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CN118750062A - 内窥镜钱包线缝合外科设备 - Google Patents

内窥镜钱包线缝合外科设备 Download PDF

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CN118750062A
CN118750062A CN202411132524.6A CN202411132524A CN118750062A CN 118750062 A CN118750062 A CN 118750062A CN 202411132524 A CN202411132524 A CN 202411132524A CN 118750062 A CN118750062 A CN 118750062A
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jaw
staples
surgical stapling
stapling instrument
jaws
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P·A·米尔曼
W·伯班克
N·弗兰克尔
S·卫克斯奈
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Intuitive Surgical Operations Inc
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Intuitive Surgical Operations Inc
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Abstract

本申请涉及内窥镜钱包线缝合外科设备。用于向组织施加缝合线的外科手术缝合器包括被构造成接收钉仓的第一钳口和第二钳口。致动机构使驱动构件通过第一钳口和第二钳口向远侧平移，以将订合钉施加到组织，使得当缝合器被激活时，缝合线与订合钉的组合形成钱包线。钉仓包括第一上部和第二下部。

Description

内窥镜钱包线缝合外科设备
本申请是2019年10月18日提交的题为“内窥镜钱包线缝合外科设备”的中国专利申请201980068800.8(PCT/US2019/056979)的分案申请。
背景技术
外科吻合术将两个中空器官连接在一起，通常是为了在切除后恢复连续性，或者不太常见地是为了绕过不可切除的疾病过程。吻合术通常在以下方面执行：血管，包括动脉和静脉；胃肠道，包括食道、胃、小肠、结肠、直肠、肛门、胆管和胰腺；或泌尿道，包括输尿管、膀胱和尿道，以及输卵管。
在吻合术过程期间可以使用钱包线缝合线和钱包线施加器。通常使用针、订合钉或其它合适的部件放置缝合线以将缝合线附接至组织。附接之后，缝合线的末端保持松弛以拉动来收缩或闭合组织。
在微创中，例如在内窥镜外科吻合术过程中，提供一种内窥镜钱包线设备将是有利的，该设备可以以微创方式施加钱包线缝合线并且与机器人外科系统兼容。
发明内容
下面给出了所要求保护的主题的简化概述，以便提供对所要求保护的主题的一些方面的基本理解。该概述不是所要求保护的主题的详尽概述。它既不旨在确认所要求保护的主题的关键或重要元素，也不旨在描绘所要求保护的主题的范围。其唯一目的是以简化的形式呈现所要求保护的主题的一些概念，作为稍后呈现的更详细描述的序言。
本公开涉及外科缝合器，该外科缝合器用于将缝合线施加到具有钉仓的组织，该钉仓包括梭子，该梭子被构造成接合一系列订合钉驱动器，用于在驱动构件向远侧平移时排出订合钉。
在另一方面，本公开涉及一种用于向组织施加缝合线的外科缝合器，该外科缝合器包括具有通过连接构件连接并且构造为沿着端部执行器的纵向轴线安装的第一上部和第二下部的钉仓。
在另一方面，本公开涉及一种钳口闭合机构，该钳口闭合机构具有固定至第一钳口和第二钳口的第一连杆构件和第二连杆构件，第一连杆和第二连杆与第一对和第二对驱动线缆耦接，该第一对和第二对驱动线缆被构造成向第一和第二连杆构件施加力，以使它们围绕枢轴销旋转并穿过凸轮槽，该凸轮槽具有用于平行闭合钳口的近侧部分和用于成角度闭合钳口的远侧部分。
