TWI428112B - 含有ｅ型桿發射機構的手術釘合工具 - Google Patents

含有ｅ型桿發射機構的手術釘合工具 Download PDF

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TWI428112B
TWI428112B TW096136827A TW96136827A TWI428112B TW I428112 B TWI428112 B TW I428112B TW 096136827 A TW096136827 A TW 096136827A TW 96136827 A TW96136827 A TW 96136827A TW I428112 B TWI428112 B TW I428112B
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anvil
groove
thickness
surgical tool
firing
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TW200833288A (en
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Shelton, Iv
Jerome R Morgan
Michael Earl Setser
Kevin R Doll
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Ethicon Endo Surgery Inc
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Description

含有E型桿發射機構的手術釘合工具
本申請案在此主張美國臨時專利申請案(標題為“含有電致動活節機構的手術工具”頒給Shelton，序號為60/591,694，申請日2004年7月28日)的權益。本申請案為美國非臨時專利申請案(標題為“含有E型桿發射機構的手術釘合工具”，頒給Shelton等人，序號為10/443,617，申請日2003年5月20日)的部份延續專利申請案，其全部揭示內容併入本文作為參考資料。
本發明大體有關於數種適合以內視鏡方式插入用縱向驅動式發射構件來啟動之末端執行器(end effector)的手術工具，且更特別的是，有關於一種具有活節軸桿(articulating shaft)的手術釘合及切割工具。
內視鏡手術工具常優於傳統的打開型手術裝置，因為較小的切口會減少手術後的恢復時間及併發症。結果，人們開發出許多內視鏡手術工具適合通過套管針(trocar)的套管用來準確地安置遠端執行器於想要的手術部位。該等遠端執行器用多種方式接合組織以達成診斷或醫療上的效果(例如，內視鏡血管切割閉合器(endocutter)、夾鉗(grasper)、切刀、釘合器、夾子置放器(clip applier)、 通路裝置(access device)、藥物/基因治療輸送裝置、以及使用超音波、射頻、雷射、等等的能量裝置)。
末端執行器的定位會受制於套管針。一般而言，該等內視鏡手術工具都包含在末端執行器與由臨床醫生操縱之把手部份之間的長軸桿。此一長軸桿使得插入想要的深度以及繞著軸桿縱軸的旋轉成為有可能，從而在一定程度上可定位末端執行器。藉由謹慎地安置套管針以及使用夾鉗(例如，通過另一套管針)常可得到足量的定位。手術釘合及切割工具(例如，描述於美國專利第5,465,895號的)為內視鏡手術工為藉由能插入及旋轉來成功地定位末端執行器的例子。
最近，美國專利第10/443,617號(標題為“含有E型桿發射機構的手術釘合工具”，頒給Shelton等人，申請日為2003氧5月20日，其全部內容併入本文作為參考資料)係描述一種改良“E型”發射桿可用來切割組織以及啟動釘針。一些額外的優點包含末端執行器(或更特別的是，打釘總成(staple applying assembly))的卡爪(jaw)間切確隔開，即使夾鉗稍大或稍小的組織仍可形成最佳的釘合。此外，E型發射桿使末端執行器與釘針卡匣(staple cartridge)接合的方式使得包含多種有利的閉鎖成為有可能。
