CN110114022A - 超声机器人工具致动 - Google Patents

超声机器人工具致动 Download PDF

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CN110114022A
CN110114022A CN201780079987.2A CN201780079987A CN110114022A CN 110114022 A CN110114022 A CN 110114022A CN 201780079987 A CN201780079987 A CN 201780079987A CN 110114022 A CN110114022 A CN 110114022A
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york piece
clamping limb
shell
actuator
surgical tool
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CN110114022B (zh
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J·柯克
K·D·费尔德
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Ethicon LLC
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Abstract

本文描述了用于执行内窥镜式外科手术、可手动地和/或与机器人外科***一起使用的工具组件的各种实施方案。该工具组件可包括从工具组件的外壳延伸的轴组件。轴的远侧端部可包括端部执行器，该端部执行器包括枢转地联接到刀以用于切割和/或密封组织的夹持臂。夹持臂在打开构型和闭合构型之间的枢转可由以能够滑动的方式被设置在工具组件的外壳内的轭架的移动引起。例如，可通过一个或多个输出部(例如，手动输出部、旋转输出部和/或线性机械输出部)使轭架移动。此外，一些工具组件实施方案可包括偏置***，该偏置***使轭架偏置成使得夹持臂处于打开构型。在一些实施方案中，工具组件可被构造用于使用夹持臂和刀进行组织展开解剖。

Description

超声机器人工具致动
技术领域
本公开整体涉及用于控制外科工具的端部执行器的夹持臂的枢转的方法、***和装置。
背景技术
由于术后恢复时间减少且瘢痕形成最小化，因此微创外科手术(MIS)器械通常优于传统的开放式外科装置。腹腔镜式外科手术是一种类型的MIS手术，其中在腹部形成一个或多个小切口，并且穿过切口***套管针以形成进入腹腔的通路。套管针用于将各种器械和工具引入腹腔中，而且提供注气使腹壁升高到器官上方。器械和工具可用于以多种方式接合和/或处理组织以达到诊断或治疗效果。内窥镜式外科手术是另一种类型的MIS手术，其中将细长的柔性轴穿过自然孔口引入体内。
内窥镜式外科器械常常优于传统的开放式外科装置，因为较小的切口趋于降低术后恢复时间和并发症。因此，已对一系列的内窥镜式外科器械进行了显著的开发，这些内窥镜式外科器械适用于穿过套管针的套管将端部执行器精确地放置在期望的外科手术部位处。这些远侧端部执行器以多种方式接合组织以实现诊断或治疗效果(例如腔内切割缝合器、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波、RF、激光等的能量装置)。
一些内窥镜式外科手术需要具有定位在细长轴的远侧端部处的端部执行器的外科工具，该端部执行器可执行功能，诸如辅助抓紧组织、切割组织、密封组织和/或释放组织。此类功能可能需要来自机械驱动源(例如，工具驱动器)的至少一个输入以激活外科工具内的机构。这些机构和输入可给内窥镜式外科工具增加不想要的复杂性、大小、重量和成本。
发明内容
本发明提供了用于枢转外科工具的端部执行器的夹持臂的方法、***和装置。在一个实施方案中，提供了一种外科工具并且该外科工具可包括外壳和轴组件，该轴组件延伸穿过外壳并且从外壳向远侧延伸。轴组件可包括具有刀的远侧端部和相对于刀枢转地联接的夹持臂。外科工具还可包括轭架，该轭架设置在外壳内并且以能够滑动的方式被设置成围绕轴组件。轭架可以操作地联接在从外壳突出的第一致动器与夹持臂之间，使得第一致动器的移动致使轭架沿轴组件纵向平移，从而使夹持臂在打开位置和闭合位置之间移动。外科工具还可包括超声换能器，该超声换能器设置在外壳内并且联接到刀以用于将超声能量递送到刀。
在一个实施方案中，外科工具可包括至少一个弹簧，该至少一个弹簧设置在外壳内并且使轭架向远侧偏置，以将夹持臂偏置到打开位置。弹簧被构造成能够当轭架在外壳内向近侧移动时压缩，以将夹持臂移动至闭合位置。在某些方面，外科工具可包括设置在外壳内的第一弹簧和第二弹簧。第二弹簧可被构造成能够由于轭架在近侧方向上的移动而在压缩第一弹簧之后压缩。夹持臂可被构造成能够在轭架的第一运动范围期间对接合在夹持臂和刀之间的组织施加第一力，并且夹持臂可被构造成能够在轭架的第二运动范围期间对接合在夹持臂和刀之间的组织施加第二力。
在另一个实施方案中，第一致动器可被构造成能够线性地平移以致使轭架在第一方向上纵向平移。外科工具可包括第二致动器，该第二致动器被构造成能够线性地平移以致使轭架在第二方向上纵向平移，第二方向是与第一方向相反的方向。
在其它实施方案中，第一致动器可被构造成能够旋转以致使轭架纵向平移。第一致动器的旋转可致使设置在外壳内的导螺杆旋转，并且导螺杆的旋转可致使轭架纵向平移。在某些实施方案中，轭架可通过滑轮组件、杠杆或小齿***作地联接到第一致动器。第一致动器可被构造成能够移动第一距离，从而致使轭架移动第二距离，并且第一距离可大于第二距离。在某些示例性实施方案中，第一致动器可包括形成在轭架上并且延伸穿过外壳中的开口的至少一个突出部。外壳可被构造成能够联接到机器人外科***的机器人臂的驱动器。