在实施例中，根据本公开的用于向组织施加缝合线的外科缝合器包括具有远端和近端的细长轴。端部执行器限定纵向轴线并且包括第一钳口和第二钳口。第一钳口和第二钳口被构造成接收钉仓并从打开位置移动到闭合位置以将订合钉施加到组织，使得当缝合器被激活时，缝合线与订合钉组合形成与组织的钱包线。外科缝合器进一步包括被构造成向远端平移并通过端部执行器向近侧缩回的驱动构件，以及被构造成使驱动构件通过端部执行器向远侧平移并使驱动构件通过端部执行器朝近侧缩回的致动机构。钉仓包括被构造成装配到第一钳口中的第一上部和被构造成装配到第二钳口中的第二下部。钉仓进一步包括梭子，该梭子被构造成与一系列订合钉驱动器接合，以在驱动构件向远侧平移时排出订合钉。在实施例中，第一上部和第二下部通过连接构件连接，并且钉仓被构造成沿着端部执行器的纵向轴线被安装。
在另一方面，根据本公开的用于向组织施加缝合线的外科缝合器的钳口闭合机构涉及第一连杆构件和第二连杆构件。第一和第二连杆构件被构造成在向第一和第二连杆构件施加力时围绕一对枢转销旋转。一对外部销被构造成将第一和第二连杆构件固定到第一钳口和第二钳口。第一对和第二对驱动线缆被构造成向第一和第二连杆施加力以引起绕枢轴销的旋转。钳口闭合机构进一步包括形成在钳口之一上的凸轮槽，该凸轮槽被构造成接受连杆构件中的至少一个连杆构件的凸轮槽销。凸轮槽具有用于使钳口平行闭合的近侧部分和用于钳口的成角度闭合的远侧部分。
附图说明
根据以下结合附图的详细描述，本外科手术器械的上述和其它方面、特征和优点将变得更加明显，在附图中：
图1是根据本公开的说明性外科手术器械的透视图；
图1A是图1的外科手术器械的远端部分的透视图，其示出为具有安装到细长轴的端部执行器和被构造成致动器械的后端机构；
图2是适合与图1的外科手术器械一起使用的订合钉钉仓的分解透视图；
图2A是示出将钉仓安装到图1的外科手术器械中的透视图；
图2B示出根据本公开的具有挠曲闩锁的说明性外科手术器械的一部分；
图2C示出了适合与图1的外科手术器械一起使用的说明性钉仓的一部分；
图2D示出了适合与图1的外科手术器械一起使用的说明性钳口，该钳口具有被构造成将图2C的钉仓接合并保持在钳口内的钩；
图2E示出了适合与图1的外科手术器械一起使用的另一种说明性钳口和钉仓的分解图；
图3是端部执行器的一部分的局部透视图，其中安装了新的重载；
图4是图1的外科手术器械的远端部分的透视图，其中钳口处于成角度的打开位置；
图5是图1的外科手术器械的远端部分的透视图，其中钳口处于平行位置；
图6是图1的外科手术器械的远端部分的透视图，其中钳口处于完全闭合位置；
图7是图1的外科手术器械的钳口闭合机构的横截面透视图；
图8是钳口闭合机构的第一和第二连杆的透视图；
图9是图1的外科手术器械的钳口的一部分的透视图；
图10是图1的外科手术器械的铰接机构的透视图，其中零件被去除以露出内部结构；
图11是图1的外科手术器械的梭子的透视图；
图11A是去除了零件的局部透视图，示出了安装在图1的外科手术器械中的未击发的钉仓；
图12是图1的外科手术器械的驱动机构的横截面透视图，其中零件被去除，示出了被构造为在致动时向远侧驱动的驱动构件；
图13是当订合钉驱动器在致动时向远侧移动时与订合钉驱动器接触的部分驱动的梭子的去除部分的局部透视图；
图13A和图13B示意性地示出订合钉的击发以捕获缝合线并形成钱包线；
图14描绘了说明性血管，该血管已经用与缝合线结合的一系列订合钉切断并固定以形成钱包线；
图15描绘了适合在图1的外科手术器械中以禁用构造使用的锁定机构；
图16描绘了处于启用构造的图15的锁定机构；
图17示出利用本公开的各方面的采用机器人外科手术系统的手术室的俯视图；以及
图18示出了可与本公开的各个方面一起使用的机械臂组件的简化侧视图。
具体实施方式
下面参考附图描述本外科手术器械的特定实施例；然而，应当理解，所公开的实施例仅是本公开的示例，并且可以以各种形式实施。因此，本文公开的特定结构和功能细节不应被解释为限制性的，而仅仅是作为权利要求的基础以及作为教导本领域技术人员以实际上任何适当的详细结构来不同地采用本公开内容的代表性基础。没有详细描述公知的功能或构造，以避免在任何不必要的细节上使本公开模糊。
尽管以下公开内容关于用于形成钱包线的外科手术器械提出，但是应当理解，目前描述的外科手术器械的某些特征可以容易地适于用于任何类型的外科夹持、切割或密封器械。外科手术夹持和切割器械可以是微创(例如，腹腔镜)器械或用于开放外科手术的器械。
另外，当前描述的外科手术缝合器械的特征可以容易地适合用于使用本领域技术人员力所能及的任何技术激活的外科手术器械，诸如例如手动激活的外科手术器械、电动外科手术器械(例如，机电驱动的器械)、机器人外科手术器械等。
图1是根据本公开的实施例的说明性外科手术器械100的透视图，其具有后端机构120和安装在细长轴106上的端部执行器110。后端机构120通常在器械的驱动肌腱或线缆与驱动系统的机械接口的机动轴之间提供机械耦接。已知的后端机构和外科系统的进一步细节例如在美国专利No.8,597,280、美国专利No.7,048,745以及美国专利No.10,016,244中描述，这些专利中的每一个在此通过引用全文并入。
