓取其间的组织。
在某些实施例中,一个或两个轴,例如轴12a',包括第一开关组件30'和第二开关组件32'。第一和第二开关组件30'和32'被构造成有选择地到向末端执行器组件100提供能量。更特别地,第一开关组件30'可以被构造成执行第一类型的手术过程(例如封闭、切割或感知),第二开关组件32'可以被构造成执行第二类型的手术过程(例如封闭、切割或感知)。在一些实施例中,一个或两个轴,例如12b',可以包括用于致动另外的激光纤维、例如激光纤维230a和/或230b(参见图3)的触发组件25'。
继续参照图1B,描绘了钳10',其具有连接钳10'和发生器40的索缆34'。以类似于钳10的型式,索缆34'在轴12b'内部分开,以通过各种传送路径向末端执行器组件100的部件输送光能。
现在参考图1C,钳10被显示为具有便携式构造,其包括用于生成光能的内部能量源50,所述内部能量源50经由一个或多个电线50a操作性地耦合至蓄电池隔室52,在某些实施例中,一个或多个蓄电池操作激光二极管或纤维激光器也可以用来提供便携光能量源。内部能量源50可以被构造成经由一个或多个激光纤维50b或任何其它适合的传送介质向末端效应器组件100和光学元件提供光能。蓄电池隔室52可以被构造成接收用于向内部能量源50提供适合的能量的一个或多个蓄电池54。在一些实施例中,控制器42也可以设置在钳10(例如外壳)内。
蓄电池隔室52可以限定在钳10的外壳20的任何适合的部分内,例如固定手柄26,如图1C所示。适合的蓄电池可以包括但不限于:镍镉、锂离子、或任何其它适合的类型。内部能量源50的设置为操作者在用钳10执行外科治疗时提供了更多的操纵性和方便性。
图2A和2B示出了依照本发明实施例的末端执行器组件100,其构造为与上述任一器械10或器械10'或者任何其它适合的手术器械一起使用。但是,为简单和一致起见,末端执行器100将在下文参照器械10进行描述。
末端执行器组件100包括具有近端110a、120a和远端110b、120b的夹爪部件110和120,近端110a、120a和远端110b、120b分别在夹爪部件110和120内限定凹槽或沟槽130和140。夹爪部件110包括在组织接触表面112上或沿着组织接触表面112设置的光漫射元件132。光漫射元件132可以由任何适合的光漫射材料制成,例如磨砂蓝宝石晶体。光漫射元件132设置在沟槽130内。组织接触表面112和122可以包括设置在其上面的反射表面。在一些实施例中,表面包括但不限于:抛光金属、涂层或任何其它适合于反射光的材料。
在其它实施例中,组织接触表面112和122还可以包括涂层或覆盖物112a和122a。在一些实施例中,涂层112a和122a可以由吸光材料(例如吸光涂层)、透明材料、散射材料或反射材料形成。在一些实施例中,涂层112a可以由一种材料(例如透明材料)形成,而涂层122a可以由不同的材料(例如吸收或反射材料)形成。在进一步的实施例中,涂层112a和122a两者都可以由同一种材料形成,例如反射材料。通过提供带有反射表面的两个组织接触表面112和122,由于光多次经过而增加了供给给组织的光的吸收,从而减少了治疗时间。
在进一步的实施例中,涂层112a和122a可以包括设置在其上的凝胶或另外的生物相容薄膜。凝胶或薄膜可以包括具有设计成吸收特定波长的光能的特定颜色的染料。在一些实施例中,凝胶可以在治疗之前施加于组织。
在另一个实施例中,涂层112a和122a为由被构造成随着温度升高而增加吸收性能的热变色材料形成的吸收性涂层。在此所使用的术语"热变色"是指响应温度变化而改变颜色的任何材料。随着夹爪部件110和120的温度在施加能量的过程中升高,吸收性涂层112a和122a变得逐渐更能吸收,并向组织提供更多热量。
光漫射元件132经由索缆34耦合至发生器40,所述索缆34包括其中的一个或多个光传输或光生成纤维。发生器40适合于产生具有从大约200nm到大约11,000nm的期望波长的光,并且适合于将光能沿着索缆34传送到钳10、10',更具体地说,传送到光漫射元件132。
光漫射元件132可以具有大体上圆柱形或圆锥形的形状,并且可以由适合的光传导材料(例如蓝宝石晶体、结晶玻璃、塑料纤维等等)形成。更具体地说,光漫射元件132可以由任何适合的激光或光传导介质制成,以获得期望的漫射性能。
凹槽140可以被构造成,当夹爪部件110和120位于闭合位置时,配合在光漫射元件132周围。凹槽140也可以具有反射表面,这样,从光漫射元件132发出的光可以穿过组织,接着反射回组织中,以形成期望的照射模式(pattern)。在一些实施例中,凹槽140可以具有吸光性能和/或包括具有吸光性能的材料(例如吸光涂层)。这样,当吸收光时,凹槽140和/或吸收材料可以加热到适合的温度,以操作性地治疗夹爪部件110和120之间保持的组织。
在操作期间,一旦组织被抓在组织接触表面112和122之间,激光就从发生器40传送到光漫射元件132,接着光漫射元件132向组织内发出光能。由于组织接触表面112和122适合于反射光,光漫射元件132发出的光能集中在夹爪部件110和120之间的体积中,该体积反过来又加热其间抓取的组织,而不会损害周围组织。在预设持续时间之后或者根据来自一个或多个传感器的信号(在下文将更详细地描述),能量终止,指示组织治疗(例如封闭或切割)完成。
现在参照图3,本公开的末端执行器组件的另一个实施例显示为末端执行器组件200。末端执行器组件200包括具有组织接触表面212和222的夹爪部件210和220。与上述夹爪部件110和120类似,夹爪部件110和120协作以抓取其间的组织。每个夹爪部件210和220限定沿其设置的沟槽或凹槽。更具体地说,夹爪部件210包括凹槽230、230a和230b;夹爪部件220包括凹槽240、240a和240b。在一些实施例中,夹爪部件210包括横跨夹爪部件210的长度以及相应凹槽230、230a和230b内的多个激光纤维(例如232、234a和234b)。激光纤维被构造成在夹爪部件210和220之间以及沿着夹爪部件210和220的长度发出激光。
夹爪部件210包括设置在沟槽230内的中心定位的激光纤维232。在沟槽230旁边,夹爪部件210还限定了从沟槽230侧向定位的沟槽或凹槽230a和230b,沟槽或凹槽230a和230b包括周边激光纤维234a和234b。激光纤维234a和234b可以被构造成用于根据所供给的光能类型、施加于夹爪部件210和220的压力、以及下文更详细地描述的设置在纤维周围的凹槽的反射或吸收性能,封闭组织。在一些实施例中,组织接触表面212和222可以包括设置在其表面上的透明涂层或覆盖物,类似于图2A和2B的组织接触表面112和122。激光纤维232可以被构造成在激光封闭纤维234a和234b已经实现有效封闭之后切割组织。在一些实施例中,切割可以独立于封闭执行。另外,可以在夹爪部件220上设置反射凹槽240,这样,当激光从激光纤维232发出时,激光从反射凹槽240反射回组织,形成期望的照射模式。另外或者作为替换,激光纤维234a和234b也可以具有位于相对夹爪部件220内的相应反射或吸收凹槽240a和240b,如上所述。
