本申请是申请号为200910171615.X、申请日为2009年8月31日、发明名称为“具有连接板的内窥镜手术施夹器”的专利申请的分案申请。This application is a divisional application of the patent application with the application number 200910171615.X, the application date being August 31, 2009, and the invention name being "endoscopic surgery clip applier with connecting plate".
相关申请的引用References to related applications
本申请要求于2008年8月29日提交的序列号为61/092,794的美国临时申请的权益和优先权，该临时申请的全部内容通过引用合并于此。This application claims the benefit of and priority to US Provisional Application Serial No. 61/092,794, filed August 29, 2008, which is hereby incorporated by reference in its entirety.
技术领域technical field
本公开涉及手术施夹器，尤其是涉及一种新型的内窥镜手术施夹器。The present disclosure relates to surgical clip appliers, and more particularly to a novel endoscopic surgical clip applier.
背景技术Background technique
内窥镜缝合器和施夹器在本领域中是公知的并且用于许多不同且有用的手术程序。在腹腔镜手术程序的情况下，通过插入皮肤中的小进入切口的窄的管子或套管来获得到腹部内部的通道。而在身体上的其它部位执行的微创程序通常一般被称作内窥镜程序。典型地，管子或者套管装置通过进入切口伸入患者的身体中，以便提供入口。此种入口允许外科医生利用套管针插入多个不同的手术器械并且用于在远离切口的地方执行手术程序。Endoscopic staplers and clip appliers are well known in the art and are used in many different and useful surgical procedures. In the case of laparoscopic procedures, access to the interior of the abdomen is obtained through a narrow tube or cannula that is inserted through a small entry incision in the skin. Minimally invasive procedures performed on other parts of the body are generally referred to as endoscopic procedures. Typically, a tube or cannula device is inserted into the patient's body through an access incision to provide access. Such access allows the surgeon to insert a number of different surgical instruments using the trocar and for performing surgical procedures away from the incision.
在大多数的这些程序中，外科医生经常必须终止血液或另一种液体通过一根或多根脉管的流动。在程序中，外科医生经常会将手术夹子施加到血管或另一种导管上，以防止体液流过这些导管。内窥镜施夹器用于在进入体腔时施加单个夹子，这在本领域中是公知的。典型地，这样的单个施夹器由生物相容性材料制成并且通常被压布在脉管上。一旦施加到脉管上，该被压布的夹子就终止了液体通过导管的流动。During most of these procedures, the surgeon must often stop the flow of blood or another fluid through one or more vessels. During the procedure, the surgeon will often apply surgical clips to blood vessels or another type of catheter to prevent bodily fluids from flowing through them. Endoscopic clip appliers are known in the art for applying a single clip when entering a body cavity. Typically, such a single clip applier is made of a biocompatible material and is usually pressed against the vessel. Once applied to the vessel, the compressed clip stops the flow of fluid through the catheter.
在共有的转让给格林（Green）等人的第5,084,057和5,100,420号美国专利中描述了在单独进入体腔中时能够在内窥镜或腹腔镜程序中施加多个夹子的内窥镜施夹器，上述两项专利的全部内容通过引用合并于此。在共有的转让给布拉德（Pratt）等人的第5,607,436号美国专利中公开了另一种复合内窥镜施夹器，该专利的全部内容同样通过引用合并于此。这些装置被典型地用在单个手术程序中，但这不是必须的。在序列号为08/515,341的美国专利申请，即现在授予给皮埃尔（Pier）等人的第5,695,502号美国专利中公开了一种可重新消毒的手术施夹器，该专利所公开的内容通过引用合并于此。该施夹器在单独插入体腔中时推进并形成多个夹子。所述可重复消毒的施夹器被配置成容纳并与可交换的弹夹合作，以便在单独进入体腔时推进和形成多个夹子。一个重要的设计目标是，在不对来自装载程序的夹子进行任何压缩的情况下将手术夹子装在钳口之间。在装载过程中的夹子的这些弯曲或扭转经常会有许多意想不到的后果。在装载时的这种压缩可能会略微地改变夹子在钳口之间的对准。这会使外科医生将夹子从钳口之间移除以便丢弃夹子。另外，这种预载压缩可能会略微地压缩夹子的某些部分而改变其几何。这会使外科医生将夹子从钳口之间移除以便丢弃夹子。Endoscopic clip appliers capable of applying multiple clips in endoscopic or laparoscopic procedures while individually entering a body cavity are described in commonly-owned U.S. Patent Nos. 5,084,057 and 5,100,420 assigned to Green et al., The entire contents of the above two patents are hereby incorporated by reference. Another compound endoscope clip applier is disclosed in commonly-owned US Patent No. 5,607,436, assigned to Pratt et al., which is also incorporated herein by reference in its entirety. These devices are typically used in a single surgical procedure, but this is not required. A resterilizable surgical clip applier is disclosed in U.S. Patent Application Serial No. 08/515,341, now issued U.S. Patent No. 5,695,502 to Pier et al., which discloses Incorporated herein by reference. The clip applier advances and forms a plurality of clips when individually inserted into a body cavity. The resterilizable clip applier is configured to receive and cooperate with an exchangeable clip to advance and form a plurality of clips when individually entered into a body cavity. An important design goal was to load the surgical clip between the jaws without any compression of the clip from the loading procedure. These bendings or torsions of the clips during loading often have many unintended consequences. This compression during loading may slightly alter the alignment of the clip between the jaws. This causes the surgeon to remove the clip from between the jaws so the clip can be discarded. Additionally, this preload compression may slightly compress portions of the clip changing its geometry. This causes the surgeon to remove the clip from between the jaws so the clip can be discarded.
