CN1732859B - 具有两件式e形梁发射机构的铰接手术缝合器 - Google Patents

具有两件式e形梁发射机构的铰接手术缝合器 Download PDF

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CN1732859B
CN1732859B CN200510089521XA CN200510089521A CN1732859B CN 1732859 B CN1732859 B CN 1732859B CN 200510089521X A CN200510089521X A CN 200510089521XA CN 200510089521 A CN200510089521 A CN 200510089521A CN 1732859 B CN1732859 B CN 1732859B
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弗雷德里克·E·谢尔顿四世
凯文·多尔·罗斯
杰里·R·摩根
迈克尔·厄尔·塞特瑟
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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
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • 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
    • 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
    • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00867—Material properties shape memory effect
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00867—Material properties shape memory effect
    • A61B2017/00871—Material properties shape memory effect polymeric
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft

Abstract

一种手术切割及缝合器械，适用于腹腔镜检查和内窥镜检查诊断过程，其将组织夹钳于细长槽的端部执行器内，其中与砧板相对的细长槽枢转设置。E形梁发射杆通过夹钳的端部执行器向远端移动，来切割组织并驱动创口每侧的缝针。E形梁发射杆将砧板与细长槽间隔开，以保证形成适当的闭合缝钉，尤其是在夹钳的组织量不足以将端部执行器间隔开时。具体地说，发射杆的上部销通过砧板狭缝纵向移动，并且通道狭缝被捕获在发射杆的下部盖和中部销之间以确保最小的间隔。通过加厚的远端部分和变细的近端条形成E形梁增强了可制造性，并有利于其在该缝合铰接手术器械中的应用。

Description

具有两件式E形梁发射机构的铰接手术缝合器
相关申请的交叉引用
本申请要求由Shelton于2004年7月28日提交的题为″SURGICALINSTRUMENT INCORPORATING AN ELECTRICALLY ACTUATED ARTICULATIONMECHANISM″、申请号为60/591,694美国临时申请的优先权。本申请是Shelton等于2003年5月20日提交的题为“SURGICAL STAPLINGINSTRUMENT INCORPORATING AN E-BEAM FIRING MECHANISM”、申请号  为10/443,617的美国正式申请的部分后续专利申请，在此引用其全部内容作为参考。