应当指出,任何数量的激光纤维都可以被使用于本发明所述的任何实施例中,以根据穿过激光纤维传送的光能实现组织封闭或切割。同样,任何数量的激光切割纤维(例如激光切割纤维232)可以被使用于本发明所述的任何实施例中。在一些实施例中,本发明的任何实施例中,单个激光纤维也可以被构造成包括封闭和切割性能。应当注意,任何一个激光纤维都可以被构造成根据外科治疗(例如封闭、切割和/或感知)传送不同波长的能量。在其它实施例中,特定的激光或光纤维可以被构造成执行特定的外科治疗(例如封闭、切割和/或感知)。可以采用一个或多个传感器,或者反馈电路可以集成到末端执行器200中,以在有效封闭和/或有效分离之后向用户发出信号。为此,也可以采用自动封闭切割算法,其使用开关、例如开关32的单次激活来启动工序。
现在参照图4A-4C,示出了末端执行器组件300的另一个实施例。末端执行器组件300包括分别具有近端310a、320a和远端310b、320b的夹爪部件310和320。每个夹爪部件310和320分别具有组织接触表面312和322。在一些实施例中,组织接触表面312和322可以包括设置在其表面上的透明涂层或覆盖物,类似于图2A和2B的组织接触表面112和122。另外,夹爪部件310包括沿其限定的沟槽或凹槽330,所述沟槽或凹槽330被构造成包括具有近端332a和远端332b的外科治疗激光纤维332(例如封闭、切割和/或感知)。外科治疗激光纤维332被构造成沿着夹爪部件310和沟槽330内限定的纵向轴线"X-X"平移。例如,外科治疗激光纤维332可以从夹爪部件310的近端310a平移到远端310b(例如沿着远侧方向"A"),以切割、封闭和/或感知夹爪部件310和320之间抓取的组织。另外或者作为替换,外科治疗激光纤维332可以从夹爪部件310的远端310b平移到近端310a(例如沿着近侧方向"B"),以切割、封闭和/或感知其间抓取的组织。应当注意,外科治疗激光纤维可以在任何一个夹爪部件310和320内都是不动的。在其它实施例中,任何其它适合类型的光能可以由上述纤维传送,应不仅仅局限于激光能量。
参照图4A-4C,激光纤维332b的远端包括激光发射器334,其被构造成向形成期望的照射模式的限定立体角336内发出激光束。激光纤维332可以为所谓的"末端发射"或"侧面发射"激光纤维。在此所使用的术语"末端发射"表示能够沿着夹爪部件310限定的纵向轴线"X-X"发出光的激光纤维。在此所使用的术语"侧面发射"表示能够发出不平行于夹爪部件310的纵向轴线"X-X"的光(或任何其它适合的光能)的激光纤维。激光发射器334可以包括各种部件,例如一个或多个反射表面(例如镜子),一个或多个光纤,一个或多个镜头,或任何其它适合的用于发出和/或分散激光束的部件。更特别地,激光发射器334被构造成向立体角336发出光,立体角336具有可变的或预定的外边界。通过改变或调节立体角336,可以调节激光目标区域338,以改变照射组织和待治疗、解剖或切割的组织的区域的激光能量的强度。激光目标区域338可以限定任何适合的目标形状,例如但不限于椭圆形、长方形、正方形和三角形。在一些实施例中,激光发射器334还可以被构造成封闭和/或切割夹爪部件之间抓取的组织。
激光发射器334除沿着纵向轴线"X-X"纵向运动之外,还可以绕轴线"X-X"旋转和/或相对于该轴线侧向移动(例如横向)。激光发射器334的纵向、侧向和转动运动允许以任何期望的方向引导光能,以实现期望的组织治疗效果。
反射凹槽340可以由抛光金属制成,或者在夹爪部件320由非金属和/或非反射材料(例如塑料)形成的情况下,可以对夹爪部件320施加一涂层。反射凹槽340将激光反射回组织。激光发射器334可以接收所反射的激光,并将信号传送回发生器40以便治疗。各种数据被积分、计算,以反映(render)各种结果或根据所传送的或所反射的光控制组织治疗。
图5示出了用于形成期望的照射模式的末端执行器组件400的另一实施例。末端执行器组件400包括具有组织接触表面412和422的夹爪部件410和420。与上述夹爪部件相类似地,夹爪部件410和420协作以抓取其间的组织。夹爪部件410限定沿其的沟槽或凹槽430,所述沟槽或凹槽430被构造成包括沿着夹爪部件410横跨的激光纤维432,并且激光纤维432被构造成在夹爪部件410的长度内并沿着夹爪部件410的长度发出激光。在一些实施例中,激光纤维432可以替换成任何激光源,例如本发明所描述的纤维激光器(例如可调铊纤维激光器)。在进一步的实施例中,组织接触表面412和422可以包括设置在其表面上的透明涂层或覆盖物,类似于图2A和2B的组织接触表面112和122。
夹爪部件420包括接收纤维440,所述接收纤维440设置在其中限定的空腔444内,所述空腔444被构造成接收从激光纤维432发出的激光。在一些实施例中,纤维440可以替换成本发明中所述的任何光学检测器或其它适合的光学检测器。光学窗口442沿着夹爪部件420的表面设置在激光纤维432和接收纤维440之间。光学窗口442可以是被构造成将从激光纤维432所发出的激光引导至接收纤维440的任何适合类型的光学透镜。空腔444可以被构造成包含气体或任何其它介质,以便于由接收纤维440接收激光纤维432发出的激光。
已知组织的光学性质在加热期间会改变。诸如吸收系数(μa)、散射系数(μs)和各向异性系数(g)的性质被显示为随着温度和时间而变化。当光与组织相互作用时,这些性质影响光的传送和反射。本发明结合有接收纤维440,其可以用来检测和/或监视在封闭周期过程中来自激光纤维432的激光穿过组织传送的变化,以确定何时已实现期望的组织效果。在该构造中,利用接收纤维440也可以检测和/或监视切割完成,例如何时组织分离。
图6示出了末端执行器组件的另一实施例,整体描绘成用于形成期望的照射模式的末端执行器组件500。末端执行器组件500包括具有组织接触表面512和522的夹爪部件510和520。与上述夹爪部件类似,夹爪部件510和520协作以抓取其间的组织。另外,夹爪部件510限定沿其的沟槽或凹槽530,所述沟槽或凹槽530被构造成包括横跨在夹爪部件510的近端532a和远端532b之间的激光切割纤维532。激光纤维532被构造成在夹爪部件510和520内并沿着夹爪部件510和520的长度发出激光。在相对一侧,一接收纤维540设置在夹爪部件520内,沿着其长度延伸,并且被构造成接收从激光纤维532发出的激光。
接收纤维540包括近端540a和远端540b,还包括位于其间的一个或多个传感器542。传感器542被构造成监视封闭周期过程中的温度,并提供有关封闭周期何时完成的反馈。因为压力是封闭治疗之后封闭质量的影响因素,传感器542还可以通过测量由组织被抓取在夹爪部件510、520之间时所施加的机械载荷引起的夹爪部件510和520上的应变,确定夹爪压力。在该构造中,可以向操作者和/或控制器42提供有关在能量激活之前,是否已经获得适合的夹爪压力以实现合适的组织封闭的反馈。