经常在远离切口的地方执行内窥镜或者腹腔镜程序。因此，对于位于装置近端的用户而言，视野或者触觉反馈的减小可能使夹子的施加复杂化。因此希望通过向用户提供单个夹子被发射的指示、包含在装载单元中的夹子的损耗或者任何其它手术事件的指示来改善器械的操作。还希望提供这样一种手术施夹器：其促进了夹子的成功负载并且分开该手术施夹器的钳口，然后将夹子装在钳口之间以防止夹子的任何损坏或者过度压缩，并在发射前防止钳口压在夹子上。Endoscopic or laparoscopic procedures are often performed away from the incision. Thus, for a user located at the proximal end of the device, a reduced field of view or tactile feedback may complicate application of the clip. It is therefore desirable to improve the operation of the instrument by providing the user with an indication that a single clip was fired, a clip contained in the loading unit was worn out, or any other surgical event. It is also desirable to provide a surgical clip applier that facilitates successful loading of the clip and separates the jaws of the surgical clip applier, then fits the clip between the jaws to prevent any damage or excessive compression of the clip, and Prevent the jaws from pressing against the clip before firing.
发明内容Contents of the invention
本公开涉及新型的内窥镜手术施夹器。The present disclosure relates to a novel endoscopic surgical clip applier.
根据本公开的一个方案，提供了一种用于将手术夹子施加到体组织上的装置。本装置包括：手柄组件；轴组件，其从手柄组件向远侧延伸，并且限定了纵轴；布置在轴组件中的多个手术夹子；钳口，其邻近轴组件的远端部安装，该钳口可在隔开的打开状态和接近的闭合状态之间移动；以及推杆，其可往复运动地布置在轴组件中，该推杆被配置成在钳口处于打开状态时将最远侧手术夹子装入钳口中，并在钳口的接近期间时与被装入的夹子保持接触。According to one aspect of the present disclosure, an apparatus for applying surgical clips to body tissue is provided. The device includes: a handle assembly; a shaft assembly extending distally from the handle assembly and defining a longitudinal axis; a plurality of surgical clips disposed within the shaft assembly; jaws mounted adjacent the distal end of the shaft assembly, the The jaws are movable between a spaced open state and an approximated closed state; and a push rod, which is reciprocatably disposed in the shaft assembly, is configured to move the most distal end when the jaws are in the open state. Surgical clips are loaded into the jaws and remain in contact with the loaded clips during the approach of the jaws.
推杆可包括形成在其远端处的推动器。推动器可具有狭窄轮廓以在单个位置上接触被装入的手术缝合钉。推动器可以限定与被装入的手术缝合钉的平面大体正交的平面。The push rod may include a pusher formed at its distal end. The pusher can have a narrow profile to contact loaded surgical staples at a single location. The pusher can define a plane that is generally normal to the plane of the loaded surgical staple.
所述装置可进一步包括可往复运动地布置在轴组件中的连接板。连接板可以连接到推杆上。在使用中，在连接板的最初远侧移动期间，推杆可以向着远侧推进，而在连接板的进一步远侧移动期间，连接板可以从推杆脱开。The device may further include a link plate reciprocally disposed in the shaft assembly. The connection plate can be connected to the push rod. In use, during an initial distal movement of the web, the push rod may be advanced distally, and during further distal movement of the web, the web may be disengaged from the push rod.
推杆可包括支撑在其上的第一弹簧夹子，该第一弹簧夹子用于在推杆处于推进位置时选择性地与轴组件的部件接合，以选择性地将推杆保持在该推进位置。推杆可进一步包括支撑于其上的第二弹簧夹子，第二弹簧夹子用于选择性地与连接板的第一部件接合。在连接板的最初远侧移动之后，连接板的第一部件可以选择性地从第二弹簧夹子脱离。The push rod may include a first spring clip supported thereon for selectively engaging a component of the shaft assembly when the push rod is in the advanced position to selectively retain the push rod in the advanced position . The push rod may further include a second spring clip supported thereon for selectively engaging the first part of the connecting plate. After the initial distal movement of the web, the first part of the web can be selectively disengaged from the second spring clip.
所述装置可进一步包括可往复运动地布置在轴组件中的推进板。推进板可包括能被推杆的肩部选择性地接合的至少一个翼片。在使用中，在推杆的远侧和近侧移动期间，推杆的肩部可与推进板的至少一个翼片接合，以实现推进板的远侧和近侧移动中的一个。The device may further include a pusher plate reciprocally disposed in the shaft assembly. The pusher plate may include at least one tab selectively engageable by a shoulder of the pushrod. In use, during distal and proximal movement of the push rod, a shoulder of the push rod is engageable with at least one tab of the pusher plate to effect one of distal and proximal movement of the pusher plate.
所述装置可进一步包括可滑动地支撑在轴组件中的夹子输出器，夹子输出器用于向远侧方向推动多个手术夹子。夹子输出器包括从其第一表面突出的第一凸起以及从其第二表面突出的第二凸起。在使用中，随着推进板向远侧移动，夹子输出器的第一凸起可与推进板接合，从而使该夹子输出器向远侧移动以推进多个手术夹子，并且其中，随着推进板向近侧移动，夹子输出器的第二凸起可与固定部件接合，从而使夹子输出器保持固定。The device may further include a clip follower slidably supported in the shaft assembly for advancing the plurality of surgical clips in a distal direction. The clip follower includes a first protrusion protruding from a first surface thereof and a second protrusion protruding from a second surface thereof. In use, as the pusher plate moves distally, the first projection of the clip follower is engageable with the pusher plate, thereby causing the clip follower to move distally to advance a plurality of surgical clips, and wherein, as the advancer As the plate moves proximally, the second protrusion of the clip follower is engageable with the securing member, thereby holding the clip follower stationary.
所述装置可进一步包括布置在轴组件中的夹子载体，其中，该夹子载体被配置成保持多个手术夹子以及夹子输出器，并且其中，夹子输出器的第二凸起可与形成在夹子载体中的部件接合。The device may further include a clip carrier disposed in the shaft assembly, wherein the clip carrier is configured to hold a plurality of surgical clips and the clip follower, and wherein the second protrusion of the clip follower may be formed in contact with the clip carrier. Parts in the joint.
可逐步推进夹子输出器通过轴组件。夹子输出器可包括从其表面伸出的窗钩（catch），其中，在最后一个手术夹子被发射之后，该窗钩可与推杆接合并可防止推杆向近侧方向移动。The clip follower may be progressively advanced through the shaft assembly. The clip follower may include a catch protruding from a surface thereof, wherein after the last surgical clip has been fired, the catch may engage the push rod and prevent movement of the push rod in a proximal direction.