技术领域
本发明涉及手术器械，其适于在内窥镜检查时插入由纵向驱动发射部件启动的端部执行器，尤其涉及一种具有铰接轴的手术缝合及切割器械。
背景技术
内窥镜检查手术器械通常优选传统的开放式手术装置，因为其创口较小，有利于缩短术后康复时间，减少并发症。相应地，适合于通过套针的套管将远端部执行器精确放置于所需手术部位的内窥镜检查手术器械的范围得到了极大发展。这些远端部执行器以多种方式与组织结合来达到诊断或治疗的效果(例如，内窥刀具、抓紧器、刀具、缝钉机、夹钳施放器、接近装置、药物/基因治疗传送装置以及使用超声波、RF、激光的能量装置等等)。
端部执行器的定位受到套针的限制。通常这些内窥检查手术器械包括一个位于端部执行器和由医生操作的手柄部件之间的细长轴。该细长轴使得其能插入到需要的深度并能围绕轴的纵向轴线旋转，从而将端部执行器定位至某一部位。随着明智的设置套针并采用抓紧器，例如，通过另一个套针，通常这种定位的量是足够的。如在美国专利US 5465895中描述的，手术缝合和切割器械，可作为内窥检查手术器械通过插入和旋转而将端部执行器成功定位的例子。
近来，Shelton等于2003年5月20提交的美国专利10/443617号、题为″SURGICAL STAPLING INSTRUMENT INCORPORATING AN E-BEAMFIRING MECHANISM″的专利申请，描述了一种用于切割组织并致动缝钉的改进的“E形梁(E-beam)”发射杆，在此引用其全部内容作为参考。另外的一些优点包括，确保将端部执行器的夹头间隔开，或者更具体地讲，将缝钉施放装置间隔开，即使为了最佳的缝钉成型而夹持了略为过大或过小的组织。而且，E形梁发射杆以能够包含多种有利锁定的方式与端部执行器及缝钉匣接合。
取决于手术的本质，最好还可根据需要进一步调整内窥检查外科器械中端部执行器的位置。具体地说，通常需要将端部执行器定向使其一轴线横跨器械轴的纵向轴线。端部执行器相对于器械轴的横向运动通常称为“铰接”。这可典型地通过将枢转(或铰接)点设置于与缝钉施放装置紧邻的伸出的轴中来实现。这样外科医生可在远处将缝钉施放装置铰接于任一侧，以更好的设置手术缝合线，并更容易进行组织操作和定向。这种铰接的定位使临床医生能够更容易以某种距离结合组织，例如从器官的后面。另外，铰接定位有利于使内窥镜定位于端部执行器的后面，而无须由器械轴锁定。
通过将铰接控制与关闭端部执行器来夹钳组织的控制，以及发射端部执行器(即缝合和切割)的控制整合于由内窥检查器械所限定的很小直径内，来铰接手术缝合及切割器械的方法显得非常复杂。通常，这三种控制运动都通过轴的纵向平移来传送。例如，美国专利US 5673840公开了一种折叠式铰接机构(“曲颈”)，其利用执行轴选择性缩回两个连接杆之一而实现铰接，每个杆各自偏置于轴的中心线相对的一侧。连接杆借助一系列不连续设置的棘轮防止倒转。
纵向控制铰接机构的另一例子是美国专利US 5865361，其包括一个从凸轮枢轴偏置的铰链，铰链的推拉轴向平移将铰接作用到每一侧。同样地，美国专利US5797537公开了一个穿过轴进行铰接的类似的杆。
在Frederick E.Shelton IV等的同时待审并共同拥有的美国专利申请10/615,973号、题为“SURGICALI NSTRUMENTI NCORPORATING ANARTICULATION MECHANISM HAVING ROTATION ABOUT THE LONGITUDINALAXIS”的申请中，作为纵向运动的替代方式，其采用旋转运动来传送关节运动，在此引用其全部内容作为参考。
