CN104822330A - 具有沿着不同周边的变化的钉宽度的外科缝合器 - Google Patents

具有沿着不同周边的变化的钉宽度的外科缝合器 Download PDF

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CN104822330A
CN104822330A CN201380063512.6A CN201380063512A CN104822330A CN 104822330 A CN104822330 A CN 104822330A CN 201380063512 A CN201380063512 A CN 201380063512A CN 104822330 A CN104822330 A CN 104822330A
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CN104822330B (zh
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J·P·米萨默
J·H·亚历山大三世
C·C·米勒
J·R·莱斯科
J·S·梅里特
T·S·V·怀登豪斯
F·E·谢尔顿四世
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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
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis in a single operation
    • A61B17/1155—Circular staplers comprising a plurality of staples
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B17/0644—Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07235—Stapler heads containing different staples, e.g. staples of different shapes, sizes or materials
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07257—Stapler heads characterised by its anvil
    • A61B2017/07264—Stapler heads characterised by its anvil characterised by its staple forming cavities, e.g. geometry or material

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  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
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Abstract

一种用于缝合组织的设备包括头部组件、与所述头部组件连通的柄部致动器和钉仓。所述头部组件能够操作以响应于致动所述柄部致动器而驱动多个钉。所述钉仓与所述头部组件连通。所述钉仓包括第一环形孔圈和第二孔圈。所述第一环形孔圈包括具有不同于所述第二环形孔圈的尺寸的孔，使得所述孔适应具有不同的冠部长度的钉。所述钉可包括能够提供更大的钉器件封装并且具有钉接收开口(704)和突片(706、708)的垫(700)。

Description

具有沿着不同周边的变化的钉宽度的外科缝合器
背景技术
在一些背景下，外科医生可能希望将外科器械穿过患者的腔道口而定位，并且使用该器械来调整、定位、附接患者体内的组织和/或以其他方式与患者体内的组织相互作用。例如，在一些外科手术中，以清除不需要的组织或者出于其他原因而可切割并移除胃肠道的部分。一旦所需组织被移除，则剩余的部分可能需要重新联接在一起。一种用于完成这些吻合手术的此类工具是穿过患者的腔道口***的圆形缝合器。
圆形外科缝合器的例子描述于：1993年4月27公布的名称为“SurgicalAnastomosis Stapling Instrument(科吻合术缝合器械)”的美国专利5,205,459；1993年12月21日公布的名称为“Surgical Anastomosis StaplingInstrument”(外科吻合术缝合器械)的美国专利5,271,544；1994年1月4日公布的名称为“Surgical Anastomosis Stapling Instrument”(外科吻合术缝合器械)的美国专利5,275,322；1994年2月15日公布的名称为“SurgicalAnastomosis Stapling Instrument”(外科吻合术缝合器械)的美国专利5,285,945；1994年3月8日公布的名称为“Surgical Anastomosis StaplingInstrument”(外科吻合术缝合器械)的美国专利5,292,053；1994年8月2日公布的名称为“Surgical Anastomosis Stapling Instrument”(外科吻合术缝合器械)的美国专利5,333,773；1994年9月27日公布的名称为“SurgicalAnastomosis Stapling Instrument”(外科吻合术缝合器械)的美国专利5,350,104；以及1996年7月9日公布的名称为“Surgical AnastomosisStapling Instrument”(外科吻合术缝合器械)的美国专利5,533,661。上文所引用的美国专利中的每个中的公开内容均以引用方式并入本文。一些这样的缝合器能够操作以向下夹紧在组织层上，切透夹紧的组织层，并驱动钉穿过组织层，以在组织层的被切断的端附近将切断的组织层基本上密封在一起，从而接合解剖内腔的两个切断的端。
