CN103930046B - 具有相变密封剂的电阻加热式外科钉仓 - Google Patents
具有相变密封剂的电阻加热式外科钉仓 Download PDFInfo
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Abstract
一种用于内窥镜外科用途的设备包括具有端部执行器和钉仓的器械，所述钉仓可***到所述端部执行器中。所述钉仓包括钉、钉孔、电阻构件和医用流体。在联接到功率源时，所述电阻构件可使所述医用流体蒸发并通过所述钉孔排出到所述被缝合的组织上。所述功率源可容纳在所述器械内。在一种构型中，具有带触点的电阻带可电联接到所述端部执行器中的导体。所述医用流体也可被划分成对应于所述钉孔的多个密封剂垫，且所述医用流体可为可解聚的氰基丙烯酸酯、可喷涂的热塑性聚氨基甲酸酯、或者任何可蒸发的药剂或药物。所述钉驱动器可包括一个或多个孔，以容许所述医用流体穿过所述钉驱动器或其周围。
Description
背景技术
在一些情况下，内窥镜式外科器械可优于传统的开放式外科装置，因为较小的切口可减少术后恢复时间和并发症。因此，一些内窥镜式外科器械可适于将远端执行器通过套管针的插管布置在所需手术部位处。这些远侧端部执行器(例如，直线切割器、抓紧器、切割器、缝合器、施夹器、进入装置、药物/基因治疗递送装置、以及使用超声、射频、激光等的能量递送装置)可以多种方式接合组织，以达到诊断或治疗的效果。内窥镜式外科器械可包括位于端部执行器和柄部部分之间的轴，所述柄部部分由临床医生操纵。此轴能够***到所需的深度并围绕轴的纵向轴线旋转，从而于将端部执行器定位在患者体内。还可通过添加一个或多个关节运动接头或特征而进一步有利于端部执行器的定位，从而使得端部执行器能够选择性地进行关节运动，或者以其它方式相对于轴的纵向轴线偏转。
内窥镜式外科器械的例子包括外科缝合器。一些这样的缝合器能够操作以夹紧在组织层上、切开被夹紧的组织层、并驱动钉穿过组织层，以在组织层的被切断的端部附近将切断的组织层基本上密封在一起。仅作为示例性的外科缝合器在以下美国专利中有所公开：1989年2月21日公布的名称为“Pocket Configuration for Internal OrganStaplers”的美国专利号4,805,823；1995年5月16日公布的名称为“Surgical Stapler andStaple Cartridge”的美国专利号5,415,334；1995年11月14日公布的名称为“SurgicalStapler Instrument”的美国专利号5,465,895；1997年1月28日公布的名称为“SurgicalStapler Instrument”的美国专利号5,597,107；1997年5月27日公布的名称为“SurgicalInstrument”的美国专利号5,632,432；1997年10月7日公布的名称为“SurgicalInstrument”的美国专利号5,673,840；1998年1月6日公布的名称为“ArticulationAssembly for Surgical Instruments”的美国专利号5,704,534；1998年9月29日公布的名称为“Surgical Clamping Mechanism”的美国专利号5,814,055；2005年12月27日公布的名称为“Surgical Stapling Instrument Incorporating an E-Beam Firing Mechanism”的美国专利号6,978,921；2006年2月21日公布的名称为“Surgical Stapling InstrumentHaving Separate Distinct Closing and Firing Systems”的美国专利号7,000,818；2006年12月5日公布的名称为“Surgical Stapling Instrument having a FiringLockout for an Unclosed Anvil”的美国专利号7,143,923；2007年12月4日公布的名称为“Surgical Stapling Instrument Incorporating a Multi-Stroke Firing Mechanismwith a Flexible Rack”的美国专利号7,303,108；2008年5月6日公布的名称为“SurgicalStapling Instrument Incorporating a Multistroke Firing Mechanism Having aRotary Transmission”的美国专利号7,367,485；2008年6月3日公布的名称为“SurgicalStapling Instrument Having a Single Lockout Mechanism for Prevention ofFiring”的美国专利号7,380,695；2008年6月3日公布的名称为“Articulating SurgicalStapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism”的美国专利号7,380,696；2008年7月29日公布的名称为“Surgical Stapling and CuttingDevice”的美国专利号7,404,508；2008年10月14日公布的名称为“Surgical StaplingInstrument Having Multistroke Firing with Opening Lockout”的美国专利号7,434,715；以及2010年5月25日公布的名称为“Disposable Cartridge with Adhesive for Usewith a Stapling Device”的美国专利号7,721,930。上面所引用的美国专利中的每一者的公开内容均以引用方式并入本文。虽然以上涉及的外科缝合器被描述为用于内窥镜式手术，但应当理解，此类外科缝合器也可用于开放式手术和/或其它非内窥镜式手术。