在Shelton等于2003年5月20日提交的申请号为10/443,617、题为“SURGICAL STAPLING INSTRUMENT INCORPORATING AN E-BEAMFIRING MECHANISM”的专利申请中，公开了一种适于腹腔镜检查和内窥镜检查手术过程的手术切割及缝合器械，将组织夹钳于与砧板轴向相对的细长槽的端部执行器内，前文中已引用其全部内容作为参考。E形梁发射杆向远端移动，通过夹钳的端部执行器切除组织并驱动创口每一侧的缝钉。E形梁发射杆确保将砧板与细长槽间隔开，以保证正确地形成闭合缝钉，尤其是当夹钳的组织量不足以将端部执行器间隔开时。具体地讲，发射杆的一个上部销通过砧板狭缝纵向移动，并且通道狭缝被捕获于发射杆的下部盖和中部销之间以确保最小的间隔。尽管这种E形梁发射杆具有诸多优点，仍需要其它部件来增强其可制造性并将尺寸变化减到最小。
相应地，非常需要有利于确保端部执行器的夹钳叉头之间形成适当的间隔并便于与其轴铰接的手术器械。
发明内容
本发明通过提供一个确保将手术缝合及切割器械的端部执行器垂直间隔开的发射机构，克服了现有技术的上述及其它缺点。因此，该器械从结构上保证了进行正确缝合的足够间隔，即使是在端部执行器中夹钳的组织过小的情况下。将这些特征整合于具有切割边缘的E形梁中，当E形梁通过端部执行器例如切割和缝合装置进行发射时，可以得到一致的间隔并实现协调作业。而且，将一个单独的变细的发射杆与E形梁临近连接，增强了其在铰接手术器械中的使用，其中可使横截面积减小并能在铰接平面中弯曲。
根据本发明的一方面，手术器械包括手柄部件，其可操作地使执行部分启动并产生发射运动。该执行部分具有一个细长槽，其中容纳与枢转连接的砧板相对的缝钉匣。发射装置包括远端设置为纵向容纳于细长槽和砧板之间的切割边缘，可与砧板槽接合的上部部件，与通道狭槽接合的下部部件，以及一个可操作的启动楔块滑车的中间部件，其与缝钉匣形成一体。中间部件有利地对抗端部执行器的缩进，即使在缝合夹钳的组织过小时，也能确保正确的缝钉成型。当将变细的发射杆与E形梁连接提供铰接弹性时，这些间隔和切割部件有利地形成E形梁。
(1)根据本发明的一种手术器械，包括：手柄部件，其可操作地产生发射运动；以及执行部分，其响应于来自手柄部件的发射运动，执行部分包括：细长槽，其与手柄部件相连并具有一通道狭槽，缝钉匣，其容纳于该细长槽中，并具有被对准的近侧定位的楔形部件以使支撑缝钉的驱动器向上凸出，砧板，其枢转连接在细长槽上并具有一砧板槽，发射装置，其包括：位于远端的纵向容纳在细长槽和砧板之间的切割边缘、能与砧板槽接合以确保将砧板与细长槽间隔开的上部部件、以其上表面与通道狭槽接合从而使发射装置能够沿着通道狭槽行进的下部部件以及一通过使缝钉匣的楔形部件向远侧平移以可操作地致动缝钉匣的中间部件，在纵向的发射行程期间，发射装置与细长槽和砧板确实地接合，以在其间形成缝钉的间隔，铰接接头，其与细长槽邻近连接，以及变细的发射条，其与发射装置近侧连接，用于通过铰接接头传送来自手柄部件的发射运动。
(2)根据第(1)条所述的手术器械，其中，砧板与在相应的远端处被向内偏压的细长槽形成枢转连接，以在缝钉匣致动过程中有助于发射装置将砧板和细长槽确实地间隔开。
(3)根据第(1)条所述的手术器械，其中，缝钉匣是多种缝钉匣类型中的一种选定类型，每个缝钉匣类型的特征在于具有这样一个厚度，即，该厚度是根据在砧板盒细长槽之间的所需间隔而选择的，并且缝钉的特征在于具有适于所需间隔的长度。
(4)根据第(3)条所述的手术器械，其中，楔形部件包括一楔块滑车，其具有多个连接的凸出楔块，每个楔块具有为选定类型的缝钉匣设定的预选高度，发射装置的中间部件被定向为抵接多种缝钉匣类型的每一种。