外科手术器械100的致动机构采用与马达和滑轮的系统结合使用的驱动线缆。众所周知的是包括机器人外科手术系统的动力外科手术系统，其利用连接至马达和滑轮的系统的驱动线缆来用于各种功能，包括钳口的打开和闭合，以及端部执行器的运动和致动。已知的驱动线缆外科手术系统的更多细节在例如美国专利No.7,666,191和美国专利No.9,050,119中描述，二者均通过引用整体并入本文。
图1A示出了外科手术器械100的远端部分，其包括端部执行器110，该端部执行器110限定了纵向轴线X-X并具有第一钳口111、第二钳口112、钉仓122、用于将钳口111、112安装到器械的U形夹140以及诸如腕部160的铰接机构。第一钳口111和第二钳口112被构造成从打开位置移动到闭合位置。在闭合位置中，钳口111、112协作以夹持组织。
图2描绘了钉仓122。在实施例中，钉仓122包括具有第一侧面123a和第二侧面123b的上部123以及具有第一侧面124a和第二侧面124b的下部124。每对第一和第二侧面123a、123b和124a、124b由中央刀通道153隔开。每一个侧面123a、123b和124a、124b限定了组织接触表面198a、198b和198c、198d，该侧面具有订合钉保持腔128和形成在其中的缝合线保持通道159a-d(也参见图3)。在实施例中，组织接触表面198a-d可以进一步包括围绕订合钉接收腔128定位的突起(未示出)。突起有助于进一步固定被夹持的组织并抵抗可能由夹持组织的切断和缝合所产生的力引起的运动。订合钉126支撑在对应的订合钉驱动器127上，该订合钉驱动器127设置在形成在钉仓122中的相应订合钉接收腔128内。订合钉接收腔128可以是基本上垂直于端部执行器110的纵向轴线的切口，并且在长度上与要击发的订合钉126的所需大小相似。每个订合钉126包括腿157和后跨158。缝合线保持通道159a-d基本上平行于端部执行器110的纵向轴线延伸，并且基本上与订合钉接收腔128的中心对准，使得在击发订合钉126时，缝合线129a、129b被捕获在订合钉126和组织197之间的各个位置，如下面更详细描述的。
钉仓122的上部123和下部124被构造成分别容纳在第一钳口111和第二钳口112内。上部123的侧面123a通过活动铰链125a在钉仓122的近端连接至下部124的侧面124a。同样，上部123的侧面123b通过活动铰链125b在钉仓122的近端处连接到下部124的侧面124b。钉仓122的侧面123a和124a的通道159a、159c延伸到活动铰链125a并与活动铰链通道169a对准。同样，钉仓122的侧面123b和124b的通道159b、159d延伸到活动铰链125b并与活动铰链通道169b对准。以这种方式，缝合线129a、129b可在器械的每一侧上从下部124被引导到上部123，以在夹持组织和致动外科手术器械时形成环。
钉仓122还可以包括具有倾斜的远侧部分131的梭子130，该远侧部分131在远侧运动时顺序地作用在订合钉驱动器127上，将它们朝向抓握的组织凸轮式移动，从而迫使订合钉朝向抓握的组织。订合钉126的腿157位于缝合线129a、129b的任一侧，并且被构造成在外科手术器械被致动时将缝合线129a、129b固定到抓握的组织。下面描述用于形成用于提供钱包线的订合钉126的机构的细节(参见图13和13A)。
在实施例中，钉仓122的上部123包括远端部分190，该远端部分190在钳口111、112闭合时与下部124的远端部分195重叠。远端部分190防止钉仓122在安装后滑出钳口。远端部分190可包括挠曲闩锁构件192，当将钉仓122安装在钳口111、112中时，该挠曲闩锁构件192将与容纳在钳口111内的凹部(未示出)接合，将闩锁构件192保持在适当位置，直到通过施加手指压力释放它而被破坏为止。挠曲将在闩锁位置和非闩锁位置之间提供偏心的卡扣感，使得外科医生将能够感觉到闩锁位置和非闩锁位置之间的差异。可以预见，闩锁192可以通过任何数量的期望的配合特征，诸如形成在钳口111上的突起或切口，而保持在适当的位置。在图2C-2D中所示的替代实施例中，钉仓122可进一步包括切口199a，该切口199a被构造成接合容纳在钳口111、112内的至少一个钩199b。在安装时，钉仓122可略微枢转，使得钩199b卡在凹部199a内，从而有助于将钉仓122保持在适当的位置。