取決於手術的本質，可進一步調整內視鏡手術工具之末端執行器的定位是合乎需要的。特別是，常常想要改變末端執行器在與工具軸桿之縱軸呈橫向的軸線中的方向。 末端執行器相對於工具軸桿的橫向運動一般被稱作“活節”。通常這可藉由在打釘總成最近端安置於加長軸桿之中的樞轉(或活節)接頭來實現。這使得外科醫生在遠端可使打釘總成活節於任何一邊用以於手術時能以更好的方式安置釘合線以及更加容易地進行組織操縱及定向。這種活節式定位(articulated positioning)使得臨床醫生在某些情況下更加容易接合組織，例如在器官之後的。此外，有利的是，活節式定位使得內視鏡可在末端執行器後面定位而不會被工具軸桿阻擋。
在內視鏡工具的小直徑約束條件內整合活節的控制與閉合末端執行器以夾住組織以及發射末端執行器的控制(亦即，釘合及切割)，會使活節手術釘合及切割工具的方法複雜化。一般而言，有3種控制運動都要通過軸桿來轉變成縱向位移。例如，美國專利第5,673,840號揭示一種類似手風琴的活節機構(“撓性頸部”)，其活節作用係通過實施軸(implement shaft)選擇性地抽回兩支連接桿中之一支，偏離中心線的連接桿係各自在軸桿的兩對邊。通過棘輪使得連接桿有一系列的離散位置。
另一個縱向控制活節機構的例子為美國專利第5,865,361號，其係包含一偏離凸輪樞軸的活節連桿藉此活節連桿的推或拉縱向位移來影響各邊的活節。同樣，美國專利第5,797,537號揭示一種穿過軸桿來實現活節的類似桿體。
在共審查中及共同擁有的美國專利申請案第 10/615,973號(標題為“含有可繞著縱軸旋轉之活節機構的手術工具”，頒給Frederick E.Shelton IV等人，其全部揭示內容併入本文作為參考資料)中，旋轉運動是用來轉移活節運動以替代縱向運動。
在標題為‘‘含有E型桿發射機構的手術釘合工具”(其係頒給Shelton等人，序號為10/443,617，申請日2003年5月20日，其全部揭示內容在前面已併入本文作為參考資料)的申請案中，適用於腹腔鏡及內視鏡臨床程序的手術切割及釘合工具係夾住在末端執行器內的組織，該末端執行器有一可對砧體樞轉的長形溝槽。E型發射桿向遠端移動穿過夾住的末端執行器以切割組織並且驅動在刀刃兩邊的釘針。E型發射桿使砧體與長形溝槽切確隔開以保證可適當地形成閉合的釘針，特別是在被夾著的組織數量不足以隔開末端執行器的時候。特別是，發射桿的上插銷縱向移動穿過砧體狹縫而且溝槽狹縫是夾在發射桿的底蓋與中插銷之間以確保有最小的間距。儘管此一E型發射桿有許多優點，然而最好有附加特徵用來增強可製造性以及最小化尺寸偏差。
因此，亟須一種有發射桿的手術工具，其中該發射桿係便於確保末端執行器的夾緊卡爪之間有適當的間距而且有助於該發射桿之軸桿的活節。
本發明能克服先前技術的上述及其他缺陷係藉由提供 一種使手術釘合及切割工具之末端執行器切確垂直隔開的發射機構。因此，該公具在結構上可確保有適當的間距以實現正確的釘合，即使是在末端執行器夾著很少組織的情形下。整體成形該等特徵於含有刀刃的E型桿在發射E型桿通過末端執行器(例如，切割及釘合總成)時可實現始終如一的間距及性能。此外，近端連接個別的減薄發射桿於E型桿可促進活節式手術工具的使用，其中減少的橫截面面積以及能在活節平面撓曲是合乎需要的。
在本發明之一方面，手術工具包含一可操作以產生一發射運動的把手部份，其係啟動一執行部份。此一執行部份的長形溝槽係容納對面連接著可樞轉砧體的釘針卡匣。可與該釘針卡匣整合的發射裝置包含：一在遠端容納於該長形溝槽、該砧體之間的縱向刀刃、一可與該砧體溝槽接合的上部構件、一與該溝槽狹縫接合的低部構件、以及一可操作以啟動該楔形滑板的中間構件。該中間構件能阻止末端執行器的夾住(pinching)是有利的，這可確保即使在夾著極少量組織的情形下仍可使釘針正確地成形。有利的是，形成該等隔開及切割特徵於E型桿同時用聯結於E型桿的減薄發射桿來提供活節撓性。