(5)根据本发明的一种手术器械，包括：手柄部件，其可操作地产生发射运动及关闭运动；以及执行部分，其响应于来自手柄部件的发射运动，并具有大小适合于进行内部手术的直径尺寸，执行部分包括：与手柄部件连接的轴，其可操作地分别传送发射运动和关闭运动，细长槽，其与轴相连并具有一通道槽，砧板，其枢转连接在细长槽上，响应于来自轴的关闭运动，并具有一砧板槽，发射装置，其远端为纵向容纳在细长槽和砧板之间的切割边缘，该发射装置包括一个能与细长槽滑动地接合的下部，和一个定位为在发射期间能砧板滑动地接合的上部，发射装置与细长槽接合并且由砧板保持了二者之间的间隔，以及变细的发射条，其近侧与发射装置连接并可操作地将发射运动传送给发射装置。
(6)根据第(5)所述的手术器械，还包括与细长槽接合的缝钉匣以及容纳发射装置的切割边缘的近端开口的槽，缝钉匣包括通过发射机构的远端纵向运动而使其向上凸出的多个缝钉。
(7)根据第(6)所述的手术器械，其中，缝钉匣还包括支撑多个缝钉的多个驱动器以及楔块滑车，该楔块滑车响应于发射机构的向远侧的纵向运动使驱动器向上凸出，从而形成多个抵靠砧板的缝钉。
(8)根据第(5)所述的手术器械，其中，所述轴包括一铰接机构，变细的条通过该铰接机构弯曲并纵向平移。
(9)根据第(6)所述的手术器械，其中，缝钉匣是多种缝钉匣类型中的一种选定类型，为了在砧板和细长槽之间形成需要的间隔，每个缝钉匣类型的特征在于具有这样一个厚度，即，该厚度为根据在砧板和细长槽之间的所需间隔而选择的，并且缝钉的特征在于具有适于所需间隔的长度。
(10)根据第(9)所述的手术器械，其中，楔块滑车包括多个连接的凸出楔块，每个楔块具有为选定类型的缝钉匣设定的预定高度，发射装置的中间部件被定向为抵靠着多种缝钉类型的每一种。
(11)根据第(5)所述的手术器械，其中，发射装置被构造成在砧板和细长槽之间的纵向行程期间，通过包括具有与细长槽接合的上表面和下表面的下部，来使砧板和细长槽确实地间隔开。
(12)根据第(11)所述的手术器械，其中，发射装置的下端部分包括一上表面与细长槽抵接的下部销，并且下端部分还包括具有与细长槽反向抵接的下表面的中间销。
(13)根据第(12)所述的手术器械，其中，发射装置还包括具有其上表面和下表面与砧板纵向滑动接合的上部部件。
(14)根据第(13)所述的手术器械，其中，砧板包括一带有变窄的垂直槽的内部纵向槽，并且发射装置在变窄的垂直槽中平移，并包括具有上表面和下表面的上部部件，该上表面和下表面位于在使砧板和细长槽确实地间隔开的内部纵向槽中。
(15)根据第(5)所述的手术器械，其中，发射装置被构造成在砧板和细长槽之间的纵向行程过程中通过包括具有上表面和下表面的上部部件来将砧板和细长槽确实地间隔开，该上表面和下表面沿纵向滑动并反向地与砧板接合。
(16)根据第(15)所述的手术器械，其中，砧板包括具有上表面和下表面的纵向槽，该上表面和下表面分别与发射装置的上部部件的上表面和下表面滑动地抵接。
(17)根据第(16)所述的手术器械，其中，纵向槽包括与变窄的垂直槽连通的内部纵向通道，并且发射装置在变窄的垂直槽中平移，并包括具有上表面和下表面的上部部件，该上表面和下表面位于将砧板和细长槽确实间隔开的内部纵向通道中。
(18)根据本发明的一种手术器械，包括：手柄部件，其用于产生发射运动及关闭运动；夹钳部件，其响应于关闭运动来夹钳组织；
发射部件，其响应于发射运动，以将夹钳部件垂直间隔开，并产生对夹钳在其中的组织的切割及缝合；以及铰接机构，其可操作地设定为将夹钳部件与手柄部件铰接；以及变细的发射条，其在近侧与发射装置连接，弯曲通过铰接机构并纵向传送发射运动。
(19)根据第(18)所述的手术器械，其中，砧板包括具有变窄的向内开口的内部纵向槽，发射装置在逐渐变窄的向内开口中平移，并具有在纵向槽中滑动地接合的上部部件。
(20)根据第(19)所述的手术器械，还包括关闭部件，其被可操作地构造成将关闭运动纵向传送到端部执行器，以将砧板和细长槽的远端向内偏压，以有助于发射装置在致动缝钉匣的过程中将砧板与细长槽确实地间隔开。
参照附图及其描述，本发明的这些和其它目的及优点将更加明显。