缝合线129a的远端部分129c延伸超过缝合线保持槽159a和159c的远端，并且缝合线129b的远端部分129d延伸超过缝合线保持槽159b和159d的远端。因此，缝合线129a可例如从远端部分190延伸，在钉仓122的上部123的侧面123a内的通道159a中向近侧延伸，穿过活动铰链通道169a围绕活动铰链125a，并且然后沿着钉仓122的下部124的侧面124a的缝合线通道159c向远侧延伸。钉仓122在基本上平行于端部执行器110的纵向轴线的方向中被安装，并在从外科手术器械100的远端朝向外科手术器械100的近端的箭头A的方向中被插入，如图2A中所示。在替代实施例中，可以预见，订合钉可以允许在基本上正交于端部执行器110的纵轴线的径向方向中安装钉仓122。图2E示出被构造为允许钉仓122的径向安装的说明性钳口112。钉仓上的钩199b可接合形成在钳口112上的凹部199a，以与前述实施例类似的方式帮助将钉仓122保持在钳口111内。
如图3中可见，当安装了新的未击发的钉仓122时，梭子130防止了钉仓122的上部123的侧面123a和123b以及钉仓122的下部124的侧面124a和124b的不必要的分离。另外，钉仓122包括被构造成滑动到形成在钳口111、112上的槽113中的突起121。钳口111、112的槽113用作突起121的导轨，以确保在安装新钉仓122时正确对准。另外，在安装和击发期间，钉仓突起121和槽113的相互作用限制了钉仓122的向上和向下运动。
图4-6描绘了在器械被闭合以准备致动时钳口111、112的运动。
在图4中，钳口111、112处于打开位置，类似于抓取器，并且处于成角度的闭合区域。如图5中所示，钳口111、112成角度地闭合，直到它们基本上平行。一旦钳口111、112基本上平行，它们就继续闭合，同时保持基本上平行以压缩组织。一旦围绕组织闭合，则可击发器械以将订合钉切开并插入到所抓握的组织中，同时使缝合线129a、129b被订合钉捕获，从而形成围绕被夹持的组织的钱包线。钳口打开和闭合的机构在下面被更详细地描述。
图7示出了外科手术器械100的一部分，该外科手术器械被构造为打开和闭合钳口，该钳口包括U形夹140、第一连杆构件145、第二连杆构件146和驱动线缆170a、170b。
如图7中所示，两条驱动线缆170a、170b对称地行进到外科手术器械100的后端，并终止于第一连杆构件145的近端141内的结172中。当通过马达(未示出)的力或经由一些其它机构拉动线缆170a、170b时，第一连杆构件145围绕U形夹140上的枢轴销143旋转，使第二连杆构件146围绕U形夹140上的枢轴销144旋转，从而取决于拉动哪条驱动线缆而移动钳口朝向打开或闭合位置。所产生的钳口力基本上类似于线缆的拉力。普通技术人员将理解，在外科手术器械100的每一侧上可以存在一对驱动线缆，每对驱动线缆包括用于闭合第一连杆的第一线缆和用于打开第一连杆的第二线缆。总共使用四根线缆来打开和闭合钳口，这减小了每根线缆上的应力，并允许通过腕部160的线缆力对称地平衡，使得致动钳口不会向腕部施加俯仰或偏航力(参见图10)。
如图8和图9中所示，连杆构件145包括上外销148a，并且连杆构件146包括下外销148b。上外销148a被构造成定位在钳口111的开口114内，而下外销148b被构造成定位在钳口112的开口115内(例如，参见图1A和图4-6)。连杆构件145还包括凸轮槽销149a，该凸轮槽销149a被构造成接合并骑在形成在钳口111上的凸轮槽118内。凸轮槽118被设计成使得凸轮槽118的近侧部分118a允许钳口111的平行闭合，而凸轮槽118的远侧部分118b由于驱动线缆170a、170b在外科手术器械致动时的力而在连杆构件145、146旋转时允许钳口111的成角度闭合。类似于连杆构件145、146，第二组连杆构件145a、145b和对应的开口和凸轮槽存在于U形夹140的钳口111、112的远侧上，并且类似地作用于连杆构件145、146。连杆构件145、146还包括齿轮齿147以强制钳口111、112的对等的对称运动。
