CN103841902A - 附接外科钉支撑件至仓 - Google Patents
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- A61B17/064—Surgical staples, i.e. penetrating the tissue
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- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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- A61B17/00—Surgical instruments, devices or methods
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07292—Reinforcements for staple line, e.g. pledgets
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- A61B17/00—Surgical instruments, devices or methods
- 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
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- 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
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- 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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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- 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
- A61B2017/07271—Stapler heads characterised by its cartridge
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Abstract
本发明提供了一种外科器械，所述外科器械包括端部执行器和能够插入所述端部执行器的钉仓。所述钉仓包括选择性地联接到所述钉仓的支撑材料。在一些型式中，所述支撑材料可通过一个或多个附接钉缝合到所述钉仓。此类附接钉可插入到穿过所述钉仓的上部平台形成的钉孔中。所述附接钉可包括弹性偏置腿以通过摩擦抵抗移除。在一些型式中，所述附接钉的尺寸设定成能够在所述钉孔中形成干涉配合。或者，所述附接钉可包括倒钩。钉驱动器可用于分离所述附接钉。所述钉驱动器可包括钉成形凹坑以在分离所述附接钉时弯曲所述附接钉的所述腿。
Description
背景技术
在一些环境下，内窥镜式外科器械可优于传统的开放式外科装置，因为较小的切口可降低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侧端部执行器通过套管针的管道放置在期望手术部位处。这些远端执行器（例如，直线切割器、抓紧器、切割器、缝合器、施夹钳、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）可以多种方式啮合组织，以达到诊断或治疗的效果。内窥镜式外科器械可包括轴，所述轴位于端部执行器与由临床医生操纵的柄部部分之间。这种轴可允许插入到期望深度并围绕轴的纵向轴线旋转，由此有利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结构而进一步有利于端部执行器的定位，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组织层，切割穿过夹紧的组织层，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。仅作为示例性目的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 Organ Staplers”（用于内脏器官缝合器的凹坑构型）的美国专利号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”（外科缝合器器械）的美国专利号5,597,107；1997年5月27日公布的名称为“Surgical Instrument”（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“SurgicalInstrument”（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 Stapling InstrumentIncorporating an E-Beam Firing Mechanism”（具有E型横梁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”（具有分开的不同的闭合和击发系统的外科缝合器械）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闭锁的外科缝合器械）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”（具有带柔性齿条的多行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 