仅作为示例性的附加的其他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”(内部器官缝合器的凹坑构型)的美国专利4,805,823；1995年5月16日公布的名称为“Surgical Stapler and Staple Cartridge(外科缝合器和钉仓)”的美国专利号5,415,334；1995年11月14日公布的名称为“Surgical Stapler Instrument(外科缝合器械)”的美国专利号5,465,895；1997年1月28日公布的名称为“Surgical Stapler Instrument(外科缝合器械)”的美国专利号5,597,107；1997年5月27日公布的名称为“SurgicalInstrument(外科器械)”的美国专利号5,632,432；1997年10月7日公布的名称为“Surgical Instrument(外科器械)”的美国专利号5,673,840；1998年1月6日公布的名称为“Articulation Assembly for Surgical Instruments(用于外科器械的关节运动组件)”的美国专利号5,704,534；1998年9月29日公布的名称为“Surgical Clamping Mechanism(外科夹紧机构)”的美国专利号5,814,055；2005年12月27日公布的名称为“Surgical StaplingInstrument Incorporating an E-Beam Firing Mechanism(并入有电子束击发机构的外科缝合器械)”的美国专利号6,978,921；2006年2月21日公布的名称为“Surgical Stapling Instrument Having Separate Distinct Closing and FiringSystems(具有的单独的分立闭合及击发***的外科缝合器械)”的美国专利号7,000,818；2006年12月5日公布的名称为“Surgical StaplingInstrument having a Firing Lockout for an Unclosed Anvil(具有用于未闭合砧座的击发锁定的外科缝合器械)”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-StrokeFiring Mechanism with a Flexible Rack(并入有具有柔性齿条的多冲程击发机构的外科缝合器械)”的美国专利号7,303,108；2008年5月6日公布的名称为“Surgical Stapling Instrument Incorporating a Multistroke FiringMechanism Having a Rotary Transmission(并入有具有旋转传输的多冲程击发机构的外科缝合器械)”的美国专利号7,367,485；2008年6月3日公布的名称为“Surgical Stapling Instrument Having a Single Lockout Mechanism forPrevention of Firing(具有用于防止击发的单个锁定机构的外科缝合器械)”的美国专利号7,380,695；2008年6月3日公布的名称为“ArticulatingSurgical Stapling Instrument Incorporating a Two-Piece E-Beam FiringMechanism(并入有两件式电子束击发机构的关节运动式外科缝合器械)”的美国专利号7,380,696；2008年7月29日公布的名称为“Surgical Staplingand Cutting Device(外科缝合和切割装置)”的美国专利号7,404,508；2008年10月14日公布的名称为“Surgical Stapling Instrument having MultistrokeFiring with Opening Lockout(具有带开口锁定的多冲程击发的外科缝合器械)”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 Use with a Stapling Device”的美国专利号7,721,930。上文所引用的美国专利中的每个中的公开内容均以引用方式并入本文。虽然上文所涉及的外科缝合器被描述为用于内窥镜式手术，但应理解，这样的外科缝合器也可用于开腹手术和/或其它非内窥镜式手术。
虽然已制造并使用各种类型的外科缝合器械，但是据信，在本发明人之前还无人研制出或使用所附权利要求书中所描述的发明。
附图说明
本说明书后附的权利要求书特别指出并明确主张本技术，但据信从下面结合附图对某些例子所作的描述将会更好地理解本技术，附图中类似的参考标号表示相同元件，其中：
图1示出了示例性圆形缝合外科器械的侧正视图；
图2A示出了图1的器械的示例性缝合头部组件的放大纵向剖面图，其示出了处于打开位置的示例性砧座；
图2B示出了图2A的缝合头部组件的放大纵向剖面图，其示出了处于闭合位置的砧座；
图2C示出了图2A的缝合头部组件的放大纵向剖面图，其示出了处于击发位置的示例性钉驱动器和刀片；
图3示出了抵靠砧座而形成的示例性钉的放大局部剖面图；
图4A示出了图1的外科器械的示例性致动器柄部组件的放大侧正视图，其中主体的一部分被移除，其示出了处于未击发位置的触发器和处于锁定位置的锁定结构；
图4B示出了图4A的致动器柄部组件的放大侧正视图，其示出了处于击发位置的触发器和处于解锁位置的锁定结构；
图5示出了图1的外科器械的示例性指示器组件的放大局部透视图，其示出了指示器窗口和指示器杠杆；
图6示出了图5的指示器窗口的图解视图，其示出了示例性指示器条和示例性对应钉表示；
图7示出了与图2A的缝合头部组件一起使用的示例性钉仓的放大透视图；
图8示出了与图7的钉仓一起使用的示例性大号钉的侧正视图；
图9示出了与图7的钉仓一起使用的示例性中号钉的侧正视图；
图10示出了与图7的钉仓一起使用的示例性小号钉的侧正视图；
图11示出了具有装载到钉仓中的大号钉、中号钉和小号钉的图7的钉仓的放大顶视图；
图12示出了示例性钉支撑元件的放大透视图；
图13示出了配备有图12的钉支撑元件的示例性外侧钉的侧正视图；
图14示出了配备有中号钉支撑元件的示例性中号钉的侧正视图；
图15示出了配备有小号钉支撑元件的示例性内侧钉的侧正视图；
图16示出了装有配备有钉支撑元件的大号钉、中号钉和小号钉的示例性钉仓的放大顶视图；
图17示出了具有纵向延伸的的突片的另选的示例性钉支撑元件的放大顶视图；
图18示出了具有横向延伸的的突片的另选的示例性钉支撑元件的放大顶视图；
图19示出了具有横向延伸的突片和纵向延伸的的突片的另选的示例性钉支撑元件的放大顶视图；并且
图20示出了示例性钉仓中的图19的钉支撑元件的透视图。
附图并非旨在以任何方式进行限制，并且预期本技术的各种实施例可以多种其他方式进行，包括在附图中不可避免地描绘的那些方式。并入本说明书中并形成其一部分的附图示出了本技术的若干方面，并连同说明书用于解释本技术的原理；然而，应当理解，本技术不限于所示出的精确布置方式。
具体实施方式
本技术的某些示例的下述描述不应用于限制其范围。通过以下举例说明(被认为是用于实施本技术的最佳方式之一)，本技术的其他例子、特征、方面、实施例和优点对于本领域技术人员将变得显而易见。正如将会意识到的，本文所述的技术包括其他不同且明显的方面，这些都未脱离本技术。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.示例性圆形缝合外科器械的概述
图1-6示出了示例性圆形外科缝合器械10，其具有缝合头部组件20、轴组件60和致动器柄部组件70，其中的每一个将在下文中更详细地描述。轴组件60从致动器柄部组件70朝远侧延伸，并且缝合头部组件20联接到轴组件60的远侧端部。简而言之，致动器柄部组件70能够操作以致动缝合头部组件20的钉驱动器24，从而将多个钉66从缝合头部组件20中驱动出来。钉66由附接在器械10的远侧端部处的砧座40弯曲以形成完整的钉。因此，可使用器械10来缝合图2A-2C中示出的组织2。
