CN1853579B - 外科夹子施加器 - Google Patents

外科夹子施加器 Download PDF

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CN1853579B
CN1853579B CN200610075216XA CN200610075216A CN1853579B CN 1853579 B CN1853579 B CN 1853579B CN 200610075216X A CN200610075216X A CN 200610075216XA CN 200610075216 A CN200610075216 A CN 200610075216A CN 1853579 B CN1853579 B CN 1853579B
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clip
jaw
assembly
shell
clip applier
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CN1853579A (zh
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D·维塔利
N·G·莫利托尔
T·W·惠特马
R·L·小科克
B·D·伯特克
K·A·拉森
R·P·福赫斯
M·A·戴维逊
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Iscon Medical
Ethicon Endo Surgery Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128Surgical 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
    • A61B17/1285Surgical 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/128Surgical 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/10Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/122Clamps or clips, e.g. for the umbilical cord
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, 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
    • A61B90/03Automatic limiting or abutting means, e.g. for safety
    • A61B2090/032Automatic limiting or abutting means, e.g. for safety pressure limiting, e.g. hydrostatic
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, 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
    • A61B90/03Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/034Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself

Abstract

本发明提供了用于在进行外科手术期间将外科夹子施加到脉管、管路、分路等的外科夹子施加器和方法。在一个示范性实施例中,所提供的外科夹子施加器具有带有扳机的壳和伸长轴,扳机可移动地连结到壳而伸长轴从壳延伸出来,相对的钳口形成在伸长轴的远端。扳机适合于使夹子前进,以将夹子定位在钳口之间,并且使钳口从打开位置移动到闭合位置,以挤压定位在钳口之间的夹子。

Description

外科夹子施加器
技术领域
本发明概括地涉及外科装置,并且更具体地涉及用于将外科夹子施加到管路、脉管、分路等的方法和装置。
背景技术
近年来,由于采用了像胆囊切除术、胃造口术、阑尾切除术和疝气修复术那样的腹腔镜外科手术和内窥镜外科手术,外科学已经取得了令人瞩目的进展。这些手术通过作为用于刺破体腔的外科器械的套管针组件实现。典型地,套管针包含尖锐的闭塞件尖端和套管针管或套管。通过使用闭塞件尖端以刺透皮肤,套管针套管插入到皮肤内,以进入体腔。在刺透之后,闭塞件移除而套管针套管留在体内。外科器械经过该套管放置。
一种通常与套管针套管一起使用的外科器械是用于在手术期间结扎血管、管路、分路或一部分身体组织的外科夹子施加器。典型地,大多数夹子施加器具有带有伸长轴的把手,伸长轴具有一对形成在其一端的可移动的相对的钳口,用于在其之间保持并且形成结扎夹子。钳口定位成围绕脉管或管路,并且通过使钳口闭合,夹子挤压在脉管上或形成在脉管上。
在许多现有技术的夹子施加器中,进给机构和形成机构需要构件的精确的定时和协调移动以进行操作。对精确定时和精确控制的需要导致对复杂机械设计的需要,由此增加了夹子施加器的成本。许多现有技术夹子施加器也使用弹簧加载的夹子前进组件,以使一个或多个夹子前进经过装置的轴。因此,钳口必须包含用于在夹子形成之前防止夹子意外地从装置突出出来的机构。当前夹子施加器的其他缺点包括不能在多种情况下对通过扳机施加到钳口的过载进行操纵。许多装置需要钳口完全闭合,当定位在钳口之间的脉管或管路由于过大而不能完全闭合的时候,或当异物定位在钳口之间的时候,这可能在钳口上导致过载。
因此,需要对用于将外科夹子施加到脉管、管路、分路等的改进的方法和装置。
发明内容
本发明提供了用于将外科夹子施加到脉管、管路、分路等的方法和装置。在一个示范性实施例中,所提供的外科夹子施加器具有带有扳机的壳和伸长轴,扳机可移动地连结到壳而伸长轴从壳延伸出来,相对的钳口形成在伸长轴的远端。扳机适合于使夹子前进,以将夹子定位在钳口之间,并且使钳口从打开位置移动到闭合位置,以挤压定位在钳口之间的夹子。
外科夹子施加器可以具有多种构形,并且它可以包括多种特征,以有助于外科夹子的前进和形成。在一个实施例中,外科夹子施加器可以包括可滑动地布置在伸长轴内并且适合于驱动至少一个外科夹子经过伸长轴的进给器底托(shoe)。在示范性实施例中,进给器底托可以只适合于在远端方向上移动,从而大致上防止了进给器底托的近端移动。伸长轴也可以包括布置在其内并且适合于安置至少一个外科夹子的夹子轨道。进给器底托可滑动地布置在夹子轨道内。
多种技术可以使用,以有助于进给器底托的远端移动和防止近端移动。在一个示范性实施例中,进给器底托可以包括适合于接合夹子轨道的柄脚,以防止进给器底托在夹子轨道内进行近端移动而允许进给器底托在夹子轨道内进行远端移动。夹子轨道可以包括几个形成在其上的开口,用于容纳柄脚,以防止进给器底托在夹子轨道内进行近端移动。在另一个示范性实施例中,进给器底托可以包括柄脚,而进给棒可以包括几个形成在其内并且适合于接合柄脚的制动件,以当进给棒在远端方向上移动的时候,在远端方向上移动进给器底托。
在另一个实施例中,伸长轴可以包括可滑动地布置在其内并且连结到扳机的进给棒,从而使扳机朝向闭合位置的移动适合于使进给棒在远端方向上前进,由此使进给器底托在远端方向上前进。作为非限制性例子,通过与扳机配合的扳机插入件,并且通过在扳机插入件和进给棒近端之间延伸的联接件,进给棒可以连结到扳机。进给棒的近端可以包括适合于容纳联接件的部分的连结件。进给棒也可以包括具有前进器的远端,前进器适合于接合最远端的夹子,并且适合于将最远端的夹子驱动到钳口内。在某些示范性实施例中,进给棒可以适合于在使进给器底托开始前进之前,接合并且使最远端的夹子开始前进到钳口内。
在另一个实施例中,提供了用于使夹子前进经过外科夹子施加器的夹子前进组件。夹子前进组件可以与多种外科夹子施加器一起使用,包括那些在本领域中所已知的外科夹子施加器。在一个示范性实施例中,夹子前进组件可以包括适合于安置至少一个夹子的夹子轨道和适合于可滑动地与夹子轨道配合并且适合于在远端方向上移动以使至少一个布置在夹子轨道内的夹子在远端方向上移动的进给器底托。在一个示范性实施例中,进给器底托可以包括适合于接合夹子轨道以防止进给器底托在夹子轨道内进行近端移动并且适合于允许进给器底托在夹子轨道内进行远端移动的柄脚。夹子轨道可以包括多个形成在其内的开口,用于容纳柄脚,以防止进给器底托在夹子轨道内进行近端移动。
夹子前进组件也可以包括适合于连结到形成在外科夹子施加器的壳上的可移动的扳机并且适合于当扳机闭合的时候可滑动地在远端方向上进行移动以使进给器底托和至少一个布置在夹子轨道内的夹子前进的进给棒。进给棒可以具有多种构形,并且在一个示范性实施例中,进给棒的远端可以包括适合于接合最远端的夹子的前进器,以将最远端的夹子从夹子轨道驱动到形成在外科夹子施加器的远端的钳口内。在另一个示范性实施例中,进给器底托可以包括柄脚,而进给棒可以包括多个形成在其内的适合于接合柄脚的制动件,以当进给棒在远端方向上移动的时候,在远端方向上移动进给器底托。在使用时,进给棒的近端可以包括适合于容纳用于将进给棒连结到外科夹子施加器的扳机的联接件的连结件。
也提供了用于使外科夹子前进经过外科夹子施加器的伸长轴的示范性方法。在一个实施例中,进给棒可以在外科夹子施加器的伸长轴内在远端方向上前进,以在远端方向上驱动布置在伸长轴内的进给器底托,由此在远端方向上使至少一个夹子前进。例如通过驱使连结到壳的与伸长轴的近端配合的扳机,进给棒可以在远端方向上前进。在一个示范性实施例中,当进给棒在远端方向上前进的时候,在进给棒的远端的前进器可以接合最远端的夹子,并且使夹子在形成在伸长轴的远端的相对的钳口之间前进。该方法也可以包括在近端方向上收回在伸长轴内的进给棒,同时使进给器底托维持在大致上固定的位置。