由以下描述(參附圖)可明白本發明其他的目標及優點。
在第1圖至第3圖中，手術釘合工具10在遠端有圖示 成打釘總成12的末端執行器，該打釘總成12係藉由長形軸桿16而與把手14隔開(第1圖)。打釘總成12包含一用於接受可替換釘針卡匣20的釘針溝槽18。可樞轉地聯結於釘針溝槽18的是與釘針卡匣20一起夾住組織的砧體22，而且它也用來使數支由釘針卡匣20中之釘孔24被驅策向上頂著砧體底面28中之釘針形成凹槽26(第6圖)的釘針23(第3圖)變形成閉合形狀。當打釘總成12閉合時，它的橫截面面積與長形軸桿16適合用來插穿小手術開孔，例如穿過套管針(未圖示)的套管。
請特別參考第1圖，打釘總成12的正確安置及定向係以把手14上的控件來協助。特別是，旋轉鈕30會使軸桿16繞著它的縱軸旋轉，從而使打釘總成12旋轉。在軸桿16中的活節接頭32處，致能附加的定位作用，該活節接頭32係使打釘總成12由軸桿16縱軸以弧形樞轉，從而使得安置於器官後或使得定位其他的工具(例如，內視鏡，未圖示)於打釘總成12後成為有可能。用把手14上的活節控制開關34以傳送電子訊號到活節接頭32之電致動聚合物(electroactive polymer，EAP)致動器36(由把手14內的EAP控制器及電源供應器38供電)的方式來影響此一活節是有利的。
一旦組織位於打釘總成12後，外科醫生藉由向手槍式握把42拉動在近端的閉合板機40來閉合砧體22。在夾住後，外科醫生抓住在較遠處的發射板機44，向後拉它來發射打釘總成12，其中有些應用系統是以一個單一發射衝程 (firing stroke)來達成而其他的應用系統是用多個發射衝程。發射會同時完成至少兩排釘針的釘合同時切割在其間的組織。
在走完行程後，可自動起始發射組件的拉回。替換地，可拉後端的拉回槓桿46以使拉回起作用。在發射組件拉回後，外科醫生稍微向手槍式握把42拉動在後端的閉合板機40並且按下閉合釋放鈕48然後釋放閉合板機40，可鬆開及打開打釘總成12，從而由打釘總成12釋出切除組織的兩個釘合末端。
打釘總成
儘管第1圖繪出活節接頭32，但為了清晰圖示以及作為替代應用，第2圖至第14圖的手術釘合工具10省略活節接頭32。不過，應瞭解，對於以下在說明第15圖至第18圖時所描述的活節，本發明的方面有特別的優點。
在第1圖至第3圖中，打釘總成12係完成下列功能：夾住組織、驅動釘針、以及藉由軸桿16在軸桿框體70上轉成縱向向下的兩個不同運動來切割組織。此一軸桿框體70是在近端聯結及耦合於把手14以便用旋轉鈕30來旋轉它。第1圖手術釘合及切割工具10的示範多衝程把手14以及如本文所述的附加特徵和變體在共審查中及共同擁有之美國專利申請案(標題為“含有多衝程發射位置指示器的手術釘合工具及拉回機構”，頒給Swayze與Shelton，序號為10/374,026)，其全部揭示內容併入本文作為參考 資料)中有說明。儘管多衝程把手14便於支援對長距離有高發射力的應用系統，然而符合本發明的應用系統可包含單一發射衝程，例如描述於共審查中及共同擁有、標題為“有個別不同閉合及發射系統的手術釘合工具”的美國專利申請案的，其係頒給Frederick E.Shelton IV、Michael E.Setser及Brian J.Hemmelgarn，為10/441,632，其全部揭示內容併入本文作為參考資料。
請特別參考第3圖，軸桿框體70的遠端係聯結於釘針溝槽18。砧體22在近端有樞轉端72，該樞轉端72係可樞轉地容納於釘針溝槽18近端74內而且與軸桿框體70的遠端剛好接合。砧體22的樞轉端72包含閉合特徵76，它與釘針溝槽18的連接件在遠端與閉合特徵76鄰接。因此，閉合管78(它的遠端包含與閉合特徵76接合的馬蹄形小孔80)會因應閉合板機40而在軸桿框體70上滑動時選擇性地，在近端縱向運動期間賦予打開運動給砧體22，以及在遠端縱向運動期間賦予閉合運動給砧體22。