虽然已经制造和使用各种类型的外科缝合器械和相关组件，但据信在本发明人之前还无人研制出或使用所附权利要求中描述的发明。
附图说明
并入本说明书并构成其一部分的附图示出了本发明的多个实施例，并且与上文所给出的本发明的一般说明和下文所给出的实施例的详细说明一起用于解释本发明的原理。
图1A示出了关节运动式外科器械的透视图，其中端部执行器处于非关节运动位置；
图1B示出了图1A的外科器械的透视图，其中端部执行器处于关节运动位置；
图2示出了图1A至图1B的外科器械的打开的端部执行器的透视图；
图3A示出了沿着图2的线3-3截取的图2的端部执行器的侧面剖视图，其中击发杆处于近侧位置；
图3B示出了图2的端部执行器沿着图2的线3-3截取的侧面剖视图，但示出击发杆处于远侧位置；
图4示出了沿着图2的线4-4截取的图2的端部执行器的端部剖视图；
图5示出了图2的端部执行器的分解透视图；
图6示出了图2的端部执行器的透视图，所述端部执行器定位在组织处并且已经在组织中被致动一次；
图7示出了示例性钉仓的透视图；
图8A示出了图7的仓的部分侧面剖视图；
图8B示出了图8A的侧面剖视图的部分，其示出了竖直地凸轮转移钉驱动器的楔形滑动件；
图8C示出了图8A的侧面剖视图的部分，其示出了用于蒸发密封剂的电阻带；
图8D示出了图8A的侧面剖视图的部分，其示出了穿过钉驱动器通道被排出的被蒸发密封剂；
图9示出了针对钉仓的示例性的可供选择的布置的部分侧面剖视图；
图10示出了针对钉仓的另一示例性布置的部分侧面剖视图；
图11示出了在钉仓体内形成的示例性通道的一对局部透视图；
图12示出了具有通道的示例性钉仓的局部透视图，所述通道联接到图1A至图1B的器械的下钳口；
图13示出了具有钉驱动器孔的示例性钉驱动器的透视图；
图14示出了具有一对凹口的替代示例性钉驱动器的透视图；
图15示出了具有多个整体式电阻带和密封剂的另一示例性钉驱动器的侧面剖视图；和
图16示出了图1A至图1B的器械的端部执行器的局部侧面剖视图。
附图并非意在以任何方式进行限制，并且可以预期本发明的各种实施例能够以多种其它方式来执行，包括那些未必在附图中示出的方式。附图并入本说明书中并构成其一部分，示出了本发明的若干方面，并与具体实施方式一起用于解释本发明的原理；然而，应当理解，本发明并不限于所示出的精确布置。
具体实施方式
本发明的某些例子的下列描述不应被用来限制本发明的范围。通过以下举例说明设想用于实施本发明的最佳方式之一的描述，本发明的其它例子、结构、方面、实施例和优点将对本领域的技术人员显而易见。正如将会意识到的，本发明能够具有其它不同且明显的方面，只要不脱离本发明即可。因此，附图和具体实施方式应被视为实质上是示例性而非限制性的。
I.示例性外科缝合器
图1至图6示出了示例性外科缝合和切断器械10，在图1A所示的非关节运动状态下，所述器械被尺寸设定成通过套管针插管通道***到患者的手术部位中，用于执行外科手术。外科缝合和切断器械10包括连接到工具部分22的柄部部分20，所述工具部分还包括朝远侧终止于关节运动机构11中的轴23和朝远侧附接的端部执行器12。一旦关节运动机构11和远侧端部执行器12穿过套管针的插管通道***后，关节运动机构11便可通过关节运动控制器13远程地进行关节运动，如图1B所示。从而，端部执行器12可从期望的角度或出于其它原因而到达器官后面或接近组织。应当理解，诸如“近侧”和“远侧”的术语在本文中是结合临床医生抓握器械10的柄部部分20来使用的。因此，端部执行器12相对于更近侧的柄部部分20处于远侧。还应当理解，为简洁和清楚起见，本文可结合附图使用诸如“竖直”和“水平”的空间术语。然而，外科器械是在多个取向和位置中使用的，并且这些术语并非意图进行限制，也并非绝对的。
本例子的端部执行器12包括下钳口16和可枢转砧座18。柄部部分20包括***式握把24，由临床医生将闭合扳机26以枢转方式拉向所述***式握把，以使砧座18朝向端部执行器12的下钳口16夹紧或闭合。砧座18的这种闭合是通过最外部的闭合套管32提供的，所述闭合套管响应于闭合扳机26相对于***式握把24的枢转而相对于柄部部分20纵向地平移。闭合套管32的远侧闭合环33由工具部分22的框架34间接地支撑。在关节运动机构11处，闭合套管32的近侧闭合管35与远侧部分(闭合环)33连通。框架34经由关节运动机构11柔性地附接到下钳口16，使得能够在单个平面中进行关节运动。框架34还在纵向上以能够滑动的方式支撑击发驱动构件(未示出)，所述击发驱动构件延伸穿过轴23并且将击发运动从击发扳机28传递到击发杆14。击发扳机28远离闭合扳机26的外侧，并且能够被临床医生枢转地拉动，以导致被夹紧的组织在端部执行器12中被缝合和切断，如下文将更详细地描述。然后，按下释放按钮30，以从端部执行器12释放所述组织。