在另一个示范性实施例中,所提供的用于施加外科夹子的方法包 括使连结到壳的扳机朝向闭合位置移动第一距离,以驱使布置在壳内的夹子前进组件,由此使夹子前进到形成在伸长轴的远端的钳口组件内,并且进一步使扳机朝向闭合位置移动第二距离,以驱使布置在壳内的夹子形成组件,由此形成布置在钳口组件内的夹子。在驱使夹子形成组件期间,扳机优选地是可相对于夹子前进组件弯曲的。在驱使夹子形成组件期间,夹子形成组件也能够是可相对于钳口组件弯曲的。
在其它方面,所提供的过载机构用于与外科装置一起使用。在一个示范性实施例中,过载机构可以包括枢转地并且可滑动地布置在壳内并且具有带有第一端和相对的第二端的表面的力接收部件和布置在壳内并且适合于阻止力接收部件移动的偏置组件。在示范性实施例中,从第一端到第二端,阻力是增加的。
力接收部件可以具有多种构形,但在一个实施例中,形成在其上的力接收表面定位在位于壳内的开口内。力接收表面可以包括适合于接收用于使在壳内的力接收部件进行枢转移动的力的第一部分和适合于接收用于使在壳内的力接收部件进行可滑动移动的力的第二部分。偏置组件也可以具有多种构形,但在一个示范性实施例中,偏置组件可以包括围绕弹簧柱布置的弹簧和相对于弹簧柱可滑动地布置的柱塞,柱塞具有形成在其上的头并且适合于当柱塞朝向弹簧柱移动时对弹簧进行压缩。
在另一个实施例中,壳可以包括连结在力接收部件和偏置组件之间的枢转组件,从而使枢转组件适合于将施加到力接收部件的力传递到偏置组件,以克服阻力。在一个示范性实施例中,枢转组件可以包括枢转地连结到力接收部件的肘接联接件和枢转地连结到肘接联接件并且适合于当其进行枢转移动时将力施加到偏置组件的枢转联接件。
在另一个实施例中,所提供的外科夹子施加器具有用于防止施加到夹子施加器的钳口的闭合力过载的过载机构。在一个示范性实施例中,外科夹子施加器可以包括具有扳机的壳、伸长轴和布置在壳和伸长轴内并且连结到扳机的凸轮系统组件,扳机可移动地连结到壳而伸长轴从壳延伸出来,相对的钳口形成在伸长轴的远端并且可以在打开位置和闭合位置之间移动。当驱使扳机时,凸轮系统组件可以适合于将闭合力施加到钳口,以使钳口从打开位置朝向闭合位置移动。当闭 合力大于过载机构施加到凸轮系统组件的阻力的时候,凸轮系统组件也可以适合于将闭合力传递到布置在壳内的过载机构。在示范性实施例中,过载机构的阻力与使钳口从打开位置朝向闭合位置移动所需要的力相关联。
尽管多种技术可以使用以将凸轮系统组件连结到过载机构,但在一个示范性实施例中,凸轮系统组件相对于过载机构的力接收表面进行移动,从而当扳机受到驱使以使得凸轮系统组件从打开位置朝向闭合位置移动钳口的时候,使凸轮系统组件的闭合力经过过载机构的力接收表面施加。过载机构的力接收表面可以适合于阻止在近端方向上的移动,并且当扳机受到驱使以使得凸轮系统组件相对于力接收表面进行移动并且使钳口从打开位置朝向闭合位置移动的时候,阻力可以增加。
在另一个示范性实施例中,过载机构可以包括具有异形(profile)联接件的壳,异形联接件可滑动地并且枢转地布置在壳内,并且具有形成其上的力接收表面并且定位成邻近形成在壳内的开口。力接收表面可以包括适合于接收用于使在壳内的力接收部件进行枢转移动的力的第一部分和适合于接收用于使在壳内的力接收部件进行可滑动移动的力的第二部分。过载机构也可以包括适合于将阻力施加到异形联接件的偏置组件。在一个示范性实施例中,通过适合于当异形联接件进行枢转移动时进行枢转并且适合于当异形联接件进行可滑动移动时进行滑动的枢转组件,偏置组件可以连结到异形联接件,以将力施加到偏置组件,以克服阻力。
也提供了用于施加具有过载机构的外科夹子施加器的方法。在一个示范性实施例中,闭合力可以施加到一对形成在外科夹子施加器上的相对的钳口。闭合力可以有效地使相对的钳口从打开位置移动到闭合位置。当闭合力大于过载机构的阀值力的时候,闭合力传递到布置在外科夹子施加器内的过载机构。在示范性实施例中,当钳口从打开位置朝向闭合位置移动的时候,过载机构的阀值力是增加的。
尽管过载机构可以具有多种构形,但在一个实施例中,过载机构可以包括适合于接收闭合力的力接收元件和适合于阻止力接收元件由于闭合力而进行移动的偏置组件。外科夹子施加器可以包括凸轮系统组件,凸轮系统组件适合于将闭合力施加到钳口,并且包括当闭合力 施加到钳口的时候滚动经过力接收元件的滚子部件。当滚子部件滚动经过力接收元件的时候,过载机构的阀值力可以增加。特别地,当滚子部件滚动经过力接收元件的第一部分的时候,如果闭合力大于阀值力,那么力接收元件就可以进行枢转,而当滚子部件滚动经过力接收元件的第二部分的时候,如果闭合力大于阀值力,那么力接收元件就可以进行滑动。在示范性实施例中,使力接收元件进行枢转所需要的阀值力小于使力接收元件进行滑动所需要的阀值力。
在其它方面,提供外科夹子施加器,且其可以包括连结到扳机并且适合于使至少一个外科夹子前进经过从壳延伸出来的伸长轴的夹子前进组件和连结到扳机并且适合于驱使形成在伸长轴的远端的钳口组件以形成外科夹子的夹子形成组件。扳机可以连结到壳,并且适合于驱使夹子前进组件和夹子形成组件。在示范性实施例中,扳机具有两个连续的驱使阶段。扳机可以在第一驱使阶段期间,有效地驱使夹子前进组件,并且扳机可以在第二驱使阶段期间,有效地驱使夹子形成组件,同时,扳机是可相对于夹子前进组件弯曲的。
附图说明
通过接下来就附图所进行的详细描述,将要更完全地理解本发明,附图如下:
图1A是外科夹子施加器的一个示范性实施例的侧视图;
图1B是图1A所示的外科夹子施加器的分解图;
图2A是图1A所示的外科夹子施加器的钳口保持器组件的顶视图;
图2B是图2A所示的钳口保持器组件的底视图;
图2C是图2B所示的钳口保持器组件的侧视图;
图2D是图2C所示的钳口保持器组件经过线D-D所做的截面图;
图3A是用于与图2A-2D所示的钳口保持器组件一起使用的进给器底托的顶视图;
图3B是图3A所示的进给器底托的底视图;
图4A是成形为使图3A和3B的进给器底托前进经过图2A-2D所示的钳口保持器组件的进给棒的侧面透视图;
图4B是图4A所示的进给棒的近端和图2A和2B所示的钳口保持器轴的近端的侧视图,显示了处在最近端位置的进给棒;
图4C是图4B所示的进给棒和钳口保持器轴的侧视图,显示了处在最远端位置的进给棒;
图4D是显示成与图2A和2B所示的钳口保持器轴的近端连接在一起的进给棒的近端的另一个实施例的侧视图,显示了处在最近端位置的进给棒;
图4E是图4D所示的进给棒和钳口保持器轴的侧视图,显示了处在最远端位置的进给棒;
图4F是显示成与图2A和2B所示的钳口保持器轴的近端连接在一起的进给棒的近端的又一个实施例的侧视图,显示了处在最近端位置的进给棒;
图4G是图4F所示的进给棒和钳口保持器轴的侧视图,显示了处在中间位置的进给棒;
图4H是图4F所示的进给棒和钳口保持器轴的侧视图,显示了处在最远端位置的进给棒;
图5A是成形为连结到图4A所示的进给棒的远端的前进器的侧面透视图;
图5B是成形为连结到图4A所示的进给棒的远端的前进器的另一个实施例的侧面透视图;
图6A是包括图2A-2D所示的钳口保持器组件、图3A-3B所示的进给器底托和图4A所示的进给棒的夹子前进组件的截面图,显示了相对于钳口保持器组件的夹子轨道处在初始近端位置的进给棒;
图6B是图6A所示的夹子前进组件的截面图,显示了在远端方向上移动的进给棒;
图6C是图6B所示的夹子前进组件的截面图,显示了进一步在远端方向上移动进给棒由此在远端方向上移动进给器底托和布置在进给器底托远端的夹子供给器;
图6D是图6C所示的夹子前进组件的截面图,显示了返回到图6A所示的初始近端位置的进给棒,而进给器底托和夹子供给器留在图6C所示的前进位置;
图6E是图5A所示的布置在图2A-2D所示的钳口保持器组件的夹子轨道内的前进器的底面透视图,显示了处在最近端位置的前进器;
图6F是图6E所示的前进器的底面透视图,显示了在使夹子前进 到外科夹子施加器的钳口内之后处在最远端位置的前进器;
图7是图1A所示的外科夹子施加器的一对钳口的侧面透视图;
图8是用于与图7所示的钳口一起使用的凸轮的侧面透视图;
图9是适合于连结到图8所示的凸轮以使凸轮相对于图7所示的钳口进行移动的推杆的顶面透视图;
图10A是图8所示的连结到图7所示的钳口的凸轮的顶视图,显示了处在初始位置并且处在钳口开口内的凸轮;
图10B是图8所示的连结到图7所示的钳口的凸轮的顶视图,显示了在钳口之上前进的凸轮和处在闭合位置的钳口;
图11是适合于连结到图2A-2D所示的钳口保持器组件的夹子轨道的远端的组织停止件的顶面透视图;
图12是图1A所示的外科夹子施加器的远端的顶视图,显示了图11所示的定位在图7所示的钳口之间的组织停止件;
图13是图1A所示的外科夹子施加器的把手部分的侧面局部截面图;
图14是图1A所示的外科夹子施加器的扳机插入件的侧面透视图;
图15A是图1A所示的外科夹子施加器的进给棒连结件的一半的侧面透视图;
图15B是图15A所示的进给棒连结件的另一半的侧面透视图;
图16是形成图1A所示的外科夹子施加器的夹子前进组件的部分的柔性联接件的顶面透视图;
图17A是图1A所示的外科夹子施加器的把手的部分的侧面局部截面图,显示了处在初始位置的夹子前进组件;
图17B是图17A所示的外科夹子施加器的把手的部分的侧面局部截面图,显示了受到部分驱使的夹子前进组件;
图17C是图17B所示的外科夹子施加器的把手的部分的侧面局部截面图,显示了受到完全驱使的夹子前进组件;
图17D是图17A所示的外科夹子施加器的把手的部分的侧面局部截面图,显示了受到驱使的夹子形成组件;
图18是形成图1A所示的外科夹子施加器的夹子形成组件的部分的闭合联接件滚子的侧视图;
图19是连结到图18所示的闭合联接件滚子以形成图1A所示的外科夹子施加器的夹子形成组件的部分的闭合联接件的顶面透视图;
图20A是连结到图19所示的闭合联接件并且也形成图1A所示的外科夹子施加器的夹子形成组件的部分的闭合联接件连结件的顶面透视图;
图20B是图20A所示的连结到图9的推杆并且具有布置在其内的偏置元件的一个实施例的闭合联接件的底视图;
图20C是图20A所示的连结到图9的推杆并且具有布置在其内的偏置元件的另一个实施例的闭合联接件的底视图;