Firing MechanismHaving a Rotary Transmission”（具有带旋转传动装置的多行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闭锁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”（具有两件式E型横梁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 HavingMultistroke Firing with Opening Lockout”（具有带开口闭锁的多行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”（与缝合装置一起使用的具有粘合剂的一次性仓）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部件，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-1B的外科器械的打开的端部执行器的透视图；
图3A示出了沿图2的线3-3截取的图2的端部执行器的侧横截面图，其中击发杆处于近侧位置；
图3B示出了沿图2的线3-3截取的图2的端部执行器的侧横截面图，但是示出了击发杆处于远侧位置；
图4示出了沿图2的线4-4截取的图2的端部执行器的端部横截面图；
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，该端部执行器定位在组织处并且已经在组织中致动一次；
图7示出了用于图2的端部执行器的钉仓的透视图，该钉仓具有联接到其的支撑材料；
图8A示出了处于未击发位置的图7的钉仓和支撑材料的侧正视图；
图8B示出了处于击发位置的图8A的钉仓和支撑材料的侧正视图；以及
图9示出了具有钉成形凹坑的示例性附接钉驱动器的透视图。
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说明本发明的原理；然而，应当理解，本发明不限于所示出的明确布置方式。
具体实施方式
本发明的某些例子的如下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、特征、形态、实施例和优点对于本领域的技术人员而言将变得显而易见。正如将会意识到的，本发明可以是其它不同且明显的方面，只要不脱离本发明。因此，附图和具体实施方式应被视为实质上是示例性的，而非限制性的。
I.示例性外科缝合器
图1-6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，其尺寸设定成通过套管针管道通道插入到患者的手术部位，以用于执行外科手术。外科缝合和切断器械10包括连接到执行部分22的柄部部分20，该执行部分还包括轴23，该轴朝远侧终止于关节运动机构11并且在远侧附接端部执行器12。一旦关节运动机构11和端部执行器12通过套管针的管道通道插入，关节运动机构11便可以通过关节运动控件13进行远程关节运动，如图1B所示。从而，端部执行器12可从期望的角度或为了其它原因到达器官或附近组织后面。应当理解，诸如“近侧”和“远侧”的术语在本文中是参考临床医生抓握的器械10的柄部部分20而使用的。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空间术语例如“竖直”和“水平”。然而，外科器械在多个取向和位置中使用，并且这些术语并非意图进行限制，也并非绝对。
本发明例子的端部执行器12包括下钳口16和可枢转砧座18。柄部部分20包括手枪式握把24，由临床医生将闭合触发器26枢转地拉向手枪式握把，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的这种闭合通过最外侧闭合套管32提供，该闭合套管响应于闭合触发器26相对于手枪式握把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由执行部分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还在纵向上滑动地支撑击发驱动构件（未示出），该击发驱动构件延伸穿过轴23并且将击发运动从击发触发器28传递到击发杆14。击发触发器28远离闭合触发器26的外侧，并且能够被临床医生枢转地拉动，以使得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的。然后，按下释放按钮30，以从端部执行器12释放组织。
图2-5示出了端部执行器12，其采用E形梁击发杆14来执行多个功能。如图3A-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、横向取向的中间销46和处于远侧的切刃48。上部销38定位在砧座18的砧座凹坑40内并且能够在该砧座凹坑中平移。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）而可滑动地接合下钳口16的下表面，该通道狭槽穿过下钳口16形成。中间销46可滑动地接合下钳口16的顶部表面，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隔开，对于最小量的夹紧组织克服在砧座18与下钳口16之间可能出现的收缩，并且对于过多量的夹紧组织克服钉变形。