在该例子中，器械10包括闭合***和击发***。闭合***包括套管针38、套管针致动器39和旋转旋钮98。砧座40可联接到套管针38的远侧端部。旋转旋钮98能够操作以相对于缝合头部组件20纵向地平移套管针38，从而当砧座40联接到套管针38时平移砧座40以夹紧砧座40与缝合头部组件20之间的组织。击发***包括触发器74、触发器致动组件84、驱动器致动器64和钉驱动器24。钉驱动器24包括刀36，当钉驱动器24被纵向地致动时，所述刀能够切断组织。此外，钉66被定位在钉驱动器24的多个钉驱动构件30的远侧，使得当钉驱动器24被纵向地致动时钉驱动器24还朝远侧驱动钉66。因此，当触发器74被致动并且触发器致动组件84经由驱动器致动器64致动钉驱动器24时，刀36和构件30基本上同时切断组织2并且相对于缝合头部组件20朝远侧驱动钉66进入组织。现在将更详细地描述闭合***和击发***的部件和功能。
A.示例性砧座
如图1-2C所示，砧座40可选择性地联接到器械10以提供这样的表面：钉66可抵靠该表面而弯曲以缝合接收在缝合头部组件20与砧座40之间的材料。该例子的砧座40可选择性地联接到相对于缝合头部组件20朝远侧延伸的套管针或尖杆38。参见图2A-2C，砧座40经由砧座40的近侧轴42的联接可选择性地联接到套管针38的远侧末端。砧座40包括大致圆形的砧座头48以及从砧座头48朝近侧延伸的近侧轴42。在示出的例子中，近侧轴42包括管状构件44，该管状构件具有弹性偏置保持夹46以选择性地将砧座40联接到套管针38，虽然这仅为可选的，但是应当理解还可使用其他用于将砧座40联接到套管针38的保持特征结构。例如，可使用C形夹、夹钳、手术线、销、粘合剂等将砧座40联接到套管针38。此外，虽然砧座40被描述为可选择性地联接到套管针38，但是在一些型式中，近侧轴42可包括单向联接特征结构以使得砧座40一旦附接，砧座40便无法从套管针38移除。仅为示例性的单向特征结构包括倒钩、单向按扣、筒夹、衬圈、突片、带等等。当然，参考本文的教导内容，用于将砧座40联接到套管针38的另一些其他构型对于本领域的普通技术人员而言将是显而易见的。例如，套管针38可替换为中空轴，并且近侧轴42可包括能够***中空轴中的尖锐杆。
该例子的砧座头48包括形成于砧座头48的近侧面50中的多个钉成形凹坑52。因此，如图2C所示，当砧座40处于闭合位置并且钉66从缝合头部组件20中被驱动出来进入钉成形凹坑52中时，钉66的腿部68被弯曲以形成完整的钉。应当理解，钉成形凹坑52仅为可选的，并且在一些型式中可以省略。
在砧座40作为独立部件的情况下，应当理解，砧座40在联接到缝合头部组件20之前可被***并且固定到组织2的一部分。仅以举例的方式，砧座40可被***并且固定到组织2的第一管状部分，而器械10被***并且固定到组织2的第二管状部分。例如，组织2的第一管状部分可缝合到砧座40的一部分或者围绕砧座40的一部分缝合，而组织2的第二管状部分可缝合到套管针38或者围绕套管针38缝合。
如图2A所示，砧座40然后联接到套管针38。该例子的套管针38显示处于最远侧致动位置。套管针38的此类延伸位置可在砧座40附接之前提供组织2可联接的更大区域。此外，套管针38的延伸位置还可提供砧座40与套管针38的更容易的附接。套管针38还包括渐缩的远侧末端。此类末端能够穿刺入组织和/或有助于砧座40***到套管针38上，但是该渐缩的远侧末端仅为可选的。例如，在其他型式中，套管针38可具有钝的末端。除此之外或作为另外一种选择，套管针38可包括磁性部分(未示出)，所述磁性部分可吸引砧座40朝套管针38。当然，参考本文的教导内容，砧座40和套管针38的另一些构型和布置方式对于本领域的普通技术人员而言将是显而易见的。
当砧座40联接到套管针38时，砧座40的近侧面与缝合头部组件20的远侧面之间的距离限定间隙距离d。该例子的套管针38能够经由位于致动器柄部组件70的近侧端部处的调节旋钮98而相对于缝合头部组件20纵向平移，如将在下文更详细地进行描述。因此，当砧座40联接到套管针38时，调节旋钮98的旋转通过相对于缝合头部组件20致动砧座40来扩大或减小间隙距离d。例如，如图2A-2B依次所示，砧座40被示为相对于致动器柄部组件70从初始打开位置朝近侧致动到闭合位置，从而减小间隙距离d以及待连接的组织2的两部分之间的距离。如图2C所示，一旦间隙距离d进入预定范围之内，缝合头部组件20便可被击发以缝合并切断砧座40与缝合头部组件20之间的组织2。缝合头部组件20能够操作以通过使用者枢转致动器柄部组件70的触发器74来缝合并切断组织2，如将在下文更详细地进行描述。
如上所述，间隙距离d对应于砧座40与缝合头部组件20之间的距离。当器械10被***到患者体内时，该间隙距离d可能不容易看到。因此，示于图5-6的可运动指示器条110被设置为通过定位成与触发器74相对的指示器窗口120可见。指示器条110能够操作以响应于调节旋钮98的旋转而运动，使得指示器条110的位置代表间隙距离d。如图6所示，指示器窗口120还包括指示砧座间隙处于期望的操作范围(例如绿色区域或“绿区”)内的标尺130，以及在标尺130的每个末端处的对应的钉压缩表示。仅以举例的方式，如图6所示，第一钉图像132示出了大的钉高度，而第二钉图像134示出了小的钉高度。因此，使用者可经由指示器条110和标尺130来观察所联接的砧座40相对于缝合头部组件20的位置。因此，使用者可随后经由调节旋钮98来调整砧座40的定位。
重新参见图2A-2C，使用者围绕管状构件44缝合组织2的一部分，使得砧座头48位于待缝合的组织2的一部分内。当组织2附接到砧座40时，保持夹46和管状构件44的一部分从组织2突起，使得使用者可将砧座40联接到套管针38。在组织2联接到套管针38和/或缝合头部组件20的另一部分的情况下，使用者将砧座40附接到套管针38，并且朝向缝合头部组件20朝近侧致动砧座40以减小间隙距离d。一旦器械10处于操作范围内，使用者然后便将组织2的末端缝合在一起，从而形成组织2的基本上邻接的管状部分。
砧座40可根据至少一些以下专利的教导内容来进一步构造：美国专利5,205,459、美国专利5,271,544；美国专利5,275,322；美国专利5,285,945；美国专利5,292,053；美国专利5,333,773；美国专利5,350,104；美国专利5,533,661，所述专利的公开内容均以引用的方式并入本文；和/或参考本文的教导内容，根据对于本领域的普通技术人员而言将是显而易见的其他构型来进一步构造。
B.示例性缝合头部组件
该例子的缝合头部组件20联接到轴组件60的远侧端部，并且包括接收可滑动钉驱动器24的管状壳体22和接收在钉凹坑32内的多个钉66。钉66和钉凹坑32以圆形阵列围绕管状壳体22设置。在该例子中，钉66和钉凹坑32被设置成一对同心的环形的钉排66和钉凹坑32。钉驱动器24能够操作以响应于致动器柄部组件70的触发器74的旋转而在管状壳体22内纵向地致动。如图2A-2C所示，钉驱动器24包括具有套管针开口26、中央凹槽28、以及围绕中央凹槽28周向地设置的多个构件30，并且相对于轴组件60朝远侧延伸的扩口圆柱形构件。每个构件30能够接触和接合钉凹坑32内的多个钉66的对应钉66。因此，当钉驱动器24相对于致动器柄部组件70朝远侧致动时，每个构件30将对应的钉66穿过形成于管状壳体22远侧端部的钉孔34从其钉凹坑32中驱动出来。因为每个构件30从钉驱动器24延伸，所以多个钉66基本上同时被从缝合头部组件20中驱动出来。当砧座40处于闭合位置时，钉66被驱动进入钉成形凹坑52以弯曲钉66的腿部68，从而缝合位于砧座40与缝合头部组件20之间的材料。图3示出了一个仅为示例性的钉66，其由构件30驱动进入砧座40的钉成形凹坑32以弯曲腿部68。