图21A是图1A所示的外科夹子施加器的抗倒退机构的放大侧面透视图;
图21B是图21A所示的抗倒退机构的棘爪机构的透视图;
图22A是图1A所示的外科夹子施加器的把手的部分的侧面局部截面图,显示了处在初始位置的抗倒退机构;
图22B是图22A所示的外科夹子施加器的把手的部分的侧面局部截面图,显示了处在受到部分驱使的位置的抗倒退机构;
图22C是图22B所示的外科夹子施加器的把手的部分的侧面局部截面图,显示了处在受到完全驱使的位置的抗倒退机构;
图22D是图22C所示的外科夹子施加器的把手的部分的侧面局部截面图,显示了正在返回到初始位置的抗倒退机构;
图22E是图22D所示的外科夹子施加器的把手的部分的侧面局部截面图,显示了已经返回到初始位置的抗倒退机构;
图23A是图1A所示的外科夹子施加器的过载机构的分解图;
图23B是图23A所示的过载机构的局部截面图,显示了首先与异形联接件相接触的闭合联接件滚子;
图23C是图23B所示的过载机构的局部截面图,显示了将力施加到异形联接件使得异形联接件进行枢转的闭合联接件滚子;
图23D是用于与外科夹子施加器一起使用的过载机构的另一个实施例的透视图;
图24A是图1A所示的外科夹子施加器的夹子数量指示器轮的侧面透视图;
图24B是图24A所示的夹子数量指示器轮的侧视图;
图25是用于与图24所示的夹子数量指示器轮一起使用的夹子数量驱使器的顶面透视图;
图26A是图1A所示的外科夹子施加器的把手的部分的侧面局部截面图,显示了图25的夹子数量驱使器和图24的夹子数量指示器轮的移动;和
图26B是图26A所示的外科夹子施加器的把手的部分的侧面局部截面图,显示了图25的夹子数量驱使器和图24的夹子数量指示器轮的进一步移动。
具体实施方式
本发明大体上提供了外科夹子施加器和用于在外科手术期间使用外科夹子施加器以将外科夹子施加到脉管、管路、分路等的方法。像在这里所描述的那样并且像在附图中所图示的那样,示范性的外科夹子施加器可以包括多种有助于施加外科夹子的特征。然而,本领域的技术人员应该意识到的是,外科夹子施加器可以只包括这些特征中的一些,和/或它可以包括多种在本领域中所已知的其它特征。在这里所描述的外科夹子施加器只是旨在表现某些示范性实施例。
图1A图示了一个示范性的外科夹子施加器10。像所显示的那样,夹子施加器10大体上包括具有固定的把手14和可移动的把手或扳机16的壳12,可移动的把手或扳机16枢转地连结到壳12。伸长轴18从壳12延伸出来,且其包括一对形成在其远端的用于挤压外科夹子的相对的钳口20。伸长轴18可以可转动地连结到壳12,并且它可以包括用于相对于壳12转动伸长轴18的转动旋钮22。图1B图示了图1A所示的外科夹子施加器10的分解图,并且在下面将要对多种构件进行更详细的描述。
图2A-12图示了外科夹子施加器10的轴18的多种构件的示范性实施例。参考图1B,轴18大体上包括容纳轴构件的外部管24,轴构件可以包括具有钳口保持器轴28的钳口保持组件26,钳口保持器轴28带有形成在其上的夹子轨道30和推杆通道32。钳口20可以成形为与夹子轨道30的远端配合。轴组件18也可以包括夹子前进组件,在一个示范性实施例中,夹子前进组件可以包括适合于可滑动地布置在夹子轨道30内以使定位在其内的一系列夹子36前进的进给器底托34和适合于驱动进给器底托34经过夹子轨道30的进给棒38。进给棒38可 以包括适合于与其远端配合以使最远端的夹子前进到钳口20内的前进器组件40。轴组件18也可以包括夹子形成组件或凸轮系统组件,在一个示范性实施例中,夹子形成组件或凸轮系统组件可以包括适合于可滑动地与钳口20配合的凸轮42和可以连结到凸轮42以使凸轮42相对于钳口20进行移动的推杆44。轴组件也可以包括可以与夹子轨道30的远端配合以有助于相对于外科位点定位钳口20的组织停止件46。
在图2A-5中,更详细地显示了一个示范性夹子前进组件的多种构件。首先参考图2A-2D,显示钳口保持组件26,且其包括伸长的、大致上平的钳口保持器轴28,钳口保持器轴28具有与外部管24匹配的近端28a和适合于与钳口20匹配的远端28b。尽管多种技术可以使用以使钳口保持器轴28的近端28a与外部管24匹配,但在所图示的实施例中,近端28a包括形成在其相对侧的齿31和形成在其内的切除部分29,齿31适合于容纳在形成在外部管24内的相应的孔或开口(未显示)内,切除部分29允许近端28a的相对侧偏斜或形成弹簧。特别地,当钳口保持器轴28插入到外部管24内的时候,切除部分29允许钳口保持器轴28的近端28a的相对侧朝向彼此压缩。一旦齿31与在外部管24内的相应的开口对准,钳口保持器轴28的近端28a就恢复成其初始的、没有压缩的构形,由此使得齿31延伸到相应的开口内,以接合外部管24。像在下面就图4A更详细讨论的那样,装置也可以包括在使用装置期间防止钳口保持器轴28的近端28a的相对侧压缩的特征部,以防止齿31与外部管24发生意外脱离。
多种技术也可以使用以使钳口保持器轴28的远端28b与钳口20匹配,然而,在所图示的实施例中,钳口保持器轴28的远端28b包括几个形成在其内的切除部分或齿78,以与形成在钳口20上的相应的突出部分或齿94匹配,在下面就图7对此进行了更详细的讨论。齿78允许钳口20的近端部分大致上与钳口保持器轴28共平面。
钳口保持组件26也可以包括形成在其上的推杆通道32,以可滑动地容纳推杆44,推杆44用于使凸轮42在钳口20之上前进,像在下面更详细讨论的那样。使用多种技术,推杆通道32可以形成,并且基于推杆44的形状和尺寸,推杆通道32可以具有任何形状和尺寸。如图2D所示,例如通过焊接,推杆通道32固定地接附到保持器轴28的上部表面,并且推杆通道32具有大致上为矩形的形状,并且限定了延伸 经过其的路径32a。推杆通道32也可以沿着保持器轴28的全部延伸,或只沿着保持器轴28的部分延伸。本领域的技术人员应该意识到的是,钳口保持组件26不必为了有助于推杆44在外科夹子施加器10的伸长轴18内进行移动而包括推杆通道32。
还如图2A-2D所示,钳口保持组件26也可以包括与其匹配或形成在其上的夹子轨道30。所显示的夹子轨道30与钳口保持器轴28的下部表面匹配,并且夹子轨道30在远端方向上延伸超过钳口保持器轴28的远端28b,以允许夹子轨道30的远端30b大致上与钳口20对准。在使用时,夹子轨道30成形为在其内安置至少一个夹子,并且优选地安置一系列夹子。因此,夹子轨道30可以包括适合于在其内安置一个或多个夹子的相对腿的相对侧轨80a、80b,从而使夹子的腿在轴向方向上彼此对准。在示范性实施例中,夹子轨道30可以成形为安置大约20个在制造期间预先布置在夹子轨道30内的夹子。本领域的技术人员应该意识到的是,基于适合于容纳在夹子轨道30内的夹子或其它像钉那样的闭合装置的形状、尺寸和构形,夹子轨道30的形状、尺寸和构形可以发生改变。而且,除了夹子轨道30,多种其它技术可以使用,以使夹子供给器与伸长轴18保持在一起。
像在下面更详细讨论的那样,夹子轨道30也可以包括几个形成在其内的开口30c,以容纳形成在进给器底托34上的适合于布置在夹子轨道30内的柄脚82a。在示范性实施例中,夹子轨道30包括一定量的开口30c,开口30c的数目至少相应于适合于预先布置在装置10内并且在使用期间施加的夹子的数目。开口30c优选地是彼此等距离的,以当进给器底托34每次前进的时候,都能确保在进给器底托34上的柄脚82a接合开口30c。尽管没有显示,但除了开口30c,夹子轨道30还可以包括制动件,或夹子轨道30可以包括其它允许夹子轨道30接合进给器底托34并且防止进给器底托34进行远端移动而允许进给器底托34进行近端移动的特征部。如图2B所示,夹子轨道30也可以包括形成在其上的停止柄脚118,像在下面更详细讨论的那样,停止柄脚118有效地与形成在进给器底托34上的相应的停止柄脚接合,以防止进给器底托34移动超过最远端位置。停止柄脚118可以具有多种构形,但在一个示范性实施例中,停止柄脚118的形式是两个邻近的片,两个片朝向彼此延伸,以包围夹子轨道的部分,这样就允许夹子通过 夹子轨道。
93在图3A和3B中更详细显示示范性的进给器底托34,且其可以适合于直接驱动夹子经过夹子轨道30。尽管进给器底托34可以具有多种构形,并且多种其他技术可以使用,以驱动夹子经过夹子轨道30,但在示范性实施例中,进给器底托34具有带有近端34a和远端34b的大体上伸长的形状。远端34b可以适合于支撑在夹子轨道30内的最近端的夹子,以推动夹子(或多个夹子)经过夹子轨道30。在所图示的示范性实施例中,远端34b大致上是V形的,以安置夹子的V形弯曲部分。远端34b也包括形成在其内的矩形凹口34c,以允许前进器40接合最远端的夹子,并且使它前进到钳口20内,像在下面更详细讨论的那样。当然,基于与装置10一起使用的夹子或其它闭合机构的构形,远端34b可以发生改变。
在另一个示范性实施例中,进给器底托34也可以包括有助于进给器底托34在夹子轨道30内进行远端移动并且大致上防止进给器底托34在夹子轨道30内进行近端移动的特征部。像在下面更详细讨论的那样,这种构形可以确保在夹子轨道30内使夹子前进并且适当地定位夹子,这样,当每次驱使扳机16的时候,都允许最远端的夹子在钳口20之间前进。在所图示的示范性实施例中,进给器底托34包括形成在其上部表面34s上的柄脚82a,柄脚82a在近端方向上成某个角度,以接合形成在夹子轨道30内的开口30c中的一个。在使用时,柄脚82a的角度允许进给器底托34在夹子轨道30内在远端方向上进行滑动。当进给器底托34每次前进的时候,柄脚82a都在远端方向上从在夹子轨道30内的一个开口30c移动到下一个开口30c。像在下面更详细讨论的那样,柄脚82a与在夹子轨道30内的开口30c的接合可以防止进给器底托34在近端方向上移动以返回到先前位置。