图2至图5示出了采用E形梁击发杆14来执行多种功能的端部执行器12。如图3A至图3B中最佳地示出，击发杆14包括横向取向的上部销38、击发杆顶盖44、横向取向的中部销46和处于远侧的切割刃48。上部销38定位在砧座18的砧座凹坑40内，并且能够在所述砧座凹坑中平移。击发杆顶盖44通过使击发杆14延伸穿过通道狭槽45(如图3B所示)而以能滑动的方式接合下钳口16的下表面，所述通道狭槽是穿过下钳口16形成的。中部销46以能够滑动的方式接合下钳口16的顶表面，从而与击发杆顶盖44协作。从而，击发杆14在击发期间肯定与端部执行器12间隔开，从而克服了最小量的夹紧组织的情况下在砧座18与下钳口16之间可能出现的挤痛情况，并且克服了在过量的夹紧组织的情况下出现的钉变形。
图2示出了朝近侧定位的击发杆14和枢转到打开位置的砧座18，从而允许将未耗尽的钉仓37以能够取出的方式安装到下钳口16的通道中。如图4至图5中最佳地示出，这个例子的钉仓37包括仓体70，所述仓体具有上部平台72并且与下部仓托盘74联接。如图2中最佳地示出，竖直狭槽49是穿过钉仓37的部分形成的。同样如图2中最佳地示出，三行钉孔51在竖直狭槽49的一侧上形成为穿过上部平台70，而另一组三行钉孔51在竖直狭槽49的另一侧上形成为穿过上部平台70。重新参见图3至图5，楔形滑动件41和多个钉驱动器43被捕集在仓体70与托盘74之间，其中楔形滑动件41位于钉驱动器43近侧。楔形滑动件41可在钉仓37内纵向地运动；而钉驱动器43可在钉仓37内竖直地运动。钉47也被定位在仓体70中，处于对应的钉驱动器43上方。具体地，每个钉47在仓体70中被钉驱动器43竖直地驱动，以将钉47从相关的钉孔51中驱动出。如图3A至图3B和图5中最佳地示出，楔形滑动件41存在倾斜凸轮表面，当楔形滑动件41被朝远侧驱动穿过钉仓37时，所述倾斜凸轮表面向上压迫钉驱动器43。
在端部执行器12如图3A所示而闭合的情况下，通过使上部销38进入纵向砧座狭槽42，将击发杆14推进至与砧座18接合。推块80位于击发杆14的远侧端处，并且能够接合楔形滑动件41，使得当朝远侧推进击发杆14穿过钉仓37时，推块80朝远侧推动楔形滑动件41。在此类击发期间，击发杆14的切割刃48进入钉仓37的竖直狭槽49，从而切断被夹紧在钉仓37与砧座18之间的组织。如图3A至图3B所示，中部销46和推块80通过进入到钉仓37内的击发狭槽中而一起致动钉仓37，从而驱动楔形滑动件41与钉驱动器43进行向上凸轮接触，所述钉驱动器继而将钉47驱动出钉孔51，并与砧座18的内表面上的钉成形凹坑53进行成形接触。图3B示出了在完成切断和缝合组织之后完全朝远侧平移的击发杆14。
图6示出了已经通过单次冲程而被致动穿过组织90的端部执行器12。如图所示，切割刃48已经切割穿过组织90，同时在切割刃48形成的切割线的每一侧上，钉驱动器43已经将交替的三行钉47驱动穿过组织90。在该例子中，钉47全部与切割线基本上平行地取向，但应当理解，钉47可被定位成任何适合的取向。在本例子中，在第一冲程完成之后，端部执行器12从套管针撤回，用新的钉仓替换用完的钉仓37，然后将端部执行器12再次穿过套管针***，以到达缝合部位用于进一步的切割和缝合。这个过程可以重复到提供了期望量的切口和钉47为止。可能需要将砧座18闭合以有利于通过套管针***和撤回；并且可能需要将砧座18打开以有利于替换钉仓37。
应当理解，在每个致动冲程期间，切割刃48可基本上在钉47被驱动穿过组织的同时切断组织。在本例子中，切割刃48仅稍微落后于钉47的驱动，使得钉47正好在切割刃48穿过组织之前被驱动穿过该组织的相同区域，但应当理解，这个顺序可以颠倒，或者切割刃48可以直接与相邻的钉同步。虽然图6示出了端部执行器12在组织90的两个层92、94中被致动，但应当理解，端部执行器12可被致动穿过组织90的单个层或者组织的多于两个层92、94。还应当理解，与切割刃48产生的切割线相邻的钉47的成形和定位可基本上密封所述切割线处的组织，从而减少或防止切割线处的出血和/或其它体液的泄漏。本领域的普通技术人员参考本文的教导内容将显而易见可以使用器械10的各种适合的设置和程序。
应当理解，可以根据以下美国专利中的任何教导内容来配置和操作器械10：美国专利号4,805,823；美国专利号5,415,334；美国专利号5,465,895；美国专利号5,597,107；美国专利号5,632,432；美国专利号5,673,840；美国专利号5,704,534；美国专利号5,814,055；美国专利号6,978,921；美国专利号7,000,818；美国专利号7,143,923；美国专利号7,303,108；美国专利号7,367,485；美国专利号7,380,695；美国专利号7,380,696；美国专利号7,404,508；美国专利号7,434,715；和/或美国专利号7,721,930。如上所述，这些专利中的每一个的公开内容均以引用方式并入本文。可提供用于器械10的其它示例性修改形式将更详细地描述于下文中。本领域的普通技术人员将显而易见可将下述教导内容并入器械10内的各种适合方式。类似地，本领域的普通技术人员将显而易见可将下述教导内容与本文引用的专利的各种教导内容进行组合的各种适合方式。还应当理解，下述教导内容并不限于本文引用的专利中所教导的器械10或装置。下述教导内容可容易地应用到多种其它类型的器械，包括将不被分类为外科缝合器的器械。本领域的普通技术人员参考本文的教导内容将显而易见可应用下述教导内容的各种其它适合装置和设置。
