CN102090912B - Surgical clip applier - Google Patents

Abstract

The present invention provides a surgical clip applier, comprising: a housing; at least one handle pivotally connected to the housing; a channel assembly extending distally from the housing; a clip carrier disposed within the channel assembly and defining a channel and a plurality of windows therein; and a plurality of clips slidably disposed within the channel of the clip carrier. The surgical clip applier further comprises: a drive channel reciprocally disposed within at least one of the housing and the channel assembly; a wedge plate reciprocally disposed within the channel assembly; a push rod reciprocatably disposed within the housing and the channel assembly; and a motion multiplier system having a plurality of links configured to move the pusher bar distally by incremental amounts based on an initial actuation of the handle, and configured to move the pusher bar and wedge plate proximally after the initial actuation of the handle.

Description

Translated fromChinese

外科施夹器Surgical clip applier

相关申请的交叉引用Cross References to Related Applications

本申请要求于2009年12月15日提交的、序列号为61/286,569的美国临时申请的利益和优先权，将所述申请的全部内容通过引用并入到这里。This application claims the benefit of and priority to US Provisional Application Serial No. 61/286,569, filed December 15, 2009, which is hereby incorporated by reference in its entirety.

技术领域technical field

本申请涉及外科器械，更特别地，涉及具有多个夹子的外科施夹器，所述外科施夹器用于在外科手术过程中将夹子施加到体组织和血管。The present application relates to surgical instruments, and more particularly, to surgical clip appliers having a plurality of clips for applying clips to body tissue and blood vessels during surgical procedures.

背景技术Background technique

外科施夹器是现有技术已知的，并由于向体组织和血管的传统缝合提供了另一种选择而越来越受外科医生的欢迎。专利号为5,030,226的格林(Green)等人的美国专利和专利号为5,431,668的伯班克三世(Burbank III)等人的美国专利公开了典型的器械。这些器械通常提供多个夹子，所述多个夹子存储在器械中并基于器械近端处手柄的开合而被相继送入器械远端处的钳夹机构。当手柄闭合时，钳夹闭合以使位于钳夹构件之间的夹子变形，而当钳夹张开以释放变形的夹子时，将一个新的夹子从其序列送入钳夹之间的位置。这个过程重复执行直到将夹子序列中的所有夹子都已用过。Surgical clip appliers are known in the art and are becoming increasingly popular with surgeons as they offer an alternative to traditional suturing of body tissues and blood vessels. Typical instruments are disclosed in US Patent No. 5,030,226 to Green et al. and US Patent No. 5,431,668 to Burbank III et al. These instruments typically provide a plurality of clips that are stored within the instrument and are sequentially fed into a jaw mechanism at the instrument's distal end upon opening and closing of a handle at the instrument's proximal end. When the handle is closed, the jaws close to deform the clip located between the jaw members, and when the jaws open to release the deformed clip, a new clip is fed from its sequence into position between the jaws. This process is repeated until all clips in the sequence of clips have been used.

典型地，外科施夹器可在从相对小的、相对中等的到相对大的多种尺寸和/或比例范围内获得。通常，每种特定尺寸的外科施夹器包括不同的零件。同样地，装配各种尺寸的外科施夹器的方法从一种尺寸到另一种尺寸而不同。Typically, surgical clip appliers are available in a variety of sizes and/or proportions ranging from relatively small, relatively medium, to relatively large. Typically, each particular size surgical clip applier includes different parts. Likewise, the method of assembling various sizes of surgical clip appliers varies from one size to another.

因而，每种不同尺寸的施夹器需要外部零件(例如，施夹器致动)的不同的行程长度，这又影响内部零件(例如，夹子部署零件)的不同的时间选择。因此，存在可以将某些主要零件构造为仅仅通过改变几何结构无需改变功能性即可用于不同尺寸的施夹器的需求。Thus, each different size clip applier requires a different stroke length of the external component (eg, clip applier actuation), which in turn affects different timing of the internal component (eg, clip deployment component). Therefore, there is a need that certain major parts can be configured to be used with different sized clip appliers simply by changing the geometry without changing the functionality.

另外，因此存在对构造为容纳简单内部零件的外科施夹器的需求，仅仅改变所述零件的几何结构，就可使所述简单内部零件以相似的方式对所有不同尺寸的施夹器都起作用。同时不会危及具有低驱动力的较高的夹子推动力。运动和力特性更好，并且零件更简单，从而使得设备的性能更好。In addition, there is thus a need for a surgical clip applier configured to accommodate simple internal parts that can be made to function in a similar manner on all different sized clip appliers simply by changing the geometry of the part. effect. At the same time, the higher clip driving forces with low driving forces are not compromised. Better motion and force characteristics and simpler parts result in better device performance.

发明内容Contents of the invention

本申请涉及具有多个夹子的外科施夹器，所述外科施夹器用于在外科手术期间将所述夹子施加到体组织和血管中。The present application relates to a surgical clip applier having a plurality of clips for applying the clips into body tissue and blood vessels during surgical procedures.

根据本公开的一个方案，提供一种外科施夹器，其包括：外壳；至少一个手柄，其可枢转地连接到外壳上；通道组件，其从外壳向远侧延伸出；夹子承载器，其配置在通道组件内且在其中限定了通道和多个窗口；多个夹子，它们可滑动地配置在夹子承载器的通道内；驱动通道，其可往复地配置在外壳和通道组件中的至少一个内，所述驱动通道具有可操作地连接到至少一个手柄上的第一端和可操作地连接到通道组件的远端上的第二端；楔板，其可往复地配置在通道组件内，所述楔板可操作地连接到至少一个手柄上且包括多个沿其长度形成的孔；推杆，其可往复地设置在外壳和通道组件内，所述推杆具有可操作地连接到至少一个手柄上的近端和限定了推动器的远端，其中所述推杆的远端被构造为与多个夹子中的最远侧夹子相接合；以及运动倍增系统，其具有多个连接件，所述连接件被构造为基于手柄的初始致动而使推杆向远侧移动递增量，并且被构造为在手柄初始致动之后使推杆和楔板向近侧移动。According to one aspect of the present disclosure, there is provided a surgical clip applier comprising: a housing; at least one handle pivotally connected to the housing; a channel assembly extending distally from the housing; a clip carrier, It is disposed in the channel assembly and defines a channel and a plurality of windows therein; a plurality of clips are slidably disposed in the channel of the clip carrier; a drive channel is reciprocally configured in at least one of the housing and the channel assembly In one, the drive channel has a first end operatively connected to at least one handle and a second end operably connected to the distal end of the channel assembly; a wedge reciprocally disposed within the channel assembly , the wedge is operably connected to at least one handle and includes a plurality of holes formed along its length; a push rod is reciprocally disposed within the housing and channel assembly, the push rod has a a proximal end on at least one handle and a distal end defining a pusher, wherein the distal end of the push rod is configured to engage a distal-most clip of the plurality of clips; and a motion multiplication system having a plurality of connections The linkage is configured to move the pushrod distally in increments based on initial actuation of the handle, and is configured to move the pushrod and wedge proximally after initial actuation of the handle.

运动倍增系统的多个连接件可以包括：近侧连接构件，其可枢转地支撑在外壳内且可操作地连接到驱动通道上；枢轴驱动臂，其使驱动通道和近侧连接构件相互连接；以及远侧连接构件，其使近侧连接构件和推杆相互连接，以使驱动通道向远侧的平移引起近侧连接构件经由枢轴驱动臂的枢轴旋转，其中近侧连接构件的枢轴旋转引起远侧连接构件的枢轴旋转。远侧连接构件的枢轴旋转引起推杆的远侧平移。近侧连接构件通过枢轴销可枢转地连接到外壳上。远侧连接构件可枢转地连接到近侧连接构件上。The plurality of links of the motion multiplication system may include: a proximal link member pivotally supported within the housing and operatively connected to the drive channel; a pivotal drive arm interconnecting the drive channel and the proximal link member connection; and a distal linking member interconnecting the proximal linking member and the push rod such that translation of the drive channel distally causes pivoting of the proximal linking member via the pivot drive arm, wherein the proximal linking member Pivoting causes pivoting of the distal connection member. Pivoting of the distal link member causes distal translation of the pushrod. The proximal connection member is pivotally connected to the housing by a pivot pin. The distal connection member is pivotally connected to the proximal connection member.

驱动通道的进一步远侧平移可引起近侧连接构件经由枢轴驱动臂的进一步枢轴旋转，其中近侧连接构件的进一步枢轴旋转可引起远侧连接构件的进一步枢轴旋转，并且其中远侧连接构件的进一步枢轴旋转引起推杆的近侧平移。Further distal translation of the drive channel may cause further pivotal rotation of the proximal connection member via the pivot drive arm, wherein further pivotal rotation of the proximal connection member may cause further pivotal rotation of the distal connection member, and wherein the distal Further pivoting of the connecting member causes proximal translation of the push rod.

在实施例中，当近侧连接构件、远侧连接构件、枢轴驱动臂、驱动通道和推杆处于第一位置时，近侧连接构件和远侧连接构件限定了第一角度。驱动通道的近侧平移导致近侧连接构件和远侧连接构件经由枢轴驱动臂而枢轴地旋转，从而将第一角度增大到大约180度的第二角度，以使近侧连接构件和远侧连接构件相对于彼此成一直线，使得近侧连接构件、远侧连接构件、枢轴驱动臂、驱动通道和推杆处于第二位置。In an embodiment, the proximal connection member and the distal connection member define a first angle when the proximal connection member, the distal connection member, the pivot drive arm, the drive channel, and the pushrod are in the first position. Proximal translation of the drive channel causes the proximal and distal connection members to pivotally rotate via the pivot drive arm, thereby increasing the first angle to a second angle of approximately 180 degrees such that the proximal and distal connection members and The distal connection members are aligned relative to each other such that the proximal connection member, distal connection member, pivot drive arm, drive channel and push rod are in the second position.

进一步，当近侧连接构件、远侧连接构件、枢轴驱动臂、驱动通道和推杆处于第二位置时，驱动通道的进一步近侧平移导致近侧连接构件和远侧连接构件经由枢轴驱动臂而枢轴旋转，从而将大约180度的第二角度减小到第三角度，以使远侧连接构件、枢轴驱动臂和驱动通道处于第三位置，同时推杆处于第一位置。Further, when the proximal link member, the distal link member, the pivot drive arm, the drive channel, and the push rod are in the second position, further proximal translation of the drive channel causes the proximal link member and the distal link member to be driven via the pivot. The arm pivots to reduce the second angle of approximately 180 degrees to a third angle such that the distal connection member, pivot drive arm and drive channel are in the third position while the push rod is in the first position.

近侧连接构件经由枢轴驱动臂的旋转致使近侧连接构件和远侧连接构件相对于彼此成一直线且沿着由近侧连接构件的近端和远侧连接构件的远端之间的参考轴线限定的纵向轴线，以使远侧连接构件引起推杆的远侧平移。Rotation of the proximal link member via the pivot drive arm causes the proximal link member and the distal link member to be aligned relative to each other and along a reference axis between the proximal end of the proximal link member and the distal end of the distal link member. A longitudinal axis is defined such that the distal connection member causes distal translation of the push rod.

近侧连接构件经由枢轴驱动臂的进一步旋转致使近侧连接构件和远侧连接构件彼此成角度地偏移，以使远侧连接构件引起推杆的近侧平移。Further rotation of the proximal link member via the pivot drive arm causes the proximal link member and the distal link member to be angularly offset from each other such that the distal link member causes proximal translation of the push rod.

由近侧连接构件的近端和远侧连接构件的远端之间的参考轴线限定的纵向轴线和近侧连接构件限定了在纵向轴线的第一侧的第一锐角，并且推杆处于近侧位置。驱动通道的远侧平移可使近侧连接构件和远侧连接构件枢转，从而使在纵向轴线的第一侧的第一锐角增大，直到近侧连接构件和远侧连接构件相对于彼此成一直线，并且推杆经由远侧连接构件向远侧平移到远侧位置为止。The longitudinal axis defined by the reference axis between the proximal end of the proximal connection member and the distal end of the distal connection member and the proximal connection member define a first acute angle on a first side of the longitudinal axis, and the push rod is proximally Location. Distal translation of the drive channel can pivot the proximal and distal connecting members such that the first acute angle on the first side of the longitudinal axis increases until the proximal and distal connecting members are aligned relative to each other. straight line, and the push rod is translated distally via the distal connecting member to a distal position.

驱动通道的进一步远侧平移致使近侧连接构件和远侧连接构件从纵向轴线的一侧枢转到纵向轴线的第二侧，从而使近侧连接构件和纵向轴线限定第二锐角，并且使推杆经由远侧连接构件向近侧平移到近侧位置。Further distal translation of the drive channel causes the proximal and distal connecting members to pivot from one side of the longitudinal axis to a second side of the longitudinal axis, thereby causing the proximal connecting member and the longitudinal axis to define a second acute angle, and causing the pusher to The rod translates proximally via the distal connection member to a proximal position.

夹子输出器(clip follower)被构造为接合楔板并且基于楔板的远侧平移向远侧移动，并且被构造为接合夹子承载器且基于楔板的近侧平移使其近侧移动停止。A clip follower is configured to engage the wedge and move distally upon distal translation of the wedge, and is configured to engage the clip carrier and stop its proximal movement upon proximal translation of the wedge.

施夹器可进一步包括钳夹组件，所述钳夹组件具有一对从通道组件的与外壳反向的端部延伸出的钳夹。钳夹组件可适于容纳多个夹子中的一个夹子于其中，并且是可操作的以便响应于手柄的运动来实现夹子的成型。The clip applier may further include a jaw assembly having a pair of jaws extending from an end of the channel assembly opposite the housing. The jaw assembly may be adapted to receive a clip of the plurality of clips therein and be operable to effect clip shaping in response to movement of the handle.

当手柄在第一方向上接近初始量时，推杆可朝向钳夹运动以将最远侧夹子移动至所述钳夹之间。当手柄在第一方向上接近附加量时，推杆可被构造且适于朝向外壳运动以将所述推动器移动到多个夹子中的最远侧夹子后面。As the handle approaches the initial amount in the first direction, the push rod is movable toward the jaws to move the distal-most clip between the jaws. The push rod may be configured and adapted to move toward the housing to move the pusher behind a distal-most clip of the plurality of clips when the handle is approximated an additional amount in the first direction.

驱动通道可被构造且定尺寸为至少部分地围绕钳夹和楔板。驱动通道可包括带箍(strap)，所述带箍横跨所述驱动通道的远端延伸，用于将钳夹和楔板保持在驱动通道内。The drive channel may be configured and dimensioned to at least partially surround the jaw and wedge. The drive channel may include a strap extending across the distal end of the drive channel for retaining the jaw and wedge within the drive channel.

当至少一个手柄在第一方向上被致动而运动时，驱动通道可朝向钳夹组件运动，以将驱动通道的第二端移动到抵靠钳夹以闭合钳夹，当至少一个手柄运动第二量时，驱动通道被移离钳夹，以使驱动通道的第二端移离钳夹以允许钳夹张开。When the at least one handle is actuated to move in a first direction, the drive channel is movable toward the jaw assembly to move the second end of the drive channel against the jaws to close the jaws, and when the at least one handle is moved a second During the second measurement, the drive channel is moved away from the jaws so that the second end of the drive channel moves away from the jaws to allow the jaws to expand.

在实施例中，施夹器可进一步包括运动反转机构，所述运动反转机构可操作地连接到楔板和驱动通道上。在驱动通道的远侧移动期间，运动反转机构的旋转导致楔板的近侧移动。In an embodiment, the clip applier may further include a motion reversal mechanism operably connected to the wedge plate and the drive channel. During distal movement of the drive channel, rotation of the motion reversal mechanism results in proximal movement of the wedge.

在实施例中，施夹器可进一步包括夹子输出器，所述夹子输出器可滑动地配置在夹子承载器的通道内，并且被配置在多个夹子的近侧，夹子输出器被构造为且适于与夹子承载器的窗口和楔板的孔可选择地接合。夹子输出器可被构造为且适于基于楔板的往复运动在相对于夹子承载器的远侧方向上推进多个夹子。In an embodiment, the clip applier may further include a clip follower slidably disposed within the channel of the clip carrier and disposed proximally of the plurality of clips, the clip follower being configured and Adapted to selectively engage with the window of the clip carrier and the hole of the wedge. The clip follower may be configured and adapted to advance the plurality of clips in a distal direction relative to the clip carrier based on reciprocating motion of the wedge.