图10示出了铰接机构，该铰接机构包括铰接腕部160和从器械的近端延伸到腕部连杆162、164的驱动线缆170c、170d。腕部160包括多个连杆，该连杆提供期望的运动量，诸如在俯仰或偏航方向中的+/-90度。在实施例中，单个关节可提供至多90度的角偏转。根据示例性实施例，腕部可包括多个连杆以实现更高的运动范围，诸如例如腕部在俯仰或偏航方向中具有至多+/-180度的运动范围。通常，诸如例如拉动/拉肌腱或推杆/拉杆的致动元件以及连接到器械的腕部和/或端部执行器的电导体可延伸通过器械的细长轴。此外，致动元件可延伸通过细长轴并连接至传动机构，该传动机构通常提供驱动肌腱的机械耦接以驱动马达。如上所述，外科手术器械100可包括两对驱动线缆，用于打开和闭合钳口，减小每根线缆上的应力，并允许通过腕部160的对称平衡的线缆力，使得致动钳口不会向腕部施加俯仰或偏航力。另外，可以预见，线缆可以在外科手术器械100的中间部分内合并，使得在输入绞盘(未示出)处仅呈现两个线缆。该类型的合并允许滑轮在腕部俯仰或偏航时保持线缆长度的节省。在国际公开WO 2015/127250A1中公开了可与本文公开的实施例一起使用的其它关节和腕部致动元件的附加细节，其全部公开内容通过引用并入本文。
图11和图11A示出了容纳在钉仓122中的梭子130。每个梭子130具有主体135，该主体135包括倾斜的远侧部分131和翼137、138。梭子130定位在钉仓122的上部123和下部124中的每一个中，并防止上部123的第一侧面123a和第二侧面123b以及下部124的第一侧面124a和第二侧面124b在处理期间张开，以确保钉仓122装配在钳口111、112的槽113内(参见图11A)。在梭子130的远侧运动时，倾斜的远侧部分131依次作用在订合钉驱动器127上，使它们向上凸轮式移动，从而迫使订合钉126通过订合钉接收腔128。梭子130还包括可基本上垂直于端部执行器110的轴线的近侧表面132。梭子130的前缘133将组织朝向中心刀通道153聚集，使得可以用刀151将组织切断(参见图13)。梭子130还包括在下面更详细描述的内边缘134(参见图15)。
图12-13示出了在致动以切断和将订合钉插入到被夹持的组织中以使得由缝合线129a、129b形成钱包线时外科手术器械100的部件的远侧平移。
图12示出了具有集成的刀刃151、梭子130、U形夹140和驱动杆155的驱动构件150。在致动外科手术器械100时，通过固定到形成在驱动构件150上的近侧切口154的驱动杆155，驱动构件150通过钉仓122的中心刀通道153向远侧推动或向近侧拉动。驱动构件150可耦接至任何已知的致动机构，包括手动致动的致动器、马达驱动或动力致动的致动器或其它类型的致动机构。驱动构件150包括与梭子130的近侧面132基本上对准的远侧边缘152。在外科手术器械100被致动时，驱动构件150的远侧边缘152与梭子130的近侧面132接合，从而使梭子130向远侧平移。驱动构件150还包括刀刃151，该刀刃151位于远侧边缘152之间，用于在外科手术器械100的击发期间在驱动构件150通过中心刀通道153向远侧平移时切断被夹持的组织。刀通道153的中心位置确保刀刃151切断与被装订和缝合的组织的两个部分相邻并在组织的两个部分之间的组织(参见图14)。
图13示出在外科手术器械100击发期间梭子130向远侧行进。在图13中，梭子130的倾斜的远侧部分131已完全展开第一订合钉126a，并与第二订合钉驱动器127接合以展开第二订合钉126b。如图13A和图13B中可见，首先，每个订合钉126在订合钉驱动器127施加到订合钉的后跨度158的力的作用下被推动，同时横向力通过订合钉接收腔128的唇部157同时施加在腿156上，使得腿156开始变形并在穿透到组织197中时彼此相对移动。如图13B中所示，在订合钉驱动器127的每个行程的末尾附近，订合钉的腿156已经基本上变形，以便彼此成交叉关系。在该位置中，订合钉将不容易从组织197中拉出。同时，缝合线129a、129b从通道159a-d中推出，并被捕获在变形的订合钉126和组织197之间。随着它们被保留在变形的订合钉126内，缝合线129形成钱包线。
图14描绘了根据本公开的已经用外科手术器械切断和装订的说明性血管或组织。缝合线129a、129b以钱包线形式固定到组织上，其中订合钉126将缝合线129a、129b保持在适当位置。一旦固定，就可以通过拉动端部129c、129d来使用另一种工具来收紧钱包线。在实施例中，夹子165a、165b可被预加载到钉仓122的远端中并固定到缝合线129a、129b的端部129c、129d，并用于允许外科医生用手将钱包线系紧以将缝合线129a、129b保持在收紧构造中。
图15和图16示出了根据本公开的实施例的可以与外科手术器械一起使用的锁定机构。
在图15中，示出了禁用的锁定机构。锁定构件180具有在锁定构件180的远端上的接合部分181和在锁定构件180的近端上的近端部分182。在实施例中，锁定构件180的远侧部分181的形状像钩子。在实施例中，锁定构件180由弹簧线形成。当安装未击发的钉仓时，梭子130的内边缘134接触锁定构件180的接合部分181，使其与驱动构件150的远侧边缘152不对准。在该位置中，驱动构件150可以向远侧平移，允许用户来致动器械。