II.示例性的可供选择的钉仓
图7示出了用于与器械10一起使用的示例性的可供选择的钉仓100。仓100包括仓体102、仓托盘104、竖直狭槽106、上部平台110、和在上部平台110中形成的多个钉孔112。竖直狭槽106纵向地延伸穿过仓体102和上部平台110，使得击发杆14和切割刃48穿过仓体102的至少部分。应当理解，竖直狭槽106可仅部分地纵向延伸穿过仓体102，或沿着仓体102的整个长度纵向延伸。本例子的仓100具有包括支撑部分122的近端120。在此例子中，如下文中将描述，支撑部分122还包括用以在将仓100***到端部执行器12中时将仓100与功率源98电联接的仓触点130。如本领域的普通技术人员将显而易见，仓触点130并不限于在仓100的近端120。事实上，仓触点130可位于仓100的底表面上，诸如在仓托盘104上或穿过仓托盘104，或者在仓体102上的任何位置处。可供选择的是，仓触点130可使得以电感方式、电容方式和/或任何其它适合方式来传送电力。此外，仓触点130仅为任选的。
A.具有导体和电阻带的替代钉仓的示例性构型和操作
图8A至图8D示出了在被***到端部执行器12的下钳口16中并用于切割和缝合组织(诸如图6的组织90)时的示例性仓100的顺序内部视图。首先参见图8A，其示出了设置在仓100内的多个钉114和钉驱动器180。在本例子中，下钳口16包括具有多个导体触点152的导体150，所述导体触点从导体150的顶表面延伸。导体150可包括：具有脊状触点的金属构件；具有嵌入式金属构件和多个触点的塑性构件，所述触点从塑性构件突出；具有薄导电通道和触点(例如，裸露式迹线等)的印刷电路板(或PCB)；或用以将电力传输到导体触点152的任何其它适合组件和/或结构。导体触点152被示出为能够与带触点162的多个提升部分电联接的对应多个提升部分，但本领域的普通技术人员根据参考本文的教导内容将显而易见其它适合的触点构型。具有带触点162的薄电阻带160联接到仓体102，使得在将仓100***到下钳口16中时，带触点162和导体触点152电联接。在一个替代方案中，带触点162可延伸穿过仓托盘104，或者具有带触点162的电阻带160可被整合到仓托盘104中。在另一仅示例性替代方案中，带触点162和导体触点152可被省略，且电阻带160和导体150可为仓托盘104内、仓体102内、或下钳口16上的一体部件。如本例子中所示，多个带触点162和导体触点152各自与各个钉孔112对齐，使得在将电荷施加到导体150时，电阻带160加热每个钉孔112下面的电阻带160的对应部分。如下文将另外解释，可利用仓100、导体150和电阻带160的替代构型。
密封剂170层设置在电阻带160上方。在本例子中，密封剂170是设置在仓体102内的基本上均匀的连续体。应当理解，密封剂170并不限于密封剂；相反，可在不脱离本公开的范围的前提下使用多种可蒸发物品。例如，密封剂170可包括可解聚的氰基丙烯酸酯、可喷涂的热塑性聚氨基甲酸酯、聚氨酯预聚物、药剂、止血剂、粘膜粘附聚合物、聚乙烯吡咯烷酮(PVP)、甲基纤维素(MC)、羧甲基纤维素钠(SCMC)、羟基丙基纤维素(HPC)和其它纤维素衍生物、阴离子型水凝胶、水凝胶阳离子、中性水凝胶(诸如carbapol、聚丙烯酸酯、脱乙酰壳多糖或Eudragits)、聚丙烯酸-聚乙二醇共聚物(所谓的颊侧粘合剂)、凝血酶、冻干凝血酶(如Ethicon,Inc.(Somerville,New Jersey)的中所使用的冻干凝血酶)、贫血小板血浆(PPP)、富血小板血浆(PRP)、贻贝基的或衍生的粘合剂、藻酸钙、血纤维蛋白、粘合剂、图像增强剂、坏死剂、硬化剂、凝结剂、治疗剂、苏醒剂、麻醉剂、抗利尿剂、止痛剂、防腐剂、镇痉剂、强心剂、抑制剂、利尿剂、激素药剂、镇静剂、***、血管药剂、定时释放剂、药物、可吸收材料、着色剂、增塑剂、填充剂、填塞材料、触变剂、抗菌剂、缓冲剂、催化剂、填料、微颗粒、增稠剂、溶剂、天然或合成橡胶、稳定剂、pH调节剂、生物活性剂、交联剂、链转移剂、纤维增强剂、着色剂、防腐剂、甲醛还原或清除剂、和/或任何其它流体(包括液体、凝胶、膏等)、或本领域的普通技术人员参考本文的教导内容将显而易见的任何其它合适的医用流体或止血剂。
此外，密封剂170可浸渍有其它材料，诸如各种药品(包括止痛药或其它适合药品)、标记材料(诸如不透射线的或回波性的标记物和/或流体)、或者可分散在密封剂170中的任何其它适合材料。密封剂170还可为固化材料，其可在经受来自电阻带160的加热时蒸发，或者密封剂170可为液态或半固态的。如果密封剂170为液态或半固态的，则可将密封剂容纳在形成于电阻带160内的贮存器或通道内，或者容纳在位于电阻带160上方的替代结构(诸如钉仓102的部分)中。下文将参考图11来论述一个这种可供选择的通道型结构。