还提供了外科方法，并且在一个实施方案中，该方法包括：致动外科机器人的驱动器工具上的马达，以致使马达向外科工具上的致动器施加力。致动器的移动可致使设置在外科工具的外壳内的轭架沿着延伸穿过外壳的轴组件线性地平移。轭架的平移可致使外科工具的端部执行器上的夹持臂从打开位置移动到闭合位置，从而接合夹持臂和刀之间的组织。
在某些实施方案中，轭架的近侧平移可压缩使轭架向远侧偏置的偏置构件。在其它方面，马达可将线性力和旋转力中的一者施加到致动器，以致使轭架线性地平移。轭架移动第一距离可致使夹持臂对接合在夹持臂和刀之间的组织施加第一力，并且轭架进一步移动第二距离可致使夹持臂对接合在夹持臂和刀之间的组织施加第二力，其中第二力大于第一力。
附图说明
结合附图阅读下述详细说明将更全面地理解本发明，其中：
图1为包括患者侧部分和用户侧部分的外科机器人***的一个实施方案的透视图；
图2为图1的外科机器***的机器人臂的侧面透视图，其中工具组件与机器人臂的工具驱动器以能够滑动的方式接合；
图3为图2的机器人臂的工具驱动器的透视图；
图4A为工具组件的一个示例性实施方案的侧面透视图，该工具组件具有从外壳延伸的细长轴和在细长轴的远侧端部处的端部执行器；
图4B为图4A的工具组件的远侧部分的侧面透视图，其示出端部执行器包括相对枢转地联接到刀的夹持臂；
图4C为图4A的外壳的具有至少一个线性输入联接件的近侧部分的侧面透视图；
图4D为图4A的外壳的侧面透视剖面图，其中轭架以能够滑动的方式被设置在工具组件的外壳内；
图4E为图4A的外壳的近侧部分的侧面透视图，其中无菌屏障覆盖外壳的一部分；
图5为工具驱动器的另一个实施方案的部分剖视图，该工具驱动器具有联接到两个线性输入联接件的轭架和包括一对弹簧的偏置***；
图6为工具驱动器的又一个实施方案的部分剖视图，该工具驱动器具有联接到单个线性输入联接件的轭架和包括单个弹簧的偏置***；
图7A为由两个线性致动器控制的轭架的另一个实施方案的侧面透视图；
图7B为由两个线性致动器控制的轭架的又一个实施方案的侧面透视图；
图8为包括复合齿轮的轭架和偏置***的另一个实施方案的侧面透视图；
图9为包括杠杆臂的轭架和偏置***的另一个实施方案的侧面透视图；和
图10为具有由旋转输出部控制的轭架和偏置构件的工具驱动器的又一个实施方案的局部剖视图。
具体实施方式
现在将描述某些示例性实施方案，以提供对本文所公开的装置和方法的结构、功能、制造和用途的原理全面理解。这些实施方案的一个或多个示例在附图中示出。本领域的技术人员将会理解，本文具体描述并在附图中示出的装置和方法是非限制性的示例性实施方案，本公开的范围仅由权利要求书限定。结合一个示例性实施方案示出或描述的特征部可与其它实施方案的特征部进行组合。此类修改和变型旨在包括在本发明的范围之内。
此外，在本公开中，各实施方案中名称相同的部件通常具有类似的特征部，因此在具体实施方案中，不一定完整地阐述每一个名称相同的部件的每一个特征部。另外，在所公开的***、装置和方法的描述中使用线性或圆形尺寸的程度上，此类尺寸并非旨在限制可结合此类***、装置和方法使用的形状的类型。本领域的技术人员将认识到，针对任何几何形状可容易地确定此类线性和圆形尺寸的等效尺寸。***和装置及其部件的大小和形状可至少取决于***和装置将用于其中的受治疗者的解剖结构、***和装置将与其一起使用的部件的大小和形状、以及***和装置将用于其中的方法和手术。
一般来讲，提供了用于执行内窥镜式外科手术、可手动地和/或与机器人外科***一起使用的工具组件的各种实施方案。工具组件可包括在工具组件的外壳内并且从工具组件的外壳向远侧延伸的轴组件。轴的远侧端部可包括端部执行器，该端部执行器具有枢转地联接到刀的夹持臂。例如，端部执行器的这种布置可用于在外科手术期间切割和/或密封组织。为了切割或密封组织，夹持臂可处于打开构型，以允许组织定位在夹持臂和刀之间。可使夹持臂枢转至闭合构型，从而压缩夹持臂和刀之间的组织，以辅助刀(包括以超声的方式)切割和/或密封组织。夹持臂在打开构型和闭合构型之间的这类枢转可由以能够滑动的方式被设置在工具组件的外壳内的轭架的移动引起。在本文所描述的一些工具组件实施方案中，通过一个或多个致动器或输入部(例如，手动输入部、旋转和/或线性机械输入部)使轭架移动，从而致使夹持臂枢转至打开构型或闭合构型。此外，本文所描述的一些工具组件实施方案包括外壳内的偏置***，该偏置***使轭架偏置，使得夹持臂偏置到打开构型，从而仅需要机械或手动输出来施加力以将夹持臂枢转至闭合构型。在一些实施方案中，工具组件可被构造用于组织展开解剖，诸如通过使用夹持臂和刀以在外科手术期间对周围组织施加足够大的力以展开组织。
如上文所指出，在一个实施方案中，本文公开的***、装置和方法可使用机器人外科***来实现。如本领域技术人员将理解的，机器人外科***的各种部件之间的电子通信可以是有线的或无线的。本领域的技术人员也将会理解，该***中的所有电子通信都可以是有线的，该***中的所有电子通信都可以是无线的，或者该***的一些部分可进行有线通信，而该***的其它部分可进行无线通信。
图1是外科机器人***100的一个实施方案的透视图，该***包括与患者P相邻定位的患者侧部分105，以及位于距离患者一定距离处(在同一房间内和/或在远程位置)的用户侧部分107。患者侧部分105通常包括一个或多个机器人臂110以及被构造成能够可释放地联接到机器人臂110的一个或多个工具组件120。用户侧部分107通常包括用于观察患者和/或外科手术部位的视觉***152，以及用于在外科手术期间控制机器人臂110和每一个工具组件120的移动的控制***154。