图7A和7B示出了用于形成期望的照射模式的末端执行器组件600的另一实施例。末端执行器组件600包括具有组织接触表面612和622的夹爪部件610和620。与上述夹爪部件类似,夹爪部件610和620协作以抓取其间的组织。夹爪部件610和620每个分别限定了纵向轴线"Z-Z"和"Y-Y",纵向轴线"Z-Z"和"Y-Y"从相应的近端610a、620b横跨至相应的远端610b、620b。纵向轴线"Z-Z"和"Y-Y"限定了一个角度"β",当从闭合构造枢转到打开构造时,该角度随着夹爪部件610和620彼此分离而增大。
末端执行器组件600包括设置在沿着夹爪部件610的长度限定的沟槽630内的一个或多个发光元件632a、632b、632c、和632d。每个发光元件632a、632b、632c、和632d被构造成在夹爪部件610和620内以及沿着夹爪部件610和620的长度发出光能。发光元件632a、632b、632c、和632d可以是任何适合类型的发光元件,例如但不限于:被构造成用于医学用途和/或组织治疗的高强度LEDs、被构造成向组织内发光的光纤或其它光学元件。发光元件632a、632b、632c、和632d可以有选择地激活(例如每次一个或几个),并可以发出不同波长的光。一个或多个光接收元件642a、642b、642c、和642d设置在沿着夹爪部件620的长度限定的沟槽640内。每个光接收单元642a、642b、642c、和642d被构造成检测由发光元件632a、632b、632c、和632d发出的光能。发光元件632a、632b、632c、632d和光接收单元642a、642b、642c、642d可以设置在被构造成传送光的保护基板636的后面。
光接收单元642a、642b、642c、和642d可以是任何适合的光接收元件,例如透镜、光纤或光检测器,并且可以被构造成测量组织的光学性质。在一些实施例中,光接收单元可以收集并向被构造成提供包括拉曼光谱测定的各种光谱测定的光学系统传送光,拉曼光谱测定适合于确定封闭完成以及特定组织类型及其成分(例如胶原、蛋白质、水等等)的识别。
在某些实施例中,光接收单元642a、642b、642c、632d和发光元件632a、632b、632c、632d可以散布在夹爪部件610和620之间,使得每一个夹爪部件610和620都包括一个或多个接收模块和一个或多个发光元件。该构造提供了在每个夹爪部件610和620处测量光学性质(例如反射和传送数据),并允许使用光学相关性层析成像(tomography)获得夹爪部件610和620之间抓取的组织的图像。其它用于确定组织光学性质的技术披露在共同拥有的、发明名称为"用于在电外科手术过程期间监视组织的方法和系统"的美国专利申请号12/665,081中,该申请的全部内容在此引入作为参考。
每个发光元件632a、632b、632c、和632d可以被构造成根据角度"β",独立地调节其沿着夹爪部件610的光能发出。例如,当角度"β"为大约45度时(例如当夹爪部件610和620朝着打开构造移动时),最远侧发光元件632d可以发出比最近侧发光元件632a具有更大强度的光能。当角度"β"减少至大约2度时(例如当夹爪部件610和620朝着闭合构造移动时),发光元件632a、632b、632c、和632d被构造成以基本相同的强度发出光能。
通过发光元件632a、632b、632c、和632d传送的光能的强度,包括上述独立强度,可以由控制器42基于所测量的角度"β"和/或夹爪部件610和620之间的间隙距离进行调节。在此所使用的术语"间隙距离"表示组织接触表面612和622之间的距离。由于夹爪部件610和620可彼此相对枢转,其间的角度"β"与间隙距离直接相关,因此这两个构思可以互换使用。可以使用分别设置在夹爪部件610和620内的任何适合的接近传感器633a、633b测量角度"β"。传感器633a、633b可以耦合至控制器42,并且包括但不限于:霍尔效应传感器、基于RF的传感器等等。在一些实施例中,传感器633a、633b可以是一对相应的光传送器/接收器元件。尤其是,传感器可以是与光检测器(例如PIN二极管)配套的发光元件(例如LED)。
在某些实施例中,能够控制角度"β"以在夹爪部件610和620之间实现期望的间隙距离,使得组织的厚度与光能的光深相匹配。如果组织的厚度不大于穿过组织的光的光深,则光能将不会被全部吸收。这在组织被压缩使得其比所使用的光能的光深薄的情况下会发生。另外,如果组织没有足够地被压缩,光能将不能完全穿透所压缩的组织,导致组织不均匀加热。通过控制间隙距离,使得光能的光深基本上与组织的厚度相匹配,确保最佳地吸收光能。
在其中夹爪部件610和620就像夹爪部件110和120那样包括反射表面的实施例中,在考虑光从组织接触表面612和622的反射时,也应控制角度"β"。
控制器42从传感器633a、633b获取角度"β",并根据该测量确定间隙距离。控制器42还获取发生器40输送的光能波长。这可以通过在可以是暂态(例如随机存取存储器)或非暂态(例如闪速存储器)的存储器或任何其它计算机可读存储装置中存储波长值来实现。然后控制器42基于所存储的波长值和所存储的组织性质,计算间隙距离。控制器42还比较实际间隙距离和/或角度"β"与根据波长所计算的期望的间隙距离和/或角度"β"。根据该比较,控制器42可以自动调节夹爪部件610和620之间的间隙距离和/或角度"β"和/或为用户输出其差。自动调节可以通过提供带有自动闭合机构的夹爪部件610和620来实现,例如共同拥有的、发明名称为"带有缓慢闭合封闭板的电手术钳和封闭组织的方法"的美国专利号7,491,202所公开的自动闭合机构,该专利公开了用于电手术钳的自动间隙控制,该专利的全部内容在此引入作为参考。
为了手动的间隙调节,控制器42能够以听觉/视觉方式输出实际和期望间隙距离和/或角度"β"之差。在一些实施例中,实际和期望的间隙距离和/或角度"β"或其差值可以用数字表示和/或用图表表示(例如颜色分类)。该差也可以用听觉警报(例如调节声音脉冲的频率或幅度)表示。
正如上述实施例中所论述的那样,发光元件632a、632b、632c、632d和接收模块642a、642b、642c、642d可以被构造成具有光学感知性质,以便每对发光元件和接收模块(例如发光元件632a和接收模块642a)可用来监视特定位置的封闭工序。发光元件632a、632b、632c、632d和接收模块642a、642b、642c、642d还可以被构造成监视封闭装置中和其周围其它材料的存在和状态,也可以根据所收集的信息改变封闭算法。
在其它实施例中,发光元件632a、632b、632c、632d和接收模块642a、642b、642c、642d还可以被构造成喷射热脉冲,测量组织的反应,测量传送和/或反射中的光谱特性,测量不同位置处的光谱特性,以及测量不同光频率的光谱特性。发光元件632a、632b、632c、632d和接收模块642a、642b、642c、642d还可以被构造成测量夹爪部件610和620的近端和远端之间的一个或多个部位处的温度。