軸桿框體70係圍繞把手14以及通過縱向前後運動的兩片式刀體和發射桿90來導引把手14的發射運動。特別是，軸桿框體70包含容納兩片式刀體及發射桿90之近端部份的縱向發射桿狹縫92，具體言之疊層削尖(laminate tapered)發射桿94。應瞭解，疊層削尖發射桿94可換為實心發射桿或應用時無意穿過活節接頭的其他材料，如第2圖至第14圖所示。
E型桿102為兩片式刀體及發射桿90的遠端部份，其 係有助於分開閉合與發射以及在發射時砧體22與長形釘針溝槽18的分開。請特別參考第3圖至第4圖，除了任何連接處理(例如，銅焊或黏著劑)以外，刀體及發射桿90由在近端形成於E型桿102且可容納在疊層削尖發射桿94遠端之對應連接凸件106的垂直連接凹穴104形成，使得各部份可由依不同功能(例如，強度、撓性、磨擦)而選定的材料及方法形成。E型桿102由材料性質適合用於形成一對上插銷110、一對中插銷112及下插銷或腳部114以及能夠得到銳利刀刃116的材料形成是有利的。此外，支架刀刃116垂直兩端、整體成形、在近端突出的上導件118及中導件120進一步界定一在切割前協助引導組織至銳利刀刃116的組織安置區(tissue staging area)122。中導件120也用來接合及發射打釘總成12，此係藉由鄰近會影響由打釘總成12形成釘針之楔形滑板(wedge sled)126(第5圖)的階梯形中構件124，這在下文會有更詳細的說明。
與由多個部件組成的相比，該等特徵(例如，上插銷110、中插銷112及下腳部114)與E型桿102整體成形有助於彼此能以較小的公差來製造、確保在發射期間有想要的操作及/或打釘總成12的不同固定特徵(lockout feature)能有有效的互動。
在第6圖至第7圖中，手術釘合工具10係圖示成打開，而且E型桿102完全拉回。在組裝期間，使E型桿102的下腳部114下降通過釘針溝槽18的加寬孔130，然後使 E型桿102前進藉此E型桿102會沿著形成於釘針溝槽18的下軌道132滑到遠端。特別是，下軌道132包含會在釘針溝槽18底面加大變成加寬狹縫134以使側向橫截面成為倒T形的窄狹縫133，特別如第7圖及第8圖所示，該窄狹縫133係與加寬孔130相通。在組裝好了以後，在近端耦合於疊層削尖發射桿94的組件不允許下腳部114再向近端行進到允許脫離的加寬孔130。
在第9圖中，疊層削尖發射桿94有助於通過套管針來插入打釘總成12。特別是，在遠端一點的朝下突出物136會在E型桿102完全拉回時使它升高。這可藉由使朝下突出物136在釘針溝槽18的加寬孔130近端邊緣處會向上凸升來達成。
在第10圖中，疊層削尖發射桿94也用以下方式增強某些固定特徵的操作：釘針溝槽18加上更靠近近端的朝上突出物138，它在發射行程的初始部份時會被軸桿框體70壓迫向下。特別是，橫桿140是界定在軸桿框體70(第3圖)的一對方孔142之間。包圍橫桿140的卡簧(clip spring)144會向下壓迫部份疊層削尖發射桿94使其遠端突出離開縱向發射桿狹縫92，這可確保在適當的時候某些有些的固定特徵會嚙合。對於在發射時朝上突出物138會與卡簧144接觸時的部份，這種壓迫能使它更加確實或有明確的約束。
在第6圖至第7圖中，E型桿102拉回時，它的上插銷110是駐在砧體22樞轉近端附近的砧體凹穴(anvil pocket)150內。開口向下的垂直砧體狹縫152(第2圖)在砧體22中橫向加寬成為砧體內軌道154，在發射期間，在E型桿102的上插銷110向遠端前進時，砧體內軌道154會抓住E型桿102的上插銷110，如第9圖至第10圖所示，使得砧體22與釘針溝槽18切確隔開。因此，藉著E型桿102的拉回，外科醫生能使打釘總成12重覆開闔直到抓取於其中的組織有可供釘合及切割的滿意位置及方向，甚至在打釘總成12直徑減少及對應剛性減少的情形下，E型桿102也有助於組織的正確地定位。