附图说明
在此结合构成说明书一部分的附图，解释本发明的实施例，并且结合上面给出的本发明的一般描述以及下面给出的实施例的详细描述，来解释本发明的原理。
图1是一种用于手术缝合及切割的内窥检查手术缝合器械的透视图，其处于开放的未铰接状态。
图2是图1的手术缝合器械中的缝钉施放装置打开状态的左前侧透视图，其右半部分是容纳于缝钉通道内的可更换的缝钉匣。    
图3是图2的缝钉施放装置的分解透视图，其具有完全可更换的缝钉匣以及一个可供选择的非铰接轴结构。
图4是图2的缝钉施放装置的两件式刀具及发射杆(“E形梁”)的透视图。
图5是图2的缝钉施放装置中缝钉匣的楔块滑车的透视图。
图6是图2的缝钉施放装置沿着中心线6-6截得的纵向横截面的左侧主视图。
图7是图2的缝钉施放装置张开状态的透视图，其处于没有可更换的缝钉匣，缝钉通道的一部分邻近两件式刀具及发射杆的中间销，并且没有缝钉通道的远端部分。
图8是图2的缝钉施放装置沿着线8-8的横截面的主视图，示出了缝钉匣的内部缝钉驱动器和两件式刀具及发射杆的一部分。
图9是图2的缝钉施放装置闭合状态沿着纵轴线6-6的左视图，包括位于两件式刀具和楔块滑车之间的中心接触点，而且横向偏置以显示缝钉匣中的缝钉及缝钉驱动器。    
图10是图9的缝钉施放装置的详细的左视图，两件式刀具略微回缩，为更换缝钉匣的典型状态。
图11是图10的缝钉施放装置的详细的左视图，两件式刀具开始发射，与图9中描绘的配置相对应。
图12是两件式刀具及发射杆朝远端发射之后，图9的缝钉施放装置的左侧横截面图。
图13是当缝钉匣发射及两件式刀具回缩之后，图12的的缝钉施放施放装置闭合状态的左侧横截面图。
图14是图13的缝钉施放装置的左侧横截面的详细的主视图，两件式刀具可落入锁定位置中。
图15是沿着图1的手术缝合器械的铰接接头(曲颈)沿线15-15截得的横截面的俯视图。
图16是在图15的铰接接头沿着线16-16截得的垂直横截面的主视图，显示了电活性的聚合物(EAP)板铰接致动器和支撑发射杆的EAP支撑板。
图17是在铰接之后，图16的铰接接头沿着线15-15截得的横截面的平面图。
图18是图15的铰接接头的透视图。
具体实施方式
在图1-3中，手术缝合器械10的远端具有一个端部执行器，图示为缝钉施放装置12，其通过细长轴16与手柄14(图2)间隔开。缝钉施放装置12包括一个缝钉通道18，以容纳可更换的缝钉匣20。与缝钉通道18枢转连接的是向缝钉匣20夹钳组织并使缝钉变形的砧板22，其将受到驱动从缝钉匣20的缝钉孔24伸出的缝钉23(图3)抵靠在砧板底面上的缝钉成型槽26(图6)中使其变形为闭合形状。当缝钉施放装置12闭合时，其横截面积以及细长轴16适于通过一个小的手术位点插入，例如通过套针插管(未显示)。
具体参考图1，通过控制手柄14以利于缝钉施放装置12的正确设置及定向。具体地，旋转按钮30导致轴16绕其纵向轴线旋转，从而导致缝钉施放装置12的旋转。也可在轴16中的铰接接头32进行其它定位，使缝钉施放装置12在由轴16的纵向轴线形成的弧面上形成枢转，从而使其置于器官的后面或者使其它器械如内窥镜(未显示)等定位于缝钉施放装置12的后面。有利地，该铰接由手柄14上的铰接控制开关34控制，其将电信号传送至铰接接头32，即传送至由手柄14中的EAP控制器和电源38供电的电活性聚合物(EAP)致动器36。
一旦将组织定位于缝钉施放装置12中，外科医生通过将关闭触发器40拉向手枪式把手42来关闭砧板22。一旦这样夹持后，外科医生可握住更远处的发射触发器44，将其回拉来发射缝钉施放装置12，在一些申请中该步骤也可通过单次发射冲程来完成，在另一些申请中也可通过多次发射冲程来完成。当切割组织时，在完成发射的同时至少在其间钉入两排缝钉。