控制***154可具有多种构型，其可邻近患者定位(例如，在手术室中)、远离患者(例如，在单独的控制室)或者分布在两个或更多个位置。例如，专用***控制台可位于手术室中，并且单独的控制台可位于远程位置。控制***154可包括使得用户能够观察患者的正在由患者侧部分105进行手术的外科部位和/或控制患者侧部分105的一个或多个零件(例如，以在外科部位处执行外科手术)。在一些实施方案中，控制***154还可包括一个或多个手动操作的用户输入装置，诸如操纵杆、外骨骼式手套、动力和重力补偿式操纵器等。这些用户输入装置可控制电子操作马达，这些电子操作马达继而控制外科***包括机器人臂110和工具组件120的移动。
患者侧部分105还可具有多种构型。如图1所描绘，患者侧部分105可联接到手术台T。然而，在一些实施方案中，患者侧部分105可安装到墙壁，安装到天花板，安装到地板或安装到其它手术室设备。另外，虽然患者侧部分105被示出为包括两个机器人臂110，但是也可包括更多或更少的机器人臂110。此外，患者侧部分105可包括诸如相对于手术台T(如图1所示)安装在各种位置的单独的机器人臂110。另选地，患者侧部分105可包括单个组件，该单个组件包括从其延伸的一个或多个机器人臂110。
图2更详细地示出机器人臂110和可释放地联接到机器人臂110的工具组件120。机器人臂110可使相关联的工具组件120沿一个或多个机械自由度(例如，所有六个笛卡尔自由度，五个或更少的笛卡尔自由度等)支撑和移动。
机器人臂110可在机器人臂110的远侧端部处包括工具驱动器112，该工具驱动器可辅助控制与工具组件120相关联的特征结构。虽然未示出，但是工具驱动器112可包括具有轴的一个或多个马达，该轴旋转或平移并且联接到工具组件以实现工具组件的各种部件的运动。机器人臂110还可包括入口引导件(例如，套管安装件或套管等)，该入口引导件可以是机器人臂110的一部分或者能够移除地联接到该机器人臂，如图2所示。工具组件120的轴可穿过驱动器112和套管***以便***患者中。本领域的技术人员将会知道，机器人臂的构型可变化，并且本文所公开的工具组件可与任何机器人臂一起使用。
图3更详细地示出工具驱动器112。如图所示，工具驱动器112可包括一个或多个马达，例如，示出四个马达114a-114d，这些马达控制与工具组件120相关联的各种移动和动作，如下文更详细地描述。例如，马达114a-114d中的任一个可与机械旋转输出部或机械线性输出部相关联，该机械旋转输出部或机械线性输出部中的任一者可被构造成能够联接到与工具组件相关联的旋转输入联接件或线性输入联接件以用于致动工具组件的至少一个机构。工具驱动器112还可包括形成于其侧壁中的轴接纳通道116，以用于接纳工具组件120的轴。在其它实施方案中，轴可延伸穿过工具驱动器112中的开口，或两个部件可以各种其它构型配合。
图4A至图4E示出工具组件220的示例性实施方案，该工具组件具有联接到轴224的近侧端部的外壳222和联接到轴224的远侧端部的端部执行器226。端部执行器226可包括相对于刀229枢转的夹持臂228。夹持臂228可在打开构型与闭合构型之间枢转，在打开构型中夹持臂228和刀229被构造成能够在其间容纳组织(例如参见图4B)，并且在闭合构型中夹持臂228和刀229被构造成能够在其之间切割或密封组织。刀229可以是超声的并且与向刀229提供超声能量的换能器223通信。例如，外壳222可包括具有压电元件的换能器223(如图4D所示)，其一起在刀229处生成机械运动(例如，振动)。夹持臂228至闭合构型以压缩在夹持臂228和刀229之间的组织的移动可改进刀223将超声能量传送到组织以用于密封和/或切割组织的能力。
外壳222可包括辅助将外壳222能够释放地联接到机器人臂110的工具驱动器112的联接特征结构。例如，外壳222可包括可由驱动器112中的一个或多个马达114a-114d致动的机构。如上文所论述，马达114a-114d中的任一个可与旋转或线性机械输出部(例如，旋转轴或线性平移轴)相关联，该旋转或线性机械输出部中的任一者可被构造成能够联接到工具组件120上的旋转输入联接件或线性输入联接件以用于致动工具组件120的至少一个机构。例如，如图4C所示，致动器(被称为线性输入联接件230)可从外壳222向外突出并且它可与工具驱动器112的线性机械输出部相互作用，使得当线性机械输出部由马达114a-114d中的一者激活时，线性机械输出部可推动和平移线性输入联接件230，从而致动外壳222内的机构以用于控制工具组件220的一个或多个功能。这种机构例如可控制与端部执行器226相关联的各种特征结构的操作(例如，夹持臂228相对于刀229枢转等)，如将在下文中更详细地描述。在示例性实施方案中，当工具外壳222联接到工具驱动器112时，工具驱动器112定位在工具外壳222的远侧，使得工具驱动器的机械输出部(例如，线性和/或旋转机械输出部)位于工具驱动器112的近侧端部处。机械输出部可与位于工具外壳222的远侧端部处的一个或多个输入部(例如，线性输入联接件230)相互作用。由于这种构型，工具驱动器112上的线性输出部的近侧平移可作用于工具的线性输入联接件，并且致使工具的线性输入联接件向近侧行进以激活工具外壳222内的机构。此外，尽管工具组件120被描述为具有一个线性输入联接件230，但是本文所描述的工具组件(包括工具组件120)中的任一者可包括可由外科机器人的工具驱动器上的至少一个输出部(例如，手动输出部、旋转输出部和/或线性机械输出部)作用以用于激活与工具组件相关联的一个或多个机构。具有线性驱动器的工具驱动的示例性实施方案在2016年12月16日提交并且题为“用于将外科工具联接到机器人外科***的工具驱动器的方法和***(Methods and Systems for Coupling a SurgicalTool to a Tool Driver of a Robotic Surgical System)”的美国专利申请No.15/381,453和2016年12月16日提交并且题为“用于将外科工具联接到机器人外科***的工具驱动器的方法和***(Methods and Systems for Coupling a Surgical Tool to a ToolDriver of a Robotic Surgical System)”的美国专利申请No.15/381,508中更加详细地描述。