图16示出了启用的锁定机构。锁定构件180被设计成使得接合部分181朝向使接合部分181与驱动构件150的远侧边缘152对准的位置偏置。如图16中可见，当梭子130移动并且梭子130的内边缘134不再接触锁定构件180时，锁定构件180的接合部分181移回到其自然偏置的位置，在该位置与驱动构件150的远侧边缘152对准。一旦器械被击发并且发生驱动构件150的缩回，则用户可能不会在未安装新的未击发钉仓的情况下再次击发器械，因为除非安装了新钉仓，否则远侧边缘152将接触锁定构件180的接合部分181，并且将防止驱动构件150向远侧平移，并且钳口已经充分闭合以使得它们平行并且夹在组织上。
用于施加一个或多个钱包线缝合线的本外科手术器械可以在机器人外科手术系统中使用。作为示例，图17示出了采用机器人外科手术系统的手术室的俯视图。在该情况下，机器人外科手术系统是机器人外科手术系统300，该机器人外科手术系统300包括外科医生(“S”)使用的控制台(“C”)，同时通常在一名或多名助手(“A”)的帮助下，对躺在手术台(“O”)上的患者(“P”)执行微创诊断或外科手术过程。
控制台包括用于向外科医生显示手术部位的图像的监视器304、可左右操纵的控制设备308和309、脚踏板305以及处理器302。控制设备308和309可以包括任何各种输入设备中的一个或多个，诸如操纵杆、手套、扳机枪、手动控制器等。处理器302可以是专用计算机，该专用计算机可以集成到控制台中或定位在其旁边。
外科医生通过操纵控制设备308和309(在本文中也称为“主操纵器”)来执行微创外科手术过程，使得处理器302使它们相应相关联的机械臂组件328和329(也称为“从动操纵器”)相应地操纵它们相应的可拆卸耦接的外科手术器械338和339(在本文中也称为“工具”)，而当由立体内窥镜340捕获时，外科医生在控制台监视器304上以3D观看手术部位。
工具338和339以及内窥镜340中的每一个都可以通过套管或其它工具导向器(未示出)插入患者体内，以便通过相应的微创切口(诸如切口366)向下延伸至手术部位。传统上，多个机械臂中的每个机械臂都由连杆(诸如连杆362)形成，它们耦接在一起，并通过马达控制的或活动的关节(诸如关节363)被操纵。
一次使用的外科手术工具的数量以及因此系统300中使用的机械臂的数量通常将取决于诊断或外科手术过程以及手术室内的空间限制，以及其它因素。如果有必要在过程期间更换一个或多个正在使用的工具，则助手可以从其机械臂上去除不再使用的工具，并将其替换为手术室托盘(“T”)中的另一个工具331。
监视器304可以定位在外科医生的手附近，使得它将显示投影的图像，该投影的图像被取向为使得外科医生感觉到他或她实际上正直接向下看向手术部位。为此，工具338和339的图像可能看起来基本上位于外科医生的手所在的位置。
处理器302在系统300中执行各种功能。它执行的一项重要功能是通过总线310上的控制信号将控制设备308和309的机械运动转换并传递到它们相应的机械臂328和329，使得外科医生可以有效地操纵他们相应的工具338和339。另一个重要功能是实施本文所述的各种控制系统过程。
尽管被描述为处理器，但是应当理解，处理器302可以在实践中通过硬件、软件和固件的任意组合来实现。此外，本文描述的其功能可以由一个单元执行，或者在不同的部件之间被划分，每个部件可以依次由硬件、软件和固件的任意组合来实现。
有关机器人外科手术系统的附加细节，请参见例如美国专利No.6,493,608和6,671,581，其全部内容通过引用结合在此。
作为示例，图18示出了保持用于执行外科手术过程的外科手术器械450(其代表工具338和339)的简化(不一定成比例或完整)的说明性机械臂组件400(其代表机械臂组件328和329)的侧视图。外科手术器械450可移除地保持在工具保持器440中。臂组件400由基座401机械地支撑，该基座401可以是患者侧可移动推车的一部分或固定到手术台或天花板。它包括耦接在一起的连杆402和403，并通过设置关节404和405耦接到基座401。
在该示例中，设置关节404和405是被动关节，其在释放制动器时允许手动定位臂400。例如，设置关节404允许连杆402围绕轴406手动旋转，而设置关节405允许连杆403围绕轴407手动旋转。
尽管在该示例中仅示出了两个连杆和两个设置关节，但是结合本发明，可以在该机械臂组件和其它机械臂组件中适当地使用或多或少的每个连杆。例如，尽管设置关节404和405对于臂400的水平定位是有用的，但是可以包括附加的设置关节并且对于臂400的有限的垂直和角度定位是有用的。然而，对于臂400的主要竖直定位，臂400还可以沿着基座401的竖直轴线滑动地移动并且锁定在适当的位置。