所述装置可进一步包括布置在手柄组件中的棘轮组件。当推杆没有返回到近侧位置时，可以防止该棘轮组件复位。The device may further include a ratchet assembly disposed within the handle assembly. The ratchet assembly is prevented from resetting when the push rod is not returned to the proximal position.
所述装置可进一步包括支撑在壳体组件中的计数器。当手术夹子已经被发射之后，该计数器可提供指示。The device may further include a counter supported in the housing assembly. The counter may provide an indication when the surgical clips have been fired.
所述装置可进一步包括支撑在壳体组件中的指示器。当至少一个手术夹子被装入钳口中、手术夹子被发射以及所述装置被复位时，指示器可提供听觉和触觉指示中的至少一个。The device may further include an indicator supported in the housing assembly. The indicator may provide at least one of an audible and tactile indication when at least one surgical clip is loaded in the jaws, the surgical clip is fired, and the device is reset.
所述装置可进一步包括可往复运动地布置在轴组件中的楔形板。楔形板可以在其远端布置在钳口中的位置和其远端不在所述钳口中的位置之间移动。楔形板可进一步包括支撑在其上用于选择性地与连接板的第二部件接合的第三弹簧夹子，其中，在连接板的最初远侧移动之后，连接板的第二部件选择性地从该第三弹簧夹子脱离。The device may further include a wedge plate reciprocally disposed in the shaft assembly. The wedge plate is movable between a position in which its distal end is disposed in the jaw and a position in which its distal end is not in said jaw. The wedge plate may further include a third spring clip supported thereon for selective engagement with the second portion of the web, wherein after the initial distal movement of the web, the second portion of the web is selectively disengaged from the The third spring clip disengages.
所述装置可进一步包括由手柄组件致动并连接到连接板的驱动杆，驱动杆用于实现连接板的移动。所述装置可进一步包括可往复运动地布置在轴组件中的驱动通道，其中，驱动杆选择性地与驱动通道接合以实现该驱动通道的平移。当驱动通道向远侧推进时，其远端可与钳口的表面接合，以实现钳口的接近。The device may further include a drive rod actuated by the handle assembly and connected to the connecting plate for effecting movement of the connecting plate. The device may further include a drive channel reciprocally disposed in the shaft assembly, wherein the drive rod is selectively engaged with the drive channel to effectuate translation of the drive channel. When the drive channel is advanced distally, its distal end is engageable with the surface of the jaws to enable access of the jaws.
驱动通道在其向远侧推进时可致动楔形锁释放装置以使楔形板向近侧移动从而使楔形板的近端从钳口退回，并允许驱动通道接近钳口。The drive channel as it is advanced distally can actuate the wedge lock release to move the wedge plate proximally to retract the proximal end of the wedge plate from the jaws and allow the drive channel to approach the jaws.
轴组件可以相对于手柄组件围绕纵轴旋转。轴组件可包括支撑在其内的保护装置。其中，该保护装置可在第三弹簧夹子平移通过该保护装置时防止第三弹簧夹子向外张开。The shaft assembly is rotatable about a longitudinal axis relative to the handle assembly. The shaft assembly may include a guard supported therein. Wherein, the protection device can prevent the third spring clip from expanding outward when the third spring clip translates through the protection device.
楔形板和/或驱动通道可被偏置到近侧位置。The wedge plate and/or drive channel can be biased to a proximal position.
根据本公开的另一个方案，提供了一种用于将手术夹子施加到体组织上的装置。该装置包括：手柄组件；轴组件，其从手柄组件向远侧延伸，并且限定了纵轴；布置在轴组件中的多个手术夹子；钳口，其邻近轴组件的远端部安装，该钳口可以在隔开的打开状态和接近的闭合状态之间移动；以及夹子输出器，其可滑动地支撑在轴组件中，用于向远侧推动多个手术夹子。该夹子输出器包括从其第一表面突出的第一凸起以及从其第二表面突出的第二凸起。随着推进板向远侧推进，夹子输出器的第一凸起与推进板接合，从而使该夹子输出器向远侧移动以推进多个手术夹子，并且，随着推进板向近侧移动，夹子输出器的第二凸起与固定部件接合，从而使夹子输出器保持固定。According to another aspect of the present disclosure, an apparatus for applying surgical clips to body tissue is provided. The device includes: a handle assembly; a shaft assembly extending distally from the handle assembly and defining a longitudinal axis; a plurality of surgical clips disposed in the shaft assembly; jaws mounted adjacent the distal end of the shaft assembly, the The jaws are movable between a spaced open state and an approximated closed state; and a clip follower slidably supported in the shaft assembly for distally advancing a plurality of surgical clips. The clip follower includes a first protrusion protruding from a first surface thereof and a second protrusion protruding from a second surface thereof. As the pusher plate is advanced distally, the first protrusion of the clip follower engages the pusher plate, thereby causing the clip follower to move distally to advance the plurality of surgical clips, and, as the pusher plate moves proximally, The second projection of the clip follower engages the securing member, thereby holding the clip follower stationary.
所述装置可进一步包括可往复运动地布置在轴组件中的推进板。推进板可限定沿其长度形成的多个窗口。在使用中，随着推进板往复运动，夹子输出器的第一凸起可与多个窗口中的一个窗口选择性地接合。The device may further include a pusher plate reciprocally disposed in the shaft assembly. The pusher plate may define a plurality of windows formed along its length. In use, the first projection of the clip follower is selectively engageable with one of the plurality of windows as the pusher plate is reciprocated.
所述装置可进一步包括可往复运动地布置在轴组件中的推杆。该推杆被配置成可以在钳口处于打开状态时将最远侧手术夹子装入钳口中，并在钳口的接近期间与被装入的手术夹子保持接触。The device may further include a push rod reciprocally disposed in the shaft assembly. The push rod is configured to load the distal-most surgical clip into the jaws when the jaws are in the open state, and to maintain contact with the loaded surgical clip during the approach of the jaws.