当全过程结束后发射部件可自动开始回缩。此外，可向后拉动回缩杆46来实现回缩。随着发射部件的回缩，通过外科医生轻轻朝向手枪式把手42向后拉动关闭触发器40，并对关闭释放按钮48施压，然后关闭触发器40，使缝钉施放装置12松开并张开，从而从缝钉施放装置12中释放被切割组织的两个缝合末端。
缝钉施放装置
当铰接接头32如图1所示时，为清楚起见并作为一种可供选择的应用，图2-14中的手术缝合装置10省略了铰接接头32。然而应当理解，如下列参照图15-18中所描述的那样，本发明在铰接方面具有特别的优点。
在图1-3中，缝钉施放装置12实现组织夹钳功能，以及由纵向向下传送至轴架70上方的轴16的两种不同的运动驱动缝钉并切割组织的功能。该轴架70邻近连接于手柄40并与其耦合，随着把手30的转动而转动。在Swayze和Shelton等人的题为“SURGICAL STAPLINGINSTRUMENT INCORPORATING A MULTISTROKE FIRING POSITION INDICATORAND RETRACTION MECHANISM”、申请号为10/374,026的同时待审并共同拥有的专利申请中详细描述了一种用于图1的手术缝合和切割器械10的示例性的多冲程手柄14，在此引用其全部内容作为参考，包括如这里所描述的另外的特征和变化。尽管多冲程手柄14有利于支持具有能发射很远距离的较大发射力的应用，与本发明一致的应用还可包括单次发射冲程，例如在Frederick E.Shelton IV，Michael E.Setser，andBrian J.Hemmelgarn等人的、申请号为10/441,632、题为“SURGICALSTAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRINGSYSTEMS”的同时待审并共同拥有的美国专利申请中所描述的，在此引用其全部内容作为参考。
具体参照图3，轴架70的远端与缝钉通道18相连。砧板22具有一个近端枢转末端72，其枢转容纳于缝钉通道18的近端内部，远离其与轴架70的接合。砧板22的枢转末端72包括一个位于近端的封闭部件76，但远离其与缝钉通道18的枢转连接。因此，其远端具有与封闭部件76接合的马蹄状窗口80的封闭管78，在向近端纵向运动期间选择性地给予砧板22开启运动，以及当响应于封闭触发器40在轴架70上滑动的封闭管78，在向远端轴向运动期间选择性地给予砧板22关闭运动。
轴架70通过纵向往复两件式刀具及发射杆90来环绕并导承来自手柄14的发射运动。特别地，轴架70包括一个纵向发射杆槽92，其容纳两件式刀具及发射杆90的近端部分，尤其是叠层锥形发射杆94。应理解，叠层锥形发射杆94可由实心发射杆或者在应用时不会穿过铰接接头的其它材料制成的发射杆来代替，如在图2-4中所示。
E形梁102是两件式刀具及发射杆90的远端部分，其有利于单独闭合和发射，并在发射过程中将砧板22与细长缝钉通道18间隔开。具体参照图3-4，包括任何连接处理例如铜焊或粘接，刀具及发射杆90由在E形梁的近侧中形成的凹形垂直安装口104形成，其中容纳相应的凸形安装部件106，该凸形安装部件106位于叠层锥形发射杆94的远端，每个部分都采用适于其特定功能的选定材料和工艺(例如强度、弹性、摩擦)。有利地，E形梁102可由具有合适的材料特性的材料制成，该材料适于形成一对顶部销110、一对中间销112和底部销或底部114，并能形成锋利的切割边缘116。此外，支撑切割边缘116的每个垂直末端的一体化形成并邻近突出的顶部引导件118和中间引导件120还限定了组织载物区域122，该组织载物区域122有助于在切割之前将组织导引至锋利的切割边缘116。中间引导件120还通过抵接楔块滑车126(图5)的阶梯状中央部件124，来接合或发射缝钉施放装置12，楔块滑车126通过缝钉施放装置12来影响缝钉的形成，如下面详细描述的那样。