多个钉驱动器180位于密封剂170上方。在本例子中，钉驱动器180各自限定穿过每个钉驱动器180形成的各个钉驱动器通道182，使得一旦钉114穿过钉孔112弹出，被蒸发的材料便可穿过钉驱动器180。钉驱动器通道182可包括穿过钉驱动器180形成的孔，诸如图13中所示的驱动器孔510，或者可包括在钉驱动器180的一个或多个侧中形成的凹口，诸如图14中所示的半圆形凹口610，或者是用于钉驱动器通道182的其它适合构型。钉114位于钉驱动器180上方，且在图8A中，钉114和钉驱动器180两者均以未部署的构型示出。钉114还可以能够分离的方式(诸如通过粘合剂)固定到钉驱动器180，以确保钉114保持与钉驱动器180对齐并在钉驱动器180顶上。
现在参见图8B，其中示出了楔形滑动件41和击发杆14驱动钉114穿过组织90，同时还切断组织90。如上文所述，砧座18抵靠上部平台110压缩组织90，同时钉驱动器180通过楔形滑动件41而竖直地凸轮转换，以驱动钉114穿过组织90并进入到钉成形凹坑53中。在钉114被驱动穿过组织90时，导体150和电阻带160可保持为不活动的，但应当理解，这仅仅是任选的。事实上，在一种构型中，导体150可在切割刃48切断组织90之后随即被顺序地启动。例如，楔形滑动件41和/或击发杆14可包括传导部分，所述传导部分可电联接到导体150和/或电阻带160以便从功率源98提供电力。可供选择的是，导体150和/或电阻带160和密封剂170可设置在钉驱动器180的侧面上，或者设置在仓体102内部的如本领域的普通技术人员参考本文的教导内容将显而易见的其它位置处。
重新参见本例子，如图8C中所示，在砧座18仍压缩组织90时，将功率源98启动并施加到导体150。可通过位于器械10的柄部部分20上的双态切换开关或按钮、或者通过另一控制机构来启动功率源98，所述控制机构包括但不限于第三扳机或自动化***，所述第三扳机或自动化***从指示击发杆14的推进的传感器接收信号。此外，功率源98可在器械10外部，或者功率源98可被容纳在器械10内。在2010年6月15日公布的名称为“Post-Sterilization Programming of Surgical Instruments”的美国专利第7,738,971号中公开了针对具有内部功率源的器械10的一种仅示例性构型，所述美国专利的公开内容以引用方式并入本文。可供选择的是，功率源98可为外部功率源。
在功率源98将电力发送到导体150时，导体150通过导体触点152和带触点162将电力转移到电阻带160。电阻带160然后加热电阻带160的适当部分和密封剂170的多个部分，以使密封剂170蒸发成液滴172。应当理解，密封剂170可被液化、雾化、或转变成任何流体和/或气态形式，使得密封剂170可从仓100中排出。在本例子中，电阻加热使密封剂170蒸发，并产生将密封剂170从仓100中排出的快速压力波。此电阻加热还可以基本上类似于热喷墨的方式实现。可供选择的是，液滴172可通过振动或压力机构(诸如压电喷墨技术)而形成。随着液滴172被形成，液滴172穿过钉驱动器通道182并从钉孔112排出，如图8D中所示。在本构型中，将钉驱动器180示出为邻接上部平台110，但应当理解，可供选择的是，钉驱动器180可在蒸发密封剂170之前返回以安放在密封剂170顶上。在替代构型中，可提供单独的孔，可通过所述孔排出液滴172。在钉114已刺穿组织90并联接到所述组织之后，密封剂170的液滴172可停留在钉114和组织90上。液滴172然后在钉114和/或组织90上重构。此重构可包括再聚合(诸如针对氰基丙烯酸酯或聚丙烯酸酯)、加成聚合(诸如针对聚氨酯预聚物)和/或从液态到固态聚合物的固化。一旦液滴172发生重构，在钉114和组织90上形成的密封剂170还可辅助密封组织90。器械10的用户可将砧座18的释放延迟预定的时间量，使得液滴172在组织90和钉114上充分地重构为密封剂170。如上文所述，用户随后可改变仓100，并重复所述过程以切断并密封组织90的其它部分。
尽管已描述了仓100的一个仅示例性构造，但本领域的普通技术人员参考本文的教导内容将显而易见针对具有电阻加热部分的仓100的其它适合的替代构造。例如，如图9中所示，仓100的替代布置示出了被划分成多个单独的密封剂垫174的密封剂170。本例子的密封剂垫174在带触点162和导体触点152上方以及钉孔112下方对齐。可供选择的是，具有导体触点152的导体150可位于仓托盘104上或仓托盘104内，而电阻带160和带触点162位于仓体102上或仓体102内。另外，单个带触点162可位于支撑部分122上，且代替仓100和下钳口16上的多个触点，可将单个导体触点152定位在下钳口16的对应部分上。在另一构型中，下钳口16可包括联接到功率源98的电阻带160，而仓托盘104和/或仓体102包括其中容纳有密封剂170的多个孔。因此，在仓100联接到下钳口16时，其中容纳有密封剂170的多个孔与电阻带160的多个部分对齐，以便在将电阻带160联接到功率源98时电阻性地加热密封剂170。此外，尽管本文中所公开的仓是参考单侧缝合仓来描述的，但应当理解，此类仓可被修改成包括双侧缝合仓。
B.示例性的可供选择的电阻组件