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，允许未耗尽的钉仓37可移除地安装到下钳口16的通道中。如图4-5中最佳地示出，这个例子的钉仓37包括仓体70，该仓体具有上部平台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穿过钉仓37的一部分形成。另外如图2中最佳地示出，三行钉孔51在竖直狭槽49的一侧上穿过上部平台72形成，并且另一组三行钉孔51在竖直狭槽49的另一侧上穿过上部平台72形成。重新参见图3-5，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被定位成邻近钉驱动器43。楔形滑动件41可在钉仓37内纵向地活动；而钉驱动器43可在钉仓37内竖直地活动。钉47也被定位在仓体70中，处于对应的钉驱动器43上方。具体地讲，每个钉47在仓体70中被钉驱动器43竖直地驱动，以将钉47驱动而从相关的钉孔51穿出。如图3A-3B和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朝远侧驱动穿过钉仓37时，该倾斜凸轮表面向上推压钉驱动器43。
利用如图3A所示地闭合的端部执行器12，通过使上部销38进入纵向砧座狭槽42，击发杆14推进至与砧座18接合。推块80位于击发杆14的远端处，并且能够接合楔形滑动件41，使得当击发杆14朝远侧推进穿过钉仓37时，楔形滑动件41被推块80朝远侧推压。在此类击发期间，击发杆14的切刃48进入钉仓37的竖直狭槽49，以切断钉仓37与砧座18之间夹紧的组织。如图3A-3B所示，中间销46和推块80通过进入钉仓37内的狭槽49而一起致动钉仓37，以将楔形滑动件41驱动为与钉驱动器43发生向上顶起接触，继而将钉47向外驱动穿过钉孔51并使钉47与砧座18的内表面上的钉成形凹坑53形成接触。图3B示出了击发杆14，其在完成切断和缝合组织之后完全朝远侧平移。
图6示出了端部执行器12，其已经通过单个行程而致动穿过组织90。切刃48已切穿组织90，同时钉驱动器43已驱动三排交替的钉47穿过由切刃48产生的切割线的每一侧上的组织90。在该例子中，钉47全部取向成与切割线基本上平行，但应当理解，钉47可被定位成任何合适的取向。在本例子中，在第一行程完成之后，端部执行器12从套管针撤回，用完的钉仓37被新的钉仓取代，然后，端部执行器12再次插入穿过套管针，以到达缝合部位以用于进一步的切割和缝合。这个过程可以重复，直到提供了期望量的切口和钉47。可能需要将砧座18闭合以有利于通过套管针插入和退出；并且可能需要将砧座18打开以有利于更换钉仓37。
应当理解，在每个致动行程期间，切刃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，切刃48仅仅稍稍落后于钉47的驱动，使得钉47正好在切刃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的层92、94。还应当理解，与切刃48产生的切割线相邻的钉47的成形和定位可基本上密封该切割线处的组织，由此减少或防止切割线处的出血和/或体内其它流体泄漏。参考本文的教导内容，可以使用器械10的各种合适的设置和手术对于本领域的普通技术人员而言将是显而易见的。
应当理解，可以根据以下美国专利中的教导内容配置和操作器械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，这些专利中的每一者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。可将下述教导内容结合到器械10内的各种合适方式对于本领域的普通技术人员而言将是显而易见的。类似地，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合适方式对于本领域的普通技术人员而言将是显而易见的。另外应当理解，下述教导内容并不限于本文引用的专利中教导的器械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。参考本文的教导内容，可应用下述教导内容的各种其它合适装置和设置对于本领域的普通技术人员而言将是显而易见的。
II.联接到钉仓的示例性支撑材料
在一些示例性变型中，钉仓37可结合（例如）如图7-9所示的支撑材料100使用。期望在切断和/或缝合组织的过程中使用支撑材料100以有助于切断区域的支撑和愈合。在本例子中，支撑材料100包括在切断和缝合手术部位时能够操作以支撑手术部位的凝结剂。例如，支撑材料100可包含血纤维蛋白和凝血酶，但参考本文的教导内容，可使用对本领域的普通技术人员而言将是显而易见的任何合适的凝结剂。此外，参考本文的教导内容，支撑材料100可包含止血剂、任何合适的胶粘材料、非细胞组织（如同种异体的或异种的）、胶原、明胶、氧化再生纤维素(ORC)、可降解的织造和非织造合成材料（例如聚乳酸、聚乙二醇、聚己酸）或对本领域的普通技术人员而言将是显而易见的任何其他合适的材料。在一些示例性变型中，支撑材料100可包含血纤维蛋白垫。另外，支撑材料100可包含多种合适材料的任何组合。
图7示出了放置在上部平台70上并基本上沿着上部平台70的长度延伸的支撑材料100。支撑材料100为联接到钉仓37的厚度大致均匀的垫，但应当理解，支撑材料100可分布在上部平台70上的离散部分中。例如，可代替单个垫使用支撑材料100条。此类条可包括纵向条、横向条、对角条等。或者，可将较大或较少量的支撑材料100定位在上部平台70的远端和/或近端，然而这仅是任选的。应当理解，参考本文的教导内容，可使用对本领域的普通技术人员而言将是显而易见的支撑材料100沿着上部平台70的任何合适的分布。本例子的支撑材料100包含半刚性和/或刚性结构，使得当与钉仓37分离时（如将在下文中所述），支撑材料100能够大致保持平坦的矩形构型。