如图3B所致,为了有助于进给器底托34在夹子轨道30内进行近端移动,进给器底托34也可以包括形成在其下部表面34i上的柄脚82b,以当进给棒38在远端方向上进行移动的时候,允许进给器底托34与进给棒38(图4A)接合。下部柄脚82b类似于上部柄脚82a,即它也可以在近端方向上成某个角度。在使用时,当进给棒38在远端方向上每次移动的时候,形成在进给棒38内的制动件84都可以接合下部柄脚82b,并且使进给器底托34在夹子轨道30内在远端方向上移动 某个预定距离。然后,进给棒38可以在近端方向上移动以返回到它的初始位置,并且下部柄脚82b的角度允许柄脚82b滑动到形成在进给棒38内的下一个制动件84内。像先前所注意到的那样,除了柄脚82a、82b和开口30c或制动件84,多种其它特征部也可以使用,以控制进给器底托34在夹子轨道30内的移动。
像先前所提及到的那样,进给器底托34也可以包括形成在其上的停止件,当进给器底托34处在最远端位置并且在装置10内没有剩下夹子的时候,停止件适合于使进给器底托34的移动停止。尽管停止件可以具有多种构形,但图3A和3B图示了形成在进给器底托34上的第三柄脚82c,第三柄脚82c向下延伸,以接合形成在夹子轨道30上的停止柄脚118(图2B)。第三柄脚82c定位为使得当进给器底托34处在最远端位置的时候,第三柄脚82c接合在夹子轨道30上的停止柄脚118,由此当夹子供给器用尽的时候,防止进给器底托34和进给棒38的移动。
图4A图示了示范性的用于驱动进给器底托34经过钳口保持组件26的夹子轨道30的进给棒38。像所显示的那样,进给棒38具有带有近端38a和远端38b的大体上伸长的形状。进给棒38的近端38a可以适合于与进给棒连结件50(图1B)匹配,在下面对此进行了更详细的讨论。进给棒连结件50可以与进给联接件52匹配,当驱使扳机16时,进给联接件52有效地使进给棒38在伸长轴18内在远端方向上进行可滑动的移动。进给棒38b的远端38b可以适合于与前进器40、40’匹配,在图5A和5B中显示了前进器40、40’的示范性实施例,前进器40、40’有效地将布置在夹子轨道30内的最远端的夹子驱动到钳口20内,在下面对此进行了更详细的讨论。
像先前所提及到的那样,进给棒38的近端38a可以包括在使用装置期间防止钳口保持器轴28(图2A和2B)的近端28a的相对侧压缩的特征部,以防止齿31与外部管24发生意外脱离。在图4A-4C所显示的一个示范性实施例中,进给棒38的近端38a可以包括形成在其上的突出部分39,突出部分39适合于延伸到形成在钳口保持器轴28的近端28a中的开口29内。如图4B所示,当进给棒38处在最近端位置的时候(即当扳机16处在打开位置的时候),突出部分39定位在开口29的近端,允许钳口保持器轴28的近端28a压缩,以允许轴28滑 动到外部管24内。如图4C所示,当进给棒38处在最远端位置的时候(即当扳机16处在至少部分闭合的位置的时候),突出部分39定位在邻近齿31的中间部位,以防止钳口保持器轴28的近端28a压缩。在使用装置期间,这是特别有利的,因为在使用装置期间突出部分39防止了钳口保持器轴28与外部管24发生意外脱离。尽管图4A-4C所图示的突出部分39具有带有倒圆边缘的矩形截面形状,但突出部分39可以具有多种其它形状和尺寸。例如,如图4D和4E所示,突出部分39’具有稍微成三角形的带有适合于在齿31之间延伸的渐尖端部的截面形状,以在使用装置期间,进一步确保钳口保持器轴28的近端28a不会压缩。也可以使用多于一个的突出部分。例如,在图4F-4H所图示的另一个实施例中,进给棒38的近端38a’包括两个形成在其上并且彼此间隔了某个距离的突出部分39a、39b。如图4F所示,当进给棒38处在最近端位置的时候,并且如图4H所示,当进给棒38处在最远端位置的时候,两个突出部分39a、39b防止钳口保持器轴28的近端28a压缩。如图4G所示,只当进给棒38处在中间位置的时候,钳口保持器轴28的近端28a的压缩可以出现,从而使齿31定位在突出部分39a、39b之间。
像先前也提及到的那样,进给棒38可以包括一个或多个形成在其内的制动件84,以接合形成在进给器底托34上的下部柄脚82b。制动件84的数量可以发生改变,但在示范性实施例中,进给棒38所具有的制动件84的数量相应于或大于适合于由装置10发送的夹子的数量,并且更优选地,与适合于由装置10发送的夹子的数量相比,进给棒38具有多出一个的制动件84。就非限制性例子而言,进给棒38可以包括18个形成在其内的制动件84,以发送17个预先布置在夹子轨道30内的夹子。这种构形允许进给棒38使进给器底托34前进17次,由此使17个夹子前进到钳口20内用于施加。制动件84优选地也是彼此等距离的,以当进给棒38每次前进的时候,都能确保进给器底托34与进给棒38接合并且通过进给棒38前进。
进给棒38也可以包括对进给棒38相对于夹子轨道30的移动量进行控制的特征部。当扳机16每次受到驱使的时候,这种构形都可以确保进给器底托34前进某个预定距离,由此只使单一的夹子前进到钳口20内。尽管多种技术可以使用以对进给棒38的远端移动进行控制,但 在示范性实施例中,进给棒38可以包括形成在其上的突出部分86,突出部分86适合于可滑动地容纳在形成在钳口保持器轴28内的相应的槽88(图2B)内。槽88的长度有效地限制了突出部分86在其内的移动,这样就限制了进给棒38的移动。因此,在使用时,进给棒38可以相对于夹子轨道30在固定的近端位置和固定的远端位置之间进行滑动,由此当进给棒38每次前进的时候,都允许进给棒38使进给器底托34前进某个预定距离。
图5A图示了适合于与进给棒38的远端38b匹配并且有效地将最远端的夹子从夹子轨道30驱动到钳口20内的前进器40的一个示范性实施例。多种技术可以使用以使前进器40与进给棒38匹配,但在所图示的实施例中,前进器40的近端40a的形式是适合于容纳形成在进给棒38的远端38b的凸连接器的凹连接器。优选地,前进器40固定地与进给棒38匹配,然而,可选择地,前进器40可以与进给棒38整合形成。优选地,进给棒38的远端40b适合于使夹子前进到钳口20内,这样,前进器40的远端40b就可以包括例如形成在其上的夹子推动器部件90。夹子推动器部件90可以具有多种形状和尺寸,但在一个示范性实施例中,夹子推动器部件90具有带有形成在其远端的凹处92的伸长的形状,以安置夹子的弯曲部分。基于夹子的特别构形,凹处92的形状可以发生改变。夹子推动器部件90也可以相对于前进器40的纵向轴线A以某个角度向上延伸。这种构形允许夹子推动器部件90延伸到夹子轨道30内,以接合夹子,同时,前进器40的剩余部分延伸成大致上平行于夹子轨道30。图5B图示了前进器40’的夹子推动器部件90’的另一个示范性实施例。在这个实施例中,夹子推动器部件90’是更稍微较狭窄的,并且它具有形成在其最远端的小的凹处92’。在使用时,前进器40可以只接合布置在夹子轨道30内的最远端的夹子,并且只使这个夹子前进到钳口20内。像先前所讨论的那样,这是由于可以可滑动地在固定的近端位置和固定的远端位置之间移动的进给棒38的定位。
图6A-6G图示了在使用时的夹子前进组件,并且特别地,图6A-6D图示了进给棒38在夹子轨道30内进行移动以使进给器底托34和夹子供给器36前进,而图6E-6F图示了前进器40进行移动以使最远端的夹子前进到钳口20内。在下面,对在壳12内的用于驱使夹子前进 组件的构件进行了更详细的讨论。
如图6A所示,在静止位置,进给棒38处在最近端位置,从而使突出部分86在近端方向上定位在位于钳口保持器轴28内的伸长槽88内。进给器底托34布置在夹子轨道30内,并且假设装置10还没有使用,那么进给器底托34就处在最近端位置,从而使在进给器底托34上的上部柄脚82a与形成在夹子轨道30内的最近端的开口或第一开口30c1接合,以防止进给器底托34进行近端移动,而在进给器底托34上的下部柄脚82b定位在位于进给棒38内的第一制动件841和第二制动件842之间,从而使下部柄脚82b通过进给棒38向上偏置。在进给棒内的制动件84依次标示为841、842等,而在夹子轨道30内的开口30c依次标示为30c1、30c2等。还如图6A所示,一系列依次标示为361、362、……36x的夹子36定位在位于进给器底托34的远端的夹子轨道30内,而36x是最远端的夹子。
当驱使扳机16时,进给棒38在远端方向上前进,使得突出部分86在槽88内在远端方向上进行滑动。当进给棒38在远端方向上进行移动的时候,在进给器底托34上的下部柄脚82b滑动到在进给棒38内的第一制动件841内。此外,如图6B所示,进给棒38的远端移动使得第一制动件841接合下部柄脚82b,并且使得在远端方向上移动进给器底托34和夹子供给器361、362等。如图6C所示,当突出部分86邻接在钳口保持器轴28内的长槽88的远端的时候,防止进给棒38进一步的远端移动。在这个位置,进给器底托34已经前进了某个预定距离,以使夹子供给器361、362、……36x在夹子轨道30内前进某个预定距离。进给器底托34的上部柄脚82a已经前进到在夹子轨道30内的第二开口30c2内,以防止进给器底托34进行近端移动,而在进给器底托34上的下部柄脚82b仍然与在进给棒38内的第一制动件841接合。
进给棒38从图6A所示的初始的最近端位置移动到图6C所示的最终的最远端位置,这也可以使最远端的夹子36x前进到钳口20内。特别地,如图6E所示,进给棒38的远端移动可以使得接附到进给棒38的远端的前进器40的夹子推动器部件90接合布置在夹子轨道30内的最远端的夹子36x,并且使夹子36x前进到钳口20内,如图6F所示。在示范性实施例中,前进器40可以在接合并且使进给器底托34开始前进之前,接合并且使最远端的夹子36x开始前进。因此,最远端的夹 子36x可以前进的距离大于进给器底托34所行进的距离。这种构形只允许最远端的夹子36x前进到钳口20内,而不会意外地使另外的夹子前进到钳口20内。
一旦夹子36x已经部分地或完全地形成,扳机16就可以释放,以释放已经形成的夹子36x。释放扳机16,这也可以在近端方向上收回进给棒38,直到突出部分86返回到在伸长槽88内的初始的最近端位置,如图6D所示。当进给棒38在近端方向上收回的时候,由于上部柄脚82a接合在夹子轨道30内的第二开口30c2,进给器底托34不会在近端方向上进行移动。下部柄脚82b不会干扰进给棒38的近端移动,并且一旦进给棒38像所显示的那样处在初始的最近端位置,下部柄脚82b就可以定位在位于进给棒38内的第二制动件842和第三制动件843之间。