在图10所示的另一构型中，多个单独的电阻组件200被布置在形成于上部平台110中的每个钉孔112下方。在此构型中，电阻组件200各自包括导体202、电阻带206、密封剂210、带触点208和导体触点204。密封剂210不限于密封剂，而是可包括针对密封剂170列举的任何医用流体和/或其它物品。如本例子中所示，具有导体触点204的导体202设置在仓托盘104内，而密封剂210和具有裸露式带触点208的电阻带206设置在仓体102内。因此，在将仓体102联接到仓托盘104时，带触点208电联接到导体触点204。在一个替代构型中，导体202可嵌入到下钳口14内，而密封剂210和电阻带206在仓体102和/或仓托盘104内。电引线220从导体202和电阻带206延伸穿过一个或多个引线孔222以电联接到功率源98，如上文所述。可供选择的是，以类似于PCB的方式或以如本领域的普通技术人员参考本文的教导内容将显而易见的任何其它适合方式，电引线220可被整合到下钳口16、仓托盘104、和/或仓体102的结构中。
C.示例性密封剂通道
图11中提供钉仓的另一构型。仓体102内形成有多个通道300。每个通道300包括通道头部302和通道主体304。通道主体304可延伸多种距离，使得在将钉孔分布在不同位置处时，每个通道头部302对应于一个钉孔，诸如钉孔51、112。例如，在图7所示的示例性仓100中，钉孔112在竖直狭槽106的具有交错钉孔112的任一侧上都形成三行。本例子的多个通道主体304还能够通过端口306与一个或多个其它通道主体304流体连通。端口306可用于在组装期间将密封剂320注入到通道300中，以在密封剂320固化之前贯穿多个通道300分布密封剂320，或者，如果使用了液态或半固态密封剂320，则端口306可容许多个通道300从密封剂320的共同贮存器中进行汲取。密封剂320并不限于密封剂，而是可包括针对密封剂170列举的任何医用流体和/或其它物品。然而，应当理解，端口306仅为任选的，且通道300可彼此独立，或者可通过端口306来连接通道300的多个子组。
电阻通道板310位于每个通道头部302内，使得电阻通道板310可加热对应钉孔下方的密封剂320并使其蒸发，以喷射到被缝合的组织上。电阻通道板310可能够作为独立组件，诸如电阻组件200，或者电阻通道板310可仅包括电阻带，诸如电阻带160。如果通道板310包括电阻带，那么可提供一个或多个通道板连接器312以将电阻通道板310电联接到导体和/或功率源。在本构型中，板连接器312嵌入到仓体内以电联接到单个导体，但应当理解，通道板连接器312可以如本领域的普通技术人员参考本文的教导内容将显而易见的各种其它方式来配置。
例如，板连接器312可以类似于图8A至图8D、图9和图10的带触点162的方式来配置，并从仓体102和/或仓托盘104的底部向外突起(或以其它方式暴露出来)。图12中示出了一个此种构型。包括具有板连接器312的电阻板310的通道300示出为能够在仓400的仓体402内。仓400基本上类似于仓100和仓37的构造，且仓400包括多个钉孔412、上部平台410、仓体402和竖直狭槽406。通道300与对应钉孔412对齐。在本例子中，下钳口16包括互补的端部执行器触点420，以在将仓400***到下钳口16中时使所述端部执行器触点电联接到板连接器312。可供选择的是，如根据一些上述具体实施可注意到，下钳口16可包括单个触点以电联接到仓400上的单个触点。在另一替代方案中，下钳口16可包括单个导体板以电联接到板连接器312，或者，下钳口14本身可具有电联接到板连接器312的部分。
尽管已公开了通道300和仓400的各种构型，但本领域的普通技术人员参考本文的教导内容将显而易见其它适合的构型。
D.示例性钉驱动器
现在参见图13至图14，不同的钉驱动器可与用于排出被蒸发的密封剂的前述构型一起使用。图13示出了具有钉驱动器主体502和一对对齐接片520的钉驱动器500，其中驱动器孔510形成于所述钉驱动器主体中。驱动器孔510竖直地延伸穿过钉驱动器主体502，且能够容许被蒸发的密封剂穿过仓的钉孔被排出。钉对齐接片520从钉驱动器主体520竖直地延伸，且能够在部署之前对齐钉驱动器500上的钉。对齐接片520还能够以能够分离的方式保持钉，诸如通过粘合剂或能够分离的机械连接。在另一构型中，对齐接片520可能够联接到形成于仓的上部平台(诸如上部平台110)内的接纳凹口(未示出)，使得钉驱动器500联接到上部平台且甚至在击发杆14回缩时仍保持邻接所述上部平台。在此构型中，任何前述构型均可随后被启动以将密封剂穿过驱动器孔510排出。图14中示出了可供选择的钉驱动器600。可供选择的钉驱动器600的构型基本上类似于钉驱动器500，但钉驱动器600包括一对形成在钉驱动器主体602的侧面上的半圆形凹口610，以容许密封剂穿过所述凹口并经过钉驱动器600。当然，如同本文中所述的其它元件，本领域的普通技术人员参考本文的教导内容将显而易见用于钉驱动器500、600的其它适合构型。
在图15中示出的另一构型中，一个或多个电阻带712和密封剂714嵌入到钉驱动器700中的对应腔室710内，或者联接到钉驱动器700的钉驱动器主体702。密封剂714并不限于密封剂，而是可包括针对密封剂170列举的任何医用流体和/或其它物品。在此构型中，钉驱动器700具有在钉驱动器700底表面上的多个钉驱动器触点708，但应当理解，钉驱动器触点708可位于钉驱动器700上的任何位置处。连接器722将驱动器触点708电联接到电阻带712，但应当理解，此仅为任选的，且电阻带712可整体地联接到驱动器触点708。形成于钉驱动器主体702内的一个或多个孔720能够容许被蒸发的密封剂716排出以密封钉和组织。在本构型中，驱动器触点708能够电联接到位于击发杆14和/或楔形滑动件41上的一个或多个触点。在击发杆14完全延伸(且因此来自仓的钉已从钉孔中排出)时，功率源98可施加到击发杆14上的一个或多个触点，从而触发电阻带712以蒸发密封剂714、使其穿过孔720排出。可供选择的是，如果楔形滑动件41包括触点，或者如果楔形滑动件41包括导电材料，那么功率源98可联接到楔形滑动件41，同时楔形滑动件41竖直地凸轮转移钉驱动器700。应当理解，此可使密封剂714蒸发，同时驱动钉穿过组织。此可减少密封剂714重构以密封钉和组织所需要的时间。在另一构型中，驱动器触点708可在钉驱动器主体702的一个或多个侧上，以电联接到凹坑的侧壁上的对应触点，其中钉驱动器700移动穿过所述凹坑。