现在参照图8A-8C,末端执行器组件的另一实施例显示为用于形成期望的照射模式的末端执行器组件700。末端执行器组件700包括具有组织接触表面712和722的夹爪部件710和720。与上述夹爪部件类似,夹爪部件710和720协作以抓取其间的组织。夹爪部件710、720经由光纤702操作性地连接至发生器40,所述光纤70提供用于治疗夹爪部件710、720之间抓取的组织。
每个夹爪部件710、720包括具有一个或多个竖直对齐的光纤732的一个或多个沟槽730,所述光纤732被构造成经由光纤702发出并从发生器40接收光能。在一些实施例中,夹爪部件710的光纤732与夹爪部件720的光纤742竖直对齐,以便建立光学连通。也就是说,光纤之一是传送光纤(例如光纤732),相对的纤维是接收光纤(例如光纤742)。任意数量的传送光纤732可以设置在夹爪部件710周围。另外或者作为替换,任意数量的传送光纤742可以设置在夹爪部件720周围。因而,在其它实施例中,光纤732和742的竖直对齐不是特别必要。
在某些实施例中,末端执行器组件700也可以包括一个或多个光学开关750,所述光学开关750提供操作者和/或发生器40往返于夹爪部件710和720的光能的激活和检测。光能的检测可以由光检测器752或类似物提供。在一些实施例中,每个沟槽730可以由透明覆盖物736覆盖,以允许夹爪部件710和720之间光学连通。应当注意,本公开的任何实施例可以使用任何类型的检测器,例如但不限于光电二极管和电荷耦合器(CCD)阵列。
图8B示出了具有贯穿其限定的单个沟槽730的夹爪部件710,所述沟槽730包括如上所述由覆盖物736覆盖的多个光纤732。覆盖物736可以是被构造成允许光纤732和742之间光学连通的任何适合的材料。在另一个实施例中,图8C示出了贯穿其限定多个沟槽730a和730b的夹爪部件710,还包括由覆盖物736覆盖的多个光纤732。
现在参照图9,末端执行器组件的另一实施例显示为用于形成期望的照射模式的末端执行器组件800。末端执行器组件800包括具有组织接触表面812和822的夹爪部件810和820。与上述夹爪部件类似,夹爪部件810和820协作以抓取其间的组织。夹爪部件810、820操作性地连接至经由发生器40提供光的能量源。
夹爪部件810包括贯穿其限定的光学元件830。光学元件830包括被构造成反射从发生器40接收的光能的反射表面832。在该实施例中,发生器40被构造成朝着光偏转器838(例如镜子)发出光束B1(例如单光束)。光偏转器838被构造成反射由发生器40发出的全部或大部分量的光束B1,作为朝着待治疗的组织的光束B2。
夹爪部件820经由光纤702与一光检测器752光学连通,所述光检测器752被构造成与光学接收纤维842光学连通。在该构造中,在任何时候,都可以通过夹爪部件810和820所传送和接受的光学信息确定夹爪部件810和820的位置。光检测器752或钳10、10'内的任何其它逻辑电路(例如发生器40和各种传感器)平移由光学接收纤维842接收的光束B3,以确定夹爪部件810和820的位置。一旦闭合,发生器40就可以发出更强的光能(或RF能量)以加热组织,光纤702可以被构造成与光检测器752连通,以向发生器40提供反馈。
现在参照图10,末端执行器组件的另一实施例显示为用于形成期望的照射模式的末端执行器组件900。末端执行器组件900包括具有组织接触表面912和922的夹爪部件910和920。与上述夹爪部件类似,夹爪部件910和920协作以抓取其间的组织。夹爪部件910、920操作性地连接至经由发生器40提供光的能量源。
在某些实施例中,夹爪部件910和920分别限定沟槽930和940。沟槽930包括被构造成发出经由光纤902从发生器40接收的光能的光纤932。光纤932可以是漫射纤维,如前面其它实施例所述的那样。另外或者作为替换,光学传送纤维932可以具有横跨沟槽930的长度的光传送效应器932a、932b、932c,如图10所示。
沟槽940包括反射表面942,反射表面942被构造成反射从夹爪部件910的光学传送纤维932和/或光传送效应器932a、932b、932c所接收的光能。在该实施例中,夹爪部件910被构造成经由光学光效应器932a、932b、932c发出一个或多个光束B4,使得反射表面942朝着光学改变器(例如透镜948)反射光束B4,形成一个或多个光束B5。应当注意,反射表面942沿着夹爪部件920定位。在某些实施例中,光学透镜948可以设置在夹爪部件920内限定的沟槽940内。
夹爪部件920经由光学透镜948与被构造成与光学透镜948光学连通的图像检测器952光学连通。在该构造中,在任何时候,都可以通过夹爪部件910和920所传送和接受的光学信息确定夹爪部件910和920的位置。也就是说,当夹爪920相对于夹爪910枢转时,反射表面942也相对于光束B4移动,导致反射光束B5相应地相对于透镜948移动。图像探测器952或钳10、10'内的任何其它逻辑电路(例如发生器40和各种传感器)测量穿过组织的光的强度,以确定夹爪部件910和920的位置和/或各种组织性质,如前面其它实施例所论述的那样。在另一个实施例中,检测器952可用来组织成像,这也可以由图像探测器952在后进行。
图11、12A和12B显示了本公开的末端执行器组件的另一实施例,大体上显示为用于形成期望的照射模式的末端执行器组件1000。末端执行器组件1000包括具有组织接触表面1012和1022的夹爪部件1010和1020。与上述夹爪部件类似,夹爪部件1010和1020协作以抓取其间的组织。夹爪部件1010、1020操作性地连接至提供光能的能量源(例如发生器40)。上述的光能可以以不同的形式提供,例如但不限于:激光、发光二极管光和任何其它适合类型的光能。
在某些实施例中,夹爪部件1010和1020分别沿其限定沟槽1014和1024。沟槽1014和1024共同限定了一区域,这样光纤1032介于其中,并被构造成发出从发生器40经由输送光纤(未显示)接收的光能。光纤1032可以是漫射晶体或纤维,如前面其它实施例所述的那样。另外或者作为替换,光纤1032最初可以设置在手术器械10、10'的轴12、12'内,有选择在远侧方向"A"上和在近侧方向"B"上沿着夹爪部件1010和1020限定的纵向轴线上平移。也就是说,光纤1032可以沿着沟槽1014和1024的长度平移,如图11所示。在一些实施例中,光纤1032可以由触发组件25、25'沿着夹爪部件1010和1020的长度平移(参见图1A和1B)。
光纤1032被构造成具有朝着远端1032a收敛的圆柱形或圆锥形形状。远端1032a被构造成在光纤1032在远侧方向上在夹爪部件1010和1020之间以及贯穿组织平移时穿透组织。在一些实施例中,光纤1032可以沿着组织侧向平移而不穿透组织。光纤1032可以具有任何适合的形状,例如但不限于长方形、卵形和多边形。另外,远端1032a也可以采用各种适合的构造(例如尖锐的或钝的)的形式。