过程可以重复进行,以使另一个夹子前进到钳口20内。通过每次驱使扳机16,下部柄脚82b可以与下一个制动件接合,即与形成在进给棒38内的制动件842接合,在进给器底托34上的上部柄脚82a可以在远端方向上移动到下一个开口内,即移动到在夹子轨道30上的开口30c3内,并且最远端的夹子可以前进到钳口20内并且释放。在装置10包括预定数量的夹子的情况下,例如在装置10包括17个夹子的情况下,扳机16可以受到17次驱使。一旦最后的夹子已经施加,在进给器底托34上的停止件,例如第三柄脚82c,就可以接合在夹子轨道30上的停止柄脚118,以防止进给器底托34进行进一步的远端移动。
图7-9图示了夹子形成组件的多种示范性构件。首先参考图7,显示了钳口20的示范性实施例。像先前所提及到的那样,钳口20可以包括具有齿94的近端部分20a,齿94用于与形成在钳口保持轴28上的相应的齿78匹配。然而,其它技术可以使用,以使钳口20与钳口保持轴28匹配。例如,燕尾连接、凸凹连接等可以使用。可选择地,钳口20可以与保持轴28整合形成。钳口20的远端部分20b可以适合于在其之间容纳夹子,这样,远端部分20b可以包括相对的第一钳口部件96a和第二钳口部件96b,第一钳口部件96a和第二钳口部件96b可以相对于彼此进行移动。在示范性实施例中,钳口部件96a、96b偏置到打开位置,并且需要力,以使钳口部件96a、96b朝向彼此进行移动。钳口部件96a、96b每个都可以包括形成在其内的在其相对的内部 表面上的凹槽(只显示了一个凹槽97),以容纳与钳口部件96a、96b对准的夹子的腿。钳口部件96a、96b每个也可以包括形成在其内的凸轮轨道98a、98b,以允许凸轮42接合钳口部件96a、96b,并且使钳口部件96a、96b朝向彼此进行移动。在示范性实施例中,凸轮轨道98a、98b形成在钳口部件96a、96b的上部表面上。
图8图示了用于与钳口部件96、96b可滑动地匹配并且接合钳口部件96、96b的示范性的凸轮42。凸轮42可以具有多种构形,但在所图示的实施例中,凸轮42包括近端42a和远端42b,近端42a适合于与推杆44匹配,在下面对此进行了更详细的讨论,远端42b适合于接合钳口部件96a、96b。多种技术可以使用,以使凸轮42与推杆44匹配,但在所图示的示范性实施例中,凸轮42包括形成在其内的凹的或装键的切除部分100,切除部分100适合于容纳形成在推杆44的远端44b的凸的或键部件102。在图示了推杆44的图9中,更详细地显示了凸的部件102。像所显示的那样,凸的部件102的形状相应于切除部分100的形状,以允许两个部件42、44匹配起来。本领域的技术人员应该意识到的是,可选择地,凸轮42和推杆44可以彼此整合形成。推杆44的近端44a可以适合于与闭合联接件组件匹配,以相对于钳口20移动推杆44和凸轮42,在下面对此进行了更详细的讨论。
还如图8所示,凸轮42也可以包括形成在其上的突出部分42c,突出部分42c适合于可滑动地容纳在形成在钳口20内的伸长槽20c内。在使用时,突出部分42c和槽20c可以发挥功能,以形成用于夹子形成组件的近端停止件。
返回来参考图8,凸轮42的远端42b可以适合于接合钳口部件96a、96b。尽管多种技术可以使用,但在所图示的示范性实施例中,远端42b包括形成在其内的凸轮系统通道或渐尖的凹处104,以可滑动地容纳在钳口部件96a、96b上的凸轮轨道98a、98b。在使用时,如图10A和10B所示,凸轮42可以从钳口部件96a、96b彼此间隔某个距离的近端位置前进到钳口部件96a、96b定位成彼此邻近并且处在闭合位置的远端位置。当凸轮42在钳口部件96a、96b上前进的时候,渐尖的凹处104可以朝向彼此推动钳口部件96a、96b,由此挤压布置在其之间的夹子。
像先前所提及到的那样,外科夹子施加器10也可以包括组织停止 件46,以有助于在钳口20内定位处在外科位点的组织。图11所显示的组织停止件46的一个示范性实施例具有近端46a和远端46b。近端46a可以适合于与夹子轨道30的远端匹配,以将组织停止件46定位成邻近钳口20。然而,组织停止件46可以与夹子轨道30整合形成,或组织停止件46可以适合于与轴18的多种其它构件匹配或与轴18的多种其它构件整合形成。组织停止件46的远端46b的形状可以适合于在其之间安置脉管、管路、分路等,以相对于目标位点定位并且对准钳口20。如图11所示,组织停止件46的远端46b大致上是V形的。远端46b也可以具有弧形的构形,以有助于放置装置经过套管针或其它进入管。可选择地,组织停止件46的远端46b也可以包括其它有助于夹子在其上进行移动的特征部。例如,如图11所示,组织停止件46包括形成在远端46b的中间部分的斜面47,以使夹子与前进器组件40的尖端维持对准。特别地,斜面47可以允许夹子的顶点沿着其行进,这样就防止了夹子相对于在远端方向上推动夹子的前进器组件40发生未对准。本领域的技术人员应该意识到的是,组织停止件46可以具有多种其它构形,并且组织停止件46可以包括多种有助于使夹子沿着其前进的特征部。
图12图示了在使用时的组织停止件46。像所显示的那样,组织停止件46恰好定位在钳口20的下部,并且定位在允许脉管、管路、分路等容纳在钳口20之间的部位。还像所显示的那样,外科夹子36定位在钳口20之间,从而使夹子36的弯曲部分36a对准组织停止件46。这可以允许夹子36的腿36b定位成完全围绕脉管、管路、分路等或其它目标位点。
图13-26B图示了壳12的多种示范性的用于控制夹子前进和形成的内部构件。像先前所提及到的那样,外科夹子施加器10可以包括在这里所披露的特征中的一些或全部,并且外科夹子施加器10可以包括多种在本领域中所已知的其它特征。在某些示范性实施例中,夹子施加器10的内部构件可以包括连结到轴18的夹子前进组件用于使至少一个夹子前进经过伸长轴18以将夹子定位在钳口20之间的夹子前进组件和连结到轴18的夹子形成组件用于使钳口20闭合以形成部分闭合或完全闭合的夹子的夹子形成组件。其它示范性的特征部包括用于控制扳机16移动的抗倒退机构、用于防止由夹子形成组件施加到钳口 20的力过载的过载机构和用于指示剩余在装置10内的夹子的数量的夹子数量指示器。
图13-16D图示了壳12的用于实现在轴18内的进给棒38的移动的夹子前进组件的示范性实施例。大体上,夹子前进组件可以包括连结到扳机16的扳机插入件48、可以与进给棒38的近端38a匹配的进给棒连结件50和适合于在扳机插入件48和进给棒连结件50之间延伸以将运动从扳机插入件48传递到进给棒连结件50的进给联接件52。
图14更详细地图示了扳机插入件48。基于壳12的其它构件,扳机插入件48的形状可以发生改变,但在所图示的实施例中,扳机插入件48包括适合于枢转地与壳12匹配的中心部分48a和适合于延伸到扳机16内并且与扳机16匹配的伸长部分48b。中心部分48a可以包括延伸经过其以容纳用于枢转地使扳机插入件48与壳12匹配的轴的钻孔106。中心部分48a也可以包括形成在上侧边缘以容纳进给联接件52的部分的第一凹处108。优选地,第一凹处108的尺寸和形状允许进给联接件52的部分在其内延伸,从而当扳机插入件48由于扳机16的移动而进行枢转的时候,使得促使进给联接件52进行枢转。如图14所示,第一凹处108大致上是伸长的,并且包括形成在其内的大致上为圆形的部分,用于安置形成在进给联接件52的近端的轴,在下面就图16对此进行了更详细的讨论。扳机插入件48也可以包括形成在后侧边缘以容纳闭合联接件滚子54的第二凹处110和形成在其底侧边缘用于与棘爪60匹配以控制扳机16的移动的棘轮齿112,闭合联接件滚子54连结到推杆44,用于移动凸轮42,以使钳口20闭合,在下面对此进行了更详细的讨论。
在图15A和15B中,更详细地显示了示范性的进给棒连结件50,并且示范性的进给棒连结件50可以适合于将进给棒38的近端连结到进给联接件52的远端。尽管多种技术可以使用以使进给棒连结件50与进给棒38的近端38a匹配,但在示范性实施例中,进给棒连结件50由两个分开的半部分50a、50b形成,两个分开的半部分50a、50b匹配在一起,以使进给棒38的近端38a维持在其之间。当匹配的时候,两个半部分50a、50b一起限定了中心轴50c,中心轴50c具有形成在其相对端并且限定了在其之间的凹处50f以安置进给联接件52的远端部分的大致上为圆形的凸缘50d、50e。中心轴50c限定了经过其的腔 50g,以容纳进给棒38的近端38a并且将进给棒38锁定在相对于进给棒连结件50大致上固定的位置。然而,进给棒连结件50可以与进给棒38整合形成,并且进给棒连结件50可以具有多种其它形状和尺寸,以有助于与进给联接件52匹配。
图16图示了可以在扳机插入件48和进给棒连结件52之间延伸的示范性的进给联接件52。大体上,进给联接件52可以具有带有近端52a和远端52b的大致上平的伸长的形状。近端52a适合于可转动地位于扳机插入件48的第一凹处108内,这样,就像先前所讨论的那样,近端52a可以包括延伸经过其的轴53(图1B)。轴53可以适合于在扳机插入件48的第一凹处108内进行枢转的转动,由此允许扳机插入件48使进给联接件52进行枢转。进给联接件52的远端52b可以适合于连结到进给棒连结件50,这样,在示范性实施例中,进给联接件52的远端52b包括形成在其上的相对的臂114a、114b,臂114a、114b限定了在其之间的开口116,以安置进给棒连结件50的中心轴50a。当进给联接件52围绕枢转轴线X进行枢转的时候,臂114a、114b有效地接合连结件50并且使连结件50进行移动。枢转轴线X可以由进给联接件52连结到壳12的部位限定,并且枢转轴线X可以定位在进给联接件52上的任何地方,但在所图示的实施例中,枢转轴线X定位成邻近进给联接件52的近端52a。
在示范性实施例中,进给联接件52可以是柔性的,以不必对夹子前进组件和夹子形成组件进行校准。特别地,进给联接件52允许扳机16朝向闭合位置进行连续的移动,即使在进给棒38和进给棒连结件50处在最远端位置之后,并且进给联接件52为夹子形成组件和夹子前进组件提供了一些自由。换言之,在使扳机闭合期间,扳机16是可相对于进给棒38弯曲的。