轴224可包括沿或穿过轴224延伸的驱动组件，以用于控制端部执行器226的致动和/或移动(例如，夹持臂228相对于刀229的枢转)。端部执行器226可包括多种外科工具中的任一种，诸如夹持臂228和刀229、缝合器、施夹器、镊子、针驱动器、烧灼装置、切割工具、钳口对、成像装置(例如，内窥镜或超声探针)，或包括各种工具的组合的组合装置。在示出的实施方案中，轴224包括内闭合管235，该内闭合管沿其延伸并以能够滑动的方式相对于外闭合管236设置，该外闭合管与工具外壳222处于固定关系。内闭合管235的远侧端部可枢转地联接到夹持臂228，使得内闭合管235的近侧行进致使夹持臂228枢转至闭合构型，并且内闭合管235的远侧致使夹持臂228枢转至打开构型。尽管外闭合管236被描述为相对于工具外壳222处于固定关系，并且内闭合管235被描述为以能够滑动的方式相对于外闭合管236设置，但在不脱离本公开范围的情况下，内闭合管235可相对于工具外壳222处于固定的关系，并且外闭合管236可以能够滑动的方式相对于内闭合管235设置。
在一个示例性实施方案中，如图4D所示，工具组件220可包括具有以能够滑动的方式被设置在外壳内的细长管状主体的轭架233。轭架233可联接到线性输入联接件230或与其成一体，并且轭架233也可联接到内闭合管235。因此，当线性输入联接件230被致动并且被致使移动(例如，通过手动地或通过线性机械输出部)时，致使轭架233和内闭合管235移动，从而使夹持臂228在打开构型和闭合构型之间枢转。例如，当线性输入联接件230被致动致使其在近侧方向上平移时，也可致使轭架233和内闭合管235在近侧方向上平移，从而将夹持臂228枢转至闭合构型。线性输出部的去激活或远侧回缩可允许或致使轭架233和内闭合管235在远侧方向上平移，从而将夹持臂228枢转至打开构型。
如图4D所示，工具组件220包括偏置***234，该偏置***使轭架233在远侧方向上偏置并且使夹持臂228偏置到打开构型。例如，当不存在作用于线性输入联接件230的激活力(例如，手动地或通过机械输出部)时，偏置***234可使轭架233偏置在远侧位置。如图4D所示，偏置***234可包括定位在远侧压缩构件250和中间压缩构件252之间的远侧偏置构件248(诸如弹簧)。远侧压缩构件250和中间压缩构件252可以是例如垫圈，并且它们可沿其相应的内开口沿外闭合管235的近侧端部以能够滑动的方式被设置，如图4D所示。轭架233可刚性地联接到远侧压缩构件250，使得轭架233的近侧移动致使远侧压缩构件250在近侧方向上对应移动。偏置***234还可包括定位在中间压缩构件252和近侧压缩构件254之间的近侧偏置构件249(诸如第二弹簧)。远侧压缩构件250、中间压缩构件252和近侧压缩构件254可彼此轴向地对齐(例如，沿中心轴线)，并且也可与远侧偏置构件248和近侧偏置构件249轴向地对齐。
如上所述，轭架233可直接联接到远侧压缩构件250，使得当轭架233在近侧方向上移动时(例如，从而使夹持臂228枢转至闭合构型)，远侧压缩构件250在近侧方向上移动，从而在远侧压缩构件250和中间压缩构件252之间压缩远侧偏置构件248。在轭架233和远侧压缩构件250已经移动第一距离从而压缩远侧偏置构件248之后，轭架233可继续在近侧方向上与远侧压缩构件250、远侧偏置构件248和中间压缩构件252一起移动。因此，近侧偏置构件249在中间压缩构件252和近侧压缩构件254之间被压缩。在示例性实施方案中，远侧偏置构件248可具有在被压缩时允许夹持臂228枢转到闭合或基本上闭合构型的第一弹簧力，并且近侧偏置构件249可具有在被压缩时允许夹持臂228对定位在夹持臂228和刀229之间的组织施加压缩力的第二弹簧力。例如，第二弹簧力可大于第一弹簧力，从而与当压缩远侧偏置构件时相比，当压缩近侧偏置构件时允许夹持臂228对组织施加更大的力。由近侧偏置构件提供的更大的第二弹簧力可辅助允许刀229密封和/或切割定位在刀229和夹持臂228之间的组织。当手动或机械线性输出部不再施加到线性输入联接件230时，远侧偏置构件248和近侧偏置构件249可扩展，从而向远侧平移中间压缩构件252和远侧压缩构件250以及联接到远侧压缩构件250的轭架233，并且将夹持臂228枢转至打开构型。
图4E示出可覆盖工具组件220的外壳222的外表面的至少一部分的无菌屏障240。无菌屏障240被构造成能够用于向外壳222提供无菌屏障，同时不会干扰允许工具组件220联接到机器人臂110的联接机构，以及不会干扰用于致动与工具组件220相关联的机构的手动输入部和/或机械输入部。例如，无菌屏障240可允许线性输入联接件230由工具驱动器112的线性机械输出部作用，以及允许平移线性输入联接件230，从而平移轭架233以枢转夹持臂228。虽然未示出，但是袋或消毒盖布可从无菌屏障240延伸以覆盖机器人臂。无菌部件(诸如器械无菌适配器(ISA)(未示出))也可放置在工具组件120和机器人臂110之间的连接接口处。将ISA放置在工具组件120和机器人臂110之间可确保工具组件120和机器人臂110具有无菌联接点。这允许从机器人臂110移除工具组件120以在外科手术过程中与其它工具组件120交换而不损害无菌外科手术区域。
本文所公开的工具组件的一些实施方案可被构造成能够用于使用夹持臂228和刀229辅助组织展开解剖。如本文所提及，使用夹持臂228和刀229进行组织展开解剖可包括将夹持臂228和刀229定位在相对组织之间的空间中并且使夹持臂228枢转远离刀229(从闭合构型到打开构型)，从而增加相对组织之间的空间。例如，这类组织展开解剖可用于使物体穿过组织，用于松动术和/或用于观察解剖结构。