在第2圖至第3圖、第5圖至第6圖、第8圖至第14圖中，圖中打釘總成12為包含楔形滑板126的可替換釘針卡匣20。多個縱向平行對齊開口向下的楔形狹縫202(第8圖)係各自容納整合於楔形滑板126的楔形物204。在第8圖至第10圖中，楔形滑板126會使多個在釘針驅動器凹槽208內可垂直滑動的釘針驅動器206向上凸升。在此一示範版本中，釘針驅動器206各包含兩個垂直叉形物，各個叉形物會向上位移進入各自的釘孔210以強迫位於其上的釘針23向上且頂著砧體22的釘針成形面214(第10圖)而變形。在釘針溝槽18A近端在釘針卡匣20內界定的中央發射凹槽216(第8圖)係允許楔形滑板126的水平底部218(第5圖)和E型桿102的中插銷112通過。具體言之，釘針卡匣托盤220(第3圖、第8圖)是在聚合物釘針卡匣主體222(其中係形成釘針驅動器凹槽208、釘孔210及中央發射凹槽216)下面聯結於它。當釘針23在兩邊形成時， 除了最遠端的部份以外，銳利刀刃116會進入穿經釘針卡匣20縱軸的垂直貫通狹縫230。
如第10圖所示，發射打釘總成12的開始是以使兩片式刀體及發射桿90向近端拉直到朝下突出物136使E型桿102的中導件120在尾端向上凸升，使得在砧體22打開(如第2圖、第6圖所示)時，新的釘針卡匣20可插進釘針溝槽18。
在第11圖中，兩片式刀體及發射桿90已向遠端前進一段小距離，使得在卡簧144向疊層削尖發射桿94的朝上突出物138壓迫的情形下，朝下突出物136會掉進下軌道132的加寬孔130。藉由靠著楔形滑板126的階梯形中構件124，中導件120可防止進一步向下旋轉，從而可使E型桿的中插銷112留在中央發射凹槽216內。
在第12圖中，兩片式刀體及發射桿90已發射到遠端，前進的楔形滑板126可使釘針23成形同時用銳利刀刃116切割夾在砧體22、釘針卡匣20之間的組織242。之後，在第13圖中，兩片式刀體及發射桿90拉回，留下位於遠端的楔形滑板126。
在第14圖中，允許中插銷112向下移動進入形成於釘針溝槽18的固定凹槽(lockout recess)240(也請參考第7圖、第10圖)。因此，當楔形滑板126(未圖示於第14圖)不在近端時(亦即，沒有釘針卡匣20或釘針卡匣20用完)，操作者的觸覺會感受到中插銷112已碰到固定凹槽240的遠端邊緣。
在第1圖中，活節接頭32經圖示成獲益於兩片式刀體及發射桿90的撓曲強度(flexible strength)是有利的。在第15圖至第18圖中，活節接頭32經圖示成為一個由脊柱體形成的撓性頸接頭(flex neck joint)300，該脊柱體302有數對橫向對稱使得在活節平面中可活節的弧形凹槽304。一般已知藉由選擇性移動各自縱向穿過側面306、308的控制桿(未圖示)可使各個側面306、308同時壓縮及拉伸。然而，圖中的是EAP平板致動器310、312，其中EAP平板致動器310、312能夠各自在一或兩個橫向中受機力操縱而撓曲。
經界定成會縱向通過脊柱體302的中央通道320(第16圖)係容納一對可防止疊層削尖發射桿94挫曲(buckling)及約束的支撐板322、324。在示範版本中，支撐板322、324各有在近端的固定端326(第15圖)與滑動端328以在活節期間適應徑向距離的改變。因此，可支援較薄的發射桿94。
儘管已藉由描述數個具體實施例來圖解說明本發明以及相當詳細地描述該等示範具體實施例，然而本案申請人不是想要讓隨附的申請專利範圍的範疇以任何方式受限於該等細節。熟諳此藝者很快會明白其他的優點及修改。
例如，儘管楔形滑板與釘針卡匣整合會有許多的優點，然而在某些符合本發明數個方面的應用系統中，楔形滑板可與E型桿整合。例如，整個末端執行器可為可替換物，而不是只有釘針卡匣。
10‧‧‧手術釘合工具
12‧‧‧打釘總成
14‧‧‧把手
16‧‧‧軸桿
18‧‧‧釘針溝槽
20‧‧‧可替換釘針卡匣
22‧‧‧砧體