基于夹子前进组件和夹子形成组件的构形,进给联接件52的具体硬度和强度可以发生改变,但在一个示范性实施例中,进给联接件52所具有的硬度的范围在75到110磅每英寸内,并且更优选地为大约93磅每英寸(像在位于联接件52和进给棒连结件50之间的界面测量到的那样),并且进给联接件52所具有的强度的范围在25磅到50磅内,并且更优选地为大约35磅。进给联接件52也可以由多种材料形成,包括多种聚合物、金属等。一种示范性的材料是玻璃加固的聚醚酰亚 胺,但许多加固的热塑性塑料可以使用,包括玻璃加固的液晶聚合物、玻璃加固的尼龙和这些的碳纤维加固的形式及类似的热塑性塑料。像热固聚酯那样的纤维加固的热固聚合物也可以使用。进给联接件52也可以由像弹簧钢那样的金属制造,以实现受限制的柔性和受控制的强度的需要的组合。
图17A-17D图示了在使用时的示范性的夹子前进组件。图17A显示了初始位置,在其中,扳机16处在打开位置,进给棒连结件50和进给棒38处在最近端位置,而进给联接件52在扳机插入件48和进给棒连结件50之间延伸。像先前所讨论的那样,在初始打开位置,在进给棒38上的突出部分86定位在位于钳口保持器轴28内的伸长槽88的近端。第一偏置部件,例如弹簧120,连结到扳机插入件48和壳12,以使扳机插入件48和扳机16维持在打开位置,而第二偏置部件,例如弹簧122,在可转动地使轴18与壳12匹配的轴连结件124和进给棒连结件50之间延伸,以使进给棒连结件50和进给棒38维持在最近端位置。
如图17B所示,当扳机16受到驱使并且朝向闭合位置即朝向固定的把手14进行移动以克服由弹簧120、122施加的偏置力的时候,扳机插入件48开始在逆时针方向上进行枢转。因此,促使进给联接件52在逆时针方向上进行枢转,由此使进给棒连结件50和进给棒38在远端方向上进行移动。这样,在进给棒38上的突出部分86就在钳口保持器轴28内的伸长槽88内在远端方向上进行移动,由此使布置在夹子轨道内的进给器底托34和夹子36前进。弹簧120在壳和扳机插入件48之间延伸,而弹簧122在进给棒连结件50和轴连结件124之间受到压缩。
当扳机16进一步受到驱使并且扳机插入件48继续进行枢转的时候,进给棒连结件50和进给棒38最终到达最远端位置。像先前所讨论的那样,在该位置,在进给棒38上的突出部分86定位在位于钳口保持器轴28内的槽88的远端,而夹子定位在钳口20之间。如图17C和17D所示,弹簧122在轴连结件124和进给棒连结件50之间受到完全压缩,而进给联接件52发生弯曲。当进给联接件52发生弯曲的时候,并且更优选地,一旦进给联接件52发生完全弯曲,夹子形成组件就受到驱使,以使钳口20闭合。在驱使夹子形成组件期间,例如在第 二驱使阶段期间,进给联接件52保持弯曲,从而使扳机插入件48是可相对于夹子形成组件弯曲的,并且特别地,是可相对于进给棒38弯曲的。
在图18-20中,更详细地显示了壳12的示范性的夹子形成组件。大体上,夹子形成组件布置在壳12内,并且夹子形成组件有效地使推杆44和凸轮42相对于钳口20进行移动,以使钳口20移动到闭合位置,由此挤压定位在其之间的夹子。尽管夹子形成组件可以具有多种构形,但所图示的示范性的夹子形成组件包括可滑动地连结到扳机插入件48的闭合联接件滚子54、适合于连结到闭合联接件滚子54的闭合联接件56和适合于连结到闲合联接件56和推杆44的闭合连结件58。
图18更详细地图示了闭合联接件滚子54,像所显示的那样,闭合联接件滚子54包括具有大致上为圆形的凸缘54b、54c的中心轴54a,凸缘54b、54c邻近中心轴54a的相对终端形成。中心轴54a可以适合于位于在扳机插入件48内的第二凹处10内,从而使凸缘54b、54c容纳在扳机插入件48的相对侧。中心轴54a也可以适合于与闭合联接件56的相对的臂126a、126b匹配,以将臂定位在扳机插入件48的相对侧。
在图19中,更详细地图示了闭合联接件56的示范性实施例,像所显示的那样,闭合联接件56具有彼此间隔了某个距离的相对的臂126a、126b。臂126a包括近端128a和远端130a,而臂126b包括近端128b和远端130b,近端128a、128b适合于接合闭合联接件滚子54的中心轴54a,而远端130a、130b适合于与闭合连结件58匹配,以将闭合联接件滚子54和闭合联接件56连结到推杆44。在示范性实施例中,臂126a的近端128a和臂126b的近端128b适合于枢转地与闭合联接件滚子54匹配,这样,臂126a、126b就可以包括例如形成在其上的钩形部件132a、132b,以接合中心轴54a。钩形部件132a、132b在相对的方向上延伸,以有助于在闭合联接件56和闭合联接件滚子54之间的接合。臂126a的远端130a和臂126b的远端130b可以彼此匹配,并且它们可以包括延伸经过其的腔134,以容纳适合于枢转地使闭合联接件56与闭合连结件58匹配的轴。本领域的技术人员应该意识到的是,多种其它技术可以使用,以使闭合联接件56与闭合联接件滚子54和 闭合连结件58匹配。
在图20A中,更详细地显示了示范性的闭合连结件58,并且像所显示的那样,闭合连结件58包括具有两个臂136a、136b的近端部分58a,两个臂136a、136b带有延伸经过其并且适合于与在闭合联接件56内的腔134对准的腔138a、138b,用于容纳轴,以使两个构件匹配。闭合连结件58也可以包括适合于与推杆44的近端44a(图9)匹配的远端部分58b。在示范性实施例中,闭合连结件58包括形成在其内的切除部分59(图20B和20C),切除部分59的形状适合于安置推杆44的近端44a。闭合连结件58的远端部分58b也可以成形为当扳机16处在打开位置的时候容纳进给棒连结件50的部分。本领域的技术人员应该意识到的是,多种其它匹配技术可以使用,以使闭合连结件58与推杆44匹配,并且可选择地,闭合连结件58和推杆44可以彼此整合形成。
在图20B和20C所示的其它示范性实施例中,偏置部件可以布置在切除部分59内,以使推杆44在远端方向上发生偏置。如果使用者松开扳机16,那么这种构形就可以防止夹子从钳口意外释放,特别是在早期闭合阶段期间。特别地,尽管在下面更详细讨论的抗倒退机构可以适合于防止扳机16打开,直到扳机16到达预定位置,但抗倒退机构可以允许扳机16进行一些微小的移动。这样,在使用者松开扳机16并且扳机16进行了微小的打开的情况下,偏置部件就使推杆44在远端方向上发生偏置,由此使推杆44维持在大致上固定的位置。尽管多种偏置部件可以使用,但在图20B所示的实施例中,偏置部件是定位在推杆44的近端44a和凹处59的后部壁之间以使推杆44在远端方向上发生偏置的悬臂梁61。悬臂梁61可以由像Nitinol那样的形状记忆材料形成,当指向近端方向的力施加到梁61的时候,形状记忆材料允许梁61弯曲或变平。梁61也可以由多种其它材料形成,例如弹簧钢或加固的聚合物,并且可以使用多于一个的梁。图20C图示了偏置部件的另一个实施例,这个实施例的形式是卷簧或其它类型的弹簧63。像所显示的那样,弹簧63布置在推杆44的近端44a和凹处59的后部壁之间,以使推杆44在远端方向上发生偏置。当指向近端方向的力施加到弹簧63的时候,弹簧63适合于压缩。本领域的技术人员应该意识到的是,多种其它偏置部件可以使用,包括弹性体压缩部件。
再次参考图17A-17D,在使用时,当扳机16开始从打开位置朝向闭合位置进行移动的时候,闭合联接件滚子54在位于扳机插入件48内的凹处110内进行滚动。一旦进给棒38和进给棒连结件50处在最远端位置,如图17C所示,对扳机16的进一步驱使就使得在扳机插入件48内的凹处110接合闭合联接件滚子54,促使闭合联接件滚子54与扳机插入件48一起进行枢转,如图17D所示。因此,闭合联接件58在远端方向上进行移动,由此使得推杆44在远端方向上进行移动。当推杆44在远端方向上前进的时候,凸轮42在钳口20上前进,以使钳口20闭合并且挤压定位在其之间的夹子。可选择地,扳机16可以部分地闭合,以使钳口20部分地闭合,这样就部分地挤压了定位在其之间的夹子。在下面,更详细地讨论了用于有助于可选择地使夹子完全地和部分地闭合的示范性技术。一旦施加了夹子,扳机16就可以释放,由此允许弹簧120将扳机插入件48拉回到它的初始位置,并且允许弹簧122使进给棒连结件50和进给棒38回到近端位置。当扳机插入件48返回到它的初始位置的时候,闭合联接件滚子54也移动回到它的初始位置,由此在近端方向上拉动闭合联接件56、闭合连结件58和推杆44。
外科夹子施加器10也可以包括多种其它有助于使用装置10的特征部。在一个示范性实施例中,外科夹子施加器10可以包括用于对扳机16的移动进行控制的抗倒退机构。特别地,抗倒退机构可以在部分闭合行程期间,防止扳机16打开。然而,一旦扳机到达定位在钳口之间的夹子可以受到部分的挤压的预定位置,抗倒退机构就可以释放扳机,以像使用者所想要的那样,允许扳机打开并且释放夹子,或允许扳机闭合以完全地挤压夹子。
图21A和21B图示了抗倒退机构的一个形式为棘轮的示范性实施例。像所显示的那样,棘轮包括一组形成在扳机插入件48上的齿112和适合于可转动地布置在壳12内并且定位成邻近扳机插入件48的棘爪60,从而使扳机16的闭合和扳机插入件48的枢转移动可以使得棘爪60接合齿112。齿112可以成形为防止棘爪60进行转动,直到棘爪60到达棘爪60可以自由转动的预定位置,由此允许扳机16打开或闭合。预定的位置优选地相应于钳口20部分闭合的位置。像所显示的那样,在示范性实施例中,齿112包括具有防止棘爪60相对其进行转动 的尺寸的第一组齿112a,例如10个齿,这样,当棘爪60与齿112的第一组112a接合的时候,就防止了扳机16打开。齿112也可以包括称为托科鸟齿112b的末端齿或终端齿,其具有这样的尺寸,即当棘爪60与托科鸟齿112b接合的时候,允许棘爪60相对于其进行转动。特别地,托科鸟齿112b的尺寸优选地大致上大于第一组齿112a的尺寸,从而使相对大的凹口140形成在第一组齿112a和托科鸟齿112b之间。凹口140的尺寸允许棘爪60在其内进行枢转,这样就允许棘爪60可选择地移动超过托科鸟齿112b或朝向第一组齿112a向后移动。本领域的技术人员应该意识到的是,托科鸟齿112b的尺寸可以与第一组10个齿112a相同,或小于第一组10个齿112a,但仍然提供形成在其之间的允许棘爪60在其内进行枢转的凹口140。