如上文所论述，一旦线性输出部不再作用于线性输入联接件230，偏置***234就可致使轭架233在远侧方向上平移，因此允许钳口返回到打开构型。这样，偏置***234可被构造成能够使得其将力(例如，组织展开解剖力)平移穿过轭架233并平移到夹持臂228，该力足以允许夹持臂228枢转至打开构型，从而产生对周围组织的展开解剖。由于展开组织的力要求增加(与仅将夹持臂228枢转至打开构型相比)，因此轭架233和/或辅助控制轭架移动的相关联的机构(例如，偏置***234)可被构造成能够向夹持臂228提供另外的力以用于展开组织。可使用当前可用的机械输出部来提供这类另外的力，其可小于组织展开解剖所需的力要求。因此，本文所公开的一些实施方案可包括例如增加在机械输出部和夹持臂228之间提供的力的量的机械优点，如将在下文中更详细地描述。
例如，施加到相对组织以用于执行组织展开解剖的展开力可需要大约25磅的力至大约35磅的力。这样，操作地联接到夹持臂228的本文所描述的偏置***和/或机械输出机构可被构造成能够提供这类所需的力以用于展开解剖。此外，偏置***和/或机械输入机构可被构造用于在不脱离本公开的范围的情况下提供更多或更少的力。
图5示出工具组件320的实施方案，该工具组件包括联接到偏置***334的轭架333，该偏置***被构造成能够辅助组织展开解剖，如将在下文更详细地描述。如图5所示，轭架333可定位在工具组件320的外壳322内并且相对于该外壳以能够滑动的方式被设置。轭架333可联接到沿外管336和轴延伸的内闭合管335，其中内管335操作地联接到可相对于刀枢转的夹持臂(诸如工具组件220的夹持臂228和刀229)。类似于上文参考工具组件220所描述的实施方案，当致使轭架333平移时，致使内闭合管335平移，从而致使夹持臂相对于刀在打开构型和闭合构型之间枢转。
如图5所示，轭架333可包括延伸部360，该延伸部360联接到内闭合管335并且在该内部闭合管和一对轭架臂362之间延伸，该对轭架臂大致平行于内闭合管335的纵向轴线延伸。例如，延伸部360可相对于内闭合管335的纵向轴线大致垂直延伸。轭架臂362中的每一个的远侧端部都可包括线性联接输入部330，这些线性联接输入部被构造成能够联接到诸如来自工具驱动器112的线性机械输出部。轭架臂362中的每一个的近侧端部都可包括被构造成能够联接到偏置构件348(例如，弹簧)的偏置联接件363(例如，平坦表面)。当线性输入联接件330各自由线性机械输出部作用时，偏置构件348可压缩，从而在近侧方向上驱动轭架333并且使夹持臂枢转至闭合位置。当线性机械输出部不再对轭架333施加力(例如，线性机械输出部被去激活)时，偏置构件348可各自对轭架333的近侧端部施加偏置力或弹簧力，一起致使轭架333平移至远侧位置，从而使夹持臂枢转至打开构型并且展开组织。这样，偏置***334可致使夹持臂枢转到打开构型，包括当枢转到打开构型时展开组织，而无需诸如来自工具驱动器112的机械输出部。
在一些情况下，可能需要手动控制夹持臂，诸如在功率损耗期间和/或当工具组件320与机器人臂110断开连接并且夹持臂需要移动到闭合构型以便从患者和套管针移除端部执行器时。因此，工具组件320可包括手动控制器(未示出)，该手动控制器可从轭架333延伸并且穿过外壳322，使得用户可操纵手动控制器以使轭架333在远侧位置和近侧位置之间移动，从而分别手动地控制夹持臂在打开构型和闭合构型之间的枢转。
图6示出工具组件420的另一个实施方案，该工具组件包括联接到偏置构件或弹簧434的轭架433，该偏置构件或弹簧定位在轭架的近侧端部以用于在远侧方向上偏置轭架433，从而将夹持臂偏置到打开构型。如图6所示，轭架433可包括大体平行于工具组件420的外壳422延伸的细长主体。轭架433可以能够滑动的方式被设置在外壳422内，并且通过在内闭合管435和轭架433的远侧端部之间延伸的闭合管联接件437联接到内闭合管435。内闭合管435可在相对于外壳422固定的外闭合管436内以能够滑动的方式平移。类似于上文参考工具组件220所描述的实施方案，当致使轭架433平移时，内闭合管435相对于外闭合管436平移，从而致使夹持臂相对于刀在打开构型和闭合构型之间枢转。
如图所示6所示，轭架433的近侧端部可以能够滑动的方式联接到线性输入联接组件465，该线性输入联接组件在由线性机械输出部作用时致使轭架433在近侧方向上平移，从而致使夹持臂枢转至闭合构型。线性输入联接组件465可包括平行于轭架433和内闭合管435的纵向轴线定位的竖直滑动轴467。竖直滑动轴467可相对于外壳422被约束，使得竖直滑动轴467可仅在平行于内闭合管435的纵向轴线的方向上平移。如图所示6所示，竖直滑动轴467可包括竖直狭槽468，其长度限定竖直滑动轴467的最大行进长度。第一销469可从外壳422延伸到狭槽468中，从而将竖直滑动轴467的行进控制在竖直狭槽468的边界内。
线性输入联接组件465还可包括水平滑动轴470，该水平滑动轴相对于内闭合管435的纵向轴线垂直延伸并且在竖直滑动轴467和轭架433之间延伸，如图6所示。水平滑动轴470可相对于外壳422被约束，使得水平滑动轴470可仅在垂直于内闭合管435的纵向轴线的方向上滑动。如图所示6所示，水平滑动轴470可包括水平狭槽471，其长度限定水平狭槽471的最大行进长度。第二销472可从外壳422延伸到水平狭槽471中，从而将水平滑动轴470的行进控制在水平狭槽471的边界内。
竖直滑动轴467的近侧端部可包括与水平滑动轴470的第二成角端部482以能够滑动的方式配合的第一成角端部480。这类联接件允许第一成角端部480沿第二成角端部482滑动，并且当竖直滑动轴467在近侧方向上行进(诸如当线性机械输出部被激活时)时，朝向轭架433推动水平滑动轴470。这类滑动联件接还允许第二成角端部482沿第一成角端部480滑动，并且当水平滑动轴470朝向竖直滑动轴467行进时(诸如当线性机械输出部被去激活时)在远侧方向上推动竖直滑动轴467。