与由多个部件组装相比，将这些部件(例如顶部销110、中间销112及底部114)与E形梁102整体形成有利于彼此之间紧密接触制造，在发射过程和/或与缝钉施放装置12的各种锁定部件有效作用时保证了良好的运转。
在图6-7中，显示了张开的手术缝合器10，其中E形梁102完全缩回。在装配时，E形梁102的底部114通过加宽的孔130落入缝钉通道18中，然后E形梁102沿着在缝钉通道18中形成的下部轨道132以向远端滑行的方式行进。具体地，下部轨道132包括一个窄槽133，其在缝钉通道18的下表面上张开成为加宽的槽134，在侧截面中形成倒转的T形，如在图7及8中具体描述的那样，并与加宽的孔130连通。一旦组装后，与叠层锥形发射杆94紧邻连接的部件将使下底部114不能再次向加宽的孔130靠近地运动而脱离。
在图9中，叠层锥形发射杆94有利于缝钉施放装置12通过套针插入。具体地，当完全回缩后，在更远端，向下的突起136将E形梁102升高。该步骤通过在缝钉通道18中的加宽的孔130的近边缘向上突出的点上设置一个向下的突起136来实现。
在图10中，叠层锥形发射杆94还加强了一些锁定部件的运转，这些锁定部件可通过包括一个在发射冲程的开始部分过程中能被轴架70向下促动的更靠近近端的向上突起138而包含在缝钉通道18中。具体地说，在轴架70中的一对方形口142之间形成横向杆140(图3)。环绕横向杆140的夹形弹簧144向下促动叠层锥形发射杆94向远端从纵向发射杆槽92中突出的那一部分，这样保证了适当的时候某些有利的锁定部件的接合。当向上的突起138与夹形弹簧144接触时，这种促动仅仅被控制或限制在发射运动的那一部分。
在图6-7中，E形梁102回缩，其顶部销110滞留于位于砧板22枢转近端附近的砧板槽150中。一个向下张开的垂直砧板槽152(图2)在砧板22中横向加宽延伸至砧板内部轨道154中，如图9-10所示，在发射过程中，当它们向远端行进时将E形梁102的顶部销110捕获在砧板内部轨道154中，确保将砧板22与缝钉通道18间隔开。因此，随着E形梁102的回缩，医生能反复开关缝钉施放装置12，直到对其中捕获的待缝合及切割的组织的放置及定位感到满意为止，即使缝钉施放装置12的直径减小并因此降低了刚性，仍有E形梁102协助对组织进行正确定位。
在图2-3、5-6、8-14中，缝钉施放装置12显示为带有包括楔块滑车126的可更换的缝钉匣20。纵向排列并平行的多个向下张开的楔块槽202(图8)容纳与楔块滑车126整体形成的各楔块204。在图8-10中，楔块滑车126使得多个可在缝钉驱动器槽208中垂直滑动的缝钉驱动器206向上凸出。在该直观的方式中，每个缝钉驱动器206具有两个垂直叉脚，每个叉脚向上插进相应的缝钉孔210，将置于其上的缝钉23向上冲出抵靠在砧板22的缝钉成型表面214(图10)上使其变形。限定于缝钉匣20中并与缝钉通道18邻近的中央发射槽216提供楔块滑车126的底部、水平部分218的通道(图5)同时作为E形梁102的中间销112的通道。具体地，缝钉匣托架220(图3、8)位于缝钉匣主体222的下部并与其连结，缝钉匣主体222包括其中形成的缝钉驱动槽208、缝钉孔210以及中央发射槽216。由于缝钉23形成于每一侧，锋利切割边缘216进入通过缝钉匣20的纵轴线但不穿过其最远端的垂直通槽230。
如图10所示，随着两件式刀具及发射杆90被拉近直到向下的突起136使E形梁102上的中间引导件120向上并向后突出，缝钉施放装置12开始发射，当砧板22如图2及6中所示张开时，可将新的缝钉匣插进缝钉通道18中。
在图11中，两件式刀具及发射杆90已朝远端行进一小段距离，在倚靠于叠层锥形发射杆94的向上突起138上的夹形弹簧144的促动下，向下的突起126落入下部轨道132的加宽孔130中。中间引导件124通过放置在楔块滑车126的阶梯状中央部件124上，阻止了进一步向下旋转，从而将E形梁的中间销112保持于中央发射槽216中。