在实施例中，施夹器可进一步包括运动反转机构，所述运动反转机构可操作地连接到驱动通道和楔板上，并且与推杆可选择地接合。在驱动通道的远侧平移期间，运动反转机构的旋转导致楔板和推杆的近侧移动。In an embodiment, the clip applier may further include a motion reversal mechanism operably connected to the drive channel and the wedge plate and selectively engageable with the push rod. During distal translation of the drive channel, rotation of the motion reversal mechanism results in proximal movement of the wedge and pushrod.

在实施例中，施夹器可进一步包括棘轮机构。棘轮机构可进一步包括：齿条，其具有多个棘轮齿，与驱动通道关联；以及棘爪，其具有至少一个齿，配置在可选择地接合齿条的位置处。棘爪可被偏压到与齿条接合，其中当驱动通道纵向往复运动时，多个齿越过棘爪。棘爪可在至少一个手柄完全致动之前防止驱动通道的无意的返回。In embodiments, the clip applier may further include a ratchet mechanism. The ratchet mechanism may further include: a rack having a plurality of ratchet teeth associated with the drive channel; and a pawl having at least one tooth disposed at a position to selectively engage the rack. The pawl may be biased into engagement with the rack, wherein the plurality of teeth pass over the pawl as the drive channel reciprocates longitudinally. The detent prevents inadvertent return of the drive channel until at least one handle is fully actuated.

在实施例中，施夹器可进一步包括配置在通道组件的远端内的锁定件。当将最后一个夹子从施夹器中射出时，可通过夹子输出器致动锁定件。锁定件可由夹子输出器推进以横跨驱动通道的路径延伸，从而防止驱动通道向远侧移动。In an embodiment, the clip applier may further include a lock disposed within the distal end of the channel assembly. The lock can be actuated by the clip follower when the last clip is ejected from the clip applier. The lock is advanceable by the clip follower to extend across the path of the drive channel, thereby preventing distal movement of the drive channel.

在实施例中，施夹器可进一步包括支撑在外壳和通道组件中的至少一个内的计数器显示机构。计数器显示机构被构造为且适于基于至少一个手柄的每次致动而显示所述施夹器的状态的改变。In an embodiment, the clip applier may further include a counter display mechanism supported within at least one of the housing and the channel assembly. The counter display mechanism is configured and adapted to display a change in state of the clip applier based on each actuation of the at least one handle.

附图说明Description of drawings

由于从下述接合下列附图考虑时的详细描述中本发明的施夹器变得更好理解，因此将能够更充分地认识本施夹器。在附图中：The present clip applier will be more fully appreciated as it becomes better understood from the following detailed description when considered in conjunction with the following drawings. In the attached picture:

图1为根据本公开的实施例的外科施夹器的立体图；1 is a perspective view of a surgical clip applier according to an embodiment of the present disclosure;

图1A为图1的外科施夹器的后视立体图，图示装运楔在适当的位置；Figure 1A is a rear perspective view of the surgical clip applier of Figure 1, showing the shipping wedge in place;

图1B为通过图1A的1B-1B剖切的剖视图；Figure 1B is a cross-sectional view taken through 1B-1B of Figure 1A;

图1C为通过图1A的1C-1C剖切的剖视图；Figure 1C is a cross-sectional view taken through 1C-1C of Figure 1A;

图2为图1的外科施夹器的俯视图；Fig. 2 is the top view of the surgical clip applier of Fig. 1;

图3为图1和图2的外科施夹器的侧面正视图；Figure 3 is a side elevational view of the surgical clip applier of Figures 1 and 2;

图4为图1至3的外科施夹器的分解立体图；Fig. 4 is an exploded perspective view of the surgical clip applier of Figs. 1 to 3;

图4A为图1至4的外科施夹器的运动倍增系统的立体图；4A is a perspective view of the motion multiplication system of the surgical clip applier of FIGS. 1-4;

图4B为图1至4的外科施夹器的运动倍增系统的分解立体图；4B is an exploded perspective view of the motion multiplication system of the surgical clip applier of FIGS. 1 to 4;

图4C为图1至4的外科施夹器的枢轴臂的俯视立体图；4C is a top perspective view of the pivot arm of the surgical clip applier of FIGS. 1-4;

图4D为图4C的枢轴臂的仰视立体图；Figure 4D is a bottom perspective view of the pivot arm of Figure 4C;

图4E为图1至4的外科施夹器的夹子输出器的俯视立体图；4E is a top perspective view of the clip follower of the surgical clip applier of FIGS. 1-4;

图4F为图1至4的外科施夹器的听觉/触觉指示器的立体图；4F is a perspective view of an audible/tactile indicator of the surgical clip applier of FIGS. 1-4;

图4G为图1至4的外科施夹器的齿条构件的立体图；4G is a perspective view of the rack member of the surgical clip applier of FIGS. 1-4;

图4H为外科夹子的俯视立体图；Figure 4H is a top perspective view of a surgical clip;

图4I为图4H的外科夹子的仰视立体图；Figure 4I is a bottom perspective view of the surgical clip of Figure 4H;

图4J为通过图4H的4J-4J剖切的图4H的外科夹子的前视剖视图；Figure 4J is a front cross-sectional view of the surgical clip of Figure 4H taken through 4J-4J of Figure 4H;

图5为图1至4的外科施夹器的纵视剖视图，图示外科施夹器处于未致动状态；5 is a longitudinal cross-sectional view of the surgical clip applier of FIGS. 1-4, showing the surgical clip applier in an unactuated state;

图6为图5所指示细节区域的放大图；Figure 6 is an enlarged view of the detailed area indicated in Figure 5;

图7为图5所指示细节区域的放大图；Figure 7 is an enlarged view of the detailed area indicated in Figure 5;

图8为图5所指示细节区域的放大图；Figure 8 is an enlarged view of the detailed area indicated in Figure 5;

图9为通过图8的9-9剖切的图1至4的外科施夹器的剖视图；9 is a cross-sectional view of the surgical clip applier of FIGS. 1-4 taken through 9-9 of FIG. 8;

图10为图1至4的外科施夹器的立体图，图示了从其移除了上半外壳；10 is a perspective view of the surgical clip applier of FIGS. 1-4, illustrating the upper housing half removed therefrom;

图11为如图10所示的图1至4的外科施夹器的放大图；Figure 11 is an enlarged view of the surgical clip applier of Figures 1 to 4 as shown in Figure 10;

图12为图1至4的外科施夹器的通道组件的远端的俯视立体图，图示了从其移除了盖；12 is a top perspective view of the distal end of the channel assembly of the surgical clip applier of FIGS. 1-4, illustrating the cover being removed therefrom;

图13为图1至4的外科施夹器的俯视立体图，图示了从其移除了上半外壳和推杆；13 is a top perspective view of the surgical clip applier of FIGS. 1 to 4, illustrating the upper housing half and push rod removed therefrom;

图14为图12的通道组件的远端的俯视立体图，图示从其移除了盖和推杆；14 is a top perspective view of the distal end of the channel assembly of FIG. 12 , showing the cap and pushrod removed therefrom;

图15为图12的通道组件的远端的俯视立体图，图示从其移除了推杆和夹子承载器；15 is a top perspective view of the distal end of the channel assembly of FIG. 12 , illustrating removal of the push rod and clip carrier therefrom;

图16为图12的通道组件的远端的俯视立体图，图示从其移除了盖、推杆、夹子承载器、外科夹子和夹子输出器；16 is a top perspective view of the distal end of the channel assembly of FIG. 12 , showing the cover, pusher, clip carrier, surgical clip, and clip outputter removed therefrom;

图17为图16所指示细节区域的放大图；Figure 17 is an enlarged view of the detailed area indicated in Figure 16;

图18为图1至4的外科施夹器的俯视立体图，图示从其移除了上半外壳、推杆和楔板；Figure 18 is a top perspective view of the surgical clip applier of Figures 1-4, shown with the upper housing half, push rod and wedge removed therefrom;

图19为图12的通道组件的远端的俯视立体图，图示从其移除了盖、推杆、夹子承载器、外科夹子、夹子输出器和楔板；19 is a top perspective view of the distal end of the channel assembly of FIG. 12 , showing the cover, pusher, clip carrier, surgical clip, clip follower, and wedge removed therefrom;

图20为图1至4的外科施夹器的俯视立体图，图示从其移除了上半外壳、推杆、楔板和驱动通道；20 is a top perspective view of the surgical clip applier of FIGS. 1-4 with the upper housing half, pushrod, wedge and drive channel removed therefrom;

图21为图1至4的外科施夹器的仰视立体图，图示从其移除了下半外壳、驱动通道和楔板；Fig. 21 is a bottom perspective view of the surgical clip applier of Figs. 1-4, shown with the lower housing half, drive channel and wedge removed therefrom;

图22为图1至4的外科施夹器的俯视图，图示从其移除了上半外壳且处于未致动状态；Figure 22 is a top view of the surgical clip applier of Figures 1-4, shown with the upper housing half removed therefrom and in an unactuated state;

图23为图22所指示细节区域的放大图；Figure 23 is an enlarged view of the detailed area indicated in Figure 22;

图24为图22所指示细节区域的放大图；Figure 24 is an enlarged view of the detailed area indicated in Figure 22;

图24A为图24的运动倍增系统的示意图；24A is a schematic diagram of the motion multiplication system of FIG. 24;

图25为图1至4的外科施夹器的俯视图，示出从其移除了上半外壳且在其初始致动期间；Figure 25 is a top view of the surgical clip applier of Figures 1-4, shown with the upper housing half removed therefrom and during initial actuation thereof;

图26为图25所指示细节区域的放大图；Figure 26 is an enlarged view of the detailed area indicated in Figure 25;

图27为图25所指示细节区域的放大图；Figure 27 is an enlarged view of the detailed area indicated in Figure 25;

图27A为图27的运动倍增系统的示意图；27A is a schematic diagram of the motion multiplication system of FIG. 27;

图28为在外科施夹器的初始致动期间的通道组件的远端的放大、纵视剖视图；28 is an enlarged, longitudinal cross-sectional view of the distal end of the channel assembly during initial actuation of the surgical clip applier;

图29为图1至4的外科施夹器的俯视立体图，示出了从其移除了上半外壳和推杆且在其初始致动期间；Figure 29 is a top perspective view of the surgical clip applier of Figures 1-4, showing the upper housing half and push rod removed therefrom and during initial actuation thereof;

图30为在外科施夹器的进一步初始致动期间的通道组件的远端的放大、纵视剖视图；30 is an enlarged, longitudinal cross-sectional view of the distal end of the channel assembly during further initial actuation of the surgical clip applier;

图31为示出在图1至4的外科施夹器的相应的初始致动期间的听觉/触觉指示器的操作的仰视立体图；31 is a bottom perspective view illustrating the operation of the audible/tactile indicators during respective initial actuations of the surgical clip appliers of FIGS. 1-4;

图32为图1至4的外科施夹器的俯视图，示出了从其移除了上半外壳且在外科施夹器的进一步致动期间；Figure 32 is a top view of the surgical clip applier of Figures 1-4, showing the upper housing half removed therefrom and during further actuation of the surgical clip applier;

图33为图32所指示细节区域的放大图；Figure 33 is an enlarged view of the detailed area indicated in Figure 32;

图34为示出图1至4的外科施夹器的计数器机构的致动的放大剖视图；34 is an enlarged cross-sectional view illustrating actuation of the counter mechanism of the surgical clip applier of FIGS. 1-4;

图35为图32所指示细节区域的放大图；Figure 35 is an enlarged view of the detailed area indicated in Figure 32;

图36为在图1至4的外科施夹器的最后一次致动期间所示出的齿条机构的放大图；36 is an enlarged view of the rack mechanism shown during the final actuation of the surgical clip applier of FIGS. 1-4;

图37和38为示出在图1至4的外科施夹器的最后一次致动期间的通道组件的远端的放大立体图；37 and 38 are enlarged perspective views showing the distal end of the channel assembly during a final actuation of the surgical clip applier of FIGS. 1-4;

图39为图1至4的外科施夹器的俯视图，示出了从其移除了上半外壳且处于外科施夹器致动后的最终状态；Figure 39 is a top view of the surgical clip applier of Figures 1-4, shown with the upper housing half removed therefrom and in its final state after actuation of the surgical clip applier;

图40为图39所指示细节区域的放大图；Figure 40 is an enlarged view of the detailed area indicated in Figure 39;

图41为图39所指示细节区域的放大图；Figure 41 is an enlarged view of the detailed area indicated in Figure 39;

图41A为图41的运动倍增系统的示意图；41A is a schematic diagram of the motion multiplication system of FIG. 41;

图42为示出在图1至4的外科施夹器致动之后的听觉/触觉指示器的位置的放大图；42 is an enlarged view showing the position of the audible/tactile indicators after actuation of the surgical clip applier of FIGS. 1-4;

图43为示出在图1至4的外科施夹器致动之后的钳夹组件的位置的钳夹组件的俯视图；43 is a top view of the jaw assembly showing the position of the jaw assembly after actuation of the surgical clip applier of FIGS. 1-4;

图44为包括外科施夹器的一个夹子的体血管的立体图，示出夹子施加到体血管上；44 is a perspective view of a body vessel including a clip of a surgical clip applier, showing the clip applied to the body vessel;

图45为图22、25、32和39所指示细节区域的放大图，示出了在外科施夹器完全致动之后的其张开或释放期间的枢轴臂的操作；Figure 45 is an enlarged view of the area of detail indicated in Figures 22, 25, 32 and 39, showing the operation of the pivot arm during its deployment or release after the surgical clip applier is fully actuated;

图46为所示在图1至4的外科施夹器的张开或释放期间的齿条机构的放大图；46 is an enlarged view of the rack mechanism shown during deployment or release of the surgical clip applier of FIGS. 1-4;

图47为示出在图1至4的外科施夹器的张开或释放期间的听觉/触觉指示器的操作的放大图；47 is an enlarged view showing the operation of the audible/tactile indicators during deployment or release of the surgical clip applier of FIGS. 1-4;

图48和49为示出在图1至4的外科施夹器的张开或释放期间的夹子输出器的运动的通道组件的纵视剖视图；48 and 49 are longitudinal cross-sectional views of the channel assembly illustrating movement of the clip follower during deployment or release of the surgical clip applier of FIGS. 1-4;

图50和51为示出在图1至4的外科施夹器的张开或释放期间的推杆和楔板的运动的通道组件的远端的纵视剖视图；和50 and 51 are longitudinal cross-sectional views of the distal end of the channel assembly showing movement of the push rod and wedge during deployment or release of the surgical clip applier of FIGS. 1-4; and

图52为示出图1至4的外科施夹器在从其弹射出最后一个外科夹子之后的锁定状态下的通道组件的远端的纵视剖视图。52 is a longitudinal cross-sectional view showing the distal end of the channel assembly of the surgical clip applier of FIGS. 1-4 in a locked state after the last surgical clip has been ejected therefrom.

具体实施方式Detailed ways

现在将参照附图对依照本公开的外科施夹器的实施例进行详细描述，其中相同的附图标记代表类似或相同的结构构件。如附图所示以及如下贯穿全文所描述的，当涉及外科器械的相对位置时，跟传统的一样，术语“近侧”表示装置靠近用户的一端，而术语“远侧”表示装置远离用户的一端。Embodiments of surgical clip appliers according to the present disclosure will now be described in detail with reference to the accompanying drawings, wherein like reference numerals represent similar or identical structural components. As shown in the drawings and described throughout the text below, when referring to the relative positions of surgical instruments, the term "proximal" refers to the end of the device that is closer to the user, and the term "distal" refers to the end of the device away from the user, as is conventional. one end.