图22A-22D图示了在使用时的棘轮机构。如图22A所示,当扳机16开始朝向闭合位置进行移动的时候,棘爪60接合第一组齿112a,由此防止了扳机16打开。对扳机16的进一步驱使使得棘爪60前进越过第一组齿112a,直到棘爪60到达紧邻托科鸟齿112b的凹口140。一旦棘爪60到达托科鸟齿112b,此时,钳口20由于凸轮42在钳口20上部分地进行远端移动而部分地闭合,棘爪60就可以自由地进行转动,由此像使用者所想要的那样,允许扳机16打开或闭合。图22C图示了在完全闭合位置的扳机16,而图22D和22E图示了返回到打开位置的扳机16。
棘轮转机构也可以成形为发出指示钳口20的位置的听得到的声音。例如,当棘爪60接合第一组齿112a的时候,可以发出第一声音,而当棘爪60接合托科鸟齿112b的时候,可以发出第二不同的声音,例如较大的声音。因此,当扳机16到达棘爪60与托科鸟齿112b接合的预定位置的时候,第二声音指示使用者钳口20处在部分闭合的位置。这样,使用者就可以释放扳机16,以释放部分闭合的夹子,或使用者可以使扳机16完全闭合,以使夹子完全闭合。
在另一个示范性实施例中,外科夹子施加器10可以包括适合于防止由扳机16施加到钳口20的力过载的过载机构。典型地,在施加外科夹子期间,需要某个大小的力,以使钳口20闭合并且将夹子围绕定位在钳口20之间的组织挤压。当形成过程进行并且夹子至少部分闭合的时候,继续使钳口20围绕夹子闭合所需要的力显著地增加。因此, 在示范性实施例中,过载机构所具有的阻力可以与使钳口20闭合所需要的力关联。换言之,当使钳口20闭合所需要的力增加的时候,过载机构的阻力可以增加。然而,阻力优选地稍大于使钳口20闭合所需要的力,以防止意外地驱使过载机构。因此,如果当扳机16开始受到驱使的时候防止钳口20闭合,那么克服过载机构的阻力所需要的力是相对小的。这是特别有利的,因为当钳口20打开或只是部分闭合的时候,钳口20更易于发生变形。在早期夹子形成阶段,过载机构更容易驱使,以防止钳口发生变形。相反地,当钳口20大致上闭合的时候,阻力是相对大的,从而使过载机构可以只当将相当大的力施加到钳口20时才受到驱使。
显示成分解图的图23A图示了过载机构62的一个示范性实施例。大体上,过载机构可以包括由两个半部分64a、64b形成的过载壳64,过载壳64包含异形联接件66、肘接联接件68、枢转联接件70和偏置组件72。偏置组件72可以包括连结到壳64的弹簧柱150,弹簧柱150包括延伸经过其的钻孔,以容纳柱塞154。弹簧152围绕弹簧柱150布置,而柱塞154延伸经过弹簧柱150,并且柱塞154包括形成在其上的适合于邻接靠在弹簧152上的头154a。枢转联接件70可以是大体上L形的,并且枢转联接件70可以通过延伸经过其的枢转销156连结到壳64。枢转联接件70的近端70a可以接触柱塞154的头154a,而枢转联接件70的远端70b可以通过枢转销166枢转地连结到肘接联接件68。接下来,肘接联接件68可以连结到异形联接件66,其可以邻近形成在壳内的开口64d可滑动地并且枢转地定位在壳64内。例如通过延伸经过异形联接件66并且布置在形成在壳64的每个半部分64a、64b内的第一槽160a(只显示了一个槽)内的枢转销158,异形联接件66可以在壳64内进行枢转移动,而例如通过形成在异形联接件66上的容纳在形成在壳64的每个半部分64a、64b内的第二槽160b(只显示了一个槽)内的相对的突出部分168a、168b,异形联接件66可以在壳64内进行可滑动移动。
在使用时,异形联接件66可以适合于接收来自夹子形成组件的力,并且适合于由偏置组件72的阻力对抗这个力。特别地,过载机构62使用连同肘接联接件68和枢转联接件70的弹簧152,以使异形联接件66发生偏置而不会围绕枢转销158进行转动或靠在壳64上进行滑 动。就转动而言,由受到压缩的弹簧152施加的力传递经过肘接联接件68和枢转联接件70,从而将转动力矩施加到异形联接件66靠在壳64上。这样,该组件就使得异形联接件66抵抗相对于壳64进行转动。如果由来自靠在异形联接件66上的闭合联接件滚子54的径向负载产生的力矩超过了枢转联接件70和肘接联接件68的力矩,那么异形联接件66就开始进行转动,使肘接联接件68变弯,并且使得枢转联接件70进一步压缩弹簧152。就滑动而言,枢转联接件70、肘接联接件68和异形联接件66对准,从而使滑动力(对滑动的阻力)是使肘接联接件68和枢转联接件70变弯所需要的力。如果来自靠在异形联接件66上的闭合联接件滚子54的径向负载超过了联动装置的变弯力,那么,当异形联接件66在近端方向上进行滑动的时候,枢转联接件70就进一步压缩弹簧152。
这在图23B-23C中得以更详细的显示,并且像所显示的那样,在壳64内的开口64d允许夹子形成组件的闭合联接件滚子54靠在异形联接件66上进行滚动。因此,当扳机16受到驱使并且朝向闭合位置移动的时候,闭合联接件滚子54将力施加到异形联接件66。然而,过载弹簧152的阻力使异形联接件66维持在大致上固定的位置,除非由闭合联接件滚子54施加的力增加到大于这个阻力,例如阀值力。例如,这可以通过定位在钳口20之间的异物实现,或当钳口20完全闭合而夹子和脉管、管路、分路等处在其之间的时候实现。当钳口20不能进一步闭合的时候,由于扳机16的闭合运动而施加到闭合联接件滚子54的力传递到异形联接件66,然后,异形联接件66在壳64内进行枢转和滑动,由此使得枢转联接件70进行枢转,这促使柱塞154压缩过载弹簧152。
像先前所注意到的那样,驱使过载机构所需要的力可以与使钳口20闭合所需要的力相关,当扳机16移动到闭合位置的时候,驱使过载机构所需要的力增加了。由于异形联接件66的构形,这可以实现。特别地,如图23B所示,当闭合联接件滚子54首先与异形联接件66相接触,由此处在下部位置的时候,异形联接件66可以在壳64内进行枢转。如图23C所示,当闭合联接件滚子54向上沿着异形联接件66进行移动的时候,克服过载机构的阻力所需要的力增加了,因为异形联接件66必须在壳64内进行滑动。使异形联接件66进行枢转所需要 的力可以小于使异形联接件66进行滑动所需要的力。因此,如果当扳机开始受到驱使的时候,例如由于异物防止钳口20闭合,那么就需要微小的力,以使得闭合联接件滚子54将力传递到异形联接件66的下部部分,这使得异形联接件66进行枢转。当钳口20大致上闭合而扳机16几乎受到完全驱使的时候,需要相当大的力,以使得闭合联接件滚子54将力传递到异形联接件66的上部部分,这使得异形联接件66在壳64内进行滑动,以克服过载弹簧152的阻力。尽管驱使过载机构所需要的力的量可以大于使钳口20闭合所需要的力,并且相对于使钳口20闭合所需要的力,驱使过载机构所需要的力可以增加,但优选地,驱使过载机构所需要的力只是稍大于使钳口20闭合所需要的力,以防止钳口20发生变形或受到其它损坏。本领域的技术人员应该意识到的是,基于使钳口20闭合所需要的力,阻力可以调整。
异形联接件66,特别是异形联接件66的面向远端的表面66s,也可以具有有助于使驱使过载机构所需要的力和使钳口20闭合所需要的力关联起来的形状。例如,在使钳口20闭合所需要的力以线性比率增加的情况下,异形联接件66的面向远端的表面66s可以是平的,以防止异形联接件66干涉闭合联接件滚子54在其上移动,并且允许将线性力施加到扳机16,以使钳口20闭合。相反地,在当扳机16移动到闭合位置的时候使钳口20闭合所需要的力是非线性的情况下,异形联接件66可以具有相应于非线性力的非线性形状。这种构形可以防止使凸轮42(图8)闭合所需要的力变得太大。
作为非限制性的例子,由于在凸轮42内的适合于推动钳口部件96a、96b朝向彼此的凹处104的形状,使钳口20闭合所需要的力可以是非线性的。如图8所示,凹处104可以具有弧形的构形,从而当凸轮42在钳口部件96a、96b上通过的时候,使力可以发生改变。因此,异形联接件66可以具有相应弧形的面向远端的表面,从而当闭合联接件滚子54在其上通过的时候,使力也可以发生改变。如图23A和23B所示,异形联接件66是弧形的,从而使异形联接件66的下部部分是大致上凸起的而异形联接件66的上部部分是大致上凹陷的。本领域的技术人员应该意识到的是,异形联接件66可以具有多种其它形状,并且多种其它技术可以使用,以对使钳口20闭合所需要的力和驱使过载机构所需要的力进行优化。
本领域的技术人员也应该意识到的是,过载机构可以具有多种其它构形。作为非限制性的例子,图23D图示了形式为用于接收由闭合联接件滚子54施加的力的悬臂梁170的过载机构。梁170可以具有大致上弧形的部件172,弧形的部件172带有连结到其一端的支架174。当负载了大于弧形的部件172所具有的弯曲力矩的力的时候,弧形的部件172可变弯,以呈现低刚性状态。支架174可以将更大的刚性提供给弧形的部件172,从而使邻近支架174的弯曲力矩增加。在使用时,梁170可以加载在夹子施加器10的壳12内,从而使闭合联接件滚子54接触凹陷的表面,并且梁170可以以某个角度定位,从而当扳机16开始受到驱使的时候,使闭合联接件滚子54更加远离梁,并且当扳机16移动到闭合位置的时候,使闭合联接件滚子54更加接近梁。因此,当闭合联接件滚子54进行移动并且夹子施加器的扳机16移动到闭合位置的时候,对变弯的阻力可以增加。虽然没有显示,但可选择地,可以以堆叠的方式使用多个梁,并且梁(或多个梁)的终端或自由端可以确定轮廓为在沿着梁的长度的某个特别的点定制变弯负载。
在另一个示范性实施例中,外科夹子施加器10可以包括用于指示剩余在装置10内的夹子的数量的夹子数量指示器。尽管多种技术可以使用以指示剩余的夹子的数量,但图24A-25所图示的夹子数量指示器的一个示范性实施例具有指示器轮74和指示器驱使器76。