推进板可包括能与推杆的肩部选择性地接合的至少一个翼片。在推杆的远侧和近侧移动期间，推杆的肩部可与推进板的至少一个翼片接合，以实现推进板的远侧和近侧移动中的一个。The pusher plate may include at least one tab selectively engageable with the shoulder of the pushrod. During the distal and proximal movement of the push rod, the shoulder of the push rod is engageable with at least one tab of the pusher plate to effect one of the distal and proximal movement of the pusher plate.
推杆可包括形成在其远端处的推动器，其中，推动器具有狭窄轮廓以在单个位置上接触装入的手术缝合钉。推动器可以限定与被装入的手术缝合钉的平面大体正交的平面。The pusher may include a pusher formed at a distal end thereof, wherein the pusher has a narrow profile to contact the loaded surgical staple at a single location. The pusher can define a plane that is generally normal to the plane of the loaded surgical staple.
所述装置可进一步包括可往复运动地布置在轴组件中的连接板。连接板可以选择性地连接到推杆上。在使用中，在连接板的最初远侧移动期间，推杆可向远侧推进，而在连接板的进一步远侧移动期间，该连接板可以从推杆脱开。The device may further include a link plate reciprocally disposed in the shaft assembly. The connecting plate can be selectively connected to the push rod. In use, during an initial distal movement of the web, the push rod may be advanced distally, and during further distal movement of the web, the web may be disengaged from the push rod.
推杆可包括支撑在其上的第一弹簧夹子，该第一弹簧夹子用于在推杆处于推进位置时可拆卸地连接到轴组件的部件上，从而将推杆保持在该推进位置。推杆可进一步包括支撑于其上的第二弹簧夹子，第二弹簧夹子用于可拆卸地连接到连接板的第一部件，其中，在连接板的最初远侧移动之后，连接板的第一部件从第二弹簧夹子脱开。The push rod may include a first spring clip supported thereon for releasable connection to a component of the shaft assembly when the push rod is in the advanced position, thereby retaining the push rod in the advanced position. The push rod may further include a second spring clip supported thereon for detachable connection to the first part of the connecting plate, wherein after the initial distal movement of the connecting plate, the first part of the connecting plate The part disengages from the second spring clip.
所述装置可进一步包括布置在轴组件中的夹子载体。夹子载体可被配置成保持多个手术夹子以及夹子输出器。夹子输出器的第二凸起可与形成在夹子载体中的部件接合。可逐步推进夹子输出器通过轴组件。夹子输出器可包括从其表面伸出的窗钩。在最后一个手术夹子被发射之后，窗钩可与推杆接合，并可防止推杆向近侧方向移动。The device may further include a clip carrier disposed in the shaft assembly. The clip carrier can be configured to hold a plurality of surgical clips as well as a clip exporter. The second projection of the clip follower is engageable with a feature formed in the clip carrier. The clip follower may be progressively advanced through the shaft assembly. The clip follower may include a hook protruding from a surface thereof. After the last surgical clip is fired, the window hook can engage the push rod and prevent the push rod from moving in the proximal direction.
所述装置可进一步包括布置在手柄组件中棘轮组件。当推杆没有返回到近侧位置时，可防止该棘轮组件复位。The device may further include a ratchet assembly disposed within the handle assembly. The ratchet assembly is prevented from resetting when the push rod is not returned to the proximal position.
所述装置可进一步包括支撑在壳体组件中的计数器，其中，当手术夹子已经被装入或者发射之后，该计数器可提供指示。所述装置可进一步包括支撑在壳体组件中的指示器，其中，当至少一个手术夹子被装入钳口中、手术夹子被发射以及所述装置被复位时，该指示器可提供听觉和触觉指示中的至少一个。The device may further include a counter supported in the housing assembly, wherein the counter may provide an indication when a surgical clip has been loaded or fired. The device can further include an indicator supported in the housing assembly, wherein the indicator can provide audible and tactile indications when at least one surgical clip is loaded into the jaws, the surgical clip is fired, and the device is reset at least one of the
所述装置可进一步包括可往复运动地布置在轴组件中的楔形板。楔形板可以在其远端布置在钳口中的位置和其远端不在所述钳口中的位置之间移动。该钳口可进一步包括支撑在其上用于与连接板的第二部件选择性地接合的第三弹簧夹子，其中，在连接板的最初远侧移动之后，连接板的第二部件可以选择性地从该第三弹簧夹子脱离。The device may further include a wedge plate reciprocally disposed in the shaft assembly. The wedge plate is movable between a position in which its distal end is disposed in the jaw and a position in which its distal end is not in said jaw. The jaw may further include a third spring clip supported thereon for selective engagement with the second part of the web, wherein the second part of the web is selectively movable after the initial distal movement of the web. firmly disengages from the third spring clip.
所述装置可进一步包括驱动杆，驱动杆由手柄组件致动并连接到连接板上用于实现连接板的移动。所述装置可进一步包括可往复运动地布置在轴组件中的驱动通道，其中，驱动杆可以与驱动通道选择性地接合以实现该驱动通道的平移，并且其中，当驱动通道向远侧推进时，其远端可与钳口的表面接合以实现钳口的接近。驱动通道在其向远侧推进时可致动楔形锁板以使楔形板向近侧移动从而使楔形板的远端从钳口退回，并且可以允许驱动通道接近钳口。The device may further include a drive rod actuated by the handle assembly and connected to the connecting plate for effecting movement of the connecting plate. The device may further comprise a drive channel reciprocally disposed in the shaft assembly, wherein the drive rod is selectively engageable with the drive channel to effectuate translation of the drive channel, and wherein when the drive channel is advanced distally , the distal end of which is engageable with the surface of the jaws to achieve jaw access. The drive channel as it is advanced distally may actuate the wedge lock plate to move the wedge plate proximally to retract the distal end of the wedge plate from the jaws and may allow the drive channel to approach the jaws.
轴组件可以相对于手柄组件围绕纵轴旋转。轴组件可包括支撑在其内的套箍（cuff），其中，该套箍可在第三弹簧夹子平移跨过该套箍时防止第三弹簧夹子向外张开。The shaft assembly is rotatable about a longitudinal axis relative to the handle assembly. The shaft assembly may include a cuff supported therein, wherein the cuff prevents the third spring clip from splaying outwardly as the third spring clip translates across the cuff.