图1至5示出的依照本公开的实施例的外科施夹器通常用100表示。可以参考下述申请：于2008年8月25日提交的、申请号为61/091,467、名称为“Surgical Clip Applier(外科施夹器)”的美国临时申请和于2008年8月25日提交的、申请号为61/091,485、名称为“Surgical Clip Applier andMethod of Assembly(外科施夹器及其装配方法)”的美国临时申请，将所述每个申请的全部内容通过引用都并入于此，用于详细讨论外科施夹器100的结构、操作和装配方法。The surgical clip applier shown in FIGS. 1-5 in accordance with an embodiment of the present disclosure is indicated generally at 100 . Reference may be made to the following applications: U.S. Provisional Application No. 61/091,467, filed August 25, 2008, entitled "Surgical Clip Applier" and filed August 25, 2008 , U.S. Provisional Application No. 61/091,485, entitled "Surgical Clip Applier and Method of Assembly," each of which is hereby incorporated by reference in its entirety, A detailed discussion of the structure, operation and assembly of surgical clip applier 100 is provided.

外科施夹器100为包括手柄组件102的外科器械，所述手柄组件102包括具有上半外壳104a和下半外壳104b的外壳104。手柄组件102进一步包括一对手柄106，所述一对手柄106可枢转地固定在外壳104上并从外壳104向外延伸。通道组件108稳固地固定在外壳104上并从外壳104向外延伸，终止于钳夹组件110。Surgical clip applier 100 is a surgical instrument that includes a handle assembly 102 that includes a housing 104 having an upper housing half 104a and a lower housing half 104b. The handle assembly 102 further includes a pair of handles 106 pivotally secured to the housing 104 and extending outwardly from the housing 104 . Channel assembly 108 is fixedly secured to housing 104 and extends outwardly from housing 104 , terminating in jaw assembly 110 .

如在图1至4中可见，施夹器100的半外壳104a和104b彼此通过卡扣配合(snap fit)接合而装在一起。外壳104限定了形成于下半外壳104b内的用于支撑和显示计数器机构的窗口104c，如在下文将更详细讨论的。外壳104由合适的塑性材料制成。As can be seen in FIGS. 1-4, the housing halves 104a and 104b of the clip applier 100 are held together by snap fit engagement with each other. The housing 104 defines a window 104c formed in the lower housing half 104b for supporting and displaying the counter mechanism, as will be discussed in more detail below. Housing 104 is made of a suitable plastic material.

如在图4中可见，手柄106通过手柄枢轴支柱104d固定在外壳104上，所述手柄枢轴支柱104d从下半外壳104b延伸出并进入到形成于手柄106上的相应的孔106a内。手柄组件102包括连杆构件122，所述连杆构件122在形成于相应手柄106上的枢轴点106b处可枢转地连接至每个手柄106。每个连杆构件122的远端122a通过驱动销124可枢转地连接到形成于驱动通道140内的枢轴点140a。驱动销124的每端可滑动地容纳在形成于相应的上、下半外壳104a、104b内的细长通道104e中。使用时，如下文将更详细描述的，当扳动手柄106时，连杆构件122通过驱动销124向远侧推动驱动通道140。As can be seen in FIG. 4 , the handle 106 is secured to the housing 104 by a handle pivot strut 104d that extends from the lower housing half 104b and into a corresponding aperture 106a formed in the handle 106 . The handle assembly 102 includes a linkage member 122 pivotally connected to each handle 106 at a pivot point 106b formed on the respective handle 106 . A distal end 122a of each linkage member 122 is pivotally connected by a drive pin 124 to a pivot point 140a formed in a drive channel 140 . Each end of the drive pin 124 is slidably received in an elongated channel 104e formed in the respective upper and lower housing halves 104a, 104b. In use, as will be described in more detail below, when the handle 106 is pulled, the linkage member 122 pushes the drive channel 140 distally through the drive pin 124 .

通道组件108包括通道或仓盖130和外部或下部通道132，各自均具有保持在外壳组件102内并位于上、下半外壳104a、104b之间的近端。仓盖130包括至少一个保持元件130a，其被构造为且适于可选择地以卡扣配合接合的方式与设置在外部通道132上的互补或相应的保持元件132a相接合。The channel assembly 108 includes a channel or compartment cover 130 and an outer or lower channel 132 each having a proximal end retained within the housing assembly 102 between the upper and lower housing halves 104a, 104b. Cap 130 includes at least one retaining element 130a configured and adapted to selectively engage in a snap-fit engagement with a complementary or corresponding retaining element 132a disposed on outer channel 132 .

如在图4和图6至12中可见，施夹器100包括可滑动地配置在仓盖130下方的夹子推杆(push bar)160。推杆160包括限定了推动器160c的远端160a，所述推动器160c被构造为且适于可选择地接合/移动存放在外科施夹器100内的最远侧夹子“C₁”。推杆160进一步包括近端160b，所述近端160b限定了其中的第一近侧窗口160d和第二近侧窗口160h。第一近侧窗口160d被构造为可滑动地容纳驱动销124于其中，并且第二近侧窗口160h被构造为可滑动地容纳固定杆154a于其中。推杆160还在其中限定了用于可操作地与稳定器162接合的远侧窗口160e和近侧窗口160g，如在下文将更详细讨论的。推杆160进一步包括孔160f，所述孔160f被构造为容纳远侧连接构件158的滑动支柱158c，如在下文将更详细讨论的。As seen in FIGS. 4 and 6-12 , the clip applier 100 includes a clip push bar 160 slidably disposed below the compartment cover 130 . Push rod 160 includes a distal end 160a defining a pusher 160c configured and adapted to selectively engage/move a distal-most clip “C₁ ” stored within surgical clip applier 100 . The push rod 160 further includes a proximal end 160b defining a first proximal window 160d and a second proximal window 160h therein. The first proximal window 160d is configured to slidably receive the drive pin 124 therein, and the second proximal window 160h is configured to slidably receive the fixation rod 154a therein. The pushrod 160 also defines a distal window 160e and a proximal window 160g therein for operably engaging the stabilizer 162, as will be discussed in greater detail below. Pushrod 160 further includes an aperture 160f configured to receive sliding strut 158c of distal connection member 158, as will be discussed in greater detail below.

施夹器100进一步包括稳定器162，所述稳定器162被构造为覆于推杆160之上并与其接合。稳定器162包括：远侧突起162a，其被构造为接合推杆160的远侧窗口160e；细长窗口162b和162d，所述细长窗口162b和162d在其中限定为位于基本覆于形成于推杆160中的近侧窗口160d和160h之上并与相应的近侧窗口160d和160h对准的位置处。如在图4和6中可见，稳定器162进一步包括多个突起162e，它们从稳定器的顶表面延伸出，位于近侧和远侧位置，并被构造且定尺寸为容纳在形成于上半外壳104a中的相应通道中。稳定器162进一步包括覆于推杆160的孔160f之上的孔162f。孔160f和162f均被构造为容纳远侧连接构件158的滑动支柱158c。Clip applier 100 further includes a stabilizer 162 configured to overlie and engage pushrod 160 . The stabilizer 162 includes: a distal protrusion 162a configured to engage a distal window 160e of the push rod 160; an elongated window 162b and 162d defined therein to lie substantially overlying the at a location above and aligned with the respective proximal windows 160d and 160h in the rod 160 . As can be seen in FIGS. 4 and 6, the stabilizer 162 further includes a plurality of protrusions 162e extending from the top surface of the stabilizer at proximal and distal corresponding passages in housing 104a. The stabilizer 162 further includes a hole 162f overlying the hole 160f of the push rod 160 . Bores 160f and 162f are each configured to receive sliding strut 158c of distal connection member 158 .

如在图4、4A、4B和24中可见，施夹器100进一步包括运动倍增系统155，所述运动倍增系统155为具有可枢转地支撑在外壳104内且通过枢轴驱动臂156可操作地连接到驱动通道140上的近侧连接构件154的三杆连接系统的形式。枢轴驱动臂156经由孔156b通过销156a可枢转地接合到外壳104上。运动倍增系统155进一步包括将近侧连接构件154和推杆160相互连接的远侧连接构件158。纵向轴线“X1”限定为沿着穿过近侧连接构件154的固定杆154a和远侧连接构件158的滑动支柱158c延伸的轴线。纵向轴线“X1”的包括枢轴驱动臂156的一侧定义为第一侧，而纵向轴线“X1”的另一侧定义为第二侧。在第一侧上，近侧连接构件154可枢转地定向在相对于纵向轴线“X1”成角度“α”处(如图24所示)。在第二侧上，近侧连接构件154可枢转地定向在相对于纵向轴线“X1”成角度“-α”处(如图35所示)。实质上，当近侧连接构件154定向在角度“α”和角度“-α”之间，角度为0度时，使得近侧连接构件154与纵向轴线“X1”成一直线(如图27所示)。在这种构造中，近侧连接构件154还与远侧连接构件158成一直线，如下文将更详细讨论的。枢轴驱动臂156通过由驱动通道140固定且驱动的枢轴销156a被可枢转地支撑。纵向轴线“X2”限定为沿着驱动通道140延伸的轴线。如此，枢轴驱动臂156可枢转地定向在相对于纵向轴线“X2”成角度“β”处(如图24所示)。As can be seen in FIGS. 4 , 4A, 4B, and 24 , clip applier 100 further includes a motion multiplication system 155 having a motion multiplication system pivotally supported within housing 104 and operable via a pivot drive arm 156 . Ground connected to the proximal connection member 154 on the drive channel 140 in the form of a three-bar connection system. Pivot drive arm 156 is pivotally coupled to housing 104 via pin 156a via bore 156b. Motion multiplication system 155 further includes distal connection member 158 interconnecting proximal connection member 154 and pushrod 160 . The longitudinal axis “X1” is defined as the axis extending through the fixed rod 154a of the proximal connection member 154 and the sliding strut 158c of the distal connection member 158 . One side of the longitudinal axis "X1" that includes the pivot drive arm 156 is defined as a first side, and the other side of the longitudinal axis "X1" is defined as a second side. On a first side, the proximal connection member 154 is pivotally oriented at an angle "α" relative to the longitudinal axis "X1" (as shown in FIG. 24 ). On the second side, the proximal connection member 154 is pivotally oriented at an angle "-α" relative to the longitudinal axis "X1" (as shown in FIG. 35 ). In essence, when the proximal connecting member 154 is oriented between the angle "α" and the angle "-α", with the angle being 0 degrees, the proximal connecting member 154 is aligned with the longitudinal axis "X1" (as shown in FIG. 27 ). In this configuration, the proximal connection member 154 is also in line with the distal connection member 158, as will be discussed in more detail below. Pivot drive arm 156 is pivotally supported by pivot pin 156 a secured and driven by drive channel 140 . The longitudinal axis “X2” is defined as the axis extending along the drive channel 140 . As such, the pivot drive arm 156 is pivotally oriented at an angle "β" relative to the longitudinal axis "X2" (as shown in FIG. 24 ).

近侧连接构件154包括毂(hub)154b，所述毂154b被构造为容纳穿过其的固定杆154a，以便建立在近侧连接构件154和外壳104之间的枢转连接。近侧连接构件154还包括近侧孔154c和远侧孔154d。近侧孔154c被构造为容纳枢轴驱动臂156的驱动支柱156c，枢轴驱动臂156以旋转的方式可选择地驱动近侧连接构件154，如在下文将更详细讨论的。远侧孔154d被构造为容纳通过远侧连接构件158的孔158b的接合销158a，接合销158a使近侧连接构件154可枢转地接合到远侧连接构件158上。远侧连接构件158进一步包括支柱158c，所述支柱158c可滑动地连接到推杆160的孔160f和稳定器162的孔162f中。远侧连接构件158通过滑动支柱158c实现推杆160和稳定器162在近侧和远侧方向上的平移。The proximal connection member 154 includes a hub 154b configured to receive a fixed rod 154a therethrough to establish a pivotal connection between the proximal connection member 154 and the housing 104 . The proximal connection member 154 also includes a proximal aperture 154c and a distal aperture 154d. Proximal aperture 154c is configured to receive drive strut 156c of pivot drive arm 156 that selectively drives proximal link member 154 in a rotational manner, as will be discussed in greater detail below. Distal aperture 154d is configured to receive engagement pin 158a through aperture 158b of distal connection member 158 that pivotally engages proximal connection member 154 to distal connection member 158 . The distal connecting member 158 further includes a post 158c slidably connected to a bore 160f of the pushrod 160 and a bore 162f of the stabilizer 162 . Distal link member 158 enables translation of pushrod 160 and stabilizer 162 in the proximal and distal directions via sliding strut 158c.

施夹器100进一步包括配置在通道组件108内且位于推杆160下方的夹子承载器170。夹子承载器170通常呈盒状结构，具有上壁170a、一对侧壁170b和下壁170c，限定了穿过其中的通道170d。夹子承载器170包括多个间隔开的窗口172，所述窗口172形成于上壁170a内并沿其长度纵向延伸。夹子承载器170包括形成于下壁170c内并沿其长度纵向延伸的细长窗口170e(如图9所示)。Clip applier 100 further includes a clip carrier 170 disposed within channel assembly 108 below push rod 160 . Clip carrier 170 is generally box-shaped in structure having an upper wall 170a, a pair of side walls 170b, and a lower wall 170c defining a passageway 170d therethrough. Clip carrier 170 includes a plurality of spaced apart windows 172 formed in upper wall 170a and extending longitudinally along its length. Clip carrier 170 includes an elongated window 170e (shown in FIG. 9 ) formed in lower wall 170c and extending longitudinally along its length.

如在图4H至4J中可见，外科夹子“C”包括第一腿部“C₂”和第二腿部“C₄”。外科夹子“C”的腿部“C₂”和“C₄”中的每一个都连接到彼此上以形成顶点“C₁₄”。外科夹子“C”的顶点“C₁₄”具有如图4H至4I所示大致V形的构造。外科夹子“C”的第一腿部“C₂”进一步包括位于内壁上且限定了多个凹槽“C₈”的夹持图案(gripping pattern)“C₆”。外科夹子“C”的第二腿部“C₄”包括在外壁上的多个凹入部“C₁₀”和在内壁上的多个凸出部“C₁₂”。当外科夹子“C”施加到组织上时，由于在下文将更详细地描述施加夹子“C”到组织上，腿部“C₂”和“C₄”会合到一起，以使多个凹入部“C₁₀”和多个凸出部“C₁₂”将组织夹紧并保持在其间。为了更详细地讨论外科夹子“C”，请参见于共有的由2006年1月23日提交的、名称为“SurgicalHemostatic Clip(外科止血夹)”、公布号为2007/0173866的美国文献，将其全部内容通过引用并入到此处。As can be seen in Figures 4H to 4J, surgical clip "C" includes a first leg "_C2 " and a second leg "_C4 ". Each of legs "_C2 " and "_C4 " of surgical clip "C" are connected to each other to form vertex "_C14 ". Apex "_C14 " of surgical clip "C" has a generally V-shaped configuration as shown in Figures 4H to 4I. The first leg "_C2 " of the surgical clip "C" further includes a gripping pattern "_C6 " on the inner wall defining a plurality of grooves "_C8 ". The second leg "_C4 " of the surgical clip "C" includes a plurality of recesses "_C10 " on the outer wall and a plurality of protrusions "_C12 " on the inner wall. When the surgical clip "C" is applied to the tissue, as will be described in more detail below to apply the clip "C" to the tissue, the legs "_C2 " and "_C4 " come together so that the multiple recesses "C₁₀ " and the plurality of protrusions "C₁₂ " clamp and hold the tissue therebetween. For a more detailed discussion of Surgical Clip "C," see co-owned U.S. Publication No. 2007/0173866, filed January 23, 2006, entitled "Surgical Hemostatic Clip," which refers to The entire contents are hereby incorporated by reference.

如在图4、9和14中可见，一叠外科夹子“C”装载和/或保持在夹子承载器170的通道170d内，以在其内滑动和/或沿其滑动。通道170d被构造且定尺寸为将一叠或多个外科夹子“C”以头尾相接的方式可滑动地保持于其中。As seen in Figures 4, 9 and 14, a stack of surgical clips "C" is loaded and/or retained within channel 17Od of clip carrier 170 to slide therein and/or along. Channel 170d is configured and dimensioned to slidably retain a stack or more of surgical clips "C" therein in an end-to-end manner.

如在图12和14中可见，夹子承载器170的远端包括一对分隔开的弹性柄脚(tang)171。柄脚171被构造为适于可选择地接合保持在夹子承载器170内的一叠外科夹子“C”的最远侧外科夹子“C1”的后跨部(backspan)。As seen in FIGS. 12 and 14 , the distal end of the clip carrier 170 includes a pair of spaced apart resilient tangs 171 . Tang 171 is configured to selectively engage the backspan of the distal-most surgical clip "C1" of a stack of surgical clips "C" held within clip carrier 170.