在图24A和24B中,更详细地显示了指示器轮74,并且像所显示的那样,指示器轮74具有大体上为圆形的或圆柱形的限定了中心轴线Y的形状,指示器轮74适合于围绕中心轴线Y进行转动。轮74包括围绕其形成且适合于与指示器驱使器76接合的齿142和指示器部件144。指示器部件144可以具有多种构形,但在示范性实施例中,指示器部件144的形式为对比色垫,对比色垫具有不同于指示器轮74的剩余部分的颜色,例如橙色、红色等。
图25更详细地图示了示范性的指示器驱使器76。驱使器76适合于可滑动地布置在壳12内,并且适合于连结到进给联接件连结件50,并且当进给棒连结件50和进给棒38进行移动的时候,驱使器76进行移动。因此,指示器驱使器76可以包括形成在其下部表面的突出部分146,以延伸到形成在位于进给棒连结件50上的圆形凸缘50d、50e之间的凹处50f内,只显示了突出部分146的部分。突出部分146允许指 示器驱使器76与进给棒连结件50接合并且与其一起进行移动。指示器驱使器76也可以包括形成在其上的接合机构148,接合机构148适合于接合形成在指示器轮74上的齿142。如图25所示,在指示器驱使器76上的接合机构148的形式为具有形成在其端部的片以接合齿142的臂。
在使用时,如图26A-26B所示,指示器轮74可转动地布置在壳12内,而指示器驱使器76可滑动地布置在壳12内,从而使接合机构148定位成邻近指示器轮74而突出部分146延伸到进给棒连结件50内。壳12包括形成在其内的窗12a,以提供看到指示器轮144的通道。当扳机16移动到闭合位置而进给棒连结件50在远端方向上进行移动的时候,指示器驱使器76与进给棒38和进给棒连结件50一起在远端方向上进行移动。因此,在指示器驱使器76上的接合机构148接合在指示器轮74上的齿142,由此当夹子前进到钳口20内的时候,使得轮74进行转动。当扳机16每次受到驱使以使夹子20前进到钳口20内的时候,指示器驱使器74都使指示器轮76进行转动。当夹子供给器还剩下两个或三个夹子的时候,在指示器轮74上的对比色垫144开始出现在形成在壳12内的窗12a内,由此指示给使用者只剩下几个夹子。当夹子供给器用尽的时候,对比色垫144可以适合于占据整个窗12a。
在另一个示范性实施例中,指示器轮74可以包括适合于防止指示器轮74在前进之后在相反方向上例如在逆时针方向上进行转动的抗倒退机构。尽管抗倒退机构可以具有多种构形,但在图24B所示的实施例中,指示器轮74包括大致上平行于轴线Y延伸的相对的臂73a、73b。每个臂73a、73b具有形成在其最远端的适合于接合形成在壳12上的相应的齿的棘爪75a、75b。尽管没有显示,但相应的齿可以形成在位于邻近窗12a的壳12的内部部分上的圆形的突出部分内。当指示器轮74布置在壳12内的时候,臂73a、73b延伸到围绕其内部圆周形成的圆形的突出部分内。当夹子得以施加而指示器轮74进行转动的时候,臂73a、73b可以在位于壳内的齿上发生偏转,以移动到下一个位置。当指示器驱使器76在近端方向上进行滑动以返回到它的初始位置的时候,臂73a、73b接合在壳内的齿,以防止指示器轮74在相反方向上进行转动,即防止指示器轮74返回到先前位置。本领域的技术人员应该意识到的是,多种其它技术可以使用,以防止指示器轮74发生倒退。
像先前所提及到的那样,外科夹子施加器10可以使用,以将部分闭合的或完全闭合的夹子施加到像脉管、管路、分路等那样的外科位点。在进行腹腔镜手术和内窥镜手术中,在患者的身体上进行小的切口,以进入外科位点。典型地,套管或进入端口用于限定从皮肤切口延伸到外科位点的工作通道。在进行外科手术期间,经常必需的是使经过脉管或其它管路的血流停止下来,并且一些手术可能需要使用分路。这样,外科夹子就可以用于挤压脉管或将分路固定到脉管。因此,像夹子施加器10那样的外科夹子施加器可以经过套管导入或另外导入到外科位点内,以将钳口20成围绕脉管、分路或其它管路等定位。组织停止件46可以有助于将钳口20围绕目标位点定位。然后,扳机16可以受到驱使,以使得夹子在钳口之间前进并且围绕目标位点定位,并且使得钳口闭合,以挤压夹子。基于夹子的用途,如棘爪60到达托科鸟齿112b的听得到的声音指示的,扳机16可以受到部分的驱使,或扳机16可以受到完全的驱使。然后,扳机16释放,以释放部分闭合的或完全闭合的夹子,并且如果需要施加更多的夹子,那么这个过程就可以重复进行。
基于上述实施例,本领域的一个技术人员应该意识到本发明的其它特征和优点。因此,除了像后附的权利要求书所指示的那样,本发明不受已经特别显示和描述的东西的限制。在这里,将在这里所引用的所有出版物和参考文献确切地通过参考完全地合并起来。

Claims (17)

1.一种外科夹子施加器,其具有用于防止施加到夹子施加器的钳口的闭合力过载的过载机构,外科夹子施加器包括具有扳机的壳、伸长轴和布置在壳和伸长轴内并且连结到扳机的凸轮系统组件,扳机可移动地连结到壳而伸长轴从壳延伸出来,相对的钳口形成在伸长轴的远端并且能够在打开位置和闭合位置之间移动。
2.根据权利要求1所述的外科夹子施加器,其特征在于,当驱使扳机时,凸轮系统组件适合于将闭合力施加到钳口,以使钳口从打开位置朝向闭合位置移动。
3.根据权利要求1所述的外科夹子施加器,其特征在于,当闭合力大于过载机构施加到凸轮系统组件的阻力时,凸轮系统组件也适合于将闭合力传递到布置在壳内的过载机构。
4.根据权利要求3所述的外科夹子施加器,其特征在于,过载机构的阻力与使钳口从打开位置朝向闭合位置移动所需要的力相关联。
5.根据权利要求1所述的外科夹子施加器,其特征在于,凸轮系统组件相对于过载机构的力接收表面进行移动,从而当扳机受到驱使以使得凸轮系统组件从打开位置朝向闭合位置移动钳口时,使凸轮系统组件的闭合力经过过载机构的力接收表面施加。
6.根据权利要求3所述的外科夹子施加器,其特征在于,过载机构的力接收表面适合于阻止在近端方向上的移动,并且当扳机受到驱使以使得凸轮系统组件相对于力接收表面进行移动并且使钳口从打开位置朝向闭合位置移动时,阻力增加。
7.根据权利要求5所述的外科夹子施加器,其特征在于,过载机构包括具有异形联接件的壳,异形联接件可滑动地并且枢转地布置在壳内,并且具有形成其上的力接收表面并且定位成邻近形成在壳内的开口。
8.根据权利要求5所述的外科夹子施加器,其特征在于,力接收表面包括适合于接收用于使在壳内的力接收部件进行枢转移动的力的第一部分,和适合于接收用于使在壳内的力接收部件进行可滑动移动的力的第二部分。
9.根据权利要求5所述的外科夹子施加器,其特征在于,过载机构也包括适合于将阻力施加到异形联接件的偏置组件。
10.根据权利要求9所述的外科夹子施加器,其特征在于,通过适合于当异形联接件进行枢转移动时进行枢转并且适合于当异形联接件进行可滑动移动时进行滑动的枢转组件,偏置组件连结到异形联接件,以将力施加到偏置组件,以克服阻力。
11.根据权利要求1所述的外科夹子施加器,该过载机构包括枢转地并且可滑动地布置在壳内并且具有带有第一端和相对的第二端的表面的力接收部件,和布置在壳内并且适合于阻止力接收部件移动的偏置组件。
12.根据权利要求11所述的外科夹子施加器,其特征在于,从第一端到第二端,阻力是增加的。
13.根据权利要求11所述的外科夹子施加器,其特征在于,形成在过载机构上的力接收表面定位在位于壳内的开口内。
14.根据权利要求11所述的外科夹子施加器,其特征在于,力接收表面包括适合于接收用于使在壳内的力接收部件进行枢转移动的力的第一部分,和适合于接收用于使在壳内的力接收部件进行可滑动移动的力的第二部分。
15.根据权利要求11所述的外科夹子施加器,其特征在于,偏置组件包括围绕弹簧柱布置的弹簧和相对于弹簧柱可滑动地布置的柱塞,柱塞具有形成在其上的头并且适合于当柱塞朝向弹簧柱移动时对弹簧进行压缩。
16.根据权利要求11所述的外科夹子施加器,其特征在于,壳包括连结在力接收部件和偏置组件之间的枢转组件,从而使枢转组件适合于将施加到力接收部件的力传递到偏置组件,以克服阻力。
17.根据权利要求16所述的外科夹子施加器,其特征在于,枢转组件包括枢转地连结到力接收部件的肘接联接件,和枢转地连结到肘接联接件并且适合于当其进行枢转移动时将力施加到偏置组件的枢转联接件。
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US20080027466A1 (en) 2008-01-31
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US8075571B2 (en) 2011-12-13
EP2289431A3 (en) 2011-06-22
JP2006289099A (ja) 2006-10-26
KR101196234B1 (ko) 2012-11-05
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CA2543272A1 (en) 2006-10-14
US20060235437A1 (en) 2006-10-19
EP2289431A2 (en) 2011-03-02
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AU2006201316A1 (en) 2006-11-02
BRPI0602587A (pt) 2006-12-26
EP2319429B1 (en) 2014-07-30
US9782181B2 (en) 2017-10-10
US20170319213A1 (en) 2017-11-09
EP2289431B1 (en) 2012-07-11
US20140303650A1 (en) 2014-10-09
SG145756A1 (en) 2008-09-29
EP1712190A2 (en) 2006-10-18
JP5063920B2 (ja) 2012-10-31
CN1853579A (zh) 2006-11-01
US10667824B2 (en) 2020-06-02
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