参照图12A,沟槽1014和1024均分别包括反射表面1040和1042,每个反射表面1040和1042均被构造成反射光纤1032接收和/或发出的光能。在该实施例中,光纤1032径向发出光能(例如在光纤1032周围),使得反射表面1040和1042接收由此发出的光能。在一些实施例中,反射表面1040和1042均被构造成包裹或涂覆各自沟槽1014、1024的表面。反射表面1040和1042分别还可以包括远端1040a和1042a,远端1040a和1042a沿着沟槽1014和1024的收敛远端1014a和1024a弯曲。这样,从光纤1032的远端1032a发出的光能穿过组织,并从反射表面1040和1042的远端1040a和1042a反射到夹爪1010和1020之间抓取的组织上。
如图12B所示,光纤1032也可以用于切割。光纤1032经由沟槽1014和1024在夹爪部件1010和1020之间平移,由此,有选择地发出光能,以通过光纤1032发出的光能切割或切断组织。在一些实施例中,光纤1032被构造成刺穿夹爪部件1010和1020之间抓取的组织,从而从组织表面内部发出光能(例如第一剂量)以及在其间抓取的整个组织辐射光能。该构造也可以用来通过如上某些实施例中所论述的压缩组织封闭组织。
现在参照图13和14,末端执行器组件的另一个实施例整体上显示为末端执行器组件1100。末端执行器组件1100包括具有组织接触表面1112和1122的夹爪部件1110和1120。与上述夹爪部件110和120类似,夹爪部件1110和1120协作以抓取其间的组织。夹爪部件1110、1120操作性地连接至提供光能的能量源(例如发生器40)。
在某些实施例中,夹爪部件1110和1020分别包括其中和沿其限定的沟槽1114和1124。沟槽1124包括被构造成发出经由输送光纤(未显示)从发生器40接收的光能的光纤1132。与具有基本上类似的尺寸的沟槽1014和1024不同,沟槽1124被显示为具有比沟槽1114大的深度。该构造完全将纤维1132封入夹爪部件1120内部,从而允许光纤1132沿着组织表面侧向平移,以在没有穿透组织的情况下实现组织的封闭和/或切割。
光纤1132可以是漫射纤维,如前面其它实施例所述的那样。另外或者作为替换,光纤1132最初可以设置在手术器械10、10'的轴12、12'内,并有选择在远侧方向"A"上和在近侧方向"B"上平移。也就是说,光纤1132可以沿着沟槽1124的长度平移,如图13所示。光纤1132可以有选择地由触发组件25、25'沿着夹爪部件1110和1120的长度平移(参见图1A和1B)。作为替换,光纤1132可以不动地固定在沟槽1124内,使得光纤1132在任何方向上都不移动。
光纤1132可以被构造成具有例如终止于远端1132a的圆柱形状。光纤1132也可可以采用诸如长方形、卵形和多边形的其它适合的形状。相应地,沟槽1124也可以采用光纤1132的形状。这样,光纤1132可以与相应的沟槽1124在几何形状上配合。
沟槽1114和1124均分别包括反射表面1140和1142,每个反射表面1140和1142均被构造成反射光纤1132接收和/或发出的光能。在该实施例中,光纤1132径向发出光能(例如在光纤1132周围),使得反射表面1140和1142接收由此发出的光能。反射表面1140和1142均被构造成包裹或涂覆各自沟槽1114、1124的表面。反射表面1140和1142分别还可以包括远端1140a和1142a,远端1140a和1142a沿着沟槽1114和1124的收敛远端1114a和1124a弯曲。这样,从光纤1132的远端1132a发出的光能从反射表面1140和1142的远端1140a和1142a反射到夹爪1110和1120之间抓取的组织上。在该实施例中,光纤1132可以被构造成完全驻留在夹爪部件1120的沟槽1124内。同样,沟槽114也可以较浅地限定在夹爪部件1110中。
在使用时,光纤1132有选择地在沟槽1124内平移以分割组织。此外,当夹爪部件1110和1120闭合而抓取组织时,组织被迫进入沟槽1124中以促进分离。作为替换,光纤1132在组织治疗期间可以以展开状态设置在沟槽1124内。一旦用光能治疗组织,光纤1132就可以缩回以切断组织。
现在参照图14,图14显示了组织接触表面1112的平面图,由于沟槽1124完全封入光纤1132,窗口1150可以设置在沟槽1124顶上。窗口1150被构造成封入光纤1132、反射表面1142和沟槽1124,以防止组织和手术碎屑进入其内。窗口1150还被构造成允许从光纤1132发出的光能穿过,以治疗夹爪部件1110和1120之间抓取的组织。窗口1150可以由任何适合的清晰材料制造,例如但不限于玻璃。
现在转到图15A-15D,显示了用于各种手术构成的内窥钳2010的一个实施例。为此,显示和描述了脉管封闭钳,但是,可以想到,也可以利用其它类型的钳或剪刀,两者都可以治疗组织,以便烧灼、凝固或如上所述的其它目的。此外,虽然附图描绘了与内窥手术过程相关使用的钳2010,但是,本发明也可以用于更多的传统开腹手术过程。为此,钳2010用内窥器械来描述;但是,可以考虑,开腹型钳2010也可以包括与图1B所述的相同或类似的操作部件和特征。
钳2010大体上包括外壳2020、手柄组件2030、转动组件2080、触发组件2070和末端执行器组件2100,这些部件相互协作以抓取、治疗和分割组织。为此,手柄组件2030、转动组件、触发组件2070和末端执行器组件2100在上文相对于图1A-1C更详细地描述了。
钳2010包括具有远端2016和近端2014的轴2012,所述远端2016的尺寸设计成机械接合末端执行器组件2100,所述近端2014机械接合外壳2020。在图15A中可以清楚地看到,钳2010还包括连接钳2010和能量源、例如发生器40的索缆2310。索缆2310在内部被分割成适合于向末端执行器2100供给动力的索缆引线,包括但不限于光纤、电引线等等。
手柄组件2030包括固定手柄2050和可动手柄2040。固定手柄2050与外壳2020一体相联,手柄2040可相对于固定手柄2050移动。转动组件2080可以与外壳2020一体相联,并可绕纵向轴线"C-C"在任一方向上转动大约180度。
如上所述,末端执行器组件2100附连在轴2012的远端2016,并且包括一对相对的夹爪部件2110和2120。手柄组件2030的可动手柄2040最终连接至内部设置的驱动组件(未示出),其共同机械地协作以赋予夹爪部件2110和2120从打开位置到夹紧或闭合位置的运动,在打开位置,夹爪部件2110和2120设置为彼此相对间隔开的关系,在夹紧或闭合位置,夹爪部件2110和2120协作以抓取其间的组织。
现在转到有关图15A-16所描述的本发明的一个实施例的更详细特征。在图15A和15D中可以清楚地看到,末端执行器组件2100包括相对的夹爪部件2110和2120,夹爪部件2110和2120协作以有效地抓取组织,以便封闭目的。末端执行器组件2100设计成单侧组件,即,夹爪部件2120相对于轴2012固定,而夹爪部件2110围绕枢轴销2103枢转抓取组织。
正如图15D清楚示出的那样,每个夹爪部件2110和2120分别包括夹爪外壳2116、2126以及组织封闭表面2112、2122。组织封闭表面2112和2122可以结合有如上有关图1-14所述的任何光能封闭部件。