如在图4、4E、7和15中可见，施夹器100进一步包括可滑动地配置在夹子承载器1-70的通道170d内的夹子输出器174。如下文将要更详细地讨论的，夹子输出器174位于这叠外科夹子“C”的后方，设置为在施夹器100致动期间将这叠夹子“C”向前推进。如下文将要更详细地讨论的，通过楔板180的前后往复运动来致动夹子输出器174。As seen in Figures 4, 4E, 7 and 15, the clip applier 100 further includes a clip follower 174 slidably disposed within the channel 170d of the clip carrier 1-70. As will be discussed in more detail below, the clip follower 174 is positioned behind the stack of surgical clips "C" and is configured to advance the stack of clips "C" during actuation of the clip applier 100. As will be discussed in more detail below, clip follower 174 is actuated by back and forth reciprocation of wedge plate 180 .

如在图4E和7中可见，夹子输出器174包括：限定了一平面的主体部174a，从主体部174a基本上向上和向后延伸出的远侧突起175，以及从主体部174a基本上向下和向后延伸出的近侧突起176。远侧突起175包括：在由主体部174a限定的所述平面下方向下延伸的远侧部175a；和在由主体部174a限定的所述平面上方向上延伸的近侧部175b。As can be seen in Figures 4E and 7, the clip output device 174 includes: a main body portion 174a defining a plane, a distal protrusion 175 extending substantially upwardly and rearwardly from the main body portion 174a, and a substantially upward direction from the main body portion 174a. Proximal protrusion 176 extends downwardly and rearwardly. The distal protrusion 175 includes: a distal portion 175a extending downwardly below the plane defined by the main body portion 174a; and a proximal portion 175b extending upwardly above the plane defined by the main body portion 174a.

远侧突起175的近侧部175b被构造且定尺寸为可选择地与形成于夹子承载器170的上壁170a内的窗口172接合。使用时，夹子输出器174的远侧突起175的近侧部175b接合在形成于夹子承载器170的上壁170a内的窗口172中，防止夹子输出器在近侧方向上平移或移动。The proximal portion 175b of the distal protrusion 175 is configured and dimensioned to selectively engage the window 172 formed in the upper wall 170a of the clip carrier 170 . In use, the proximal portion 175b of the distal projection 175 of the clip follower 174 engages in the window 172 formed in the upper wall 170a of the clip carrier 170, preventing the clip follower from translating or moving in the proximal direction.

近侧突起176被构造且定尺寸为可选择地与形成于楔板180内的窗口180b接合。使用时，夹子输出器174的近侧突起176接合在形成于楔板180内的窗口180b中，使得夹子输出器174基于楔板180的远侧移动而向远侧前进或移动。The proximal protrusion 176 is configured and dimensioned to selectively engage a window 180b formed in the wedge plate 180 . In use, proximal protrusion 176 of clip follower 174 engages in window 180b formed in wedge plate 180 such that clip follower 174 is advanced or moved distally upon distal movement of wedge plate 180 .

如在图4、7至9、16和17中可见，施夹器100进一步包括可滑动地配置在手柄组件102和通道组件108内的楔板180。楔板180定位或配置在夹子承载器170下方。楔板180包括用于选择性操作地插在钳夹120之间的基本锥形的远端180a。楔板180限定了：多个沿其长度纵向延伸并形成于其隆起部分中的间隔开的窗口或孔180b、位于孔180b远侧的远侧窗口或孔180c、以及定位在孔180c近侧的最近侧横向定向槽180d。As seen in FIGS. 4 , 7-9 , 16 and 17 , clip applier 100 further includes a wedge 180 slidably disposed within handle assembly 102 and channel assembly 108 . Wedge plate 180 is positioned or disposed below clip carrier 170 . Wedge 180 includes a generally tapered distal end 180a for selectively operatively inserted between jaws 120 . Wedge plate 180 defines: a plurality of spaced apart windows or holes 180b extending longitudinally along its length and formed in its raised portion, a distal window or hole 180c positioned distal to hole 180b, and a window positioned proximal to hole 180c. The proximal-most transverse orientation slot 180d.

如在图4、8、16和17中可见，施夹器100包括由仓盖130支撑的远侧锁定件178。远侧锁定件178包括尾部或突起178a，所述尾部或突起178a基本上向后和向下延伸并构造且定尺寸为容纳在楔板180的远侧窗口或孔180c中。As seen in FIGS. 4 , 8 , 16 and 17 , clip applier 100 includes a distal lock 178 supported by canopy cover 130 . Distal lock 178 includes a tail or protrusion 178 a that extends substantially rearward and downward and is configured and dimensioned to be received within a distal window or aperture 180 c of wedge 180 .

如在图4、4C、4D、6、11、13、18和20中可见，施夹器100包括楔板运动反转机构(motion reversing mechanism)，其呈枢轴臂179的形式，可枢转地支撑在外壳104的下半外壳104b上，用于将驱动通道140的平移传递成楔板180的反转平移(reverse translation)。枢轴臂179包括：被构造为可枢转地连接到外壳104上的枢轴凸起部(pivot boss)179a、设置在枢轴臂179的一端处并沿与枢轴凸起部179a相反的方向延伸的第一柱杆或指状部179b、以及设置在枢轴臂179的第二端处并在沿第一柱杆或指状部179b和枢轴凸起部179a的方向上延伸的第二柱杆或指状部179c。第一柱杆或指状部179b被构造为适于接合在楔板180的最近侧槽180d中。第二柱杆或指状部179c被构造为接合在形成于驱动通道140中的槽140g中，其连接在限定于驱动通道140中的窗口140g中。槽140g包括：彼此轴向和横向偏离的纵向延伸远侧部和纵向延伸近侧部，以及使远侧部和近侧部相互连接的横向部。4, 4C, 4D, 6, 11, 13, 18, and 20, clip applier 100 includes a wedge motion reversing mechanism in the form of a pivot arm 179 that pivots Groundly supported on the lower half shell 104b of the shell 104 for transferring the translation of the drive channel 140 into the reverse translation of the wedge plate 180 (reverse translation). The pivot arm 179 includes: a pivot boss (pivot boss) 179a configured to be pivotally connected to the housing 104, disposed at one end of the pivot arm 179 and along the opposite side of the pivot boss 179a. A first post or finger 179b extending in the direction, and a first post or finger 179b extending in a direction along the first post or finger 179b and the pivot boss 179a disposed at the second end of the pivot arm 179. Two posts or fingers 179c. The first post or finger 179b is configured to be engaged in the proximal-most slot 180d of the wedge plate 180 . The second post or finger 179c is configured to engage in a slot 140g formed in the drive channel 140 which connects in a window 140g defined in the drive channel 140 . Slot 140g includes a longitudinally extending distal portion and a longitudinally extending proximal portion that are axially and laterally offset from each other, and a transverse portion interconnecting the distal and proximal portions.

使用时，如在下文将详细讨论的，当驱动通道140向远侧移动时，在一停顿时间段(dwell period)之后(即，驱动通道140的槽140g的纵向延伸的远侧部的长度)，第二柱杆或指状部179c在远侧方向上移动，使枢轴臂179旋转，从而使第一柱杆或指状部179b在第二方向上移动。当第一柱杆或指状部179b在第二方向上移动时，第一柱杆或指状部179b将楔板180从钳夹120之间拉出，推动楔板。当楔板180在远侧方向上移动时，如在图17中可见，楔板180的远端180a凸靠(cam against)钳夹120的内表面，从而保持钳夹120彼此间隔开。In use, as will be discussed in detail below, when the drive channel 140 moves distally, after a dwell period (i.e., the length of the longitudinally extending distal portion of the slot 140g of the drive channel 140) , the second post or finger 179c moves in the distal direction, causing the pivot arm 179 to rotate, thereby moving the first post or finger 179b in the second direction. When the first post or finger 179b moves in the second direction, the first post or finger 179b pulls the wedge 180 out of between the jaws 120, pushing the wedge. As wedge plate 180 moves in the distal direction, as seen in FIG. 17 , distal end 180 a of wedge plate 180 cams against the inner surface of jaws 120 , thereby keeping jaws 120 spaced apart from each other.

如在图4、6至11、13、18和19中可见，施夹器100包括驱动通道140，所述驱动通道140可往复地支撑在手柄组件102的外壳104和通道组件108内并在二者之间延伸。驱动通道140的近端支撑在外壳104的上、下半外壳104a、104b之间，而驱动通道140的远端支撑在仓盖130和通道组件108的外部通道132之间，位于楔板180的下方一位置处。As seen in FIGS. 4, 6 to 11, 13, 18 and 19, the clip applier 100 includes a drive channel 140 that is reciprocally supported within the housing 104 and the channel assembly 108 of the handle assembly 102 and on both sides. extend between. The proximal end of the drive channel 140 is supported between the upper and lower housing halves 104a, 104b of the housing 104, while the distal end of the drive channel 140 is supported between the cover 130 and the outer channel 132 of the channel assembly 108, at the edge of the wedge 180. a position below.

驱动通道140的远端是基本呈U形的通道，其包括在远离外部通道132且朝向仓盖130的方向上、从其后跨部140c延伸出的间隔开的一对侧壁140b。驱动通道140进一步限定了形成于后跨部140c内、用于可枢转地容纳驱动销124穿过其中的驱动销凹槽140a。驱动通道140进一步限定了位于驱动销凹槽140a远侧的位置处、从后跨部140c突出的肋块(rib)140e。驱动通道140进一步限定了形成于后跨部140c内、位于槽140e远侧的位置处的往复限制槽140f。The distal end of the drive channel 140 is a generally U-shaped channel including a pair of spaced side walls 140b extending from a rear span 140c thereof in a direction away from the outer channel 132 and toward the canopy 130 . The drive channel 140 further defines a drive pin recess 140a formed in the rear span 140c for pivotally receiving the drive pin 124 therethrough. Drive channel 140 further defines a rib 140e projecting from rear span 140c at a location distal to drive pin groove 140a. Drive channel 140 further defines a reciprocating limiting slot 140f formed in rear span 140c at a location distal to slot 140e.

如在图4、8、9、12、14至16和19中可见，施夹器100包括固定到驱动通道140上的驱动通道带箍143。带箍143固定到驱动通道140的直立部140b上，以横向地横跨直立部140b延伸。带箍143固定到驱动通道140上、位于往复限制槽140f的远侧。带箍143固定到驱动通道140上以使楔板180在带箍143下方和钳夹120上方延伸。As seen in FIGS. 4 , 8 , 9 , 12 , 14 to 16 and 19 , clip applier 100 includes drive channel strap 143 secured to drive channel 140 . A strap 143 is secured to the upright portion 140b of the drive channel 140 to extend laterally across the upright portion 140b. A strap 143 is secured to the drive channel 140 distal to the reciprocation limiting slot 140f. Strap 143 is secured to drive channel 140 such that wedge plate 180 extends below strap 143 and above jaw 120 .

如在图4、4F、6、10和21中可见，施夹器100进一步包括通过驱动销124连接到驱动通道140的听觉/触觉指示器148。指示器148包括弹性指状部148a和一对凸起部148b。使用时，如在下面将更详细地描述的，当将施夹器100致动并使驱动通道140往复运动时，指示器148的第一弹性指状部148a与设置在施夹器100上的相应的互补结构或凸缘149相互作用，以给用户生成听觉和/或触觉反馈。指示器148的凸起部148b搭在形成于上半外壳104a的通道104e内并向指示器148提供支撑以防止指示器148旋转。As seen in FIGS. 4 , 4F , 6 , 10 and 21 , clip applier 100 further includes an audible/tactile indicator 148 connected to drive channel 140 through drive pin 124 . The indicator 148 includes a resilient finger 148a and a pair of protrusions 148b. In use, as will be described in more detail below, when the clip applier 100 is actuated and the drive channel 140 is reciprocated, the first resilient finger 148a of the indicator 148 engages with the clip applier 100 provided on the clip applier 100 Corresponding complementary structures or flanges 149 interact to generate audible and/or tactile feedback to the user. The raised portion 148b of the indicator 148 rides within the channel 104e formed in the upper housing half 104a and provides support to the indicator 148 to prevent the indicator 148 from rotating.

如在图4、6、10、11、13、18和20中可见，施夹器100进一步包括偏压构件146，其呈拉力弹簧的形式，可操作地固定到驱动通道140的近端和外壳104上并处于二者之间，趋向于保持驱动通道140处于缩回的或最近侧的位置。偏压构件146的作用在于在位于钳夹120之间的夹子“C”成型之后使驱动通道140缩回或便于驱动通道140缩回。As seen in FIGS. 4, 6, 10, 11, 13, 18 and 20, clip applier 100 further includes a biasing member 146 in the form of a tension spring operably secured to the proximal end of drive channel 140 and the housing. 104, tending to maintain drive channel 140 in a retracted or proximal-most position. The biasing member 146 functions to retract or facilitate retraction of the drive channel 140 after the clip “C” between the jaws 120 is formed.

如在图4、4G、11、13、18和20中可见，驱动通道140的近端包括齿条构件141，其固定在驱动销124上并可与驱动通道140一起移动。齿条构件141包括槽141b，以便可滑动地容纳固定杆154a。齿条构件141进一步包括从其近端延伸出的突起141c，其在下半外壳104b内可滑动地平移。齿条构件141被构造为且适于与支撑在外壳104内的棘爪142接合。齿条构件141和棘爪142限定了棘轮机构144。使用时，当驱动通道140轴向移动时，齿条构件141也移动。齿条构件141限定了一系列具有一定长度的齿条齿141a，当随着驱动通道140到达最近或最远侧位置而使齿条构件141在近侧移动和远侧移动之间变化时，所述长度允许棘爪142反向并在齿条构件141上返回。As seen in FIGS. 4 , 4G , 11 , 13 , 18 and 20 , the proximal end of drive channel 140 includes a rack member 141 that is fixed to drive pin 124 and is movable with drive channel 140 . The rack member 141 includes a slot 141b to slidably receive the fixing rod 154a. Rack member 141 further includes a protrusion 141c extending from a proximal end thereof that slidably translates within lower housing half 104b. The rack member 141 is configured and adapted to engage with a pawl 142 supported within the housing 104 . Rack member 141 and pawl 142 define a ratchet mechanism 144 . In use, when the drive channel 140 moves axially, the rack member 141 also moves. The rack member 141 defines a series of rack teeth 141a having a length that changes between proximal and distal movement of the rack member 141 as the drive channel 140 reaches the closest or most distal position. This length allows the pawl 142 to reverse and return on the rack member 141.

通过棘爪销147将棘爪142可枢转地连接到下半外壳104b上，在此处棘爪142基本上与齿条构件141可操作地接合。棘爪142能够与齿条构件141接合以限制齿条构件141的纵向移动，并且接着限制驱动通道140的纵向移动。棘轮机构144进一步包括爪簧145，所述爪簧145被构造且定位为将棘爪142偏压至与齿条构件141可操作的接合。爪簧145的作用在于保持棘爪142的齿与齿条构件141的齿141a啮合，以及保持棘爪142处于旋转或倾斜的位置。The pawl 142 is pivotally connected to the lower housing half 104b by a pawl pin 147 where the pawl 142 is substantially operatively engaged with the rack member 141 . The pawl 142 is engageable with the rack member 141 to limit the longitudinal movement of the rack member 141 and, in turn, limit the longitudinal movement of the drive channel 140 . The ratchet mechanism 144 further includes a claw spring 145 configured and positioned to bias the pawl 142 into operative engagement with the rack member 141 . The function of the pawl spring 145 is to keep the teeth of the pawl 142 engaged with the teeth 141a of the rack member 141, and to keep the pawl 142 in a rotated or tilted position.

如在图1至4、8、10、12、14至17和19中可见，施夹器100包括一对安装在通道组件108的远端上或远端处的钳夹120，其能够通过手柄组件102的手柄106来致动。钳夹120由例如不锈钢或钛的适合的生物相容性材料制成。1 to 4, 8, 10, 12, 14 to 17, and 19, clip applier 100 includes a pair of jaws 120 mounted on or at the distal end of channel assembly 108 that can be The handle 106 of the assembly 102 is used for actuation. Jaws 120 are made of a suitable biocompatible material such as stainless steel or titanium.