已对本例子的仓37进行修改，使得一个或多个钉驱动器43（图8A-8B中所示）不具有插入其中的钉47。相反，附接钉110穿过支撑材料100插入与那些没有钉47的钉驱动器43对应的钉孔51。在图7示出的例子中，六个附接钉110穿过支撑材料100插入钉孔51中，以将支撑材料100基本上固定到钉仓37的上部平台70。应当理解，可使用许多附接钉110以将支撑材料100联接到钉仓37。附接钉110各自包括一对有回弹力的腿112，这对腿从每个附接钉110的主要部分向外偏置。因此，当附接钉110穿过支撑材料100插入钉孔51中时，弹性偏置的腿112邻接并选择性地接合钉孔51的侧壁，以通过摩擦抵抗从钉孔51内移除。当钉仓37用于通过楔形滑动件41的致动来部署钉47时（示于图3A-3B中），位于附接钉110下面的各个钉驱动器43使弹性偏置腿112与钉孔51的侧壁分离，使得附接钉110与其相应的钉孔51分离并从中逐出，如将在下文中参考图8A-8B进行更详细的描述。一个普通技术人员应当理解，附接钉110相对于上部平台70和组织的取向为当从钉仓37中部署钉47时，附接钉110未刺穿组织。例如，附接钉110可仅保持固定到支撑材料100，可自由地进入手术部位，可由砧座18中的结构保持等。
参考本文的教导内容，用于附接钉110的其他合适的构型或选择性地联接到钉孔51并与其分离的其他部件对于本领域的普通技术人员而言将是显而易见的。例如，在一些型式中，附接钉110可包括线材，该线材的直径大于用于钉47的线材的直径。因此，由于较大直径的线材在钉孔51内的干涉配合，弹性偏置腿112还可选择性地固定到钉孔51。在另外的型式中，附接钉110可包括能够掘入钉孔51的材料中以抵抗移除的倒钩114。或者，可代替附接钉110使用矩形的可插入构件（未示出）。此类可插入构件可包括倒钩114以同样地抵抗移除。另外，在上部平台70和支撑材料100之间可包含粘合剂以进一步（或作为另外一种选择）将支撑材料100固定到上部平台70。
图8A示出了具有通过附接钉110联接到上部平台70的支撑材料100的钉仓37。在钉驱动器43的顶部还示出了多个未部署状态的钉47。图8B示出了部署有钉47并联接到组织90的支撑材料100。如图8A所示，将钉47初始装载到钉仓37的钉孔51中，并以未部署状态定位在钉驱动器43的顶部。在所示的例子中，一个钉孔51未将钉47容纳在其中。相反，一旦支撑材料100位于上部平台70的顶部，附接钉110插入并选择性地固定在钉孔51中。虽然示出了单个的附接钉110，但应当理解，可使用不止一个附接钉110。仅以举例的方式，在钉仓37的每一侧均可使用三个附接钉110以将支撑材料100固定到其上。如图8A所示，具有联接到其上的支撑材料100的钉仓37处于未部署状态，并可以用于缝合组织。
当组织90定位在钉仓37的顶部待缝合和切断时，使用者致动闭合触发器26以将组织90固定在砧座18和支撑材料100之间。然后使用者致动击发触发器28以通过钉仓37向远侧致动击发杆14。如上所述，击发杆14的切刃48进入钉仓37的竖直狭槽49，以切断钉仓37与砧座18之间夹紧的组织。中间销46和推块80通过进入钉仓37内的击发狭槽而一起致动钉仓37，以将楔形滑动件41驱动为与钉驱动器43发生向上顶起接触，继而将钉47向外驱动穿过钉孔51，穿过支撑材料100，穿过组织90并使钉47与砧座18的内表面上的钉成形凹坑53形成接触。楔形滑动件41还将各个钉驱动器43驱动至附接钉110中，以移出弹性偏置腿112并使附接钉110与钉孔51分离，如图8B所示。因此，当从钉仓37中部署时，钉47同时缝合组织90并将支撑材料100固定至组织90。应当理解，在本例子中，附接钉110仅与钉仓37分离并且未联接到组织90。在一些型式中，弹性偏置腿112可包括钝的顶端。
当然，参考本文的教导内容，用于附接钉110和/或钉仓37的其他构型对于本领域的普通技术人员来说将是显而易见的。例如，如图9所示，示例性的附接钉驱动器150可在附接钉110待插入的各个钉孔51处包括在钉仓37中。本例子的附接钉驱动器150包括驱动器主体152和在驱动器主体152上形成的钉成形凹坑154。本例子的钉成形凹坑154能够接合弹性偏置腿112并将其弯曲成卷曲的钉腿。因此，当支撑材料100、钉47和附接钉110联接到体内的组织90时，卷曲的弹性偏置腿112可形成光滑平面，使得其他组织不被弹性偏置腿112捕获。当然，参考本文的教导内容，用于钉仓37和/或支撑材料100的其他型式和构型对于本领域的普通技术人员来说将是显而易见的。仅以举例的方式，可根据提交于2011年9月15日的名称为“Surgical Instrument and Buttress Material”（外科器械和支撑材料）的美国专利申请序列号13/233,664教导内容中的至少一些来构造钉仓37和/或支撑材料100，该专利的公开内容以引用方式并入本文。
尽管已描述出示例性外科器械的某些构型，但根据本文的教导内容，可构造外科器械的各种其它方式对于本领域的普通技术人员将是显而易见的。仅以举例的方式，本文提及的外科器械可根据下述美国专利的教导内容中的至少一些进行构造：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；以及美国专利号7,721,930。