在图12中，两件式刀具及发射杆90已朝远侧发射，使楔块滑车126行进以成形缝钉23，同时锋利的切割边缘116切割夹钳在砧板22与缝钉匣20之间的组织242。然后，在图13中，两件式刀具及发射杆90回缩，而将楔块滑车126留在远端位置。
在图14中，允许中间销112向下平移进入在缝钉通道18中形成的锁定槽240(同样参见图7和10)。因此，当楔块滑车126(在图4中未显示)不能定位在近侧时(也就是说，没有缝钉匣20或者耗尽缝钉匣20)，由于中间销112碰到锁定槽240的远端边缘，操作员可接收到触觉指示。
在图1中所示的铰接接头32有利地受益于两件式刀具及发射杆90的弹性强度。在图15-18中，铰接接头32被描绘为一个由椎柱体302形成的柔性颈部接头300，其中椎柱体302具有能容许在铰接平面上进行铰接的成对的横向对称的弧形凹槽304。众所周知，通过纵向穿过每个横向侧306、308的控制杆(未显示)的选择性运动，可同时分别压缩或扩张横向侧306、308。然而，所描绘的是EAP板致动器310、312，每个都能朝一侧或两侧方向动力偏转。
通过椎柱体302受到纵向限定的中央通道320(图16)中容纳一对支撑板322、324，其避免了叠层锥形发射杆94的冲撞及粘结。在该直观的方式中，每个支撑板322、324具有近侧固定末端326(图15)以及滑动末端328，以适应铰接过程中的径向距离的变化。发射杆94具有减小的厚度并因而被支撑。
尽管通过对多个实施例的描述对本发明进行了解释，而且这些解释性的实施例描述得非常详细，但申请人并不是想将所附的权利要求书的范围限制或以任何方式限定得如此详细。其它优点和变化对本领域技术人员来说是显而易见的。
例如，带有与缝钉匣成一体的楔块滑车带来许多优点，在一些与本发明的这些方面相一致的申请中，楔块滑车也可与E形梁整合在一起。例如，可以更换整个端部执行器，而不是仅仅更换缝钉匣。

Claims (4)

1.一种手术器械，包括：
手柄部件(14)，其可操作地产生发射运动；以及
执行部分(12)，其响应于来自手柄部件的发射运动，执行部分包括：
细长槽(18)，其与手柄部件相连并具有一通道狭槽，
缝钉匣(20)，其容纳于该细长槽中，并具有被对准的近侧定位的楔形部件以使支撑缝钉的驱动器向上凸出，
砧板(22)，其枢转连接在细长槽上并具有一砧板槽，
发射装置，其包括：位于远端的纵向容纳在细长槽和砧板之间的切割边缘(116)，能与砧板槽接合以确保将砧板与细长槽间隔开的上部部件(110)、以其上表面与通道狭槽接合从而使发射装置能够沿着通道狭槽行进的下部部件(114)以及一通过使缝钉匣的楔形部件向远侧平移以可操作地致动缝钉匣的中间部件(120)，在纵向的发射行程期间，发射装置与细长槽和砧板确实地接合，以在其间形成缝钉的间隔，
铰接接头(32)，其与细长槽邻近连接，以及
变细的发射条，其与发射装置近侧连接，用于通过铰接接头传送来自手柄部件的发射运动。
2.根据权利要求1所述的手术器械，其特征在于，砧板与在相应的远端处被向内偏压的细长槽形成枢转连接，以在缝钉匣致动过程中有助于发射装置将砧板和细长槽确实地间隔开。
3.根据权利要求1所述的手术器械，其特征在于，缝钉匣是多种缝钉匣类型中的一种选定类型，每个缝钉匣类型的特征在于具有这样一个厚度，即，该厚度是根据在砧板盒细长槽之间的所需间隔而选择的，并且缝钉的特征在于具有适于所需间隔的长度。
4.根据权利要求3所述的手术器械，其特征在于，楔形部件包括一楔块滑车，其具有多个连接的凸出楔块，每个楔块具有为选定类型的缝钉匣设定的预选高度，发射装置的中间部件被定向为抵接多种缝钉匣类型的每一种。
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