钉驱动器24还包括圆柱形刀36，所述圆柱形刀与套管针开口26同轴并且从钉凹坑32***。在该例子中，圆柱形刀36被设置在中央凹槽28内以利用钉驱动器24朝远侧平移。如上所述，当砧座40被固定到套管针38时，砧座头48提供表面，圆柱形刀36抵靠该表面切割接收在砧座40与缝合头部组件20之间的材料。在一些型式中，砧座头48可包括用于圆柱形刀36的凹槽(未示出)以有助于切割材料(例如，通过提供协作剪切边缘)。除此之外或作为另外一种选择，砧座头48可包括与圆柱形刀36错开的一个或多个相对的圆柱形刀(未示出)，使得可提供剪刀型切割动作。参考本文的教导内容，另一些其他构型对于本领域的普通技术人员而言将是显而易见的。因此，缝合头部组件20能够操作以响应于通过致动器柄部组件70的致动而基本上同时缝合和切割组织2。
当然，缝合头部组件20可根据至少一些以下专利的教导内容来进一步构造：美国专利5,205,459、美国专利5,271,544；美国专利5,275,322；美国专利5,285,945；美国专利5,292,053；美国专利5,333,773；美国专利5,350,104；美国专利5,533,661，所述专利的公开内容均以引用的方式并入本文；和/或参考本文的教导内容，根据对于本领域的普通技术人员而言将是显而易见的其他构型来进一步构造。
如前文所述，钉驱动器24包括套管针开口26。套管针开口26能够允许套管针38相对于缝合头部组件20和/或轴组件60纵向滑动。如图2A-2C所示，套管针38联接到套管针致动器39，使得套管针38可经由旋转旋钮98的旋转被纵向地致动，如将参考致动器柄部组件70在下文更详细地进行描述。在该例子中，套管针致动器39包括联接到套管针38的伸长的、相对刚性的轴，但是这仅为可选的。在一些型式中，致动器39可包括纵向刚性材料同时允许侧向弯曲，使得器械10的部分在使用期间可选择性地弯曲或弯折；或者器械10可包括预置的弯曲轴组件60。一种仅为示例性的材料是镍钛诺。当砧座40联接到套管针38时，套管针38和砧座40能够经由致动器39平移以调整砧座40与缝合头部组件20之间的间隙距离d。参考本文的教导内容，用于致动器39纵向地致动套管针38的另一些构型对于本领域的普通技术人员而言将是显而易见的。
C.示例性轴组件
如图2A-2C所示，缝合头部组件20和套管针38被定位在轴组件60的远侧端部。该例子的轴组件60包括外部管状构件62和驱动器致动器64。外部管状构件62联接到缝合头部组件20的管状壳体22和致动器柄部组件70的主体72，从而为其中的致动部件提供机械接地。驱动器致动器64的近侧端部联接到致动器柄部组件70的触发器致动组件84，如下所述。驱动器致动器64的远侧端部联接到钉驱动器24，使得触发器74的旋转纵向地致动钉驱动器24。如图2A-2C所示，驱动器致动器64包括具有开放纵向轴线的管状构件，使得联接到套管针38的致动器39可在驱动器致动器64内且相对于驱动器致动器64纵向地致动。当然，应当理解，参考本文的教导内容，可如对于本领域的普通技术人员而言将显而易见地一样将其他部件设置在驱动器致动器64内。
轴组件60可根据至少一些以下专利的教导内容来进一步构造：美国专利5,205,459、美国专利5,271,544；美国专利5,275,322；美国专利5,285,945；美国专利5,292,053；美国专利5,333,773；美国专利5,350,104；美国专利5,533,661，所述专利的公开内容均以引用的方式并入本文；和/或参考本文的教导内容，根据对于本领域的普通技术人员而言将是显而易见的其他构型来进一步构造。
D.示例性致动器柄部组件
现在参见图4A-5，致动器柄部组件70包括主体72、触发器74、锁定特征结构82、触发器致动组件84和套管针致动组件90。该例子的触发器74以能够枢转的方式安装到主体72，并且联接到触发器致动组件84，使得触发器74从未击发位置(示于图4A)到击发位置(示于图4B)的旋转致动上文所述的驱动器致动器64。弹簧78联接到主体72和触发器74以朝未击发位置来偏置触发器74。锁定特征结构82是联接到主体72的可枢转构件。在第一锁定位置中，锁定特征结构82向上枢转并且远离主体72，使得锁定特征结构82接合触发器74并且通过使用者来机械抵抗触发器74的致动。在第二解锁位置中，例如图1和4B所示，锁定特征结构82向下枢转，使得触发器74可被使用者致动。因此，在锁定特征结构82处于第二位置的情况下，触发器74可接合触发器致动组件84以击发器械10。
如图4A-4B所示，该例子的触发器致动组件84包括与驱动器致动器64的近侧端部接合的可滑动触发器滑架86。滑架86包括在滑架86近侧端部上的一组突片88以保持并接合从触发器74延伸的一对触发器臂76。因此，当触发器74被枢转时，滑架86被纵向地致动并将纵向运动传递至驱动器致动器64。在示出的例子中，滑架86固定地联接到驱动器致动器64的近侧端部，但是这仅为可选的。实际上，在一个仅为示例性的替代方案中，滑架86可仅邻接驱动器致动器64，同时远侧弹簧(未示出)相对于致动器柄部组件70朝近侧偏置驱动器致动器64。
触发器致动组件84可根据至少一些以下专利的教导内容来进一步构造：美国专利5,205,459、美国专利5,271,544；美国专利5,275,322；美国专利5,285,945；美国专利5,292,053；美国专利5,333,773；美国专利5,350,104；美国专利5,533,661，所述专利的公开内容均以引用的方式并入本文；和/或参考本文的教导内容，根据对于本领域的普通技术人员而言将是显而易见的其他构型来进一步构造。
主体72还接收套管针致动组件90，所述套管针致动组件能够响应于调节旋钮98的旋转而纵向地致动套管针38。如图4A-5最佳显示，该例子的套管针致动组件90包括调节旋钮98、沟槽状柄94和套管92。该例子的沟槽状柄94位于套管针致动器39的远侧端部，但是应当理解，沟槽状柄94和套管针致动器39可以作为另外一种选择为接合以传递纵向运动的独立部件。调节旋钮98由主体72的近侧端部可旋转地支撑，并且能够操作以经由内部突片(未示出)使与沟槽状柄94接合的套管92旋转。该例子的沟槽状柄94包括形成于沟槽状柄94的外表面中的连续的沟槽96。因此，当调节旋钮98旋转时，内部突片搭乘在沟槽96内，并且沟槽状柄94相对于套管92被纵向地致动。由于沟槽状柄94位于套管针致动器39的远侧端部处，因此沿第一方向旋转调节旋钮98将相对于致动器柄部组件70朝远侧推进套管针致动器39。因此，砧座40与缝合头部组件20之间的间隙距离d增加。通过在相反的方向上旋转调节旋钮98，套管针致动器39相对于致动器柄部组件70被朝近侧致动，以减小砧座40与缝合头部组件20之间的间隙距离d。因此，套管针致动组件90能够操作以响应于旋转调节旋钮98而致动套管针38。当然，参考本文的教导内容，套管针致动组件90的其他构型对于本领域的普通技术人员而言将是显而易见的。