此外，轭架433的近侧端部可包括成角狭槽484，并且水平滑动轴470可包括在与轭架433相邻的端部处的轭架销486。轭架销486可延伸到成角狭槽484中并且沿该成角狭槽可滑动，使得当水平滑动轴470垂直于内闭合管435的纵向轴线行进时，致使轭架433平行于内闭合管435的纵向轴线行进。例如，当水平滑动轴470朝向轭架433行进时，使轭架433在近侧方向上移动，从而压缩偏置构件434并且将夹持臂枢转到闭合构型。在这种构型中，在水平滑动轴470和轭架433之间的成角联接件可使机械线性输出部相对于夹持臂的枢转的影响不敏感。例如，竖直滑动臂467可行进第一距离，这导致轭架433行进第一距离的一半，从而与同竖直滑动轴467和/或机械线性输出部具有1:1行进比的轭架相比，使夹持臂枢转更小距离。线性输入联接组件465的成角联接件也可提供机械优势，使得机械输出力可小于偏置构件434的弹簧力，然而线性输入联接组件465可作用于轭架433以压缩偏置构件434。例如，偏置构件434可具有足够的弹簧力以在远侧方向上驱动轭架433，以便枢转夹持臂以用于执行组织展开解剖。
在一些实施方式中，线性输入联接组件465可被构造成能够允许多于一个线性机械输出部对线性输入联接组件465(诸如竖直滑动轴467)施加力以用于激活线性输入联接组件465并且平移轭架433。任意数目的机械输出部可激活线性输入联接组件465，以用于致使轭架在近侧方向上平移，从而使夹持臂枢转至闭合构型。
在一些实施方案中，工具组件420可包括手动控制器(未示出)，该手动控制器可从轭架433延伸并且穿过外壳422，使得用户可操纵手动控制器以使轭架433在远侧位置和近侧位置之间移动，从而手动地控制夹持臂在打开构型和闭合构型之间枢转。例如，可能需要手动控制夹持臂，诸如在功率损耗期间和/或当工具组件与机器人臂断开连接并且夹持臂需要移动到闭合构型以便从患者和套管针移除端部执行器时。
在工具组件的一些实施方式中，线性机械输出部可控制轭架的双向移动，诸如轭架相对于工具组件的外壳的近侧平移和远侧平移，以致使夹持臂分别在闭合构型和打开构型之间枢转。在这类构型中，例如，机械输出部(例如，来自工具驱动器)可辅助组织展开解剖。
图7A示出包括轭架533的工具组件520的另一个实施方案，该轭架可具有由机械线性输出部控制的双向移动(例如，近侧和远侧指向的平移)。如图7A所示，轭架533可包括大体平行于工具组件520的外壳522延伸的细长主体。轭架533可定位在外壳522内并且相对于该外壳以能够滑动的方式被设置。轭架533可联接到内闭合管535，使得当致使轭架533在远侧位置和近侧位置之间平移时，致使内闭合管535平移，从而致使内闭合管535的远侧端部处的夹持臂相对于刀分别在打开构型和闭合构型之间枢转。内闭合管535可沿相对于外壳522固定的外闭合管536延伸并且相对于该外闭合管以能够滑动的方式被设置。
如图7A所示，轭架533可联接到包括打开致动器567和闭合致动器569的致动组件565，其各自被构造成能够联接到线性机械输出部以用于在近侧方向上单独地平移打开致动器567和闭合致动器569。致动组件565还可以包括可包括将闭合致动器569连接到打开致动器567的一个或多个滑轮的滑轮***570。例如，闭合致动器569可直接联接到轭架533，如图7A所示。滑轮***570可被构造成能够使得当致使闭合致动器569在近侧方向上移动(从而将轭架533在近侧方向上平移并且将夹持臂枢转至闭合构型)时，致使打开致动器567向远侧移动。此外，滑轮***570可被构造成能够使得当致使打开致动器567在近侧方向上移动时，闭合致动器569在远侧方向上移动，从而使轭架533向远侧移动并且将夹持臂枢转至打开构型。
如图7B所示，替代滑轮***570，小齿轮590可将闭合致动器569b联接到打开致动器567b。例如，闭合致动器569b可直接联接到轭架533b，如图7B所示。小齿轮590可沿小齿轮590的第一侧与闭合致动器569b接合并且沿小齿轮590的第二侧(例如，与第一侧相对)与打开致动器567b接合，使得当致使闭合致动器在近侧方向上移动(从而使轭架533b在近侧方向上平移并且使夹持臂枢转至闭合构型)时，致使打开致动器567b向远侧移动。此外，当致使打开致动器567b在近侧方向上移动时，小齿轮590可致使闭合致动器569b在远侧方向上移动，从而向远侧移动轭架533b并且将夹持臂枢转至打开构型。用于联接打开致动器和闭合致动器的其它机构(诸如枢转连杆)已经被设想并且在本公开的范围内。
图8示出包括轭架633的工具组件620的又一个实施方案，该轭架也可具有由机械线性输出部控制的双向移动(例如，近侧和远侧指向的移动)。轭架633可包括大体平行于工具组件620的外壳延伸的细长主体。轭架633可定位在外壳内并且相对于外壳以能够滑动的方式被设置。轭架633可联接到内闭合管635，使得当致使轭架633平移时，致使内闭合管635平移，从而使夹持臂相对于刀在打开构型和闭合构型之间枢转。
如图8所示，轭架633可联接到包括打开致动器667和闭合致动器669的致动组件665，打开致动器667和闭合致动器669各自被构造成能够联接到线性机械输出部以用于在近侧方向上单独地平移打开致动器667和闭合致动器669。致动组件665还可以包括可将闭合致动器669机械地联接到打开致动器667的复合齿轮660。此外，复合齿轮660可将打开致动器667和闭合致动器669机械地联接到轭架633，使得打开致动器667或闭合致动器669的平移移动致使轭架633平移。