更特别地,单侧末端执行器组件2100包括以固定关系安装在轴2012上的一个静止或固定夹爪部件2120和在附连至静止夹爪部件2120的枢轴销2103周围安装的枢转夹爪部件2120。往复套筒2060可滑动地设置在轴2012内,并且可以由上述与手柄2040协作的驱动组件(未显示)远程操作,以打开和闭合夹爪部件2110和2120。枢转夹爪部件2120包括掣子或突起2117,掣子或突起2117从夹爪部件2110延伸,穿过设置在王府套筒2060内的孔2062(图15D)。通过使套筒2060在轴2012内轴向滑动,致动枢转夹爪部件2110,使孔2062抵靠枢转夹爪部件2110上的掣子2117。通过拉近套筒2060,绕其间做抓取的组织闭合夹爪部件2110和2120,通过远推套筒2060,打开夹爪部件2110和2120,以便接近并抓取目的。
一旦被致动,手柄2040以大体上弓形的型式绕枢转点朝固定手柄2050移动,这迫使驱动凸缘(未显示)接近驱动组件(未显示),这反过来又在大体上近侧方向上拉动往复套筒2060,以相对于夹爪部件120闭合夹爪部件2110。此外,手柄2040的近侧转动还引起锁定凸缘2044被释放,即,"锁定"触发组件2070以便有选择地致动。
现在转到本发明的操作特性,如大多数附图所示的,钳2010设计成封闭组织(或者通过上述脉管封闭或利用其它类似器械的凝固或烧灼)和解剖组织。例如,图15A-D和16-18显示了包括光解剖元件2154的钳2010的一个实施例,所述光解剖元件2154可以被有选择地延伸并有选择地激活以治疗组织。
解剖元件2154经由光纤215耦合至发生器40。光纤2155设置在索缆2310内。解剖元件2154还包括解剖尖端2156。在一些实施例中,解剖尖端2156可以由任何适合的光传送材料形成,包括但不限于人造蓝宝石等等。解剖尖端2156可以具有用于传送和/或聚焦光能的任何适合的形状,包括但不限于:圆锥形、截头圆锥形、金字塔形、任何其它碎粒表面、它们的组合等等,
图15A-15D和16-18显示了一个实施例,其中,解剖元件2154被安放在末端执行器组件2100的一个夹爪部件内,例如夹爪部件2120内,以便有选择地延伸。更特别地,解剖元件2154设计成独立于刀组件2180地移动,并且可以通过触发组件2070(图15A、16和17)的进一步近侧运动或通过独立的致动器2450(图18)被延伸。
正如图15A和15C清楚示出的那样,触发组件2070安装在手柄2040顶上,并与解剖元件2154(图16-17)协作,以有选择地平移解剖元件2154穿过组织。更特别地,触发组件2070包括指状物致动器2071和枢轴销2073,枢轴销2073将触发组件2070安装到外壳2020上。指状物致动器2071的尺寸设计成当手柄2040设置在非致动位置时,即夹爪部件2110和2120打开时,使锁定凸缘2044抵接在手柄2040上。
在某些实施例中,解剖元件2154连接至往复杆2065,所述往复杆2065贯穿轴2012外周上的细长凹口2013延伸,正如图15B所显示的那样。触发组件2070可以设计成,在夹爪部件2110和2120位于打开或闭合位置时,解剖元件2154可以被延伸。例如,可以使触发器2071从其原始、休止、中间或预致动位置向远侧(或向上)移动,以使解剖元件2154前进。作为替换,不管夹爪部件2110和2120的方向如何,解剖元件2154都可以前进。例如,触发组件2070可以设计成可以侧向移动(即垂直于纵向轴线"C")以使解剖元件2154前进,或者触发组件2070可以设计成,在触发器2071移动到最近侧位置(即经过上述"切割"位置)时和/或在触发器2071从中间或预致动位置向远侧前进时,解剖元件2154可延伸。可以包括一复位弹簧(未显示),其在触发器2071释放时,使解剖元件2154返回到非延伸位置。
在解剖元件2154延伸时,发生器2300被构造成使钳2010从封闭模式(即撤销能量输送至夹爪部件2110和2120)自动切换到光学解剖激活模式(即激活解剖元件2154)。
如上所述,当钳2010被构造成封闭操作时,开关2200的激活使能量从夹爪部件2110和/或夹爪部件2120传递而封闭组织。在解剖模式,开关2200(或独立开关,例如脚踏开关)的激活向解剖元件2154供给光能。解剖元件2154的激活允许外科医生快速治疗无血管组织结构和/或快速解剖狭窄的组织平面。
在某些实施例中,触发组件2070还可以被构造成在延伸时向解剖元件2154输送光能。例如,触发组件2070可以被构造成,使得触发器2071的最近侧致动(图15C)既延伸又激活解剖元件2154。可以采用一自动安全回路(未显示),其在解剖元件2154被延伸时防止开关2200向夹爪部件2110和2120供给光能。
在某些实施例中,解剖元件2145可以设置在夹爪部件2110和2120中的一个内,并且可以有选择地被开关2200激活。如图18A和18B所示,在进一步的实施例中,光解剖元件2445可以设置在夹爪部件2110和2120中的一个的外周上。为简单起见,将只论述单个夹爪部件,即夹爪部件2110。
解剖元件2445可以是光漫射元件,例如上面有关图2A和2B所述的光漫射元件132。解剖元件2445经由光纤2446耦合至发生器40,并设置在夹爪部件2110的外周2110a的至少一部分上或者沿着该至少一部分设置。术语"外周"表示夹爪部件2110的任何表面,例如夹爪外壳2116,其不是组织封闭接触表面2112或2122。解剖元件2445可以被开关2200有选择地激活,类似于解剖元件2145,并且可以结合类似的特征,例如,防止光能传送到封闭表面2112和2122,如上有关解剖元件2145所述的那样。
现在参照图19,末端执行器组件的另一实施例显示为用于形成期望的照射模式的末端执行器组件1900。末端执行器组件1900包括具有组织接触表面1912和1922的夹爪部件1910和920。与上述夹爪部件类似,夹爪部件1910和1920协作以抓取其间的组织。夹爪部件1910、1920经由光纤1911操作性地连接至光能量源(例如发生器40)。尤其是,光纤1911耦合至夹爪部件1910。光可以以不同的形式提供,包括但不限于:激光、发光二极管和任何其它适合类型的光能。
夹爪部件1910由具有外反射涂层1910a的光学传送材料形成。传送材料可以是光学漫射材料,例如磨砂蓝宝石晶体,或者可以是光学散射材料,例如以商标出售的聚甲醛,其可从德国Willmington的DuPont获得。来自光纤1911的光被传送至夹爪部件1910,并由反射涂层1910a包含在其中。这防止光除了通过组织接触表面1912外逃逸到夹爪部件1910外面。
夹爪部件1920可以由任何光学吸收或反射组织材料形成。在一些实施例中,夹爪部件1920可以包括位于组织接触表面1922上的光学吸收或反射涂层1920a。涂层1920a和/或夹爪部件1920阻止光穿过夹爪部件1920,从而使光能集中在夹爪部件1910和1920之间抓取的组织上。