该例子的沟槽96包括多个不同部分96A,96B,96C，所述不同部分每轴向距离具有不同的节距或不同数目的沟槽。本发明的沟槽96被分成远侧部分96A、中间部分96B和近侧部分96C。如图5所示，远侧部分96A包括细节距或在沟槽状柄94的短的轴向距离上的很多沟槽，使得需要调节旋钮98的大量旋转来横穿短的轴向距离。中间部分96B包括每轴向距离具有相比之下较粗节距或较少沟槽的部分，使得需要相对较少的旋转来横穿长的轴向距离。因此，间隙距离d可通过调节旋钮98相对较少的旋转而快速减小。该例子的近侧部分96C基本上类似于远侧部分96A，并且包括细节距或在沟槽状柄94的短的轴向距离上的很多沟槽，使得需要大量旋转来横穿短的轴向距离。当砧座40基本上靠近缝合头部组件20时，该例子的近侧部分96C被定位在套管92内，使得指示器条110在指示器窗口120内沿着标尺130运动以指示砧座间隙处于期望的操作范围内，如将在下文进行更详细的描述。因此，当突片位于沟槽96的近侧部分96C内时，调节旋钮98的每次旋转可少量减小间隙距离d以提供微调。
套管针致动组件90可根据至少一些以下专利的教导内容来进一步构造：美国专利5,205,459、美国专利5,271,544；美国专利5,275,322；美国专利5,285,945；美国专利5,292,053；美国专利5,333,773；美国专利5,350,104；美国专利5,533,661，所述专利的公开内容均以引用的方式并入本文；和/或参考本文的教导内容，根据对于本领域的普通技术人员而言将是显而易见的其他构型来进一步构造。
在示于图4A-4B的例子中，U形夹具100附接到位于沟槽状柄94远侧的套管针致动器39的中间部分。U形夹具100与主体72的一部分接合以基本上防止当调节旋钮98旋转时套管针致动器39围绕其轴线旋转。U形夹具100还包括在其相对侧的每一侧上的用于接收附接构件(例如螺钉、螺桩、销、夹具等)的伸长狭槽102，从而出于相对于标尺130校准指示器条110的目的而相对于套管针致动器39选择性地调整U形夹具100的伸长狭槽102的纵向位置。
如图5所示，致动器柄部组件70还包括能够接合并枢转指示器104的指示器托架140。该例子的指示器托架140可相对于主体72并沿着形成于主体72上的一对狭槽滑动。指示器托架140包括矩形板144、指示器臂146和成角度法兰142。成角度法兰142形成在矩形板144的近侧端部处，并且包括孔(未示出)以可滑动地安装到套管针致动器39和/或沟槽状柄94上。卷簧150***法兰142与凸台152之间，以便抵靠U形夹具100来偏置法兰142。因此，当U形夹具100利用套管针致动器39和/或沟槽状柄94朝远侧致动时，卷簧150推动指示器托架140与U形夹具100一起朝远侧行进。此外，当套管针致动器39和/或沟槽状柄94朝近侧平移时，U形夹具100将指示器托架140相对于凸台152朝近侧推动，从而压缩卷簧150。当然，应当理解，在一些型式中，指示器托架140可固定地附接到套管针致动器39和/或沟槽状柄94。
在该例子中，当指示器托架140处于不对应于当砧座间隙在期望的操作范围(例如绿色区域或“绿区”)内的纵向位置时，锁定特征结构82的一部分邻接指示器托架140的表面141。当砧座间隙在期望的操作范围(例如绿色区域或“绿区”)内时，指示器托架140变窄以在指示器臂146的任一侧上提供一对间隙145，该指示器臂允许锁定特征结构82枢转，从而释放触发器74。因此，锁定特征结构82和指示器托架140可基本上防止使用者释放和操作触发器74，直至砧座40处于预定操作范围内。当然，应当理解，锁定特征结构82在一些型式中可以全部省去。
如上文所简要描述的，该操作范围可经由抵靠标尺130所示的指示器104的指示器条110从视觉上传达给使用者。朝远侧突出的指示器臂146在指示器托架140的远侧端部处，该指示器臂终止于侧向突出的指状件148处以用于控制指示器104的运动。如图5最佳显示，指示器臂146和指状件148能够接合指示器104的突片106，使得当指示器托架140被纵向地致动时指示器104被枢转。在该例子中，指示器104在指示器104的第一端部处以能够枢转的方式联接到主体72，但是这仅为可选的，并且参考本文的教导内容，指示器104的其他枢转点对于本领域的普通技术人员而言将是显而易见的。指示器条110被定位在指示器104的第二端部上，使得指示器条110响应于指示器托架140的致动而运动。因此，如上所述，指示器条110通过指示器窗口120抵靠标尺130(示于图6中)而显示，以示出砧座40与缝合头部组件20之间的相对间隙距离d。
当然，指示器托架140、指示器104和/或致动器柄部组件70可根据至少一些以下专利的教导内容来进一步构造：美国专利5,205,459、美国专利5,271,544；美国专利5,275,322；美国专利5,285,945；美国专利5,292,053；美国专利5,333,773；美国专利5,350,104；美国专利5,533,661，所述专利的公开内容均以引用的方式并入本文；和/或参考本文的教导内容，根据对于本领域的普通技术人员而言将是显而易见的其他构型来进一步构造。
II.示例性钉仓
在器械10的操作期间，钉仓200可用于将准备用于击发的钉66保持在多个同中心地布置的圈中。在一些情况下，钉仓200内的每个钉66圈可通过通过改变钉圈内的每个钉的总宽度而具有相等数量的钉66，甚至当圈在半径上有所不同时。应当理解，改变钉66的宽度可允许同心的钉66圈中的内圈比外圈更紧密地装填。还应当理解，给每个同心的圈提供相等数量的钉66可实现当钉66被驱动到组织中时的更好的止血。也可产生其它理想的特性。图7示出了能够操作以与器械10一起使用的示例性钉仓200，其中三个钉圈包括每个圈中的相同数量的钉。一般而言，钉仓200能够操作以保持如下文将更详细描述的具有不同形状和尺寸的多个钉250,252,254(示于图8-10中)。在一些情况下，钉250,252,254也可与下文将进一步讨论的可能够与钉250一起击发的其它补充件和/或部件一起定位在钉仓200中。当然，应当理解，钉250,252,254可独自而不与另外的部件一起装载到钉仓200中。
钉仓200包括上圈204和下部主体202。在示例性型式中，钉仓200具有细长的环形状，但应当理解，钉仓200可具有如参考本文的教导内容对于本领域的普通技术人员而言将显而易见的任何合适的形状。上圈204限定环绕上圈204的多个钉孔210。钉孔210具有细长的六边形状，所述六边形具有如在图7中且进一步在图11中所见的倒圆端。应当理解，钉孔210可具有其它形状，诸如细长的矩形、椭圆形、圆形、方形、狭缝形或如参考本文的教导内容对于本领域的普通技术人员而言将显而易见的用于接收一个或多个钉的任何其它合适的形状。