应当理解，所述以引用方式并入本文中的任何专利、出版物或其他公开材料，无论是全文或部分，仅在并入的材料与本公开中给出的定义、陈述或其他公开材料不冲突的范围内并入本文。由此，在必要的程度下，本文所明确阐述的公开内容将取代以引用方式并入本文的任何相冲突的材料。如果据述以引用方式并入本文但与本文所述的现有定义、陈述或其它公开材料相冲突的任何材料或其部分，仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。
本发明的一些实施例可在传统的内窥镜检查和开放性手术器械以及机器人辅助手术中得到应用。例如，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 SurgicalTool with Ultrasound Cauterizing and Cutting Instrument”（具有超声烧灼和切割器械的机器人外科工具）的美国专利号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。
本文所公开的装置的实施例可在至少一次使用之后进行修复以供再使用。修复可包括以下步骤的任意组合：拆卸装置、然后清洗或更换特定部件和随后进行重新组装。具体地讲，可对本文所公开的装置的实施例进行拆卸，并且可选择性地、以任何组合更换或拆除装置的任意数量的具体部件或零件。在清洗和/或更换特定零件时，装置的实施例可在修复设施中重新组装或者在即将进行外科手术前由外科手术团队重新组装，以供随后使用。本领域的技术人员将会知道，修复装置时可利用多种技术进行拆卸、清洗/更换和重新组装。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，可对本文所述的实施例在外科手术之前进行处理。首先，可获取新的或用过的器械，并根据需要进行清洗。然后可对器械进行消毒。在一种消毒技术中，将器械置于闭合并密封的容器中，例如塑料袋或TYVEK袋。然后可将容器和器械置于可穿透该容器的辐射场（例如γ辐射、X射线或高能电子）中。辐射可将器械上和容器中的细菌杀死。然后可将消毒后的器械储存在无菌容器中。该密封容器可将器械保持在无菌状态，直到在医疗设施中打开该容器。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。
已经示出和描述了本发明的多个实施例，可由本领域普通技术人员进行适当修改来实现本文描述的方法和系统的进一步改进而不偏离本发明的范围。已经提及了若干这类潜在的修改形式，并且其它修改形式对本领域的技术人员而言将是显而易见的。例如，上面讨论的例子、实施例、几何形状、材料、尺寸、比率、步骤等均是例证性的而非必需的。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 (20)
1.一种设备，包括：
(a)外科器械，其中所述外科器械能够操作以切断和缝合一部分组织，其中所述外科器械包括远端，并且其中所述外科器械包括在所述远端处的端部执行器；以及
(b)钉仓，其中所述钉仓能够选择性地插入所述端部执行器，所述钉仓包括：
i.上部平台，
ii.与所述上部平台连通的支撑材料，以及
iii.附接钉驱动器，
其中所述支撑材料通过一个或多个紧固件选择性地联接到所述钉
仓，
其中所述附接钉驱动器能够操作以接合所述一个或多个紧固件，并且其中所述附接钉驱动器能够操作以分离所述一个或多个紧固件。
2.根据权利要求1所述的设备，其中所述一个或多个紧固件包括附接钉，其中所述附接钉将所述支撑材料选择性地联接到所述上部平台。
3.根据权利要求2所述的设备，其中所述上部平台包括附接钉孔，其中所述附接钉插入到所述附接钉孔中。
4.根据权利要求3所述的设备，其中所述附接钉包括线材，其中所述线材具有直径，其中所述附接钉孔具有宽度，并且其中所述线材的所述直径大于所述附接钉孔的所述宽度。
5.根据权利要求3所述的设备，其中所述附接钉包括线材，其中所述线材具有直径，其中所述附接钉孔具有宽度，并且其中所述线材的所述直径基本上等于所述附接钉孔的所述宽度。
6.根据权利要求3所述的设备，其中所述钉仓还包括设置在其中的多个钉和多个钉驱动器，其中所述上部平台包括多个钉孔，其中所述多个钉中的每个钉与所述多个钉驱动器中相应的钉驱动器连通。
7.根据权利要求6所述的设备，其中所述附接钉孔与所述钉孔中的一个或多个纵向对齐。
8.根据权利要求6所述的设备，其中所述多个钉驱动器能够操作以驱动所述多个钉穿过所述支撑材料。
9.根据权利要求3所述的设备，其中所述附接钉驱动器与所述附接钉孔连通。
10.根据权利要求9所述的设备，其中所述附接钉驱动器能够相对于所述上部平台竖直地平移。
11.根据权利要求9所述的设备，其中所述附接钉驱动器包括钉成形凹坑。
12.根据权利要求2所述的设备，其中所述附接钉包括一对弹性偏置腿。
13.根据权利要求12所述的设备，其中所述弹性偏置腿向外偏置。
14.根据权利要求12所述的设备，其中所述弹性偏置腿包括倒钩。
15.根据权利要求1所述的设备，其中所述支撑材料选自包括以下项的组：
止血剂；
凝血酶；或
血纤维蛋白。
16.一种设备，包括：
(a)外科器械，所述外科器械包括砧座、下钳口和具有切割刃的击发杆，其中所述砧座和所述下钳口能够操作以将一部分组织固定在其间，其中所述击发杆能够操作以相对于所述砧座和下钳口向远侧推进，以切割所述一部分组织；以及
(b)钉仓，其中所述钉仓能够选择性地插入所述下钳口，所述钉仓包括：
i.仓体，
ii.具有穿过其形成的多个钉孔的上部平台，
iii.多个钉驱动器，其中所述多个钉驱动器的每个钉驱动器与所述多个钉孔中相应的钉孔连通，
iv.设置在所述仓体中的一个或多个钉，其中所述一个或多个钉与所述多个钉驱动器中的一个或多个钉驱动器连通，以及
v.与所述上部平台连通的支撑材料，