现在参照图20-24,末端执行器组件的另一实施例显示为用于形成期望的照射模式的末端执行器组件3100。末端执行器组件3100包括具有组织接触部件3112和3122的夹爪部件3110和3120,所述组织接触部件3112和3122,分别限定组织接触表面3112a和3122a。与上述夹爪部件类似,夹爪部件3110和3120协作以抓取其间的组织"T"。夹爪部件3110、3120经由光纤3111操作性地连接至光能量源(例如发生器40)。尤其是,光纤3111耦合至夹爪部件3110。光可以以不同的形式提供,包括但不限于:激光、发光二极管和任何其它适合类型的光能。
组织接触部件3112可以由光学传送材料形成,所述光学传送材料可以是光学漫射材料,例如磨砂蓝宝石晶体,或者可以是光学散射材料,例如以商标出售的聚甲醛,其可从德国Willmington的DuPont获得。组织接触部件3122也可以由与组织接触部件3112类似的材料形成。在一些实施例中,组织接触部件3122可以由任何光学吸收或反射组织材料形成。
夹爪部件3110还包括用于将由纤维3111传送的光朝着组织接触表面3112a聚焦、与光3114成一条直线(in a line of light 3114)的圆柱形透镜3113。图21显示了夹爪部件3110的俯视图。在某些实施例中,以大约90°的角度反射光。该角度可以是任何适合的量,其取决于纤维3111相对于组织接触表面3112a的位置。
然后,所聚焦的光穿过设置在透镜3113和组织接触部件3112之间的衍射光栅3115。衍射光栅3115被构造成,根据其中所设置的多个贯通线3117,如图22和23所示,将光线3114分成两个或更多个光束3116a、3116b、3116c。
如图22和23所示,衍射光栅3115还包括中心配置的切割狭缝3118。衍射光栅3115可以产生三个光束3116a、3116b、3116c。当其穿过光栅3115时,光束3116a和3116c在夹爪部件3110、3120的周边产生。光束3116b穿过切割狭缝3118,并且具有比光束3116a和3116c高的强度。光束3116a和3116c由于强度低而适合于封闭组织,而光束3116c由于强度高而更适合于切割组织。夹爪部件3120的组织接触部件3122包括其中设置的切割沟槽3123,所述切割沟槽3123与切割狭缝3118对齐。在一些实施例中,组织接触部件3122可以具有平的、不变的表面。在进一步的实施例中,如图24所示,组织接触部件3122可以具有设置在组织接触表面3122a中心上的突出部件3126,用以在夹爪部件3110和3120之间抓取的组织上提供附加压力。突出部件3126可以具有吸收性能,以快速加热,增强切割。
由于光能通过以分子级吸收而转变为热能,所以光能适合于封闭组织。尤其是,某些分子吸收某些波长的光。另外,当治疗组织时,其经受物理和化学变化,从而也改变了光被最佳吸收的波长。在一些实施例中,可以在两个或更多个波长提供光能,以提供被两个或更多个分子最佳吸收的光能(例如组织型)。
图25显示了包括发生器40和钳10的光能手术系统2600。钳10可以包括上述任何实施例的夹爪部件。可以共同使用发生器40与钳10,以生成具有期望的波长的光。发生器40可以产生单一波长或多个波长的光能,并且可以包括如上所述的多个激光源,所述多个激光源能够产生多个波长的光。发生器40包括用以产生具有从大约100nm到大约11,000nm的波长的激光的多个激光源,这覆盖了大多数组织成分。尤其是,发生器40包括ArF准分子激光器2602a、KrF准分子激光器2602b、XeCl准分子激光器2602c、氩-染料激光器2602d、Nd:YAG激光器2602e、Ho:YAG激光器2602f、Er:YAG激光2602g。
钳10可用于确定组织的状态和组分,正如上有关图7A和7B所更详细地描述的那样。图26显示了各种组织成分的吸收与范围从紫外线(UV)光谱到红外线(IR)光谱的波长的关系曲线图。尤其是,图27也列出了设置在发生器40中的激光源2602a-2602g,这些激光源生成能够更佳地匹配组织成分的吸收系统的波长的光。组织中遇到的组织成分包括但不限于:水,脉管系统,表皮及其它表层,全血,黑色体,胶原等等。
在操作期间,钳10用来分析组织,包括测量其吸收性。发生器40的控制器42分析吸收测量,然后控制器42确定所述一个或多个激光源2602a-2602g中的哪一个被激活以获得光能的最佳吸收。控制器42可以耦合至多路复用器(未显示)和/或另外的光学输出开关设备,以控制激光源2602a-2602g的激活。
钳10在封闭过程中可以持续地感知组织光学性质,以改变包括强度的光能输出以及改变激光源2602a-2602g中的哪个被激活。一旦确定封闭过程完成,控制器42就可以激活特定的最适合于切割被封闭的组织的激光源2602a-2602g。
尽管已经在附图中示出和/或在本文中论述了本发明的若干实施例,但是,这不作为对本发明的限制,本发明应根据本领域所允许的的范围来广义地解释,说明书的阅读也是如此。所以,上述描述不应当被解读为限制性的,而仅仅是作为特定实施例的范例。本领域技术人员能够在本文所附的权利要求书的范围和精神内得到其它的变型。
Claims (19)
1.一种医疗器械,所述医疗器械包括:
外壳;和
操作性地连接至所述外壳的末端执行器组件,所述末端执行器组件包括:
第一和第二夹爪部件,所述第一和第二夹爪部件均具有组织接触表面,所述第一和第二夹爪部件中的至少一个可以在第一间隔位置和第二紧邻位置之间移动,其中,在第二位置,夹爪部件协作以限定被构造成接收夹爪部件之间的组织的空腔;以及
耦合至所述第一和第二夹爪部件中的至少一个的至少一个发光元件,所述至少一个发光元件适合于向所述第一和第二夹爪部件之间抓取的组织输送光能以治疗组织。
2.根据权利要求1所述的医疗器械,其中,所述至少一个发光元件被构造成无中间光学组件地向组织中直接发光。
3.根据权利要求1所述的医疗器械,还包括耦合至所述至少一个发光元件的光学组件,所述光学组件被构造成向组织传输从所述至少一个发光元件发出的光,并用期望的照射模式照射组织。
4.根据权利要求3所述的医疗器械,其中,所述光学组件包括光纤、折射元件、反射元件、衍射元件及其组合中的至少一种。
5.根据权利要求4所述的医疗器械,其中,所述光学组件设置在第一夹爪部件或第二夹爪部件中的至少一个内。
6.根据权利要求5所述的医疗器械,其中,所述光学组件被构造成在第一夹爪部件或第二夹爪部件中的至少一个内沿着由第一夹爪部件或第二夹爪部件中的至少一个所限定的纵向轴线平移。
7.根据权利要求1所述的医疗器械,其中,所述至少一个发光元件选自包括发光二极管、激光器及其组合的组。
8.根据权利要求1所述的医疗器械,其中,所述组织接触表面中的至少一个包括吸收元件,所述吸收元件被构造成吸收从所述至少一个发光元件发出的光能,由此加热一部分组织、第一夹爪部件、第二夹爪部件及其组合中的至少一个。
9.根据权利要求1所述的医疗器械,其中,所述组织接触表面中的至少一个包括被构造成反射穿过组织的光的反射元件。
10.根据权利要求1所述的医疗器械,其中,所述至少一个发光元件设置在所述外壳内。