如在图7和图11中也可见，三个钉孔210圈环绕上圈204。外圈214、中圈216和内圈218构成环形的钉孔210排。钉孔210的外圈214具有最大的钉孔210，且因此，应当理解，外圈214具有最低密度的或最少的钉孔210。内圈218具有最小尺寸的孔210，使得内圈218具有最高密度的钉孔210。中圈216定位在外圈214与内圈218之间。中圈216包括其尺寸设定成介于外圈214和内圈218的钉孔210之间的钉孔210。因此，中圈216具有介于外圈214和内圈218之间的钉孔210密度。外圈214、中圈216和内圈218围绕由钉仓200限定的开口212同中心地定位。在一些型式中，内圈218的钉孔210的数量等于中圈216的钉孔210的数量，并且等于外圈214的钉孔210的数量。然而，应当理解，在一些型式中，钉孔210的数量也可在圈214,216,218之间改变。此外，外圈214、中圈216和内圈218被定位成使得中圈216的钉孔210在外圈214和内圈218的钉孔210之间迂回。应当理解，可使用如对于本领域的普通技术人员而言将显而易见的定位外圈214、中圈216和内圈218的其它合适的构型。例如，尽管中圈216大致分离内圈218与外圈214之间的距离，但应当理解，中圈216可更靠近内圈218或更靠近外圈214定位。还应当理解，尽管在示例性型式中外圈214、中圈216和内圈218包括围绕上圈204以环形方式布置的钉孔210，但也可使用钉孔210的其它布置方式。例如，钉孔210可围绕上圈204以椭圆形或方形方式布置。实际上，钉孔210可围绕上圈204以如参考本文的教导内容对于本领域的普通技术人员而言将显而易见的任何合适的方式布置。
钉仓200配合到缝合头部组件20的管状外壳22中。具体地讲，下部主体202提供与管状壳体22的摩擦配合。应当理解，可使用如参考本文的教导内容对于本领域的普通技术人员而言将显而易见的连接钉仓200和缝合头部组件20的其它合适的方式。例如，钉仓200可夹紧到、经由按扣配合附接、拧入、或者以任何其它合适的方式选择性地连接到缝合头部组件20。钉仓200的下部主体202还限定通道206，所述通道能够操作以接收钉驱动器24的互补结构。通道206与钉孔210连通，使得钉驱动器24的互补结构可推进穿过通道206以驱动钉250,252,254。开口212的尺寸设定成接收圆柱形刀36，所述刀被驱动穿过开口212以在组织被夹在缝合头部组件20和砧座40之间时以如上所述的方式切断组织。
图8示出了可定位在外圈214的钉孔210中的大号钉250。大号钉250包括冠部262和从冠部262延伸的腿部260。如在所示出的型式中所见，腿部260向外张开，使得腿部260限定腿部260之间的距离“A”，其中“A”宽于冠部262。每个腿部260终止于成角度末端264中，所述成角度末端能够操作以帮助将大号钉250的腿部260推动穿过组织。应当理解，距离“A”处的腿部260的宽度对应于外圈214中的钉孔210的尺寸。在一些情况下，“A”略大于外圈214的钉孔210的宽度，使得大号钉250通过轻微的干涉配合能够释放地固定在钉孔210中。
图9示出了可定位在中圈216的钉孔210中的中号钉252。中号钉252包括冠部268和从冠部268延伸的腿部266。如在所示出的型式中所见，腿部266向外张开，使得腿部266限定腿部266之间的距离“B”，其中“B”宽于冠部268。腿部266终止于成角度末端270中，所述成角度末端能够操作以帮助将中号钉252推动穿过组织。应当理解，距离“B”处的腿部266的宽度对应于中圈216中的钉孔210的尺寸。在一些情况下，“B”略大于中圈216的钉孔210的宽度，使得中号钉252通过轻微的干涉配合能够释放地固定在钉孔210中。
图10示出了可定位在内圈218的钉孔210中的小号钉254。小号钉254包括冠部274和从冠部274延伸的腿部272。如在所示出的型式中所见，腿部272向外张开，使得腿部272限定腿部272之间的距离“C”，其中“C”宽于冠部274。腿部272终止于成角度末端276中，所述成角度末端能够操作以帮助将小号钉254推动穿过组织。应当理解，距离“C”处的腿部272的宽度对应于内圈218中的钉孔210的尺寸。在一些情况下，“C”略大于内圈218的钉孔210的宽度，使得小号钉254通过轻微的干涉配合能够释放地固定在钉孔210中。
如在图8-10中所见，大号钉250具有比中号钉252的冠部268和小号钉254的冠部274长的冠部262，其中中号钉252的冠部长于小号钉254的冠部274。应当理解，钉250,252,254的相对宽度是如此以致于小号钉254可布置在钉孔210中，使得小号钉254具有围绕钉仓200的相对高的钉密度。因此，中号钉252和大号钉250可围绕钉仓布置，使得中号钉252以较小的密度间隔开且大号钉250以最小的密度间隔开。由于冠部262,268,274长度的上述渐进减小，每个圈214,216,218中的钉250,252,254的数量可在数目上相等。
尽管腿部260,266,272被示出为向外张开，但应当理解，腿部260,266,272可垂直于冠部262,268,274，相对于冠部262,268,274成锐角，或相对于冠部262,268,274取向成如参考本文的教导内容对于本领域的普通技术人员而言将显而易见的任何其它合适的角度。此外，应当理解，腿部260,266,27未必具有直线形状。例如，腿部260,266,272可为弧形的，弯曲的，或能够操作以帮助将钉250,252,254驱动穿过组织的任何其它合适的形状。另外，尽管图8-10示出了钉250,252,254具有大体相等的厚度的腿部260,266,272，但应当理解，腿部260,266,272可具有不同的厚度。例如，大号钉250可具有比小号钉254或中号钉252的腿部272,266厚或薄的腿部260。在另一些其它型式中，不是具有均匀的厚度，腿部260,266,272可具有变化的厚度。例如，腿部260,266,272可具有更厚或更薄的近冠部262,268,274或近末端264,270,276或如参考本文的教导内容对于本领域的普通技术人员而言将显而易见的任何其它合适的变型。尽管示例性型式示出了钉仓200具有三个钉250,252,254圈214,216,218，但应当理解，也可使用两个或三个以上的钉圈。
图11示出了钉250,252,254放置在钉仓200的钉孔210中。应当理解，钉250,252,254可能会预装载，但在其它型式中，应当理解，钉250,252,254可在使用缝合器械10之前的任何合适的时间装载到钉仓200中。
在钉仓200的一个示例性使用中，钉仓200可如在图11中所见进行装载。下部主体202可被***到管状壳体22中。管状构件44定位穿过钉仓200的开口212。此外，圆形刀36能够操作以平移穿过钉仓200的开口212。钉驱动器24相对于钉仓200定位，使得当钉驱动器24朝远侧平移时，钉驱动器24推进穿过通道206以将钉250,252,254朝远侧驱动。因此，当旋转触发器74时，钉驱动器24纵向致动，从而将钉250,252,254朝远侧驱动到组织中。钉250,252,254的腿部260,266,272接触砧座头48的钉成形凹坑52，从而使腿部260,266,272朝其相应的冠部262,268,274弯曲。圆形刀36也平移以切割组织。圆形刀36然后缩回且钉驱动器24缩回。钉250,252,254保持在组织中，在那里钉固定患者体内的两个体腔之间的吻合(例如，将食管、结肠或其它胃肠道部分的两端固定在一起)。应当理解，一旦被驱动到组织中，则由最外面的大号钉250形成的钉圈可用来在结构上固定吻合而由中号钉252或小号钉254形成的钉圈用来防止吻合的渗漏。换句话讲，大号钉250可主要起结构加固的作用，而中号钉252和/或小号钉254可主要起提供不透流体的密封的作用。钉250,252,254可以能够操作以在稍后的时间点溶解。