楔形板和/或驱动通道可被偏置到近侧位置。The wedge plate and/or drive channel can be biased to a proximal position.
根据本公开的又一个方案，提供了一种用于将手术夹子施加到体组织上的装置，其中，所述装置包括手柄组件以及从该手柄组件向远侧延伸并且限定了纵轴的轴组件。手柄组件包括扳机以及驱动杆，该驱动杆在扳机致动时可通过扳机往复平移。轴组件包括：壳体；布置在壳体中的多个手术夹子；钳口，其邻近壳体的远端部安装，该钳口可在隔开的打开状态和接近的闭合状态之间移动；可往复运动地布置在壳体中的推杆，该推杆被配置成在钳口处于打开状态时将最远侧手术夹子装入钳口中，并在钳口的接近期间与被装入的手术夹子保持接触；邻近推杆可往复运动地布置在壳体中的推进板，推进板包括选择性地与推杆的肩部接合的至少一个翼片，其中，在推杆的远侧和近侧移动期间，推杆的肩部与推进板的至少一个翼片接合，以实现推进板的远侧和近侧移动中的一个；邻近推进板布置在壳体中的夹子载体，其中，该夹子载体被配置成保持多个手术夹子；夹子输出器，其可滑动地支撑在夹子载体中最多个手术夹子的近侧位置上，该夹子输出器被配置成向远侧方向推动多个手术夹子，该夹子输出器包括从其第一表面突出的第一凸起以及从其第二表面突出的第二凸起，其中，随着推进板向远侧移动，夹子输出器的第一凸起与推进板接合，从而使该夹子输出器向远侧移动以推进多个手术夹子，并且其中，随着推进板向近侧移动，夹子输出器的第二凸起与夹子载体接合，从而使夹子输出器保持固定；邻近夹子载体可往复运动地布置在壳体中的驱动通道，其中，驱动杆与驱动通道选择性地接合以实现该驱动通道的平移，其中，当驱动通道向远侧推进时，其远端与钳口的表面接合以实现钳口的接近；以及邻近驱动通道可往复运动地布置在壳体中的楔形板，该楔形板在其远端布置在钳口中的位置和其远端不在所述钳口中的位置之间移动。According to yet another aspect of the present disclosure, there is provided a device for applying surgical clips to body tissue, wherein the device includes a handle assembly and a shaft assembly extending distally from the handle assembly and defining a longitudinal axis . The handle assembly includes a trigger and a drive rod that is reciprocally translated by the trigger when the trigger is actuated. The shaft assembly includes: a housing; a plurality of surgical clips disposed in the housing; jaws mounted adjacent the distal end of the housing, the jaws movable between spaced apart open states and approximated closed states; a push rod reciprocatably disposed in the housing, the push rod configured to load the distal-most surgical clip into the jaws when the jaws are in the open state, and engage the loaded surgical clip during access of the jaws; the clip remains in contact; a pusher plate reciprocably disposed in the housing adjacent to the push rod, the push plate including at least one tab selectively engaging a shoulder of the push rod, wherein the distal and proximal sides of the push rod During movement, a shoulder of the push rod engages at least one tab of the pusher plate to enable one of distal and proximal movement of the pusher plate; a clip carrier disposed in the housing adjacent to the pusher plate, wherein the clip carrier configured to hold a plurality of surgical clips; a clip follower slidably supported in a position proximal to the plurality of surgical clips in the clip carrier, the clip follower configured to push the plurality of surgical clips in a distal direction, the The clip follower includes a first protrusion protruding from its first surface and a second protrusion protruding from its second surface, wherein, as the pusher plate moves distally, the first protrusion of the clip follower and the pusher plate engagement, thereby moving the clip follower distally to advance a plurality of surgical clips, and wherein, as the pusher plate moves proximally, the second projection of the clip follower engages the clip carrier, thereby retaining the clip follower fixed; a drive channel reciprocably disposed in the housing adjacent to the clip carrier, wherein the drive rod is selectively engaged with the drive channel to achieve translation of the drive channel, wherein when the drive channel is advanced distally, its distal The end engages with the surface of the jaws to realize the approaching of the jaws; and a wedge plate reciprocably arranged in the housing adjacent to the drive channel, the wedge plate is disposed at a position in the jaws at its distal end and is not at the position at its distal end. Move between positions in the jaws described above.
推杆可包括形成在其远端处的推动器。推动器可以具有狭窄轮廓以在单个位置上接触被装入的手术缝合钉。推动器可以限定与被装入的手术缝合钉的平面大体正交的平面。推杆可包括支撑在其上的第一弹簧夹子，该第一弹簧夹子可以在推杆处于推进位置时与轴组件的壳体的部件选择性地接合，以选择性地将推杆保持在该推进位置。推杆可进一步包括支撑于其上的第二弹簧夹子，第二弹簧夹子用于与连接板的第一部件选择性地接合，其中，在连接板的最初远侧移动之后，连接板的第一部件选择性地从第二弹簧夹子脱离。The push rod may include a pusher formed at its distal end. The pusher may have a narrow profile to contact loaded surgical staples at a single location. The pusher can define a plane that is generally normal to the plane of the loaded surgical staple. The push rod may include a first spring clip supported thereon that is selectively engageable with a member of the housing of the shaft assembly when the push rod is in the advanced position to selectively retain the push rod in the advanced position. advance position. The push rod may further include a second spring clip supported thereon for selectively engaging the first part of the link plate, wherein after the initial distal movement of the link plate, the first part of the link plate The component is selectively disengaged from the second spring clip.
可逐步推进夹子输出器通过轴组件。夹子输出器可包括从其表面伸出的窗钩。在使用中，在最后一个手术夹子被发射之后，窗钩可与推杆接合，并且可防止推杆向近侧方向移动。The clip follower may be progressively advanced through the shaft assembly. The clip follower may include a hook protruding from a surface thereof. In use, after the last surgical clip has been fired, the window hook is engageable with the push rod and prevents movement of the push rod in a proximal direction.