通过一个或多个延伸穿过驱动通道140的往复限制槽140f的铆钉120c或类似物将钳夹120安装在驱动通道140的远端，以使得钳夹120相对于外部通道132和驱动通道140是纵向静止的。如在图12、14、17和19中可见，钳夹120在其间限定了用于容纳外科夹子“C₁”于其中的通道120a。The jaws 120 are mounted on the distal end of the drive channel 140 by one or more rivets 120c or the like extending through the reciprocating limiting groove 140f of the drive channel 140, so that the jaws 120 are opposite to the outer channel 132 and the drive channel 140. vertically stationary. As seen in Figures 12, 14, 17 and 19, the jaws 120 define a channel 120a therebetween for receiving a surgical clip "C₁ " therein.

如在图1至4、6、11、13和20中可见，施夹器100进一步包括支撑在手柄组件102的外壳104中的计数器机构190。计数器机构190包括显示器192、处理器194和电池等形式的能源198。显示器192为向外科医生显示施夹器100的一个或多个操作参数的液晶显示器。所显示的操作参数可为剩余夹子的数量或数目、已经使用过的夹子的数目、位置参数、使用的手术时间、或者该过程的任何其它参数。As seen in FIGS. 1-4 , 6 , 11 , 13 and 20 , clip applier 100 further includes a counter mechanism 190 supported in housing 104 of handle assembly 102 . The counter mechanism 190 includes a display 192, a processor 194, and an energy source 198 in the form of a battery. Display 192 is a liquid crystal display that displays one or more operating parameters of clip applier 100 to the surgeon. The displayed operating parameters may be the number or number of clips remaining, the number of clips that have been used, positional parameters, operative time used, or any other parameter of the procedure.

计数器机构190包括由PVC制成的翼片192a，翼片192a配置在电池或能源198和处理器194的触点194a之间或配置在处理器194的触点194a之间以防止电池或能源198在存放过程中被耗尽。如在图1A和1B中可见，翼片192a从施夹器100的外壳104向外部延伸以允许所述翼片易于从外壳移除。一旦移除翼片192a，电池或能源198与处理器194的触点194a电接触或在处理器194的触点194a之间形成电接触。The counter mechanism 190 includes a tab 192a made of PVC disposed between the battery or power source 198 and the contacts 194a of the processor 194 or between the contacts 194a of the processor 194 to prevent the battery or power source 198 from depleted during storage. As seen in FIGS. 1A and 1B , tab 192a extends outwardly from housing 104 of clip applier 100 to allow for easy removal of the tab from the housing. Once the tab 192a is removed, the battery or power source 198 makes electrical contact with or between the contacts 194a of the processor 194 .

可通过形成于驱动通道140中的突块(nub)140e来致动计数器机构190。使用时，如在图36中可见，当向前驱动驱动通道140时，其突块140e与触点194a接合，使得触点194a形成一电路并触发处理器194执行功能(例如，将出现在显示器192上的数目减少给定的增量或数值)。The counter mechanism 190 may be actuated by a nub 140 e formed in the drive channel 140 . In use, as seen in FIG. 36, when drive channel 140 is driven forward, its protrusion 140e engages contact 194a such that contact 194a forms an electrical circuit and triggers processor 194 to perform a function (e.g., will appear on the display 192 by the given increment or value).

如在图1A和1C中可见，施夹器100包括支撑在外壳104上并插在手柄106之间的装运楔200。装运楔200的作用在于：在装运和/或存放施夹器100时保持手柄106间隔开或不被扳动。装运楔200连接到计数器机构190的翼片192a上，以使得终端用户使用施夹器100时，终端用户必须移除装运楔200，从而也移除翼片192a来启动计数器机构190。As seen in FIGS. 1A and 1C , clip applier 100 includes a shipping wedge 200 supported on housing 104 and inserted between handles 106 . The function of the shipping wedge 200 is to keep the handle 106 spaced apart or not pulled when the clip applier 100 is shipped and/or stored. Shipping wedge 200 is attached to tab 192a of counter mechanism 190 such that when an end user uses clip applier 100, the end user must remove shipping wedge 200 and thereby also remove tab 192a to activate counter mechanism 190.

如在图1A和1C中可见，装运楔200包括卡圈形式的主体部202，主体部202限定了被构造且定尺寸为可容纳一部分外壳104于其中的通道204。装运楔200包括直立部206，其从主体部202的相反两侧向外延伸出并被构造为容纳手柄106于其中。装运楔200进一步包括从直立部206的相反两侧向内延伸的突起208。装运楔200的突起208被构造且定尺寸为当装运楔200合适地固定到施夹器100上时与手柄106接合。As seen in FIGS. 1A and 1C , shipping wedge 200 includes a body portion 202 in the form of a collar that defines a channel 204 configured and dimensioned to receive a portion of housing 104 therein. Shipping wedge 200 includes upright portions 206 extending outwardly from opposite sides of body portion 202 and configured to receive handle 106 therein. Shipping wedge 200 further includes protrusions 208 extending inwardly from opposite sides of upright portion 206 . Protrusion 208 of shipping wedge 200 is configured and dimensioned to engage handle 106 when shipping wedge 200 is properly secured to clip applier 100 .

参照图22至53，提供了施夹器100的操作。在初始扳动施夹器100的手柄106之前，如在图22至24中可见，施夹器100的内部零件处于所谓的“原始”位置或“起动”位置。更具体地，在“原始”位置，驱动销124位于最近侧位置，棘爪142位于驱动通道140的齿条140d的远侧，枢轴臂179的第二指状部179c位于驱动通道140的窗口140g的远侧部内的最远侧位置，以使得楔板180位于最远侧位置，并且没有夹子“C”设置在钳夹120内。由于驱动销124处于最近侧位置，因此推杆160、稳定器162和驱动通道140也处于最近侧位置。Referring to Figures 22 through 53, the operation of the clip applier 100 is provided. Before the handle 106 of the clip applier 100 is initially pulled, as seen in FIGS. 22-24 , the internal parts of the clip applier 100 are in a so-called "home" or "start" position. More specifically, in the "home" position, the drive pin 124 is in the most proximal position, the pawl 142 is located distally of the rack 140d of the drive channel 140, and the second finger 179c of the pivot arm 179 is located in the window of the drive channel 140 The most distal position within the distal portion of 140g such that wedge plate 180 is in the most distal position and no clip “C” is disposed within jaw 120 . With drive pin 124 in the proximal-most position, pusher rod 160, stabilizer 162, and drive channel 140 are also in the proximal-most position.

如在图24中可见，当驱动通道140和推杆160位于最近侧位置时，枢轴驱动臂156的驱动支柱156c位于最近侧位置，并且指示器148的第二弹性指状部148b配置在形成于下半外壳104b中的凸台(edge)149的近侧。在实施例中，在对指示器148略作修改后，凸台149可形成在上半外壳104a内。在“原始”位置，近侧连接构件154的角度“α”可从大约45度到大约60度的范围变化，同时枢轴驱动臂156的角度“β”可从大约20度到大约25度的范围变化。此外，在初始扳动施夹器100的手柄106之前，在楔板180位于最远侧位置时，其远端180a插在钳夹120之间。As can be seen in FIG. 24 , when the drive channel 140 and push rod 160 are in the proximal-most position, the drive strut 156c of the pivotal drive arm 156 is in the proximal-most position, and the second resilient finger 148b of the indicator 148 is configured to form a proximal-most position. On the proximal side of an edge 149 in the lower housing half 104b. In an embodiment, with minor modifications to the indicator 148, a boss 149 may be formed in the upper housing half 104a. In the "home" position, the angle "α" of the proximal connection member 154 can range from about 45 degrees to about 60 degrees, while the angle "β" of the pivot drive arm 156 can range from about 20 degrees to about 25 degrees. Range changes. Additionally, the distal end 180a of the wedge 180 is inserted between the jaws 120 when the wedge 180 is in the most distal position prior to initial actuation of the handle 106 of the clip applier 100 .

如在图22、24和24A中可见，同样是在“原始”位置，远侧连接构件158的接合销158a位于纵向轴线“X1”的第一侧。As can be seen in Figures 22, 24 and 24A, also in the "home" position, the engagement pin 158a of the distal connection member 158 is located on a first side of the longitudinal axis "X1".

下列的方程式用于计算处于“原始”位置的运动倍增系统155的动力学。所述“原始”位置直接涉及到当推杆160处于“原始”位置(即，最近侧位置)时的情况，例如，当“α”为大约60度时的情况。The following equations are used to calculate the dynamics of the motion multiplication system 155 in the "home" position. The "home" position directly relates to when the pushrod 160 is in the "home" position (ie, the proximal-most position), eg, when "α" is about 60 degrees.

XP＝(2)(L1)(cosα)-(L1)(1)XP=(2)(L1)(cosα)-(L1)(1)

其中，距离“XP”为由滑柱158c行进的距离，并且长度“L1”为近侧连接构件154和远侧连接构件156的长度，如图24A所示。Wherein, distance "XP" is the distance traveled by spool 158c, and length "L1" is the length of proximal link member 154 and distal link member 156, as shown in FIG. 24A.

XD＝(B)+(C)(cosα)-(L2)(cosβ)(2)XD=(B)+(C)(cosα)-(L2)(cosβ)(2)

其中，距离“XD”为由枢轴驱动臂156的枢轴柱156a沿纵向轴线“X2”行进的距离，距离“B”为沿着纵向轴线“X1”的枢轴驱动臂156的枢轴销156a和近侧连接构件154的固定杆154a之间的距离，距离“C”为近侧连接构件154的固定杆154a和枢轴驱动臂156的驱动支柱156c之间的距离，并且长度“L2”为枢轴驱动臂156从枢轴柱156a到驱动支柱156c的长度，如图24A所示。where distance "XD" is the distance traveled by pivot post 156a of pivot drive arm 156 along longitudinal axis "X2" and distance "B" is the pivot pin of pivot drive arm 156 along longitudinal axis "X1". 156a and the fixed rod 154a of the proximal connection member 154, the distance "C" is the distance between the fixed rod 154a of the proximal connection member 154 and the drive post 156c of the pivot drive arm 156, and the length "L2" is the length of pivot drive arm 156 from pivot post 156a to drive post 156c, as shown in FIG. 24A.

此外，在初始扳动之前，钳夹120内没有夹子“C”。在初始扳动手柄106期间首先将夹子“C”装载到钳夹120内。如在图25至33中可见，在初始扳动手柄106(即，工作行程)期间，连杆构件122的远端122a相对于外壳104向远侧移动。当连杆构件122的远端122a向远侧移动时，驱动销124向远侧移动，从而将远侧轴向运动传递给驱动通道140。Additionally, there is no clip "C" within jaw 120 prior to initial pulling. Clip "C" is first loaded into jaw 120 during initial pulling of handle 106 . As can be seen in FIGS. 25-33 , during the initial pulling of the handle 106 (ie, the working stroke), the distal end 122a of the linkage member 122 moves distally relative to the housing 104 . As the distal end 122a of the linkage member 122 moves distally, the drive pin 124 moves distally, thereby transferring the distal axial movement to the drive channel 140 .

随后，如在图25至31中可见，当驱动通道140向远侧移动时，运动倍增系统155从“原始”位置移动到初始致动位置。更确切地说，驱动通道140在远侧方向上前进，这又致使枢轴驱动臂156在远侧方向上移动。就是说，枢轴驱动臂156枢转且驱动近侧连接构件154以便在一方向上旋转，以使角度“β”增大，例如，不限于从大约22度到大约45度变化。如此，当角度“β”增大时，近侧连接构件154关于近侧连接构件154的固定杆154a旋转，这又导致沿着稳定器162的槽162b和推杆160的近侧窗口160d向远侧驱动远侧连接构件158的驱动支柱158c。当向远侧驱动远侧连接构件158的驱动支柱158c时，远侧连接构件158的驱动支柱158c在远侧方向上驱动推杆160。Subsequently, as seen in FIGS. 25-31 , as the drive channel 140 moves distally, the motion multiplication system 155 moves from the "home" position to the initial actuated position. More specifically, drive channel 140 is advanced in the distal direction, which in turn causes pivot drive arm 156 to move in the distal direction. That is, pivot drive arm 156 pivots and drives proximal link member 154 to rotate in a direction such that angle "β" increases, eg, without limitation, from about 22 degrees to about 45 degrees. Thus, as the angle "β" increases, the proximal connecting member 154 rotates about the fixed rod 154a of the proximal connecting member 154, which in turn causes The drive strut 158c of the distal connection member 158 is driven laterally. When the drive strut 158c of the distal connection member 158 is driven distally, the drive strut 158c of the distal connection member 158 drives the push rod 160 in the distal direction.

如在图25、32和33中可见，在初始扳动手柄106期间，指示器148随着驱动通道140的远侧移动一起向远侧移动。使用时，指示器148的作用在于创建咔嗒听觉和/或触觉振动，从而向用户指示外科施夹器100的手柄106已经经历了至少一部分行程。特别地，如在图32和33中可见，当致动手柄106时，听觉/触觉指示器148的第一弹性臂148a搭跨在形成于上、下半外壳104a、104b的至少一个内的凸缘149上和/或沿着所述凸缘149搭跨，从而使第一弹性臂148a弯曲。当听觉/触觉指示器148的臂148a到达凸缘149的近端时，弹性臂148a搭到(snap over)凸缘149的近端上并且与凸缘149的表面149a接触，从而在弹性臂148a与凸缘149的表面149a接触时形成了第一可听声音和触觉振动。听觉/触觉指示器148的第一指示向用户指示夹子“C”已经被适当地装载。As can be seen in FIGS. 25 , 32 and 33 , during initial pulling of the handle 106 , the indicator 148 moves distally along with the distal movement of the drive channel 140 . In use, the function of the indicator 148 is to create audible clicking and/or tactile vibrations to indicate to the user that the handle 106 of the surgical clip applier 100 has experienced at least a portion of its travel. In particular, as can be seen in FIGS. 32 and 33, when the handle 106 is actuated, the first resilient arm 148a of the audible/tactile indicator 148 rides over a protrusion formed in at least one of the upper and lower housing halves 104a, 104b. The first elastic arm 148a bends over and/or along the flange 149. When the arm 148a of the auditory/tactile indicator 148 reaches the proximal end of the flange 149, the elastic arm 148a snaps over the proximal end of the flange 149 and contacts the surface 149a of the flange 149, thereby snapping over the proximal end of the flange 149. Contact with the surface 149a of the flange 149 creates a first audible sound and tactile vibration. The first indication of the audible/tactile indicator 148 indicates to the user that the clip "C" has been properly loaded.

如在图28和30中可见，同样在初始扳动手柄106期间，当推杆160在远侧方向上移动时，其推动器160c接合最远侧夹子“C₁”的后跨部并且开始将最远侧夹子“C₁”向远侧移动或推出夹子承载器170并进入到钳夹102中。当最远侧夹子“C₁”向远侧移动时，夹子承载器170的柄脚171偏转或做凸轮运动而脱离与最远侧夹子“C₁”的接合并返回到它们未偏转或未做凸轮运动的状态，以获取一叠夹子“C”的下一个夹子。在初始扳动手柄106期间，推杆160前进足够的量以将最远侧夹子“C₁”置于钳夹120的通道120a中。As can be seen in FIGS. 28 and 30 , also during initial pulling of the handle 106 , as the push rod 160 moves in the distal direction, its pusher 160c engages the rear span of the most distal clip “C₁ ” and begins to pull the The distal-most clip “C₁ ” moves or exits clip carrier 170 distally and into jaw 102 . As the most distal clip "C₁ " moves distally, the tangs 171 of the clip carrier 170 deflect or cam out of engagement with the most distal clip "C₁ " and return to their undeflected or unengaged position. The state of the camming to fetch the next clip in the stack of clips "C". During initial pulling of the handle 106 , the push rod 160 is advanced a sufficient amount to place the distal-most clip “C₁ ” in the channel 120a of the jaw 120 .