机械臂组件400还包括由马达驱动的三个活动关节。偏航关节410允许臂区段430围绕轴线461旋转，而俯仰关节420允许臂区段430围绕垂直于轴线461并且正交于附图平面的轴线旋转。臂区段430被构造成使得当俯仰关节420通过其马达旋转时，区段431和432总是彼此平行。结果，可以通过驱动偏航马达和俯仰马达来可控制地移动器械450，以便围绕枢轴点462枢转，该枢轴点通常通过设置关节404和405的手动定位而放置，以使其位于患者的切口点处。另外，插入齿轮445可以耦接至线性驱动机构(未示出)以沿着其轴线463延伸或缩回器械450。
尽管偏航、俯仰和插入关节或齿轮410、420和445中的每一个均由单独的关节或齿轮控制器控制，但三个控制器由通用的主/从控制系统控制，使得机械臂组件400(在本文中也称为“从动操纵器”)可以通过用户(例如，外科医生)对其相关联的主操纵器的操纵来控制。
尽管已经在附图中示出了几个实施例，但是不意图将本公开限制于此，因为意图是使本公开的范围与本领域将允许的范围一样宽泛，并且同样地阅读说明书。因此，以上描述不应解释为限制性的，而仅应作为当前公开的实施例的示例。因此，实施例的范围应该由所附权利要求及其合法等同物来确定，而不是由给出的示例来确定。
本领域技术人员将理解，本文中具体描述并在附图中示出的设备和方法是非限制性示例性实施例。结合一个示例性实施例示出或描述的特征可以与其它实施例的特征组合。在不脱离本公开的情况下，本领域技术人员可以设计出各种替代和修改。因此，本公开旨在涵盖所有此类替代、修改和变化。同样，基于上述实施例，本领域技术人员将理解本公开的其它特征和优点。因此，除了由所附权利要求书指出的以外，本公开不受限于已经具体示出和描述的内容。

Claims (25)

1.一种外科手术缝合器械，其包括：
具有远端和近端的细长轴；
端部执行器，其耦接到所述轴的所述远端并包括第一钳口和第二钳口；
所述第一钳口中的第一排订合钉；
所述第二钳口中的第二排订合钉；
缝合线，其延伸穿过所述第一排订合钉和所述第二排订合钉；和
驱动构件，其被构造成向远侧平移通过所述端部执行器，以将所述第一排订合钉和所述第二排订合钉驱动到组织中，使得所述缝合线被设置在所述第一排订合钉和所述组织之间以及所述第二排订合钉和所述组织之间。
2.根据权利要求1或18所述的外科手术缝合器械，其中所述端部执行器包括纵向轴线，所述器械还包括在所述纵向轴线的与所述第一排订合钉的相对侧上的所述第一钳口中的第三排订合钉。
3.根据权利要求2所述的外科手术缝合器械，还包括在所述纵向轴线的与所述第二排订合钉的相对侧上的所述第二钳口中的第四排订合钉。
4.根据权利要求3所述的外科手术缝合器械，其中所述缝合线是延伸穿过所述第一排订合钉和第二排订合钉的第一缝合线，所述器械还包括延伸穿过所述第三排订合钉和所述第四排订合钉的第二缝合线。
5.根据权利要求1所述的外科手术缝合器械，还包括切割元件，其耦接到所述驱动构件，并被构造成在所述驱动构件向远侧平移通过所述第一钳口和第二钳口时解剖组织，其中所述第二排订合钉包括至少两排线性订合钉。
6.根据权利要求1或13所述的外科手术缝合器械，还包括可拆卸耦接到所述第一钳口和所述第二钳口的钉仓，其中所述钉仓包括第一部分和第二部分，并且其中所述第一钳口包括用于接收所述第一部分的第一通道，并且所述第二钳口包括用于接收所述第二部分的第二通道。
7.根据权利要求6所述的外科手术缝合器械，其中所述第一通道和所述第二通道均具有远侧开口，用于接收所述钉仓的所述第一部分和所述第二部分。
8.根据权利要求6所述的外科手术缝合器械，其中所述钉仓还包括远侧部分，所述远侧部分被构造成将所述钉仓的所述第一部分和所述第二部分保持在所述第一钳口和所述第二钳口中。
9.根据权利要求5所述的外科手术缝合器械，其中所述钉仓包括位于所述第一部分中的第一梭子和位于所述第二部分中的第二梭子，其中所述第一梭子和所述第二梭子均包括用于接合所述订合钉的倾斜的远侧部分，使得所述缝合线与所述订合钉组合形成与所述组织的钱包线。
10.根据权利要求5所述的外科手术缝合器械，还包括位于所述钉仓的所述第一部分和所述第二部分之间的连接构件。
11.根据权利要求6所述的外科手术缝合器械，其中所述连接构件包括用于接收所述缝合线的通道，其中所述通道被构造成将所述缝合线形成环。
12.根据权利要求1或13所述的外科手术缝合器械，还包括：
致动机构，其被构造成使所述驱动构件向远侧平移通过所述端部执行器；以及