III.示例性钉支撑元件
应当理解，当钉250,252,254被驱动到组织中时，在一些情况下，鉴于钉250,252,254的厚度，钉250,252,254可具有落下穿过组织或者无法保持锚定在组织中的倾向。图12示出了示例性钉垫或支撑元件300，所述钉垫或支撑元件可用于有效地增加钉冠部的器件封装尺寸，从而降低冠部原本可能牵拉穿过组织的风险。此例子的支撑元件300包括限定一对开口304的支撑元件主体302，所述开口能够操作以接收钉250,252,254的腿部260,266,272。主体302还限定延伸穿过钉支撑元件300的主体的主体开口310。应当理解，钉支撑元件300可用于防止钉250,252,254撕裂组织。此外，钉支撑元件300可以能够操作以减少其中钉250,252,254被***到组织中的区域中的渗漏路径并且还可以能够操作以在确实发生渗漏的情况下吸收渗漏。钉支撑元件300的尺寸设定成使得钉支撑元件300可放置在钉250,252,254上，使得钉250,252,254仍可放置在(例如)图11所示的钉孔210中。此外，应当理解，钉支撑元件300的尺寸可被不同地设计成配合钉250,252,254的不同的尺寸。钉支撑元件300可由能够操作以防止渗漏或吸收渗漏流体的任何合适的材料构成，所述渗漏流体来自围绕钉250,252,254的施加的组织。例如，钉支撑元件300可由聚合物材料或除此之外或作为另外一种选择可由吸收性材料构成。可包括如根据本文中的教导内容对于本领域的普通技术人员而言将显而易见的用于钉支撑元件300的其它合适的材料。
开口304被定位成如在图13-15中配合时所示与钉250,252,254的腿部260,266,272对齐。开口304具有圆形，但应当理解，开口304可具有任何合适的形状。例如，开口304可具有方形、椭圆形或用于接收腿部260,266,272的任何其它合适的形状。一旦腿部260,266,272被***到开口304中，则开口304被成形为足够紧密或间隔开，使得摩擦配合将主体302保持在钉250,252,254之上。主体开口310被定位成与钉250,252,254的冠部262,268,274大致对齐。在示例性型式中，主体开口310具有加宽的十字形。在其它型式中，应当理解，主体开口310可具有任何合适的形状。例如，主体开口310可具有圆形、方形或任何合适的形状。在一些型式中，应当理解，主体开口310可被省略。
钉支撑元件300还包括从主体302向外延伸的翼部306。尽管在示例性型式中翼部306具有类似块的形状，但也可使用其它合适的形状。仅以举例的方式，翼部306可具有倒圆形状或三角形状。示例性型式示出了翼部306位于主体开口310的相对侧上，但应当理解，翼部306可围绕钉支撑元件300定位在任何合适的区域处。此外，翼部306可被构造成使得多于两个翼部306可围绕钉支撑元件300定位。参考本文的教导内容，其他合适的变型对于本领域的普通技术人员而言将是显而易见的。
钉支撑元件300还包括靠近开口304定位的多个脊308。脊308围绕开口304等距定位，但应当理解，脊308可围绕开口304以任何合适的方式定位。在一些型式中，脊308可以被完全排除在外。
图13示出了配备在大号钉250上的钉支撑元件300。图14示出了中号钉支撑元件350，所述中号钉支撑元件基本上相同于钉支撑元件300，但按比例缩小以配合中号钉252。中号钉支撑元件350可如在图14中所见配备在中号钉252上。图15示出了小号钉支撑元件352，所述小号钉支撑元件基本上相同于钉支撑元件300，但按比例缩小以配合小号钉254。小号钉支撑元件352可如在图15中所见配备在小号钉254上。应当理解，钉支撑元件300,350,352可具有在所示出的型式中未示出的另一些其它尺寸以适应更大或更小的钉。此外，在一些型式中，仅一组钉(例如，大号钉250)配有支撑元件300，而其它钉(例如，钉252,254则不配有支撑元件300。参考本文的教导内容，使仅一些钉配备有支撑元件300的其它合适的变型对于本领域的普通技术人员而言将是显而易见的。
图16示出了示例性钉仓400以及装载到钉仓400的钉孔410中的钉250,252,254。应当理解，钉孔410可与图7所示的钉孔210为相同的尺寸，但还应当理解，钉孔410可被成形为与配备有钉支撑元件300的钉250,252,254互补。此外，钉仓400可以其它方式配置并且能够以与上文针对钉仓200所述的方式基本上相同的方式操作。应当理解，钉支撑元件300以及钉250,252,254可以能够操作以提供更大的吻合结构完整性并且还可以能够操作以通过使吻合处的可能渗漏路径的数量和尺寸最小化来降低渗漏的风险。
IV.具有突片的示例性钉支撑元件
图17示出了钉支撑元件500的另选的示例性型式，所述钉支撑元件具有主体502、开口504和纵向取向的突片506。纵向取向的突片506沿着由主体502限定的纵向轴线从主体502向外延伸。突片506能够操作以增大钉支撑元件500的器件封装以进一步降低钉250,252,254原本可能无意中滑动穿过组织的风险。如在图17中可见，由于包括了突片506，钉支撑元件500具有加长的器件封装。突片506可以能够操作以结合支撑元件500和钉250,252,254提供更大的吻合结构完整性并且还可以能够操作以通过使吻合处的可能渗漏路径的数量和尺寸最小化来降低渗漏的风险。
图18示出了钉支撑元件600的另选的示例性型式，所述钉支撑元件具有主体602、开口604和横向取向的突片606。应当理解，横向取向的突片606可以能够操作以为钉支撑元件600提供加宽的器件封装。尽管示例性型式示出了钉支撑元件600具有四个横向取向的突片606，但应当理解，可使用任何合适数量的突片606。图19示出了钉支撑元件700的另选的示例性型式，所述钉支撑元件具有主体702、开口704和横向取向的突片706与纵向取向的突片708的组合。由于横向取向的突片706和纵向取向的突片708，应当理解，钉支撑元件700具有更宽和更长的器件封装。如上所述，突片606以及支撑元件600可以能够操作以结合钉250,252,254提供更大的吻合结构完整性并且还可以能够操作以通过使吻合处的可能渗漏路径的数量和尺寸最小化来降低渗漏的风险。
图20示出了钉支撑元件700放置在钉仓750的孔710中。水平突片706和垂直突片708能够操作以装配在孔710的外面，使得突片706,708不会落下穿过孔710。钉支撑元件700可装有穿过开口704的钉(未示出)。在击发装有钉支撑元件700的钉时，钉和支撑元件700两者离开钉仓750的孔710以接合组织。
应当理解，本文所述教导内容、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结合。因此上述教导内容、表达方式、实施例、实例等不应视为彼此隔离。参考本文教导内容，其中本文教导内容可结合的各种合适方式对于本领域的普通技术人员而言将会显而易见。此类修改形式以及变型旨在包括在权利要求书的范围内。