手柄组件可进一步包括布置于其内的棘轮组件。在使用中，当推杆没有返回到近侧位置时，可以防止该棘轮组件复位。手柄组件可进一步包括支撑在壳体组件中的计数器，其中，当手术夹子已经被发射之后，该计数器可提供指示。更进一步地，手柄组件可包括支撑在其内的指示器。指示器可提供指示事件的听觉和触觉指示中的至少一个。例如，所述事件可以是至少一个手术夹子被装入钳口中、手术夹子被发射以及所述装置被复位。The handle assembly may further include a ratchet assembly disposed therein. In use, the ratchet assembly is prevented from resetting when the push rod is not returned to the proximal position. The handle assembly may further include a counter supported in the housing assembly, wherein the counter may provide an indication when the surgical clip has been fired. Still further, the handle assembly may include an indicator supported therein. The indicator may provide at least one of an audible and tactile indication indicative of an event. For example, the event may be at least one surgical clip being loaded into the jaws, the surgical clip being fired, and the device being reset.
楔形板可进一步包括支撑在其上用于与连接板的第二部件选择性地接合的第三弹簧夹子。在使用中，在连接板的最初远侧移动之后，连接板的第二部件可以选择性地从该第三弹簧夹子脱离。The wedge plate may further include a third spring clip supported thereon for selective engagement with the second part of the web. In use, the second part of the web is selectively disengageable from the third spring clip after an initial distal movement of the web.
轴组件可包括楔形板锁。在使用中，驱动通道可以在其向远侧推进后致动楔形板锁以使楔形板向近侧移动从而使楔形板的远端从钳口退回，并且允许驱动通道接近钳口。The shaft assembly may include a wedge plate lock. In use, the drive channel may actuate the wedge plate lock after it has been advanced distally to move the wedge plate proximally to retract the distal end of the wedge plate from the jaws and allow the drive channel to approach the jaws.
轴组件可以相对于手柄组件围绕纵轴旋转。轴组件可包括支撑在壳体内的套箍，其中，该套箍在第三弹簧夹子平移跨过该套箍时防止第三弹簧夹子向外张开。The shaft assembly is rotatable about a longitudinal axis relative to the handle assembly. The shaft assembly may include a ferrule supported within the housing, wherein the ferrule prevents the third spring clip from splaying outwardly as the third spring clip translates across the ferrule.
楔形板和/或驱动通道可被偏置到近侧位置。The wedge plate and/or drive channel can be biased to a proximal position.
附图说明Description of drawings
通过结合附图的下列详细描述，本施夹器将被更全面地认识并变得更好理解，在附图中：The present clip applier will be more fully appreciated and better understood by the following detailed description taken in conjunction with the accompanying drawings, in which:
图1是根据本公开的一个实施方式的手术施夹器的前视立体图；Figure 1 is a front perspective view of a surgical clip applier according to one embodiment of the present disclosure;
图2是图1所示的施夹器的后视立体图，图示了其轴组件的旋转；Figure 2 is a rear perspective view of the clip applier shown in Figure 1 illustrating rotation of its shaft assembly;
图3是图1和图2所示的施夹器的轴组件的远端的前视立体图；3 is a front perspective view of the distal end of the shaft assembly of the clip applier shown in FIGS. 1 and 2;
图4是图1和图2所示的施夹器的俯视图；Fig. 4 is the top view of clip applier shown in Fig. 1 and Fig. 2;
图5是图1和图2所示的施夹器的侧面正视图；Figure 5 is a side elevational view of the clip applier shown in Figures 1 and 2;
图6是图1至图5所示的施夹器的手柄组件的立体图，图示了左半壳体被从其中移走的情况；6 is a perspective view of the handle assembly of the clip applier shown in FIGS. 1-5, illustrating the left half-shell being removed therefrom;
图7是图1至图5所示的施夹器的手柄组件的立体图，图示了右半壳体被从其中移走的情况；7 is a perspective view of the handle assembly of the clip applier shown in FIGS. 1-5, illustrating the right half-shell being removed therefrom;
图8是图1至图5所示的施夹器的手柄组件的部件分解的立体图；8 is an exploded perspective view of the handle assembly of the clip applier shown in FIGS. 1-5;
图8A是图6至图8所示的手柄组件在扳机被从其中移走的情况下的立体图；8A is a perspective view of the handle assembly shown in FIGS. 6-8 with the trigger removed therefrom;
图8B是图6至图8所示的手柄组件的反馈构件的立体图；8B is a perspective view of the feedback member of the handle assembly shown in FIGS. 6-8;
图9是图1至图5所示的施夹器的轴组件的部件分解的立体图；9 is an exploded perspective view of the shaft assembly of the clip applier shown in FIGS. 1-5;
图10是图9所示的轴组件的右侧前视立体图，示出了装配的情况；Figure 10 is a right side front perspective view of the shaft assembly shown in Figure 9, shown assembled;
图11是图10中显示的细节表示区域的放大视图；Figure 11 is an enlarged view of the detail representation area shown in Figure 10;
图12是图9至图11所示的轴组件的右侧前视图，示出了上壳体被从其中移走的情况；Figure 12 is a right side front view of the shaft assembly shown in Figures 9-11, showing the upper housing removed therefrom;
图13是图12中显示的细节表示区域的放大视图；Figure 13 is an enlarged view of the detail representation area shown in Figure 12;
图14是图12中显示的细节表示区域的放大视图；Figure 14 is an enlarged view of the detail representation area shown in Figure 12;
图15是图12中显示的细节表示区域的放大视图；Figure 15 is an enlarged view of the detail representation area shown in Figure 12;
图16是图9至15所示的轴组件的推杆的近端以及弹簧夹子（snap clip）的部件分解的立体图；16 is an exploded perspective view of the proximal end of the push rod and the snap clip of the shaft assembly shown in FIGS. 9 to 15;
图17是图9至图15所示轴组件的仰视图，图示了推杆的近端以及布置在上壳体中的弹簧夹子；Figure 17 is a bottom view of the shaft assembly shown in Figures 9-15, illustrating the proximal end of the push rod and the spring clip disposed in the upper housing;