11.根据权利要求1所述的医疗器械,其中,所述至少一个发光元件被构造成在第一夹爪部件或第二夹爪部件中的至少一个内沿着由第一夹爪部件或第二夹爪部件中的至少一个限定的纵向轴线平移。
12.根据权利要求1所述的医疗器械,还包括被构造成测量光的至少一种性质的至少一个光检测元件。
13.根据权利要求11所述的医疗器械,还包括控制器,所述控制器被构造成基于所测量的光的至少一种性质确定是否已实现期望的组织效果。
14.一种用于治疗组织的系统,所述系统包括:
医疗器械,所述医疗器械包括:
外壳;
操作性地连接至所述外壳的末端执行器组件,所述末端执行器组件包括:
第一和第二夹爪部件,所述第一和第二夹爪部件均具有组织接触表面,所述第一和第二夹爪部件中的至少一个可以在第一间隔位置和第二紧邻位置之间移动,其中,在所述第二位置,夹爪部件协作以限定被构造成接收夹爪部件之间的组织的空腔;
耦合至所述第一和第二夹爪部件中的至少一个的至少一个发光元件,所述至少一个发光元件适合于向所述第一和第二夹爪部件之间抓取的组织输送光能以治疗组织;
至少一个光检测元件,所述至少一个光检测元件被构造成测量穿过组织的光能的至少一种性质;以及
控制器,所述控制器耦合至所述至少一个光检测元件和所述至少一个发光元件,并且所述控制器被构造成基于所测量的穿过组织的光能的至少一种性质控制所述至少一个发光元件。
15.根据权利要求14所述的系统,其中,所述至少一个发光元件和所述控制器中的至少一方设置在外壳内。
16.根据权利要求14所述的系统,其中,所述组织接触表面中的至少一个包括设置在其上的吸收涂层,所述吸收涂层被构造成吸收从所述至少一个发光元件发出的光能,以加热第一和第二夹爪部件中的至少一个的至少一部分。
17.根据权利要求14所述的医疗器械,其中,所述组织接触表面中的至少一个包括设置在其上的反射涂层,所述反射涂层被构造成反射从所述至少一个发光元件发出的光能。
18.一种用于治疗组织的方法,所述方法包括:
在第一和第二夹爪部件之间抓取组织,所述第一和第二夹爪部件中的至少一个可以在第一间隔位置和第二紧邻位置之间移动,其中,在所述第二位置,夹爪部件协作以限定被构造成接收夹爪部件之间的组织的空腔;
向所述第一和第二夹爪部件之间抓取的组织施加光能;
测量向组织施加的光能的至少一种性质;以及
基于所测量的光能的至少一种性质控制光能。
19.根据权利要求18所述的方法,其中,所述第一和第二夹爪部件中的至少一个包括:
至少一个发光元件,所述至少一个发光元件适合于向所述第一和第二夹爪部件之间抓取的组织输送光能以治疗组织;以及
至少一个光检测元件,所述至少一个光检测元件被构造成测量向组织施加的光能的至少一种性质。
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US (6) | US9375282B2 (zh) |
EP (1) | EP2830525B1 (zh) |
JP (1) | JP6254144B2 (zh) |
CN (1) | CN104394791B (zh) |
AU (1) | AU2013240532B2 (zh) |
CA (1) | CA2866686C (zh) |
WO (1) | WO2013148054A1 (zh) |
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2012
- 2012-03-26 US US13/430,325 patent/US9375282B2/en active Active
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2013
- 2013-03-01 WO PCT/US2013/028520 patent/WO2013148054A1/en active Application Filing
- 2013-03-01 JP JP2015503220A patent/JP6254144B2/ja active Active
- 2013-03-01 CN CN201380016698.XA patent/CN104394791B/zh active Active
- 2013-03-01 EP EP13767281.2A patent/EP2830525B1/en active Active
- 2013-03-01 CA CA2866686A patent/CA2866686C/en not_active Expired - Fee Related
- 2013-03-01 AU AU2013240532A patent/AU2013240532B2/en not_active Ceased
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2016
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2017
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CA2866686A1 (en) | 2013-10-03 |
US11819270B2 (en) | 2023-11-21 |
EP2830525B1 (en) | 2021-08-18 |
JP6254144B2 (ja) | 2017-12-27 |
US20210030473A1 (en) | 2021-02-04 |
US10806514B2 (en) | 2020-10-20 |
JP2015512713A (ja) | 2015-04-30 |
EP2830525A1 (en) | 2015-02-04 |
AU2013240532B2 (en) | 2017-04-06 |
CA2866686C (en) | 2021-11-16 |
US20160302860A1 (en) | 2016-10-20 |
CN104394791B (zh) | 2017-12-29 |
EP2830525A4 (en) | 2015-11-11 |
AU2013240532A1 (en) | 2014-09-25 |
US9375282B2 (en) | 2016-06-28 |
US20130253489A1 (en) | 2013-09-26 |
US9610121B2 (en) | 2017-04-04 |
US20180296272A1 (en) | 2018-10-18 |
WO2013148054A1 (en) | 2013-10-03 |
US10806515B2 (en) | 2020-10-20 |
US20170181797A1 (en) | 2017-06-29 |
US20180193096A1 (en) | 2018-07-12 |
US9925008B2 (en) | 2018-03-27 |
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