应当理解，所述以引用的方式并入本文中的任何专利、出版物或其它公开材料，无论是全文或部分，仅在所并入的材料与本公开中给出的定义、陈述或者其它公开材料不冲突的范围内来并入本文。由此，在必要程度下，本文所明确阐述的公开内容将会取代以引用的方式并入本文中的任何相冲突的材料。如果据述以引用的方式并入本文但与本文所述现有定义、陈述或者其它公开材料相冲突的任何材料或其部分，仅在所并入的材料与现有公开材料之间不产生冲突的程度下并入本文。
上文所述装置型式可适用于医学专家所执行的常规医疗处理和手术中，并且可适用于机器人辅助的医疗处理和手术中。仅以举例的方式，本文的各种教导内容可易于结合到诸如由Sunnyvale,California的Intuitive Surgical公司提供的DAVINCITM***的机器人外科***中。相似地，本领域的普通技术人员将认识到，本文的各种教导内容可易于与2004年8月31日公布的名称为“Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument”的美国专利6,783,524的各种教导内容相结合，该专利的公开内容以引用方式并入本文。
上文所述型式可设计为在单次使用后丢弃，或者它们可设计为能够使用多次。在上述任一种或两种情况下，都可针对这些型式进行修复，以便在使用至少一次后重复使用。修复可以包括以下步骤任何组合：拆卸装置，然后清洗或者更换特定部件，并且随后重新组装。具体地讲，可以拆卸所述装置中的一些型式，并可选择性地以任何组合的形式更换或者移除所述装置中任何数量的特定件或部件。在清洗和/或更换特定零件时，所述装置的一些型式可在修复设施中重新组装或在即将进行手术前由用户重新组装以供随后使用。本领域的技术人员将会知道，装置修复可以利用多种技术进行拆卸、清洗/更换以及重新组装。此类技术的使用和所得修复装置全都在本发明的范围内。
仅以举例方式，本文所述型式可在手术之前和/或之后进行消毒。在一种消毒技术中，装置放置在闭合并密封的容、诸如塑料袋或TYVEK袋中。随后，可将容器和装置放置在可穿透容器的诸如γ辐射、X射线或高能电子等的辐射场中。辐射可以杀死装置上和容器中的细菌。消毒后的装置随后可以存放在消毒容器中，以备以后使用还可使用在本领域中已知的任何其它技术进行装置消毒，所述技术包括但不限于β或γ辐射、圈氧乙烷或者蒸汽消毒。
尽管已在本发明中示出并描述了多个型式，但是本领域的普通技术人员可在不脱离本发明的范围的前提下进行适当修改以对本文所述的方法和***进行进一步地改进。已经提及若干此类潜在修改形式，并且其它修改形式对于本领域的技术人员而言将会显而易见。例如，上文所讨论的例子、型式、几何形状、材料、尺寸、比率、步骤等等均是示例性的而非所要求的。因此，本发明的范围应以以下权利要求书作考虑，并且应理解为不限于说明书和附图中示出并描述的结构以及操作细节。

Claims (20)

1.一种用于缝合组织的设备，所述设备包括：
(a)头部组件；
(b)柄部致动器，所述柄部致动器与所述头部组件连通，其中所述头部组件能够响应于致动所述柄部致动器而驱动多个钉；和
(c)钉仓，所述钉仓与所述头部组件连通，其中所述钉仓包括第一环形孔圈和第二环形孔圈，其中所述第一环形孔圈包括具有不同于所述第二环形孔圈的尺寸的孔。
2.根据权利要求1所述的设备，其中所述第一环形孔圈包括较小的孔，其中所述第二环形孔圈包括较大的孔，其中所述第二环形孔圈定位在所述第一环形孔圈外面。
3.根据权利要求1所述的设备，其中所述钉仓还包括环形通道，所述环形通道能够将钉驱动器接收在所述头部组件内。
4.根据权利要求1所述的设备，还包括定位在所述第二环形孔圈外面的第三环形孔圈。
5.根据权利要求1所述的设备，还包括第一钉和第二钉，其中所述第一钉的尺寸设定成与所述第一环形孔圈互补，其中所述第二钉的尺寸设定成与所述第二环形孔圈互补。
6.根据权利要求5所述的设备，还包括能够操作以接合所述第一钉的至少一个钉支撑元件。
7.根据权利要求6所述的设备，其中所述至少一个钉支撑元件是由聚合物制成。
8.根据权利要求6所述的设备，其中所述至少一个钉支撑元件是由吸收性材料制成。
9.根据权利要求6所述的设备，其中所述至少一个钉支撑元件包括具有至少一个翼部的主体，所述至少一个翼部从所述至少一个支撑元件的所述主体延伸。
10.根据权利要求6所述的设备，其中所述至少一个钉支撑元件能够装配在所述第一孔圈的孔内。
11.根据权利要求6所述的设备，其中所述至少一个钉支撑元件限定一对开口，所述一对开口能够操作以接收所述第一钉的腿部，其中所述至少一个钉支撑元件还包括靠近所述一对开口的至少一个脊。
12.根据权利要求6所述的设备，其中所述至少一个钉支撑元件还包括至少一个突片，所述至少一个突片从所述至少一个钉支撑元件向外延伸。
13.根据权利要求12所述的设备，其中所述至少一个突片横向取向。
14.根据权利要求12所述的设备，其中所述至少一个突片纵向取向。
15.根据权利要求12所述的设备，其中所述至少一个突片包括横向取向的突片和纵向取向的突片的组合。
16.一种钉仓，包括：
(a)主体，其中所述主体具有大体圆柱形形状，其中所述主体限定延伸穿过所述主体的中心的纵向轴线；和
(b)多个孔，所述多个孔围绕所述主体延伸，其中所述孔围绕所述主体以环形布置方式取向，其中所述多个孔能够接收多个钉，其中靠近所述纵向轴线定位的孔的部分比远离所述纵向轴线定位的孔的部分更密集地定位。
17.根据权利要求16所述的钉仓，其中靠近所述纵向轴线的所述孔的部分具有比远离所述纵向轴线的所述孔的部分小的宽度。
18.根据权利要求16所述的钉仓，其中所述多个孔限定至少两个环形圈。
19.一种设备，包括：
(a)钉仓；
(b)多个钉，所述多个钉能够围绕所述钉仓以环形布置方式装配在所述钉仓内，其中所述多个钉能够被驱动到组织中，其中所述多个钉中的每一个包括冠部和腿部；
(c)至少一个垫，所述至少一个垫能够接合所述多个钉的所述腿部，其中所述至少一个垫能够沿着所述多个钉的所述腿部朝所述冠部滑动，其中所述至少一个垫具有比所述冠部大的宽度；和
(d)至少一个突片，所述至少一个突片与所述至少一个垫连通，其中所述至少一个突片从所述至少一个垫向外延伸，其中所述至少一个突片相对于所述至少一个垫纵向或横向取向。
20.根据权利要求19所述的设备，其中所述至少一个垫包括至少第一垫和第二垫，其中所述第一垫具有比所述第二垫大的横截面。
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WO2014089200A3 (en) 2014-08-21
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MX364130B (es) 2019-04-12
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US20140158747A1 (en) 2014-06-12
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