23‧‧‧釘針
24‧‧‧釘孔
26‧‧‧釘針形成凹槽
28‧‧‧砧體底面
30‧‧‧旋轉鈕
32‧‧‧活節接頭
34‧‧‧活節控制開關
36‧‧‧電致動聚合物(EAP)致動器
38‧‧‧電源供應器
40‧‧‧閉合板機
42‧‧‧手槍式握把
44‧‧‧發射板機
46‧‧‧拉回槓桿
48‧‧‧閉合釋放鈕
70‧‧‧軸桿框體
72‧‧‧樞轉端
74‧‧‧近端
76‧‧‧閉合特徵
78‧‧‧閉合管
80‧‧‧馬蹄形小孔
90‧‧‧發射桿
92‧‧‧發射桿狹縫
94‧‧‧疊層削尖發射桿
102‧‧‧E型桿
104‧‧‧垂直連接凹穴
106‧‧‧連接凸件
110‧‧‧上插銷
112‧‧‧中插銷
114‧‧‧下插銷、下腳部
116‧‧‧銳利刀刃
118‧‧‧上導件
120‧‧‧中導件
122‧‧‧組織安置區
124‧‧‧階梯形中構件
126‧‧‧楔形滑板
130‧‧‧加寬孔
132‧‧‧下軌道
133‧‧‧窄狹縫
134‧‧‧加寬狹縫
136‧‧‧朝下突出物
138‧‧‧朝上突出物
140‧‧‧橫桿
142‧‧‧方孔
144‧‧‧卡簧
150‧‧‧砧體凹穴
152‧‧‧砧體狹縫
154‧‧‧砧體內軌道
202‧‧‧楔形狹縫
204‧‧‧楔形物
206‧‧‧釘針驅動器
208‧‧‧釘針驅動器凹槽
210‧‧‧釘孔
214‧‧‧釘針成形面
216‧‧‧中央發射凹槽
218‧‧‧水平底部
220‧‧‧釘針卡匣托盤
222‧‧‧聚合物釘針卡匣主體
230‧‧‧垂直貫通狹縫
240‧‧‧固定凹槽
242‧‧‧組織
300‧‧‧撓性頸接頭
302‧‧‧脊柱體
304‧‧‧弧形凹槽
306,308‧‧‧側面
310,312‧‧‧EAP平板致動器
320‧‧‧中央通道
322,324‧‧‧支撐板
326‧‧‧固定端
328‧‧‧滑動端
併入本專利說明書且構成本專利說明書之一部份的附圖係圖解說明本發明的具體實施例，而且上述[發明內容]和以下的[實施方式]一起用來解釋本發明的原理。
第1圖的透視圖係圖示用於手術釘合及切割、處於打開未活節狀態的內視鏡手術釘合工具。
第2圖的左前透視圖係圖示第1圖手術釘合工具中打開的打釘總成以及可替換釘針卡匣內含於釘針溝槽的右半部。
第3圖為第2圖打釘總成的展開透視圖，其中有完整的可替換釘針卡匣和替代的非活節軸桿建構。
第4圖的透視圖係圖示第2圖打釘總成的兩片式刀體(two－piece knife)與發射桿(“E型桿”)。
第5圖的透視圖係圖示第1圖打釘總成中之釘針卡匣的楔形滑板。
第6圖的左側正視圖係沿著第2圖打釘總成的中心線6－6繪成的縱向橫截面。
第7圖的透視圖係圖示沒有可替換釘針卡匣而且打開的第2圖打釘總成、釘針溝槽靠近兩片式刀體及發射桿之中插銷的部份、而且沒有釘針溝槽的遠端部份。
第8圖為沿著第2圖打釘總成直線8－8剖開之橫截面的前方正視圖，其係圖示釘針卡匣的內置釘針驅動器和兩片式刀體及發射桿之一部份。
第9圖為大體沿著第2圖閉合打釘總成直線6－6繪製的左側正視圖，其係圖示兩片式刀體與楔形滑板的中央接觸點，並且顯示出釘針卡匣內的釘針與釘針驅動器。
第10圖為第9圖打釘總成的左側正視詳圖，其中兩片式刀體比在正常時拉回一點以便更換釘針卡匣。
第11圖為建構與第9圖相對應之第10圖打釘總成的左側正視詳圖，其中兩片式刀體正開始發射。
第12圖為閉合第9圖打釘總成在兩片式刀體及發射桿已發射至遠端之後的左側橫截面正視圖。
第13圖為閉合第12圖打釘總成在發射釘針卡匣且拉回兩片式刀體之後的左側橫截面正視圖。
第14圖為第13圖打釘總成的左側橫截面正視詳圖，其中允許兩片式刀體落下到閉鎖位置。
第15圖的上視圖係圖示沿著第1圖手術釘合工具中之活節接頭(撓性頸)的直線15－15剖開的橫截面。
第16圖為沿著第15圖活節接頭直線16－16剖開之垂直橫截面的前方正視圖，其係圖示發射桿的電致動聚合物(EAP)平板活節致動器與EAP支撐板。
第17圖為第16圖活節接頭在活節後沿著直線15－15剖開之橫截面的上視圖。