例如，复合齿轮660可包括第一齿轮661和第二齿轮662，其共享枢转点或旋转轴线663并且相对于彼此附连，使得它们被迫使一起旋转。此外，第二齿轮662可具有比第一齿轮661更小的直径，如图8所示。例如，第二齿轮662的直径可以是第一齿轮661的直径的一半，从而允许复合齿轮660在较小的第二齿轮662和较大的第一齿轮661之间具有2:1的机械优点。较大的第一齿轮661可联接到各自沿第一齿轮661的相对侧定位和接合的打开致动器667和闭合致动器669，如图8所示。打开致动器667和闭合致动器669可与第一齿轮661接合，使得打开致动器667和闭合致动器669两者在相反方向上的线性平移(例如，打开致动器667在远侧方向上平移并且闭合致动器669在近侧方向上平移)致使第一齿轮661旋转。较小的第二齿轮662可联接到轭架633，使得第二齿轮662的旋转致使轭架633线性地平移。这样，打开致动器667和闭合致动器669的线性移动可致使第一齿轮661和第二齿轮662旋转，从而平移轭架633并且致使夹持臂628枢转。此外，当向较大的第一齿轮661施加第一扭矩时，来自较小的第二齿轮662的输出扭矩(例如，通过夹持臂)可大于第一扭矩，诸如两倍。同样，由较大的第一齿轮661的旋转产生的第一弧长可大于由较小的第二齿轮662的相关联的旋转所产生的第二弧长，诸如两倍。复合齿轮可提供机械优点，使得向夹持臂提供比从线性机械输出部施加到第一齿轮的力的量更多的力以用于展开解剖。复合齿轮还可通过使轭架633以比打开致动器667和闭合致动器669更慢的速率平移来在机械线性致动器和轭架633(以及夹持臂)之间提供脱敏，从而允许改进轭架633和夹持臂的精度和控制。
图9示出包括轭架733的工具组件720的又一个实施方案，该轭架也可具有由机械线性输出部控制的双向移动(例如，近侧和远侧指向的移动)。轭架733可包括大体平行于工具组件720的外壳722延伸的细长主体。轭架733可定位在外壳722内并且相对于该外壳以能够滑动的方式被设置。轭架733可联接到内闭合管735，使得当致使轭架733平移时，致使内闭合管735平移，从而使夹持臂相对于刀在打开构型和闭合构型之间枢转。
如图9所示，轭架733可联接到杠杆臂770。杠杆臂770可在第一端部处联接到枢转接头750。在一些实施方案中，枢转接头750可附连于外壳722。杠杆臂770可在杠杆臂770的第二端部处联接到致动器或线性输入联接件730或与其对接。在杠杆臂770的两端之间的某个点处，杠杆臂770可在杠杆联接件774处枢转地联接到轭架733，如图9所示。这种构型可提供机械优点，诸如机械输出部(通过线性输入联接件730)与轭架733具有大约2:1的行进比。例如，线性输入联接件730的行进距离(例如，当由线性机械输出部作用时)可以是轭架733行进所得的距离的两倍长。此外，这种构型可提供1:2的力机械优点，其中由机械线性输出部施加的力可以是由杠杆臂770施加到轭架733的力的一半。
尽管上述实施方案论述了用于控制用于枢转夹持臂的轭架的移动的线性机械输出部，但是工具组件的一些实施方式可包括由至少一个机械旋转输出部控制的轭架，如下文将更详细地描述。
图10示出工具组件820的实施方案，该工具组件具有联接到致动组件865的轭架833，该致动组件由外科机器人的工具驱动器上的至少一个机械旋转输出部控制。如图10所示，轭架833可包括大体平行于工具组件820的外壳822延伸的细长主体。轭架833可以能够滑动的方式被设置在外壳822内并且通过在内闭合管835和轭架833的远侧端部之间延伸的闭合管联接件837联接到内闭合管835。内闭合管835可在相对于外壳822固定的外闭合管836内以能够滑动的方式平移。当致使轭架833平移时，内闭合管835相对于外闭合管836平移，从而致使夹持臂相对于刀在打开构型和闭合构型之间枢转。
如图10所示，致动组件865可包括辅助轴890，该辅助轴在远侧端部处具有旋转输入联接件891并且被构造成能够联接到机械旋转输出部，使得当机械旋转输出部被激活时，致使辅助轴890旋转。致动组件865还可包括可联接到辅助轴890和导螺杆893并且在其间延伸的滑轮组件892。如图10所示，导螺杆893可从轭架833(诸如从近侧端部延伸)延伸，并且可通过螺纹联接到轭架833，使得导螺杆893的旋转致使轭架833平移。例如，当导螺杆893在第一方向上旋转时，轭架833在近侧方向上行进(例如，夹持臂枢转至闭合构型)，并且当导螺杆893在第二方向上旋转时，轭架833在远侧方向上行进(例如，夹持臂枢转至打开构型)。滑轮组件892可包括第一滑轮895和第二滑轮896，其中第一滑轮895联接到辅助轴890并且第二滑轮896联接到导螺杆893，使得辅助轴890的旋转致使第一滑轮895旋转并且将扭矩传输至第二滑轮896，从而致使导螺杆893旋转。
在一些情况下，可能需要手动控制夹持臂，诸如在功率损耗期间和/或当工具组件与机器人臂断开连接并且夹持臂需要移动到闭合构型以便从患者和套管针移除端部执行器时。例如，工具组件820可包括手动控制器(未示出)(诸如杠杆、按钮或闩锁)，该手动控制器可从轭架833延伸并且穿过外壳822，使得用户可操纵手动控制器以使轭架833在远侧位置和近侧位置之间移动，从而手动地控制夹持臂分别在打开构型和闭合构型之间枢转。此外，轭架可包括对开螺母(未示出)，使得手动控制器的致动可展开对开螺母，从而使轭架833与导螺杆893断开联接。为了诸如在准备将工具组件联接到机器人臂时使轭架833和导螺杆893联接复位，可重新接合对开螺母。在这类手动控制之后，二次过程步骤可能是必要的，以便允许控制单元确定轭架833诸如相对于导螺杆893的位置。可例如在将工具组件联接到机器人臂之后执行这类二次过程步骤。
本文所描述的工具组件中的任一者可包括控制向工具组件递送电力的各种电源开关机构。这类电源开关机构可提供安全特征，以确保处理工具组件的人员不被触电。例如，外科医生可利用工具组件执行外科手术，并且在某个点处将工具组件递给护士，以允许护士清洁工具组件的一部分。电源开关机构可确保在工具组件内适当关闭电源，以确保护士在清洁工具组件时护士不会被触电。