图18是图9至图17所示的轴组件的右侧前视立体图，示出了上壳体和推杆被从其中移走的情况；Figure 18 is a right side front perspective view of the shaft assembly shown in Figures 9-17, showing the upper housing and pushrod removed therefrom;
图19是图18中显示的细节表示区域的放大视图；Figure 19 is an enlarged view of the detail representation area shown in Figure 18;
图20是图18中显示的细节表示区域的放大视图；Figure 20 is an enlarged view of the detail representation area shown in Figure 18;
图21是图9至图20所示的轴组件的右侧前视立体图，示出了上壳体、推杆和推进板被从其中移走的情况；Figure 21 is a right side front perspective view of the shaft assembly shown in Figures 9-20, showing the upper housing, push rod and push plate removed therefrom;
图22是图21中显示的细节表示区域的放大视图；Figure 22 is an enlarged view of the detail representation area shown in Figure 21;
图23是夹子输出器以及闭锁板的部件分解的立体图；Figure 23 is an exploded perspective view of the clip follower and the locking plate;
图23A是图23所示的夹子输出器以及闭锁板装配完毕后的俯视立体图；Fig. 23A is a top perspective view after the clip output device and the locking plate shown in Fig. 23 are assembled;
图24是图23所示的夹子输出器的仰视立体图；Figure 24 is a bottom perspective view of the clip follower shown in Figure 23;
图25是图9至图23所示的轴组件的远端的右侧前视立体图，示出了上壳体、推杆、推进板以及夹子载体被从其中移走的情况；25 is a right side front perspective view of the distal end of the shaft assembly shown in FIGS. 9-23 , showing the upper housing, push rod, pusher plate, and clip carrier removed therefrom;
图26是图25所示的轴组件的远端的右侧前视立体图，示出了上壳体、推杆、推进板、夹子载体以及驱动通道被从其中移走的情况；26 is a right side front perspective view of the distal end of the shaft assembly shown in FIG. 25, showing the upper housing, push rod, pusher plate, clip carrier, and drive channel removed therefrom;
图27是图9至图26所示的轴组件的左侧前视立体图，示出了上壳体、推杆、推进板、夹子载体、驱动通道以及楔形板被从其中移走的情况；27 is a left side front perspective view of the shaft assembly shown in FIGS. 9-26 showing the upper housing, push rod, pusher plate, clip carrier, drive channel, and wedge plate removed therefrom;
图28是图27中显示的细节表示区域的放大视图；Figure 28 is an enlarged view of the detail representation area shown in Figure 27;
图29是图27中显示的细节表示区域的放大视图；Figure 29 is an enlarged view of the detail representation area shown in Figure 27;
图30是图9至29所示的轴组件的下壳体的左侧前视立体图；30 is a left side front perspective view of the lower housing of the axle assembly shown in FIGS. 9-29;
图31是图30中显示的细节表示区域的放大视图；Figure 31 is an enlarged view of the detail representation area shown in Figure 30;
图31A是图30中显示的细节表示区域的放大视图；Figure 31A is an enlarged view of the detail representation area shown in Figure 30;
图32是图1至31A所示的施夹器的纵向截面图，图示了处于未致动状态下的施夹器；32 is a longitudinal cross-sectional view of the clip applier shown in FIGS. 1-31A, illustrating the clip applier in an unactuated state;
图33是图32中显示的细节表示区域的放大视图；Figure 33 is an enlarged view of the detail representation area shown in Figure 32;
图34是图1至图31A所示的施夹器的轴组件的远端的纵向截面图；34 is a longitudinal cross-sectional view of the distal end of the shaft assembly of the clip applier shown in FIGS. 1-31A;
图35是沿图34中的35-35截取的截面图；Figure 35 is a cross-sectional view taken along line 35-35 in Figure 34;
图36是图34中显示的细节表示区域的放大视图；Figure 36 is an enlarged view of the detail representation area shown in Figure 34;
图37是沿图36中的37-37截取的截面图；Figure 37 is a cross-sectional view taken along line 37-37 in Figure 36;
图38是图34中显示的细节表示区域的放大视图；Figure 38 is an enlarged view of the detail representation area shown in Figure 34;
图39是沿图38中的39-39截取的截面图；Figure 39 is a cross-sectional view taken along line 39-39 in Figure 38;
图40是图34中显示的细节表示区域的放大视图；Figure 40 is an enlarged view of the detail representation area shown in Figure 34;
图41是沿图40中的41-41截取的截面图；Figure 41 is a cross-sectional view taken along line 41-41 in Figure 40;
图42是图34中显示的细节表示区域的放大视图；Figure 42 is an enlarged view of the detail representation area shown in Figure 34;
图43是沿图42中的43-43线截取的截面图；Figure 43 is a cross-sectional view taken along line 43-43 in Figure 42;
图44是图1至43所示的施夹器在最初致动期间的纵向截面图；44 is a longitudinal cross-sectional view of the clip applier shown in FIGS. 1-43 during initial actuation;
图45是图44中显示的细节表示区域的放大视图；Figure 45 is an enlarged view of the detail representation area shown in Figure 44;
图46是图34中显示的细节表示区域36的在施夹器的最初致动期间的放大视图；FIG. 46 is an enlarged view of the detail showing area 36 shown in FIG. 34 during initial actuation of the clip applier;
图47是图34中显示的细节表示区域40的在施夹器的最初致动期间的放大视图；FIG. 47 is an enlarged view of the detail showing area 40 shown in FIG. 34 during initial actuation of the clip applier;
图47A是推杆的俯视图，图示了推杆在施夹器的最初致动期间的移动；47A is a top view of the push rod illustrating movement of the push rod during initial actuation of the clip applier;
图47B和图47C均是轴组件的纵向截面图，图示了在施夹器的最初致动期间楔形板的移动；47B and 47C are each longitudinal cross-sectional views of the shaft assembly illustrating movement of the wedge plate during initial actuation of the clip applier;
图48和图49是在施夹器的最初驱动期间轴组件沿图40中41-41截取的截面的放大视图；48 and 49 are enlarged views of a section of the shaft assembly taken at 41-41 in FIG. 40 during initial actuation of the clip applier;
图50是在施夹器的最初致动期间图34中显示的细节表示区域42的放大视图；Figure 50 is an enlarged view of the detail showing region 42 shown in Figure 34 during initial actuation of the clip applier;