第18圖為第15圖活節接頭的透視圖。
12‧‧‧打釘總成
16‧‧‧軸桿
18‧‧‧釘針溝槽
20‧‧‧可替換釘針卡匣
22‧‧‧砧體
23‧‧‧釘針
24‧‧‧釘孔
70‧‧‧軸桿框體
72‧‧‧樞轉端
74‧‧‧近端
76‧‧‧閉合特徵
78‧‧‧閉合管
80‧‧‧馬蹄形小孔
94‧‧‧疊層削尖發射桿
102‧‧‧E型桿
110‧‧‧上插銷
112‧‧‧中插銷
126‧‧‧楔形滑板
136‧‧‧朝下突出物
138‧‧‧朝上突出物
140‧‧‧橫桿
142‧‧‧方孔
144‧‧‧卡簧
220‧‧‧釘針卡匣托盤
222‧‧‧聚合物釘針卡匣主體
230‧‧‧垂直貫通狹縫

Claims (20)

  1. 一種手術工具，其係包含：一可操作以產生一發射運動的把手部份；以及，一對於該把手部份之該等發射運動有回應的執行部份，該執行部份包含：一與該把手部份耦合且包含一溝槽狹縫的長形溝槽；一釘針卡匣，其係容納於該長形溝槽且含有一配置於近端的楔形構件，該楔形構件係經對齊成可使一支撐一釘針的驅動器向上凸升；一與該長形溝槽耦合成可樞轉且包含一砧體溝槽的砧體並界定一樞轉軸；一發射裝置，其係包含：一在遠端縱向容納於該長形溝槽與該砧體之間的刀刃、一可與該砧體溝槽嚙合的上部構件、一嚙合該溝槽狹縫的低部構件、以及一藉使該釘針卡匣之楔形構件向遠端位移可操作以啟動該釘針卡匣的中間構件，在縱向發射行進期間，該發射裝置係與該長形溝槽、該砧體兩者確實地嚙合以於其間提供用於使釘針成形的間距，該發射裝置在其一遠端處具有一橫向延伸的插銷，該發射裝置鄰近於該插銷具有一以平行於該樞轉軸測量的第一厚度，以及在鄰近於該第一厚度處具有一以平行於該樞轉軸 測量的第二厚度，其中該第二厚度小於該第一厚度，且該第一厚度小於該插銷的一厚度；一閉合裝置，其用以選擇性地賦予該砧體一打開運動及一閉合運動，該閉合裝置獨立於該發射裝置的任何運動而移動該砧體；以及一在近端與該長形溝槽耦合的活節接頭。
  2. 如申請專利範圍第1項所述之手術工具，其中該砧體與該長形溝槽形成一可樞轉連接向內偏壓各個遠端以在致動該釘針卡匣期間協助該發射裝置在該砧體與該長形溝槽之間切確隔開。
  3. 如申請專利範圍第1項所述之手術工具，其中該釘針卡匣為由多種釘針卡匣選出的類型，各種釘針卡匣的特徵為使該砧體與該長形溝槽之間有想要隔開的厚度以及長度適合用於該想要隔開的釘針。
  4. 如申請專利範圍第3項所述之手術工具，其中該楔形構件包含一有多個相連之凸頂楔形物的楔形滑板，該等楔形物各有一建構成適合用於選定類型之釘針卡匣的預選高度，該發射裝置之該中間構件係經定向成鄰接於該等多種釘針卡匣中之每一種。
  5. 一種手術工具，其係包含：一可操作以產生一發射運動與一閉合運動的把手部份；以及，一對於該把手部份之該發射運動有回應而且直徑尺寸經製作成適合供內視鏡手術使用的執行部份，該執行部份包含：一軸桿，其係與該把手部份耦合成可操作以個別轉移該發射運動與該閉合運動；一與該軸桿耦合且包含一溝槽狹縫的長形溝槽；一砧體，其係與該長形溝槽耦合成可樞轉以回應該軸桿的該閉合運動而且包含一砧體溝槽並界定一樞轉軸；一發射裝置，其係包含一在遠端縱向容納於該長形溝槽與該砧體之間的刀刃，該發射裝置包含在發射期間會與該長形溝槽滑動接合的下半部(lower portion)以及一與該砧體滑動接合的上半部，該發射裝置與該長形溝槽及該砧體的接合會在其間保持一間距；該發射裝置在其一遠端處具有一橫向延伸的插銷，該發射裝置於其近端處具有一以平行於該樞轉軸測量的第一厚度，以及一以平行於該樞轉軸測量的第二厚度，該第二厚度鄰近於該第一厚度，其中該第二厚度小於該第一厚度，且該第一厚度小於該插銷的一厚度； 一閉合裝置，其用以選擇性地賦予該砧體一打開運動及一閉合運動，該閉合裝置獨立於該發射裝置的任何運動而移動該砧體。
  6. 如申請專利範圍第5項所述之手術工具，其更包含一釘針卡匣，其係與該長形溝槽嚙合且包含一開口在近端的狹縫用以容納該發射裝置的刀刃，該釘針卡匣包含多支釘針，藉由該發射機構向遠端的縱向運動可使該等多支釘針向上凸升。