致动器，其可操作地连接到所述致动机构，其中所述致动器包括机器人外科手术系统的控制设备。
13.一种外科手术缝合器械，其包括：
细长轴，其具有远端和近端；
端部执行器，其具有被构造成接收钉仓的第一钳口和第二钳口，其中所述钳口中的至少一个能够在打开位置至部分闭合位置之间移动，在所述打开位置，所述钳口在其间限定角度，在所述部分闭合位置，所述钳口基本上彼此平行并在其间限定第一间隙；和
驱动构件，其被构造成向远侧平移通过所述端部执行器，以将订合钉和缝合线施加到组织，其中所述驱动构件使所述钳口移动到闭合位置，在所述闭合位置，所述钳口基本上彼此平行并在其间限定第二间隙，其中所述第二间隙小于所述第一间隙。
14.根据权利要求13所述的外科手术缝合器械，其中所述钳口在所述闭合位置彼此接触。
15.根据权利要求13所述的外科手术缝合器械，其中所述第一钳口和所述第二钳口中的至少一个包括凸轮槽，所述凸轮槽具有用于平行闭合所述钳口的近侧部分和用于成角度闭合所述钳口的远侧部分。
16.根据权利要求15所述的外科手术缝合器械，还包括：
至少一个连杆构件，其被构造成在向所述连杆构件施加力时围绕至少一个枢轴销旋转；和
凸轮槽销，其从所述连杆构件延伸并穿过所述凸轮槽，其中所述凸轮槽销被构造成在所述连杆构件旋转时平移通过所述凸轮槽。
17.根据权利要求15所述的外科手术缝合器械，其中所述端部执行器限定纵向轴线，并且其中所述凸轮槽的所述远侧部分与所述纵向轴线成横向角度延伸，并且所述凸轮槽的所述近侧部分基本平行于所述纵向轴线。
18.根据权利要求13所述的外科手术缝合器械，还包括：
所述第一钳口中的第一排订合钉；
所述第二钳口中的第二排订合钉；以及
缝合线，其延伸穿过所述第一排订合钉和所述第二排订合钉。
19.根据权利要求13所述的外科手术缝合器械，还包括致动机构，所述致动机构被构造成使所述驱动构件向远侧平移通过所述端部执行器，其中所述致动机构被构造成在所述第一钳口和所述第二钳口处于所述部分闭合位置后使所述驱动构件向远侧平移。
20.根据权利要求19所述的外科手术缝合器械，其中所述致动机构被构造成在所述第一钳口和所述第二钳口在组织上闭合后使所述驱动构件向远侧平移。
21.一种外科手术缝合器械，其包括：
具有远端和近端的细长轴；
端部执行器，其耦接到所述轴的所述远端并包括第一钳口和第二钳口，其中所述钳口中的至少一个能够在打开位置和闭合位置之间移动；
耦接构件，其将所述端部执行器与所述轴耦接，所述耦接构件包括第一连杆构件和第二连杆构件；和
延伸穿过所述轴并耦接到所述第一连杆构件的第一力传动构件和第二力传动构件，其中所述第一连杆构件和所述第二连杆构件的轴向运动使所述第一连杆构件旋转，其中所述第一连杆构件的旋转导致所述第二连杆构件的旋转，以使所述钳口在所述打开位置和所述闭合位置之间移动。
22.根据权利要求21所述的外科手术缝合器械，还包括所述耦接构件上的第一枢轴销和第二枢轴销，其中所述第一连杆构件能够围绕所述第一枢轴销旋转，并且所述第二连杆构件能够围绕所述第二枢轴销旋转。
23.一种外科手术缝合器械，其包括：
具有远端和近端的细长轴；
端部执行器，其耦接到所述轴的所述远端并包括第一钳口和第二钳口，其中所述钳口中的至少一个能够在打开位置和闭合位置之间移动；
订合钉钉仓，其包括多个订合钉和订合钉驱动器；和
梭子，其包括主体以及横向延伸的第一翼和第二翼，其中所述第一翼和所述第二翼中的每一个包括倾斜的远侧部分，所述倾斜的远侧部分被构造成在所述梭子向远侧平移时接合所述订合钉驱动器。
24.根据权利要求23所述的外科手术缝合器械，还包括：
驱动构件，其被构造成向远侧平移通过所述订合钉钉仓；
锁定构件，其能够在允许所述驱动构件向远侧平移的第一位置和禁止所述驱动构件向远侧平移的第二位置之间移动；和
其中所述梭子包括内边缘，所述内边缘被构造成接合所述锁定构件以将所述锁定构件保持在所述第一位置。
25.一种机器人外科手术系统，其包括：
外科手术器械，其包括具有远端和近端的细长轴、耦接到所述轴的所述远端并包括第一钳口和第二钳口的端部执行器、所述第一钳口或所述第二钳口中的至少一排订合钉、延伸穿过所述排订合钉的缝合线以及驱动构件，所述驱动构件被构造成向远侧平移通过所述端部执行器以将所述排订合钉驱动到组织中，使得所述缝合线被设置在所述排订合钉和所述组织之间；
机械臂，其被构造用于耦接到所述外科手术器械；
控制设备，其与所述机械臂远程间隔开并且能够移动以提供所述机械臂和所述外科手术器械的所需运动；和
控制器，其被构造成基于所述控制设备的运动来控制所述机械臂。
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