尽管已公开了钉驱动器500、600、700的各种构型，但本领域的普通技术人员参考本文的教导内容将显而易见其它适合的构型。
E.用于端部执行器电联接的示例性构型
图16示出了具有一个或多个电触点800的端部执行器12，所述电触点通过连接器810联接到远程功率源，诸如功率源98。如先前提及，功率源98可位于柄部部分20内(图1A至图1B中所示)，或者功率源98可在器械10外部。在将仓***到下钳口16中时，本布置中的电触点800联接到对应仓触点，诸如仓100的仓触点130。电触点800可能够在器械10的使用期间与多个钉仓一起使用多次。尽管仅示出了一个电触点800，但应当理解，可利用不止一个电触点800。事实上，对于其中血液或其它体液可干扰一个或多个电触点800的电连接的情况而言，提供冗余的电触点800可为有利的，但应当理解，此冗余仅为任选的。此外，尽管将电触点800示出为位于下钳口16的近端附近，但本领域的普通技术人员参考本文的教导内容将显而易见电触点800在下钳口16、砧座18或击发杆14上的其它适合位置。
应当理解，本文所述的教导内容、表达方式、实施例、例子等中的任何一个或多个可与本文所述的其它教导内容、表达方式、实施例、例子等中的任何一个或多个相结合。因此下述教导内容、表达方式、实施例、例子等不应视为相对于彼此隔离。参考本文的教导内容，本领域的普通技术人员将显而易见可结合本文的教导内容的各种适合方式。此类修改形式和变型旨在包括在权利要求的范围之内。
上文所述的装置的型式可适用于由医疗专业人员进行的常规医疗处理和手术中、以及可适用于机器人辅助的医疗处理和手术中。
上文所述的型式可被设计为单次使用后丢弃，或者它们可被设计为可使用多次。在上述任一种或两种情况下，均可对这些型式进行修复，以便在使用至少一次后重复使用。修复可包括如下步骤的任意组合：拆卸装置、然后清洗或置换特定零件、以及随后重新组装。具体地讲，可拆卸所述装置的一些型式，并且可选择性地以任何组合形式来替换或取出所述装置的任意数量的特定部件或零件。清洗和/或替换特定部分后，该装置的一些型式可以在修复设施处重新组装或者在即将进行手术前由使用者重新组装以便随后使用。本领域的技术人员将了解，修复装置时可利用多种技术进行拆卸、清洁/替换和重新组装。这些技术的使用以及所得的修复装置均在本发明的范围内。
仅以举例的方式，本文所述的型式可在手术之前和/或之后进行消毒。在一种消毒技术中，将装置布置在闭合并密封的容器中，例如，布置在塑料袋或TYVEK袋中。然后可将容器和装置布置在能够穿透该容器的辐射场中，诸如γ辐射、X射线或高能电子。辐射可杀死装置上和容器中的细菌。消毒后的装置随后可存放于无菌容器中，以备以后使用。还可使用本领域已知的任何其它技术对装置消毒，所述技术包括(但不限于)β辐射或γ辐射、环氧乙烷或蒸汽消毒。
尽管已在本发明中示出和描述了多个型式，但本领域的普通技术人员可在不脱离本发明范围的前提下进行适当修改以对本文所述的方法和***进行进一步改进。已经提及了若干此类潜在的修改形式，并且其它修改形式对于本领域的技术人员而言将显而易见。例如，上文讨论的例子、型式、几何形状、材料、尺寸、比率、步骤等均是示例性的而非必需的。因此，本发明的范围应以下面的权利要求书考虑，并且应理解为不限于说明书和附图中示出和描述的结构和操作细节。
Claims (19)
1.一种用于内窥镜外科用途的设备，所述设备包括：
(a)器械，所述器械包括：
i.柄部部分，
ii.端部执行器，所述端部执行器包括：
(1)下钳口；
(2)可枢转砧座；和
(b)能够***到所述端部执行器中的钉仓，所述钉仓包括：
i.具有上部平台的仓体，所述上部平台包括：
(1)形成于所述上部平台中并且从所述上部平台的近端纵向延伸的竖直狭槽，其中切割刃能够穿过所述竖直狭槽纵向平移，和
(2)多个钉孔，
ii.能够相对于所述仓体竖直地平移的一个或多个钉驱动器，其中，
每个钉驱动器包括驱动器通道,所述驱动器通道被构造成能够提供用于流体连通的通路，
iii.设置在所述一个或多个钉驱动器上方的多个钉，其中所述多个钉能够相对于所述仓体竖直地平移，
iv.设置在所述仓体内的电阻构件，
v.具有至少部分与所述电阻构件连通的医用流体，其中，所述电阻构件能够操作以提供通过所述一个或多个钉驱动器的驱动器通道的医用流体的连通。
2.根据权利要求1所述的设备，其中所述电阻构件包括电阻带。
3.根据权利要求2所述的设备，其中所述下钳口包括导体，其中所述导体选择性地联接到功率源。
4.根据权利要求3所述的设备，其中所述电阻带包括带触点，其中所述导体包括导体触点，其中所述带触点能够操作以电联接到所述导体触点。
5.根据权利要求4所述的设备，其中所述带触点的至少部分与所述多个钉孔基本竖直地对齐。