  7. 如申請專利範圍第6項所述之手術工具，其中該釘針卡匣更包含多個支撐該等釘針的驅動器與一楔形滑板，該楔形滑板係因應該發射機構向遠端的縱向運動而使該等驅動器向上凸升從而以頂著該砧體來形成該等釘針。
  8. 如申請專利範圍第5項所述之手術工具，其中該軸桿包含一活節機構，通過該活節機構，該減薄長條會彎曲並且在縱向位移。
  9. 如申請專利範圍第6項所述之手術工具，其中該釘針卡匣為由多種釘針卡匣選出的類型，各種釘針卡匣的特徵為使該砧體與該長形溝槽之間有想要隔開的厚 度以及長度適合用於該想要隔開的釘針。
  10. 如申請專利範圍第9項所述之手術工具，其中該楔形滑板包含多個相連的凸頂楔形物，該等楔形物各有一建構成適合用於該選定類型之釘針卡匣的預選高度，該發射裝置之該中間構件係經定向成可鄰接於該等多種釘針卡匣中之每一種。
  11. 如申請專利範圍第5項所述之手術工具，其中該發射裝置係經建構成可：藉由包含一有上表面及下表面與該長形溝槽滑動接合的下半部，使得在該砧體與該長形溝槽之間的縱向位移期間，該砧體與該長形溝槽會切確地隔開。
  12. 如申請專利範圍第11項所述之手術工具，其中該發射裝置的下半部(lower portion)包含一上表面鄰接該長形溝槽的下插銷，而且該下半部更包含一下表面在對面鄰接該長形溝槽的中插銷。
  13. 如申請專利範圍第12項所述之手術工具，其中該發射裝置更包含一有上表面及下表面在縱向與該砧體滑動接合的上部構件。
  14. 如申請專利範圍第13項所述之手術工具，其中該砧 體包含一有一變窄垂直溝槽的內置縱向狹縫，其中該發射裝置在該變窄垂直溝槽中位移而且包含一上部構件，該上部構件係具有駐留在該內置縱向狹縫內的上、下表面使得該砧體與該長形溝槽切確隔開。
  15. 如申請專利範圍第5項所述之手術工具，其中該發射裝置係經建構成可：藉由包含一有上表面及下表面在對面沿著縱向與該砧體滑動接合的上部構件，使得在該砧體與該長形溝槽之間的縱向位移期間，該砧體與該長形溝槽切確隔開。
  16. 如申請專利範圍第15項所述之手術工具，其中該砧體包含一具有一上表面及一下表面的縱向狹縫，該上表面及下表面係各自與該發射裝置之該上部構件的下表面及上表面滑動鄰接。
  17. 如申請專利範圍第16項所述之手術工具，其中該縱向狹縫包含一與一變窄垂直溝槽相通的內置縱向溝槽，其中該發射裝置是在該變窄垂直溝槽中位移而且包含一具有上、下表面的上部構件，該上、下表面係駐留在該內置縱向溝槽內用來使該砧體與該長形溝槽切確隔開。
  18. 一種手術工具，其係包含： 一用於產生一閉合運動與一發射運動的把手構件；一夾緊構件，其係因應該閉合運動而夾緊組織；一發射構件，其係因應該發射運動而與該夾緊構件垂直隔開以及用來切割及釘合夾在其中的組織；以及一活節機構，其係經建構成可操作以相對於該把手構件活節該夾緊構件並界定一活節軸；該發射構件在其一遠端處具有一橫向延伸的插銷，該發射構件於其近端處具有一以垂直於該活節軸測量的第一厚度，以及一以垂直於該該活節軸測量的第二厚度，該第二厚度鄰近於該第一厚度，其中該第二厚度小於該第一厚度，且該第一厚度小於該插銷的一厚度；以及一閉合裝置，其用以選擇性地賦予該砧體一打開運動及一閉合運動，該閉合裝置獨立於該發射構件的任何運動而移動該砧體。
  19. 如申請專利範圍第18項所述之手術工具，其進一步包括一砧體，該砧體包含一有一向內變窄開口的內置縱向狹縫，該發射裝置係於該向內變窄開口內位移而且使一上部構件在該縱向狹縫內滑動接合。
  20. 如申請專利範圍第19項所述之手術工具，其更包含一閉合構件，其係可操作地建構成能縱向轉移該閉合 運動至該末端執行器以向內偏壓該砧體及該長形溝槽的遠端以在致動該釘針卡匣期間協助該發射裝置在該砧體與該長形溝槽之間切確隔開。
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