如在图27和31中可见，同样在初始扳动手柄106期间，当驱动通道140在远侧方向上移动时，棘轮机构144的齿条构件141向远侧移动，致使其齿141a移动到与棘爪142的齿接合并且越过或横过棘爪142的齿。一旦棘轮机构144的齿条构件141移动到与棘爪142接合，则驱动通道140在齿条构件141跳过棘爪142之前不能返回到原始或最近侧位置。As can be seen in FIGS. 27 and 31 , also during initial pulling of the handle 106 , when the drive channel 140 moves in the distal direction, the rack member 141 of the ratchet mechanism 144 moves distally, causing its teeth 141 a to move in alignment with each other. The teeth of the pawl 142 engage and ride over or traverse the teeth of the pawl 142 . Once the rack member 141 of the ratchet mechanism 144 is moved into engagement with the pawl 142 , the drive channel 140 cannot return to the home or proximal-most position until the rack member 141 clears the pawl 142 .

在初始扳动手柄106期间，如在图25至33中可见，驱动通道140向远侧移动直到枢轴臂179的指状部179c接合驱动通道140的槽140g的横向部分(即，停顿(dwell))。一旦槽140g的横向部分与枢轴臂179的指状部179c邻接(即停顿已经结束之后)，驱动通道140的进一步的远侧移动导致指状部179c移动并且使枢轴臂179旋转。枢轴臂179的旋转导致指状部179b的移动，这又导致楔板180在近侧方向上被拖动，从而使其远端180a从钳夹120之间缩回并允许钳夹120最终被闭合或接近，由此允许钳夹120最终被闭合或接近。During initial pulling of handle 106, as seen in FIGS. 25-33 , drive channel 140 moves distally until finger 179c of pivot arm 179 engages a lateral portion of slot 140g of drive channel 140 (i.e., dwells). )). Once the lateral portion of slot 140g abuts finger 179c of pivot arm 179 (ie, after the dwell has ended), further distal movement of drive channel 140 causes finger 179c to move and pivot arm 179 to rotate. Rotation of the pivot arm 179 causes movement of the fingers 179b, which in turn causes the wedge 180 to be dragged in a proximal direction, thereby retracting its distal end 180a from between the jaws 120 and allowing the jaws 120 to eventually be pulled. closed or approximated, thereby allowing the jaws 120 to finally be closed or approximated.

一旦实现枢轴臂179所需的旋转，当枢轴臂179的指状部179c通过驱动通道140的槽140g的近侧部时，枢轴臂179就停止旋转，。枢轴臂179的指状部179c在驱动通道140的行程结束之前都保留在驱动通道140的槽140g的近侧部内。Once the desired rotation of pivot arm 179 is achieved, rotation of pivot arm 179 ceases when finger 179c of pivot arm 179 passes a proximal portion of slot 140g of drive channel 140 . Finger 179c of pivot arm 179 remains within the proximal portion of slot 140g of drive channel 140 until the end of drive channel 140's stroke.

如在图25至31中可见，在进一步扳动手柄106期间，推杆160与驱动通道140向远侧移动，如上所述，直到枢轴驱动臂156已经到达适当的位置为止，以使得角度“β”为45度。在这种构造中，近侧连接构件154和远侧连接构件158沿着纵向轴线“X1”成一直线，以使它们之间的角度“α”为0度。As can be seen in FIGS. 25 to 31, during further pulling of handle 106, pushrod 160 and drive channel 140 move distally, as described above, until pivot drive arm 156 has reached the proper position such that the angle " β" is 45 degrees. In this configuration, the proximal connecting member 154 and the distal connecting member 158 are aligned along the longitudinal axis "X1" such that the angle "α" therebetween is 0 degrees.

下列的方程式用于计算运动倍增系统155处于“完全展开(fullyextended)”位置时的动力学。所述“完全展开”位置直接涉及推杆160处于“完全展开”位置(即最远侧位置)的情况，例如，当角度“α”为大约0度时的情况。The following equations are used to calculate the dynamics of the motion multiplication system 155 in the "fully extended" position. The "fully deployed" position is directly related to the situation where the push rod 160 is in the "fully deployed" position (ie, the most distal position), eg, when the angle "α" is about 0 degrees.

XE＝(B)+(C)-(L2)(cos β₀)(3)XE＝(B)+(C)-(L2)(cos β₀ )(3)

其中，距离“XE”为沿着驱动通道140的纵向轴线“X2”的在枢轴驱动臂156的枢轴销156a的“原始”位置和枢轴驱动臂156的枢轴销156a的“完全展开”位置之间的距离，距离“B”为沿着纵向轴线“X1”的枢轴驱动臂156的枢轴销156a和近侧连接构件154的固定杆154a之间的距离，距离“C”为远侧连接构件158的接合销158c和枢轴驱动臂156的驱动支柱156c之间的距离，长度“L2”为枢轴驱动臂156从枢轴柱156a到驱动支柱156c的长度，并且角度“β₀”为当角度“α”为大约0度时的角度“β”的“完全展开”位置角度。在这种情况下，枢轴驱动臂156的角度“β₀”大约为45度，如上所述且如图27A所示。where distance "XE" is the "home" position of pivot pin 156a of pivot drive arm 156 and the "fully extended" position of pivot pin 156a of pivot drive arm 156 along longitudinal axis "X2" of drive channel 140. ” position, distance “B” is the distance between pivot pin 156a of pivot drive arm 156 and fixed rod 154a of proximal connection member 154 along longitudinal axis “X1”, distance “C” is The distance between engagement pin 158c of distal connection member 158 and drive post 156c of pivot drive arm 156, length "L2" is the length of pivot drive arm 156 from pivot post 156a to drive post 156c, and angle "β₀ " is the "fully deployed" position angle of angle "β" when angle "α" is about 0 degrees. In this case, the angle "β₀ " of pivot drive arm 156 is approximately 45 degrees, as described above and shown in FIG. 27A.

如在图31中可见，当驱动通道140进一步向远侧前进时，驱动通道140将指示器148的弹性指状部148a拉到凸缘149的近端上或者使弹性指状部148a在凸缘149的近端上弯曲。如此，产生第一指示(即，听觉和/或触觉)以向用户指示外科夹子“C”已经适当地装载。As can be seen in FIG. 31 , when the drive channel 140 is advanced further distally, the drive channel 140 pulls the resilient finger 148a of the indicator 148 onto the proximal end of the flange 149 or the resilient finger 148a rests on the flange. The proximal end of 149 is curved. As such, a first indication (ie, audible and/or tactile) is generated to indicate to the user that surgical clip "C" has been properly loaded.

如在图25和27中可见，同样在“完全展开”位置，近侧连接构件154和远侧连接构件158与纵向轴线“X1”成一直线和/或与纵向轴线“X1”平行。As can be seen in Figures 25 and 27, also in the "fully deployed" position, the proximal and distal connecting members 154, 158 are aligned with and/or parallel to the longitudinal axis "X1".

现在参照图32至35，在进一步扳动手柄106期间，致使连杆构件122的远端122a相对于外壳104进一步向远侧移动。当连杆构件122的远端122a进一步向远侧移动时，导致驱动销124进一步向远侧移动，从而将远侧轴向移动传递给驱动通道140。Referring now to FIGS. 32-35 , during further pulling of the handle 106 , the distal end 122 a of the linkage member 122 is caused to move further distally relative to the housing 104 . Further distal movement of the distal end 122a of the link member 122 causes the drive pin 124 to move further distally, thereby transferring the distal axial movement to the drive channel 140 .

如在图32、33和35中可见，当继续扳动手柄106时，枢轴驱动臂156继续沿远侧方向移动，以使得随着驱动通道140沿远侧方向移动，枢轴驱动臂156和驱动通道140的纵向轴线“X2”之间的角度“β”继续增大到大约90度。这种移动还导致近侧连接构件154(即，位于第一侧)相对于纵向轴线“X1”枢转或移动越过中心到达第二侧，以使近侧连接构件154之间的角度相对于纵向轴线“X1”被可枢转地定向在角度“-α”处(如图35所示)。如此，当近侧连接构件154关于纵向轴线“X1”旋转时，角度“-α”从大约0度减小到大约60度，致使远侧连接构件158在近侧方向上移动。在这种构造中，远侧连接构件158的滑柱158c在近侧方向上滑动，这又使推杆160和稳定器162滑回到缩回位置或“安全”位置。在“安全”位置，诸如驱动杆140的施夹器100的其它零件仍然在远侧方向上移动，以使夹子“C”可形成在钳夹构件120之间。然而，在“安全”位置，推杆160安全地缩回到近侧位置，以使得在钳夹构件120彼此接近时推杆160不干扰施夹器100。As can be seen in FIGS. 32, 33 and 35, as the handle 106 continues to be pulled, the pivot drive arm 156 continues to move in the distal direction such that as the drive channel 140 moves in the distal direction, the pivot drive arm 156 and The angle "β" between the longitudinal axes "X2" of the drive channels 140 continues to increase to approximately 90 degrees. This movement also causes the proximal connecting members 154 (ie, on the first side) to pivot or move across the center relative to the longitudinal axis “X1” to the second side so that the angle between the proximal connecting members 154 is relative to the longitudinal axis “X1”. Axis "X1" is pivotally oriented at angle "-α" (as shown in Figure 35). As such, as the proximal connection member 154 is rotated about the longitudinal axis "X1," the angle "-α" decreases from about 0 degrees to about 60 degrees, causing the distal connection member 158 to move in the proximal direction. In this configuration, the spool 158c of the distal link member 158 slides in the proximal direction, which in turn slides the pushrod 160 and stabilizer 162 back to the retracted or "safety" position. In the “safe” position, other parts of clip applier 100 , such as drive rod 140 , are still moved in the distal direction so that clip “C” can be formed between jaw members 120 . However, in the "safe" position, the push rod 160 is safely retracted to the proximal position such that the push rod 160 does not interfere with the clip applier 100 as the jaw members 120 approach each other.

下列的方程式用于计算运动倍增系统155在“安全”位置时的动力学。如上所述，所述“安全”位置直接涉及推杆160在安全缩回位置(即，最近侧位置)的情况，而施夹器100的其它零件(例如手柄106)仍然在工作行程中。The following equations are used to calculate the dynamics of the motion multiplication system 155 in the "safe" position. As noted above, the "safe" position directly relates to the situation where push rod 160 is in the safe retracted position (ie, the proximal-most position), while other parts of clip applier 100 (eg, handle 106 ) are still in the working stroke.

(L2)-(C)(sin(-α))＝A    (4)(L2)-(C)(sin(-α))＝A (4)

其中，长度“L2”为枢轴驱动臂156从枢轴柱156a到驱动支柱156c的长度，距离“C”为沿着纵向轴线“X1”的远侧连接构件158的接合销158c和枢轴驱动臂156的驱动支柱156c之间的距离，并且距离“A”为沿着与纵向轴线“X1”正交的参考轴线的近侧连接构件154的固定杆154a和枢轴驱动臂156的枢轴销156a之间的距离，如图41A所示。Wherein length "L2" is the length of pivot drive arm 156 from pivot post 156a to drive post 156c, and distance "C" is the length of engagement pin 158c and pivot drive arm 158 of distal link member 158 along longitudinal axis "X1". The distance between the drive strut 156c of the arm 156, and the distance "A" is the fixed rod 154a of the proximal connection member 154 and the pivot pin of the pivot drive arm 156 along a reference axis orthogonal to the longitudinal axis "X1". 156a, as shown in Figure 41A.

继续参照图32至38，在进一步扳动手柄106期间，在将翼片192a从计数器机构190移除的情况下，当驱动通道140向远侧前进时，其突块140e接合处理器194的触点194a，从而完成电路并且使处理器194执行功能，如上所述。With continued reference to FIGS. 32 to 38 , during further actuation of the handle 106 , with the tab 192 a removed from the counter mechanism 190 , as the drive channel 140 is advanced distally, its lug 140 e engages the touch pad 140 e of the processor 194 . point 194a, thereby completing the circuit and causing processor 194 to perform functions as described above.

现在参照图39至44，示出了在最后一次扳动手柄106时的施夹器100。在这种状态下，驱动通道140处于远侧位置，推杆160处于远侧位置，楔板180处于近侧位置，偏压构件146被拉伸，并且棘爪142位于齿条140d的近侧。Referring now to FIGS. 39-44 , the clip applier 100 is shown with the handle 106 being pulled a final time. In this state, drive channel 140 is in the distal position, push rod 160 is in the distal position, wedge plate 180 is in the proximal position, biasing member 146 is stretched, and pawl 142 is proximal to rack 140d.

另外，如在图43中可见，在将楔板180的远端180a从钳夹120之间移出的情况下，当驱动通道140进一步向远侧移动时，驱动通道140和/或驱动通道带箍143的远侧边缘紧密接合钳夹120的凸起表面(cammingsurface)120b，由此使得钳夹120接近彼此并且使插入其间的外科夹子“C₁”成型。由于驱动通道带箍143固定在驱动通道140上且随其移动，因此驱动通道带箍143发挥作用以覆盖驱动通道140，以便在钳夹120接近时将钳夹120保持在驱动通道140内，并且在施夹器100操作期间将楔板180保持在驱动通道140内。Additionally, as can be seen in FIG. 43 , with the distal end 180 a of the wedge plate 180 removed from between the jaws 120 , the drive channel 140 and/or the drive channel band are moved further distally when the drive channel 140 is moved further distally. The distal edges of 143 tightly engage camming surface 120b of jaws 120, thereby bringing jaws 120 closer to each other and shaping surgical clip "C₁ " inserted therebetween. Because drive channel band 143 is fixed to drive channel 140 and moves therewith, drive channel band 143 acts to cover drive channel 140 to retain jaws 120 within drive channel 140 as jaws 120 approach, and Wedge plate 180 is retained within drive channel 140 during operation of clip applier 100 .

如在图44中可见，外科夹子“C₁”可形成或压接到血管“V”上或任何其它生物组织上。As can be seen in Figure 44, a surgical clip "_C1 " can be formed or crimped onto a blood vessel "V" or any other biological tissue.

由于指示器148的凸起部148b穿过推杆160的槽160d平移，因此允许驱动通道140相对于推杆160向远侧移动。As the protrusion 148b of the indicator 148 translates through the slot 160d of the push rod 160 , the drive channel 140 is allowed to move distally relative to the push rod 160 .

此外，当驱动通道140完全向远侧前进时，如在图41中可见，棘轮机构144的齿条构件141向远侧移动到超过棘爪142的位置，以使齿条构件141的齿141a移动到棘爪142的齿的远侧，从而使齿条构件141和棘爪142彼此脱离。如此，驱动通道140被允许或能够自由返回到原始或最近侧位置。Furthermore, when the drive channel 140 is fully advanced distally, as seen in FIG. to the distal side of the teeth of the pawl 142, thereby disengaging the rack member 141 and the pawl 142 from each other. As such, the drive channel 140 is allowed or able to return freely to the original or proximal-most position.

如在图42中可见，当驱动通道140向远侧移动时，听觉/触觉指示器148的弹性臂148a搭到凸缘149的远端并且与凸缘149的表面149a接触，从而产生可听声音和/或触觉振动。这种可听声音和/或触觉振动与外科夹子“C”的装载相符。As can be seen in FIG. 42, when the drive channel 140 is moved distally, the resilient arm 148a of the audible/tactile indicator 148 rides over the distal end of the flange 149 and makes contact with the surface 149a of the flange 149, producing an audible sound. and/or haptic vibrations. This audible sound and/or tactile vibration coincides with loading of the surgical clip "C".

现在参照图45至52，在张开或释放手柄106期间，促使连杆构件122的远端122a相对于外壳104向近侧移动。当连杆构件122的远端122a向近侧移动时，促使驱动销124向近侧移动，从而将近侧轴向移动传递给驱动通道140，这又依次传递给推杆160。通过偏压构件146的收缩使得驱动通道140的近侧移动变得容易。可选择地，释放手柄106导致偏压构件146在近侧方向上缩回驱动通道140。Referring now to FIGS. 45-52 , during deployment or release of handle 106 , distal end 122 a of linkage member 122 is caused to move proximally relative to housing 104 . As the distal end 122a of the linkage member 122 moves proximally, it causes the drive pin 124 to move proximally, thereby transferring the proximal axial movement to the drive channel 140 , which in turn is transferred to the pushrod 160 . Proximal movement of drive channel 140 is facilitated by retraction of biasing member 146 . Optionally, releasing handle 106 causes biasing member 146 to retract drive channel 140 in the proximal direction.