其中所述支撑材料通过至少一个紧固件选择性地联接到所述钉仓；并且
其中所述多个钉驱动器中的至少一个钉驱动器能够操作以使所述支撑材料与所述钉仓选择性地分离。
17.根据权利要求16所述的设备，其中所述至少一个紧固件包括多个附接钉，其中所述多个附接钉中的每个附接钉插入到钉孔中。
18.根据权利要求17所述的设备，其中所述多个附接钉中的每个附接钉包括一对弹性偏置腿。
19.根据权利要求18所述的设备，其中所述多个钉驱动器中的所述至少一个钉驱动器选择性地接合所述多个附接钉中的至少一个附接钉的所述弹性偏置腿。
20.一种使用一个或多个附接构件将支撑材料选择性地联接到外科器械的钉仓的方法，其中所述外科器械包括能够容纳所述钉仓的端部执行器，其中所述端部执行器在所述钉仓插入其中时能够操作以切割一部分组织和缝合一部分组织，其中所述钉仓包括具有多个钉孔的上部平台和钉驱动器，所述方法包括：
(a)将所述支撑材料放置在所述上部平台的至少一部分的顶部上；以及
(b)穿过所述支撑材料将所述一个或多个附接构件插入到所述多个钉孔中的至少一个钉孔中；
其中所述一个或多个附接构件的插入将所述支撑材料选择性地联接到所述钉仓，并且其中所述钉驱动器能够操作以选择性地分离所述一个或多个附接构件。
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US13/251,682 US8899464B2 (en) | 2011-10-03 | 2011-10-03 | Attachment of surgical staple buttress to cartridge |
| US13/251,682 | 2011-10-03 | ||
| PCT/US2012/058388 WO2013052435A1 (en) | 2011-10-03 | 2012-10-02 | Attachment of surgical staple buttress to cartridge |
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| CN103841902A true CN103841902A (zh) | 2014-06-04 |
| CN103841902B CN103841902B (zh) | 2016-12-14 |
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| CN201280048566.0A Active CN103841902B (zh) | 2011-10-03 | 2012-10-02 | 外科钉支撑件至仓的附接设备和方法 |
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| US (1) | US8899464B2 (zh) |
| EP (1) | EP2765923B1 (zh) |
| JP (1) | JP6208138B2 (zh) |
| CN (1) | CN103841902B (zh) |
| BR (1) | BR112014008028B1 (zh) |
| MX (1) | MX341799B (zh) |
| PL (1) | PL2765923T3 (zh) |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| CN107106171A (zh) * | 2014-09-18 | 2017-08-29 | 伊西康有限责任公司 | 具有多个切割元件的外科缝合器 |
| CN108348233A (zh) * | 2015-08-26 | 2018-07-31 | 伊西康有限责任公司 | 用于允许改变钉特性并实现轻松仓加载的外科钉条 |
| CN110366390A (zh) * | 2017-02-17 | 2019-10-22 | 爱惜康有限责任公司 | 用于外科缝合器的附属物释放 |
| CN110366390B (zh) * | 2017-02-17 | 2023-01-20 | 爱惜康有限责任公司 | 用于外科缝合器的附属物释放 |
Also Published As
| Publication number | Publication date |
|---|---|
| US20130082086A1 (en) | 2013-04-04 |
| JP2014533128A (ja) | 2014-12-11 |
| RU2014117163A (ru) | 2015-11-10 |
| RU2621117C2 (ru) | 2017-05-31 |
| BR112014008028A2 (pt) | 2017-04-11 |
| MX341799B (es) | 2016-09-01 |
| EP2765923A1 (en) | 2014-08-20 |
| PL2765923T3 (pl) | 2018-09-28 |
| BR112014008028B1 (pt) | 2021-01-05 |
| US8899464B2 (en) | 2014-12-02 |
| CN103841902B (zh) | 2016-12-14 |
| JP6208138B2 (ja) | 2017-10-04 |
| WO2013052435A1 (en) | 2013-04-11 |
| MX2014004084A (es) | 2014-09-22 |
| EP2765923B1 (en) | 2018-04-04 |
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