例如，在一些实施方案中，电源开关机构可与发电机、脚踏开关和手激活通信，使得哪一者被首先激活，则那个获得优先权而其它被关闭或忽略。在一些实施方案中，电源开关机构可包括手动控制，用户可通过外科医生控制或床侧控制之间的拨动装置来选择该手动控制。例如，拨动装置可以在发电机上。在一些实施方案中，电源开关机构可在工具组件上包括拨动装置，该拨动装置允许床侧用户控制工具组件。在一些实施方案中，电源开关机构可包括有源选择，例如，控制台上的菜单、按钮或开关等。在一些实施方案中，电源开关机构可包括通过工具组件上的对接开关进行的自动控制，该对接开关知道何时将其对接到机器人臂上以及何时不必接通。例如，当工具组件安装到机器人臂时，用户或外科医生可进行控制。当将工具组件从机器人臂移除时，手激活可变为有效，并且用户或外科医生可失去对工具组件的控制。
优选地，本文所述的本发明的部件将在使用之前处理。首先，获取新的或用过的器械，并根据需要进行清洁。然后可对器械进行灭菌。在一种灭菌技术中，将所述器械放置在密闭且密封的容器(诸如，塑料或TYVEK袋)中。然后将容器和器械放置在可穿透该容器的辐射场诸如γ辐射、x射线或高能电子中。辐射杀死器械上和容器中的细菌。然后可将经灭菌的器械储存在无菌容器中。密封容器使器械保持无菌，直到其在医疗设施中被打开。
通常，对该装置进行灭菌。这以通过本领域的技术人员已知的任何多种方式来完成，包括β辐射或γ辐射、环氧乙烷、蒸汽以及液浴(例如冷浸)。在2008年2月8日提交的名称为“System And Method Of Sterilizing An Implantable Medical Device”的美国专利No.8,114,345中更详细地描述了对包括内部电路的装置进行灭菌的示例性实施方案。优选的是，如果植入的话，将装置气密密封。这可通过本领域技术人员已知的任何数量的方式而完成。
根据上述实施方案，本领域的技术人员将会认识到本发明的另外的特征和优点。因此，本发明不应受到已具体示出和描述内容的限制，除非所附权利要求有所指示。本文引用的所有出版物和参考文献全文明确地以引用方式并入本文中。

Claims (20)

1.一种外科工具，包括：
外壳；
轴组件，所述轴组件延伸穿过所述外壳并且从所述外壳向远侧延伸，所述轴组件具有带有刀的远侧端部和枢转地联接到所述刀的夹持臂；和
轭架，所述轭架设置在所述外壳内并且以能够滑动的方式设置成围绕所述轴组件，所述轭架操作地联接在所述夹持臂和从所述外壳突出的第一致动器之间，使得所述第一致动器的移动致使所述轭架沿所述轴组件纵向平移，从而使所述夹持臂在打开位置和闭合位置之间移动。
2.根据权利要求1所述的外科工具，还包括超声换能器，所述超声换能器设置在所述外壳内并且联接到所述刀以用于将超声能量递送到所述刀。
3.根据权利要求1所述的外科工具，还包括至少一个弹簧，所述至少一个弹簧设置在所述外壳内并且使所述轭架向远侧偏置以将所述夹持臂偏置到所述打开位置。
4.根据权利要求3所述的外科工具，其中，所述弹簧被构造成能够当所述轭架在所述外壳内向近侧移动时压缩以将所述夹持臂移动至所述闭合位置。
5.根据权利要求1所述的外科工具，还包括设置在所述外壳内的第一弹簧和第二弹簧，所述第二弹簧被构造成能够由于所述轭架在近侧方向上的移动而在所述第一弹簧的压缩之后压缩。
6.根据权利要求1所述的外科工具，其中，所述夹持臂被构造成能够在所述轭架的第一运动范围期间对接合在所述夹持臂和所述刀之间的组织施加第一力，并且所述夹持臂被构造成能够在所述轭架的第二运动范围期间对接合在所述夹持臂和所述刀之间的组织施加第二力。
7.根据权利要求1所述的外科工具，其中，所述第一致动器被构造成能够线性地平移以致使所述轭架在第一方向上纵向平移。
8.根据权利要求7所述的外科工具，其中，第二致动器被构造成能够线性地平移以致使所述轭架在第二方向上纵向平移，所述第二方向是与所述第一方向相反的方向。
9.根据权利要求1所述的外科工具，其中，所述第一致动器被构造成能够旋转以致使所述轭架纵向平移。
10.根据权利要求8所述的外科工具，其中，所述第一致动器的旋转致使设置在所述外壳内的导螺杆旋转，并且其中所述导螺杆的旋转致使所述轭架纵向平移。
11.根据权利要求1所述的外科工具，其中，所述轭架通过滑轮组件操作地联接到所述第一致动器。
12.根据权利要求1所述的外科工具，其中，所述轭架通过杠杆操作地联接到所述第一致动器。
13.根据权利要求1所述的外科工具，其中，所述轭架通过小齿***作地联接到所述第一致动器。
14.根据权利要求1所述的外科工具，其中，所述第一致动器被构造成能够移动第一距离以致使所述轭架移动第二距离，其中所述第一距离大于所述第二距离。
15.根据权利要求1所述的外科工具，其中，所述第一致动器包括形成在所述轭架上并且延伸通过所述外壳中的开口的至少一个突出部。
16.根据权利要求1所述的外科工具，其中，所述外壳被构造成能够联接到机器人外科***的机器人臂的驱动器。
17.一种用于夹持组织的方法，包括：
致动外科机器人的驱动器工具上的马达以致使所述马达向外科工具上的致动器施加力，所述致动器的移动致使设置在所述外科工具的外壳内的轭架沿着延伸穿过所述外壳的轴组件线性地平移，其中所述轭架的平移致使所述外科工具的端部执行器上的夹持臂从打开位置移动到闭合位置，从而接合所述夹持臂和刀之间的组织。
18.根据权利要求17所述的方法，其中，所述轭架的近侧平移压缩使所述轭架向远侧偏置的偏置构件。
19.根据权利要求17所述的方法，其中，所述马达将线性力和旋转力中的一者施加到所述致动器以致使所述轭架线性地平移。
20.根据权利要求17所述的方法，其中，所述轭架移动第一距离致使所述夹持臂对接合在所述夹持臂和所述刀之间的所述组织施加第一力，并且所述轭架进一步移动第二距离致使所述夹持臂对接合在所述夹持臂和所述刀之间的所述组织施加第二力，所述第二力大于所述第一力。
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