当驱动通道140向近侧移动时，驱动通道140的远侧凸台和/或驱动通道带箍143脱离钳夹120的凸起表面120b，由此释放了钳夹120使它们彼此分离，以将楔板180的远端180a重新插入在所述钳夹120之间，并且将另一个外科夹子“C”容纳在其间。尤其，当驱动通道140向近侧移动时，槽140g的横向部分作用于指状部179c上，以使枢轴臂179旋转并且使枢轴臂179的指状部179b向远侧推动楔板180。当楔板180在远侧方向上移动时，如在图51和52中可见，楔板180的远端180a被重新插入或重新引入到钳夹120中，从而使钳夹120分开。As drive channel 140 moves proximally, the distal boss of drive channel 140 and/or drive channel band 143 disengages from raised surface 120b of jaws 120, thereby releasing jaws 120 to separate them from each other to The distal end 180a of the wedge 180 is reinserted between the jaws 120 and receives another surgical clip "C" therebetween. In particular, when drive channel 140 moves proximally, the transverse portion of slot 140g acts on finger 179c to rotate pivot arm 179 and finger 179b of pivot arm 179 pushes wedge 180 distally. . As wedge plate 180 is moved in the distal direction, as seen in FIGS. 51 and 52 , distal end 180 a of wedge plate 180 is reinserted or reintroduced into jaws 120 , causing jaws 120 to separate.

如在图48和49中可见，当楔板180向远侧移动时，夹子输出器174的近侧突起176接合楔板180的窗口180b并且因此被向远侧推进给定的距离。当夹子输出器174被向远侧推进时，一叠夹子“C”也被向远侧推进。从图50中可见，当楔板180到达最远侧位置时，夹子通道170邻接、接合、推进或凸靠远侧突起175的近侧部分175b，直到楔板180的腹板(web)180f基本上搁置在远侧突起175的远侧部分175a下方。这样进行时，远侧突起175的近侧部分175b移动延伸进入夹子通道170的更远侧的窗口172。As seen in FIGS. 48 and 49 , as wedge plate 180 is moved distally, proximal protrusion 176 of clip follower 174 engages window 180b of wedge plate 180 and is thus advanced distally a given distance. As clip follower 174 is advanced distally, stack of clips "C" is also advanced distally. It can be seen from FIG. 50 that when the wedge 180 reaches the most distal position, the clip channel 170 abuts, engages, advances or protrudes against the proximal portion 175b of the distal projection 175 until the web 180f of the wedge 180 is substantially The upper rests below the distal portion 175a of the distal protrusion 175 . In doing so, the proximal portion 175b of the distal projection 175 moves to extend into the more distal window 172 of the clip channel 170 .

如在图50和51中可见，当夹子输出器174被向前推进时，使得一叠夹子“C”向前移动，最远侧夹子“C₁”通过在推杆160的推动器160c下方的凸轮运动而移动到推动器160c的远侧，直到该最远侧夹子“C₁”被施夹器170的柄脚171挡住。As can be seen in FIGS. 50 and 51 , when the clip follower 174 is advanced forward, causing the stack of clips "C" to move forward, the most distal clip "C₁ " passes through the pusher 160c below the pusher 160. The cam moves distally of the pusher 160c until the distal-most clip “C₁ ” is blocked by the tang 171 of the clip applier 170 .

暂时回到图47，当驱动通道140在近侧方向上移动时，听觉/触觉指示器148的臂148a越过凸缘149急速返回(snap back)并且使其自身复位以用于手柄106的下一次弹射行程或扳动。Returning momentarily to FIG. 47, when drive channel 140 is moved in the proximal direction, arm 148a of audible/tactile indicator 148 snaps back over flange 149 and resets itself for the next pass of handle 106. Ejection stroke or toggle.

当驱动通道140进一步在近侧方向上移动时，驱动通道140实现了枢轴驱动臂156的近侧移动，这又使运动倍增系统的运动反向。As drive channel 140 moves further in the proximal direction, drive channel 140 enables proximal movement of pivot drive arm 156, which in turn reverses the motion of the motion multiplication system.

如在图45至51中可见，当释放手柄106且通过偏压构件146在近侧方向上移动驱动通道140时(如图39所示)，枢轴驱动臂156的接合销156a在近侧方向上移动，以使得当驱动通道140也在近侧方向上移动时，在枢轴驱动臂156和驱动通道140的纵向轴线“X2”之间的角度“β”继续减小。如此，远侧连接构件158的驱动支柱158c开始在远侧方向上移动，以使得推杆160和稳定器162通过滑柱158c向远侧移回到“完全展开”位置。大体上同时，当远侧连接构件158的驱动支柱158c开始在远侧方向上移动时，位于纵向轴线“X1”的第二侧的近侧连接构件154的角度“-α”从大约-60度增大到大约0度。当驱动通道140进一步在近侧方向上移动时，近侧连接构件154从纵向轴线“X1”的第二侧枢转到第一侧，以使得在“完全展开”位置，近侧连接构件154和远侧连接构件158再次可枢转地定位在彼此成一直线的位置，从而使角度“α”为大约0度。换句话说，近侧连接构件154和远侧连接构件158位于纵向轴线“X1”的第一侧和第二侧之间。As seen in FIGS. 45-51 , when the handle 106 is released and the drive channel 140 is moved in the proximal direction by the biasing member 146 (as shown in FIG. 39 ), the engagement pin 156a of the pivot drive arm 156 moves in the proximal direction. The angle "β" between the pivotal drive arm 156 and the longitudinal axis "X2" of the drive channel 140 continues to decrease as the drive channel 140 also moves in the proximal direction. As such, drive strut 158c of distal link member 158 begins to move in the distal direction such that pushrod 160 and stabilizer 162 move distally via spool 158c back to the "fully deployed" position. Substantially simultaneously, when the drive strut 158c of the distal connection member 158 begins to move in the distal direction, the angle "-α" of the proximal connection member 154 on the second side of the longitudinal axis "X1" changes from about -60 degrees to increase to about 0 degrees. As the drive channel 140 is moved further in the proximal direction, the proximal connecting member 154 pivots from the second side of the longitudinal axis "X1" to the first side such that in the "fully deployed" position, the proximal connecting member 154 and The distal connecting members 158 are again pivotally positioned in-line with each other such that the angle "α" is about 0 degrees. In other words, the proximal and distal connecting members 154, 158 are located between the first and second sides of the longitudinal axis "X1".

在所述构造中，当驱动通道140进一步继续在近侧方向上移动时，推杆160与驱动通道140一起向近侧移动，如上所述，直到枢轴驱动臂156已经到达适当的位置，以使得在枢轴驱动臂156和驱动通道140的纵向轴线“X2”之间的角度“β”为大约45度。如此，近侧连接构件154移动到第一侧，以使角度“α”开始从大约0度增大到大约60度。In this configuration, as drive channel 140 continues to move further in the proximal direction, pushrod 160 moves proximally with drive channel 140, as described above, until pivot drive arm 156 has reached the proper position to Such that the angle "β" between the pivot drive arm 156 and the longitudinal axis "X2" of the drive channel 140 is approximately 45 degrees. As such, proximal connection member 154 moves to the first side such that angle "α" begins to increase from about 0 degrees to about 60 degrees.

接着，当驱动通道140向近侧移动时，反向的运动倍增系统155从“完全展开”位置移动到“原始”位置。更确切地，驱动通道140在近侧方向上前进，这又使得枢轴驱动臂156在近侧方向上移动。也就是说，枢轴驱动臂156在一方向上枢转并驱动近侧连接构件154，以使在枢轴驱动臂156和驱动通道140的纵向轴线“X2”之间的角度“β”从大约45度减小到大约22度。如此，近侧连接构件使得远侧连接构件沿着稳定器162的槽162b和推杆160的近侧窗口160d向近侧滑动。在这种构造中，远侧连接构件158在近侧方向上驱动推杆160。Next, as the drive channel 140 moves proximally, the inverted motion multiplication system 155 moves from the "fully deployed" position to the "home" position. More specifically, drive channel 140 is advanced in the proximal direction, which in turn causes pivot drive arm 156 to move in the proximal direction. That is, the pivot drive arm 156 pivots and drives the proximal connection member 154 in a direction such that the angle "β" between the pivot drive arm 156 and the longitudinal axis "X2" of the drive channel 140 changes from approximately 45 degrees down to about 22 degrees. As such, the proximal connection member slides the distal connection member proximally along the slot 162b of the stabilizer 162 and the proximal window 160d of the pushrod 160 . In this configuration, the distal connection member 158 drives the pushrod 160 in the proximal direction.

当驱动通道140和推杆160位于最远侧位置时，枢轴驱动臂156的滑柱156c位于最远侧位置并且指示器148的第二弹性指状部148b配置在凸台149的近侧。此外，当释放施夹器100的手柄106时，在楔板180位于最远侧位置的情况下，其远端180a插在钳夹120之间。另外，当驱动通道140在近侧方向上移动时，其突块140e脱离处理器194的触点194a。When drive channel 140 and push rod 160 are in the most distal position, spool 156c of pivot drive arm 156 is in the most distal position and second resilient finger 148b of indicator 148 is disposed proximal to boss 149 . Furthermore, when the handle 106 of the clip applier 100 is released, the distal end 180a of the wedge plate 180 is inserted between the jaws 120 with the wedge plate 180 in the most distal position. Additionally, when drive channel 140 is moved in the proximal direction, its tab 140e disengages contact 194a of processor 194 .

现在参照图52，示出了在手柄106的完整行程或扳动之后且在从其射出最后一个夹子之后的施夹器100的远端。在弹射出最后一个夹子之后，如在图52中可见，夹子输出器的近侧突起176配置在楔板180的孔180b中的最远侧孔或窗口内。如此，当在弹射出夹子之后楔板180向远侧移动时，以上述方式，夹子输出器174也向远侧移动。因此，当夹子输出器174向远侧移动时，其远侧凸起175被移动到夹子承载器170的窗口172的最远侧窗口的远侧。如此，远侧突起175的近侧部分175b紧密接合夹子承载器170的顶壁的内表面并向下做凸轮运动或推进。Referring now to FIG. 52 , the distal end of clip applier 100 is shown after a full stroke or toggle of handle 106 and after the last clip has been ejected therefrom. After the last clip has been ejected, as seen in FIG. 52 , the proximal protrusion 176 of the clip follower is disposed within the distal-most hole or window in the hole 180b of the wedge plate 180 . As such, as wedge plate 180 moves distally after ejection of the clip, clip follower 174 also moves distally in the manner described above. Thus, when the clip follower 174 is moved distally, its distal protrusion 175 is moved distal to the most distal of the windows 172 of the clip carrier 170 . As such, the proximal portion 175b of the distal protrusion 175 tightly engages the inner surface of the top wall of the clip carrier 170 and is cammed or pushed downwardly.

当远侧突起175的近侧部分175b向下做凸轮运动或推进时，远侧突起175的近侧部分175b紧密接合锁定件178的突起178a的上表面并且使锁定件178的突起178a向下做凸轮运动或推进而横跨带箍143的路径被支撑在驱动通道140上且进入到楔板180的远侧窗口180c内。如此，如果驱动通道140向远侧前进，以上述方式，带箍143将紧邻锁定件178的突起178a并且防止或阻碍带箍143并且依次防止或阻碍驱动通道140向远侧移动。此时，棘爪142停顿在齿条140d的远侧，并且手柄106布置在完全张开位置，因此不能被再进一步地张开。在这种构造中，施夹器被锁定且不能再使用。When the proximal portion 175b of the distal protrusion 175 cams or advances downward, the proximal portion 175b of the distal protrusion 175 closely engages the upper surface of the protrusion 178a of the locking member 178 and causes the protrusion 178a of the locking member 178 to move downward. Camming or advancing across the path of strap 143 is supported on drive channel 140 and into distal window 180c of wedge 180 . As such, if drive channel 140 is advanced distally, in the manner described above, band 143 will abut protrusion 178a of lock 178 and prevent or impede band 143 and, in turn, drive channel 140 from moving distally. At this point, the pawl 142 is parked distally of the rack 140d, and the handle 106 is disposed in the fully extended position and thus cannot be extended any further. In this configuration, the clip applier is locked and can no longer be used.

基于施夹器的尺寸，施夹器100的零件的尺寸必须是相应比例的。各种尺寸的施夹器的大部分零件彼此基本上是相同的。可相应地调节涉及夹子宽度的零件尺寸，例如钳夹120和楔板180，或者涉及夹子长度的零件尺寸，例如推杆160和枢轴臂179。如此，基本以相同的方式装配各种尺寸的每一个施夹器，并且以基本相同的方式操作所述施夹器的内部机构。Based on the size of the clip applier, the dimensions of the components of the clip applier 100 must be proportional. Most parts of clip appliers of various sizes are basically the same as each other. Dimensions of parts related to the width of the clip, such as jaw 120 and wedge 180 , or parts of length related to the clip, such as push rod 160 and pivot arm 179 , can be adjusted accordingly. As such, each clip applier of various sizes is assembled in substantially the same manner, and the internal mechanisms of the clip appliers are operated in substantially the same manner.

例如，可提供相对小的、中等的和较大尺度的施夹器100，其中每一种尺寸的施夹器都存储且弹射相对小的、中等的或较大的外科夹子。基于外科夹子的相对尺寸，相应的施夹器及它们相应的零件必须是适当比例的。然而，依据本公开，各种尺寸的施夹器中的每一种都包括相同的零件并且可以彼此相同的顺序装配。如此，装配施夹器的技术人员仅仅需要学会装配一种尺寸的施夹器所需的顺序和/或步骤，这又使得技术人员同样能够装配其它尺寸的施夹器，无需学习新的装配顺序或步骤。For example, relatively small, medium and large size clip appliers 100 may be provided, wherein each size clip applier stores and ejects a relatively small, medium or large surgical clip. Based on the relative dimensions of the surgical clips, the corresponding clip appliers and their corresponding parts must be properly proportioned. However, in accordance with the present disclosure, each of the various sized clip appliers includes the same parts and can be assembled in the same order as one another. As such, a technician assembling a clip applier only needs to learn the sequence and/or steps required to assemble one size of clip applier, which in turn enables the technician to similarly assemble other sized clip appliers without having to learn a new assembly sequence or steps.

因此，用于相对小的、中等的或较大的施加器的装配方法和/或步骤彼此基本上是相同的。Therefore, the assembly methods and/or steps for relatively small, medium or larger applicators are substantially the same as each other.

许多其它剩余的零件或部件在特征尺寸或比例方面是相同的或具有微小的变化。然而，如果需要，为了达到相同的结果，则可以修改下列部件的形状，即近侧连接构件154的长度、枢轴驱动臂156的长度和/或远侧连接构件158的长度。Many other remaining parts or components are the same or have minor variations in feature size or proportion. However, if desired, the shape of the proximal connection member 154, the pivot drive arm 156, and/or the distal connection member 158 may be modified in shape to achieve the same result.

可以想到的是，改变角度“α”的起动角度，例如相对于大约60度，在大约45度处是更有效的，以使得角度差产生用于施夹器100的工作行程的更平滑的起动动作。然而，当起动角度“α”为大约45度时，由于较长的近侧连接构件154和远侧连接构件158，使得比在大约60度的起动角度“α”时占据了施夹器100的外壳104内的更多面积。运动倍增系统155的全部参数都能够并且应该被单独设计，以用于特定设备的任何构造需要，其中所述运动倍增系统被认为是补充于所述特定设备中。It is conceivable that varying the actuation angle of angle "α", for example at about 45 degrees relative to about 60 degrees, is more effective so that the angular difference produces a smoother actuation for the working stroke of clip applier 100 action. However, when the actuation angle "α" is about 45 degrees, due to the longer proximal connection member 154 and distal connection member 158, it occupies more of the clip applier 100 than at the actuation angle "α" of about 60 degrees. More area within housing 104 . All parameters of the motion multiplication system 155 can and should be individually designed for any configuration needs of the particular device in which the motion multiplication system is considered supplementary.