6.根据权利要求1所述的设备，其中所述医用流体包括多个密封剂垫。
7.根据权利要求6所述的设备，其中所述密封剂垫中的每一个的至少部分与所述多个钉孔基本竖直地对齐。
8.根据权利要求1所述的设备，其中每个驱动器通道包括竖直地延伸穿过所述一个或多个钉驱动器的孔。
9.根据权利要求1所述的设备，其中每个驱动器通道包括在所述一个或多个钉驱动器的一侧上竖直地延伸的凹口。
10.根据权利要求1所述的设备，其中所述医用流体包括可解聚的氰基丙烯酸酯或可喷涂的热塑性聚氨基甲酸酯。
11.根据权利要求1所述的设备，其中所述医用流体是可蒸发的药剂或药物。
12.根据权利要求1所述的设备，其中所述仓体包括形成于所述仓体的基底部分中的仓通道，其中所述电阻构件和所述医用流体设置在所述仓通道内。
13.根据权利要求1所述的设备，还包括联接到所述电阻构件并且能够操作以将所述电阻构件电联接到功率源的触点。
14.根据权利要求13所述的设备，其中所述仓体包括具有支撑部分的近端，并且其中所述触点位于所述支撑部分上。
15.根据权利要求13所述的设备，其中所述功率源容纳在所述器械内。
16.一种用于内窥镜外科用途的设备，所述设备包括：
(a)具有上部平台的仓体，所述上部平台包括：
i.形成于所述上部平台中并且从所述上部平台的近端纵向延伸的竖直狭槽，和
ii.多个钉孔；
(b)能够相对于所述仓体竖直地平移的一个或多个钉驱动器；
(c)多个钉，其中所述多个钉能够相对于所述仓体竖直地平移；
(d)设置在所述仓体内的多个电阻构件；
(e)医用流体，至少部分所述医用流体设置在所述多个电阻构件和所述一个或多个钉驱动器之间；和
(f)联接到所述多个电阻构件并且能够操作以将所述多个电阻构件电联接到功率源的触点。
17.根据权利要求16所述的设备，还包括形成于所述仓体中的多个通道，其中所述多个电阻构件设置在所述多个通道内。
18.根据权利要求17所述的设备，还包括端口，其中所述端口能够提供所述多个通道中的两个或更多个之间的流体连通。
19.根据权利要求17所述的设备，其中所述医用流体的至少部分容纳在贮存器内，所述贮存器与所述多个通道中的一个或多个通道流体连通。
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-
2011
- 2011-09-13 US US13/230,994 patent/US8998060B2/en active Active
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2012
- 2012-09-10 IN IN1850DEN2014 patent/IN2014DN01850A/en unknown
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- 2012-09-10 CN CN201280055446.3A patent/CN103930046B/zh not_active Expired - Fee Related
- 2012-09-10 EP EP12762150.6A patent/EP2755570B1/en not_active Not-in-force
- 2012-09-10 JP JP2014530716A patent/JP6072041B2/ja not_active Expired - Fee Related
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- 2012-09-10 RU RU2014114496A patent/RU2624332C2/ru not_active IP Right Cessation
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Also Published As
| Publication number | Publication date |
|---|---|
| JP6072041B2 (ja) | 2017-02-01 |
| MX351214B (es) | 2017-10-04 |
| US8998060B2 (en) | 2015-04-07 |
| CN103930046A (zh) | 2014-07-16 |
| RU2014114496A (ru) | 2015-10-20 |
| BR112014005984B1 (pt) | 2020-12-15 |
| RU2624332C2 (ru) | 2017-07-03 |
| US20130062393A1 (en) | 2013-03-14 |
| EP2755570A1 (en) | 2014-07-23 |
| BR112014005984A2 (pt) | 2017-04-04 |
| MX2014002975A (es) | 2015-03-19 |
| WO2013039818A1 (en) | 2013-03-21 |
| JP2014531239A (ja) | 2014-11-27 |
| EP2755570B1 (en) | 2018-12-05 |
| IN2014DN01850A (zh) | 2015-05-15 |
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