应该理解的是，之前的描述仅仅是本公开示意性的描述。在不脱离本公开的情况下，所属领域技术人员可设计多种变形和修改。因此，本公开旨在包含所有这些变形、修改和变化。参考随附的附图描述的实施例仅仅展示了本公开的特定实例。其它非实质性不同于以上描述和/或附加的权利要求的元件、步骤、方法和技术也希望包括在本公开的范围内。It should be understood that the foregoing description is only illustrative of the disclosure. Various variations and modifications can be devised by those skilled in the art without departing from the present disclosure. Accordingly, the present disclosure is intended to embrace all such variations, modifications and variations. The embodiments described with reference to the accompanying drawings merely illustrate specific examples of the present disclosure. Other elements, steps, methods and techniques that are insubstantially different from those described above and/or in the appended claims are also intended to be within the scope of the present disclosure.

Claims (18)

Translated fromChinese

1.一种用于将外科夹子施加到体组织的外科施夹器，所述外科施夹器包括：1. A surgical clip applier for applying surgical clips to body tissue, the surgical clip applier comprising:外壳；shell;至少一个手柄，其可枢转地连接到所述外壳上；at least one handle pivotally connected to the housing;通道组件，其从所述外壳向远侧延伸出；a channel assembly extending distally from the housing;夹子承载器，其配置在所述通道组件内且在其中限定了通道和多个窗口；a clip carrier disposed within the channel assembly and defining a channel and a plurality of windows therein;多个夹子，它们可滑动地配置在所述夹子承载器的通道内；a plurality of clips slidably disposed within the channel of the clip carrier;驱动通道，其可往复地配置在所述外壳和所述通道组件中的至少一个内，所述驱动通道具有可操作地连接到至少一个手柄上的第一端和可操作地连接到通道组件的远端上的第二端；a drive channel reciprocally disposed within at least one of the housing and the channel assembly, the drive channel having a first end operably connected to at least one handle and a first end operably connected to the channel assembly the second end on the distal end;楔板，其可往复地配置在所述通道组件内，所述楔板可操作地连接到至少一个手柄上且包括多个沿其长度形成的孔；a wedge reciprocally disposed within the channel assembly, the wedge operably connected to at least one handle and including a plurality of apertures formed along its length;推杆，其可往复地设置在所述外壳和所述通道组件内，所述推杆具有可操作地连接到至少一个手柄上的近端和限定了推动器的远端，其中所述推杆的远端被构造为与所述多个夹子中的最远侧夹子相接合；a push rod reciprocally disposed within the housing and the channel assembly, the push rod having a proximal end operably connected to at least one handle and a distal end defining a pusher, wherein the push rod a distal end configured to engage a distal-most clip of the plurality of clips;运动倍增系统，其具有多个连接件，所述连接件被构造为基于所述手柄的初始致动而使所述推杆向远侧移动递增量，并且被构造为在手柄初始致动之后使推杆和楔板向近侧移动；a motion multiplication system having a plurality of links configured to move the pushrod distally by incremental amounts based on initial actuation of the handle and configured to move the pushrod distally after initial actuation of the handle Push rod and wedge move proximally;其中，所述运动倍增系统的多个连接件包括：Wherein, the multiple connectors of the motion multiplication system include:近侧连接构件，其可枢转地支撑在所述外壳内且可操作地连接到所述驱动通道上；a proximal connection member pivotally supported within the housing and operatively connected to the drive channel;枢轴驱动臂，其使所述驱动通道和所述近侧连接构件相互连接；以及a pivotal drive arm interconnecting the drive channel and the proximal connection member; and远侧连接构件，其使所述近侧连接构件和所述推杆相互连接；a distal connection member interconnecting the proximal connection member and the push rod;其中，所述驱动通道的远侧平移引起所述近侧连接构件经由所述枢轴驱动臂枢轴旋转，以使得所述近侧连接构件促使所述远侧连接构件的第一端在第一方向上枢轴旋转且所述远侧连接构件的第二端使所述推杆在远侧方向上可滑动地移动。wherein distal translation of the drive channel causes the proximal link member to pivot via the pivot drive arm such that the proximal link member urges the first end of the distal link member in the first pivoting in a distal direction and the second end of the distal link member slidably moves the push rod in a distal direction.2.根据权利要求1所述的施夹器，其中，所述驱动通道的进一步远侧平移引起所述近侧连接构件经由所述枢轴驱动臂枢轴旋转，以使得所述近侧连接构件促使所述远侧连接构件的第一端在第二方向上枢轴旋转且所述远侧连接构件的第二端使所述推杆在近侧方向上可滑动地移动。2. The clip applier of claim 1 , wherein further distal translation of the drive channel causes the proximal link member to pivot via the pivot drive arm such that the proximal link member Causing the first end of the distal connection member to pivot in a second direction and the second end of the distal connection member to slidably move the push rod in a proximal direction.3.根据权利要求1所述的施夹器，其中，所述运动倍增系统的多个连接件包括：3. The clip applier of claim 1, wherein the plurality of linkages of the motion multiplication system comprises:近侧连接构件，其可枢转地支撑在所述外壳内并且可操作地连接到所述驱动通道上；a proximal connection member pivotally supported within the housing and operatively connected to the drive channel;枢轴驱动臂，其使所述驱动通道和所述近侧连接构件相互连接；以及a pivotal drive arm interconnecting the drive channel and the proximal connection member; and远侧连接构件，其使所述近侧连接构件和所述推杆相互连接；a distal connection member interconnecting the proximal connection member and the push rod;其中所述驱动通道的远侧平移引起所述近侧连接构件经由所述枢轴驱动臂的枢轴旋转，其中所述近侧连接构件的所述枢轴旋转引起所述远侧连接构件的枢轴旋转，并且其中所述远侧连接构件的所述枢轴旋转引起所述推杆的远侧平移。wherein distal translation of the drive channel causes pivotal rotation of the proximal connection member via the pivot drive arm, wherein the pivotal rotation of the proximal connection member causes pivoting of the distal connection member The shaft rotates, and wherein the pivotal rotation of the distal connection member causes distal translation of the pushrod.4.根据权利要求3所述的施夹器，其中，所述驱动通道的进一步远侧平移引起所述近侧连接构件经由所述枢轴驱动臂的进一步枢轴旋转，其中所述近侧连接构件的所述进一步枢轴旋转引起远侧连接构件的进一步枢轴旋转，并且其中所述远侧连接构件的所述进一步枢轴旋转引起所述推杆的近侧平移。4. The clip applier of claim 3, wherein further distal translation of the drive channel causes further pivotal rotation of the proximal link member via the pivot drive arm, wherein the proximal link The further pivotal rotation of the member causes further pivotal rotation of the distal connection member, and wherein the further pivotal rotation of the distal connection member causes proximal translation of the push rod.5.根据权利要求3所述的施夹器，其中当所述近侧连接构件、远侧连接构件、枢轴驱动臂、驱动通道和推杆处于所述驱动通道的近侧平移之前的第一位置时，所述近侧连接构件和所述远侧连接构件限定了小于大约180度的第一角度，其中所述驱动通道的近侧平移引起所述近侧连接构件和所述远侧连接构件经由所述枢轴驱动臂而枢轴旋转，从而将小于大约180度的第一角度增大到大约180度的第二角度，以使所述近侧连接构件和所述远侧连接构件相对于彼此成一直线，从而使得所述近侧连接构件、远侧连接构件、枢轴驱动臂、驱动通道和推杆处于所述驱动通道的近侧平移之后的第二位置。5. The clip applier of claim 3, wherein said proximal link member, distal link member, pivotal drive arm, drive channel, and push rod are in a first moment prior to proximal translation of said drive channel. position, the proximal and distal connecting members define a first angle of less than about 180 degrees, wherein proximal translation of the drive channel causes the proximal and distal connecting members to pivoting via the pivot drive arm to increase a first angle of less than about 180 degrees to a second angle of about 180 degrees such that the proximal connection member and the distal connection member are relative to each other In line with one another such that the proximal link member, distal link member, pivot drive arm, drive channel and pushrod are in a second position following proximal translation of the drive channel.6.根据权利要求5所述的施夹器，其中当所述近侧连接构件、远侧连接构件、枢轴驱动臂、驱动通道和推杆处于所述第二位置时，所述驱动通道的进一步近侧平移引起所述近侧连接构件和所述远侧连接构件经由所述枢轴驱动臂而枢轴旋转，从而将大约180度的第二角度减小到小于大约180度的第三角度，以使所述远侧连接构件、枢轴驱动臂和驱动通道处于所述驱动通道的进一步近侧平移之后的第三位置，同时所述推杆处于所述第一位置。6. The clip applier of claim 5, wherein when the proximal link member, distal link member, pivot drive arm, drive channel, and push rod are in the second position, the drive channel's Further proximal translation causes the proximal connection member and the distal connection member to pivot via the pivot drive arm, thereby reducing the second angle of approximately 180 degrees to a third angle of less than approximately 180 degrees , such that the distal link member, pivot drive arm, and drive channel are in a third position following further proximal translation of the drive channel while the pushrod is in the first position.7.根据权利要求3所述的施夹器，其中，所述近侧连接构件经由所述枢轴驱动臂的旋转致使所述近侧连接构件和所述远侧连接构件相对于彼此成一直线并且沿着由所述近侧连接构件的近端和所述远侧连接构件的远端之间的参考轴线限定的纵向轴线，以使所述远侧连接构件引起所述推杆的远侧平移。7. The clip applier of claim 3, wherein rotation of the proximal link member via the pivot drive arm causes the proximal link member and the distal link member to be aligned relative to each other and along a longitudinal axis defined by a reference axis between a proximal end of the proximal connection member and a distal end of the distal connection member, such that the distal connection member causes distal translation of the push rod.8.根据权利要求7所述的施夹器，其中，所述近侧连接构件经由所述枢轴驱动臂的进一步旋转致使所述近侧连接构件和所述远侧连接构件彼此成角度地偏移，以使所述远侧连接构件引起所述推杆的近侧平移。8. The clip applier of claim 7, wherein further rotation of the proximal link member via the pivot drive arm causes the proximal link member and the distal link member to be angularly offset from each other. to cause the distal connection member to cause proximal translation of the pushrod.9.根据权利要求3所述的施夹器，其中，由所述近侧连接构件的近端和所述远侧连接构件的远端之间的参考轴线限定的纵向轴线和所述近侧连接构件限定了在所述纵向轴线的第一侧的第一锐角，并且所述推杆处于近侧位置，其中所述驱动通道的远侧平移引起所述近侧连接构件和所述远侧连接构件枢转，从而使在所述纵向轴线的第一侧的所述第一锐角增大，直到所述近侧连接构件和所述远侧连接构件相对于彼此成一直线，并且所述推杆经由远侧连接构件向远侧平移到远侧位置为止。9. The clip applier of claim 3, wherein a longitudinal axis defined by a reference axis between a proximal end of the proximal connection member and a distal end of the distal connection member and the proximal connection member The members define a first acute angle on a first side of the longitudinal axis, and the pushrod is in a proximal position, wherein distal translation of the drive channel causes the proximal connection member and the distal connection member to Pivot so that the first acute angle on the first side of the longitudinal axis increases until the proximal and distal connection members are aligned relative to each other and the push rod passes through the distal The side connection member translates distally to a distal position.10.根据权利要求9所述的施夹器，其中，所述驱动通道的进一步远侧平移致使所述近侧连接构件和所述远侧连接构件从所述纵向轴线的所述一侧枢转到纵向轴线的第二侧，从而使所述近侧连接构件和所述纵向轴线限定第二锐角，并且使所述推杆经由所述远侧连接构件向近侧平移到近侧位置。10. The clip applier of claim 9, wherein further distal translation of the drive channel causes the proximal and distal link members to pivot from the one side of the longitudinal axis to a second side of the longitudinal axis such that the proximal connection member and the longitudinal axis define a second acute angle and the pushrod is translated proximally via the distal connection member to a proximal position.11.根据权利要求1所述的施夹器，其中，夹子输出器被构造为接合所述楔板并且基于所述楔板的远侧平移而向远侧移动，并且被构造为接合夹子承载器且在所述楔板近侧平移时阻止夹子输出器的近侧移动。11. The clip applier of claim 1 , wherein a clip follower is configured to engage the wedge and move distally based on distal translation of the wedge, and is configured to engage a clip carrier And the proximal movement of the clip follower is prevented when the wedge plate is translated proximally.12.根据权利要求1所述的施夹器，进一步包括钳夹组件，所述钳夹组件包括一对从所述通道组件的与所述外壳反向的端部延伸出的钳夹，所述钳夹组件适于容纳多个夹子中的一个夹子于其中，并且是可操作的以便响应于所述手柄的移动来实现夹子的成型。12. The clip applier of claim 1, further comprising a jaw assembly including a pair of jaws extending from an end of the channel assembly opposite the housing, the The jaw assembly is adapted to receive a clip of the plurality of clips therein and is operable to effect clip shaping in response to movement of the handle.13.根据权利要求12所述的施夹器，其中，当使所述手柄在第一方向上接近初始量时，所述推杆朝向钳夹移动以将最远侧夹子移动至所述钳夹之间，并且当使所述手柄在第一方向上接近附加量时，所述推杆被构造为且适于朝向外壳移动以将所述推动器移动到多个夹子中的最远侧夹子后面。13. The clip applier of claim 12, wherein when the handle is approximated an initial amount in a first direction, the push rod moves toward the jaws to move the most distal clip to the jaws between, and when the handle is approached an additional amount in a first direction, the push rod is configured and adapted to move toward the housing to move the pusher behind the most distal clip of the plurality of clips .14.根据权利要求13所述的施夹器，其中，所述驱动通道被构造且定尺寸为至少部分地围绕钳夹和楔板，其中所述驱动通道包括带箍，所述带箍横跨所述驱动通道的远端延伸，用于将钳夹和楔板保持在驱动通道内。14. The clip applier of claim 13, wherein the drive channel is configured and dimensioned to at least partially surround the jaw and wedge, wherein the drive channel includes a band spanning A distal end of the drive channel extends for retaining the jaw and wedge within the drive channel.15.根据权利要求13所述的施夹器，其中，当所述至少一个手柄在第一方向上被致动而移动时，所述驱动通道朝向钳夹组件移动，以将驱动通道的第二端移动到抵靠钳夹以闭合钳夹，当所述至少一个手柄移动第二量时，驱动通道被移离钳夹，以使驱动通道的第二端移离钳夹以允许钳夹张开。15. The clip applier of claim 13 , wherein when the at least one handle is actuated to move in a first direction, the drive channel moves toward the jaw assembly to move a second portion of the drive channel toward the jaw assembly. end moves against the jaws to close the jaws, and when the at least one handle moves a second amount, the drive channel is moved away from the jaws so that the second end of the drive channel moves away from the jaws to allow the jaws to open .16.根据权利要求15所述的施夹器，进一步包括运动反转机构，所述运动反转机构可操作地连接至所述楔板和所述驱动通道，其中在驱动通道的远侧移动期间，运动反转机构的旋转导致楔板的近侧移动。16. The clip applier of claim 15, further comprising a motion reversal mechanism operably connected to the wedge plate and the drive channel, wherein during distal movement of the drive channel , rotation of the motion reversal mechanism results in proximal movement of the wedge.17.根据权利要求1所述的施夹器，进一步包括：17. The clip applier of claim 1, further comprising:夹子输出器，其可滑动地配置在所述夹子承载器的通道内，并且被配置在多个夹子的近侧，所述夹子输出器被构造为且适于与所述夹子承载器的窗口和所述楔板的孔可选择地接合，其中所述夹子输出器被构造为且适于基于所述楔板的往复运动在夹子承载器的远侧方向上推进多个夹子。a clip follower slidably disposed within the channel of the clip carrier and disposed proximally of the plurality of clips, the clip follower configured and adapted to cooperate with the window of the clip carrier and The aperture of the wedge is selectively engageable, wherein the clip follower is configured and adapted to advance a plurality of clips in a distal direction of the clip carrier based on reciprocating motion of the wedge.18.根据权利要求1所述的施夹器，进一步包括：18. The clip applier of claim 1, further comprising:运动反转机构，其可操作地连接至所述驱动通道和所述楔板，并且与所述推杆可选择地接合，其中在所述驱动通道的远侧平移期间，所述运动反转机构的旋转导致楔板和推杆的近侧移动。a motion reversal mechanism, operatively connected to the drive channel and the wedge plate, and selectively engageable with the push rod, wherein during distal translation of the drive channel, the motion reversal mechanism Rotation of the wedge causes proximal movement of the wedge and pushrod.