图51是在施夹器的最初致动期间轴组件的远端的左侧仰视立体图；51 is a left bottom perspective view of the distal end of the shaft assembly during initial actuation of the clip applier;
图52至图54均是轴组件的纵向截面图，图示了在施夹器的最初致动期间楔形板的进一步移动，以及连接板的杆从楔形板的弹簧夹子的脱离；52-54 are each longitudinal cross-sectional views of the shaft assembly illustrating further movement of the wedge plate during initial actuation of the clip applier, and disengagement of the rod of the connecting plate from the spring clip of the wedge plate;
图55是图1至图54所示的施夹器的纵向截面图，图示了在进一步致动期间的施夹器；55 is a longitudinal cross-sectional view of the clip applier shown in FIGS. 1-54 illustrating the clip applier during further actuation;
图56是图55中显示的细节表示区域的放大视图；Figure 56 is an enlarged view of the detail representation area shown in Figure 55;
图56A是移去上壳体的轴组件的右视立体图，图示了在施夹器的进一步致动期间推杆的移动；56A is a right perspective view of the shaft assembly with the upper housing removed, illustrating movement of the push rod during further actuation of the clip applier;
图56B和图56C均是推进板的仰视图，图示了在施夹器的进一步致动期间推进板的移动；56B and 56C are each a bottom view of the pusher plate illustrating movement of the pusher plate during further actuation of the clip applier;
图57是在施夹器的进一步致动期间图34中显示的细节表示区域36的放大视图；Figure 57 is an enlarged view of the detail showing region 36 shown in Figure 34 during further actuation of the clip applier;
图58是在施夹器的进一步致动期间图34中显示的细节表示区域40施夹器的放大视图；FIG. 58 is an enlarged view of the clip applier in the detail showing region 40 shown in FIG. 34 during further actuation of the clip applier;
图59和图60是轴组件的纵向截面图，图示了在施夹器的进一步致动期间推杆的移动以及支撑在推杆上的夹子与上壳体的凸台的连接；59 and 60 are longitudinal cross-sectional views of the shaft assembly illustrating movement of the push rod and connection of the clip supported on the push rod to the boss of the upper housing during further actuation of the clip applier;
图61是在施夹器的进一步致动期间图34中显示的细节表示区域40的放大视图；Figure 61 is an enlarged view of the detail showing region 40 shown in Figure 34 during further actuation of the clip applier;
图62是在施夹器的进一步致动期间图34中显示的细节表示区域42的放大视图；Figure 62 is an enlarged view of the detail showing region 42 shown in Figure 34 during further actuation of the clip applier;
图63是轴组件的纵向截面图，图示了在施夹器的进一步致动期间驱动杆的移动；63 is a longitudinal cross-sectional view of the shaft assembly illustrating movement of the drive rod during further actuation of the clip applier;
图64和图65是在施夹器的进一步致动期间轴组件沿图40中41-41截取的截面的放大视图；64 and 65 are enlarged views of a section of the shaft assembly taken at 41-41 in FIG. 40 during further actuation of the clip applier;
图66是在施夹器的进一步致动期间轴组件的远端的俯视左侧立体图；66 is a top left perspective view of the distal end of the shaft assembly during further actuation of the clip applier;
图67至图69是轴组件的纵向截面图，图示了在施夹器的进一步致动期间连接板的移动；67-69 are longitudinal cross-sectional views of the shaft assembly illustrating movement of the connecting plate during further actuation of the clip applier;
图67A至图69A是根据本公开的另一可选实施方式的轴组件的纵向截面图，图示了在施夹器的进一步致动期间连接板的移动；67A-69A are longitudinal cross-sectional views of a shaft assembly illustrating movement of the connecting plate during further actuation of the clip applier, according to another alternative embodiment of the present disclosure;
图70是图1至图69所示的施夹器在最后的致动期间的纵向截面图；70 is a longitudinal cross-sectional view of the clip applier shown in FIGS. 1-69 during final actuation;
图71是图70中显示的细节表示区域的放大视图；Figure 71 is an enlarged view of the detail representation area shown in Figure 70;
图72是在施夹器的最后致动期间图34中显示的细节表示区域42的放大视图；FIG. 72 is an enlarged view of the detail showing region 42 shown in FIG. 34 during final actuation of the clip applier;
图73和图74是轴组件的远端的前视立体图，图示了在施夹器的最后致动期间钳口的致动；73 and 74 are front perspective views of the distal end of the shaft assembly illustrating actuation of the jaws during final actuation of the clip applier;
图75是图示了施加到脉管上的手术夹子的立体图；Figure 75 is a perspective view illustrating a surgical clip applied to a vessel;
图76是在施夹器的扳机被松开时图70中显示的细节表示区域71的放大视图；Figure 76 is an enlarged view of the detail showing area 71 shown in Figure 70 when the trigger of the clip applier is released;
图76A是在扳机在其完全致动后松开时手柄组件的侧面正视图；Figure 76A is a side elevational view of the handle assembly when the trigger is released after its full actuation;
图77是轴组件的纵向截面图，图示了在扳机松开期间连接板的移动；Figure 77 is a longitudinal sectional view of the shaft assembly illustrating movement of the connecting plate during trigger release;
图78是轴组件的纵向截面图，图示了在扳机的松开期间推杆的移动以及支撑在推杆上的夹子从上壳体的凸台的脱开；Figure 78 is a longitudinal sectional view of the shaft assembly illustrating movement of the push rod and disengagement of the clip supported on the push rod from the boss of the upper housing during release of the trigger;
图79是移去上壳体的轴组件的右视立体图，图示了在扳机的松开期间推杆的移动；Figure 79 is a right perspective view of the shaft assembly with the upper housing removed, illustrating movement of the push rod during release of the trigger;
图80是在扳机松开期间图34中显示的细节表示区域40的放大视图；Figure 80 is an enlarged view of the detail showing area 40 shown in Figure 34 during trigger release;
图81是轴组件的纵向截面图，图示了在扳机松开期间连接板的杆再次连接到推杆的弹簧夹子上；Figure 81 is a longitudinal sectional view of the shaft assembly illustrating the reconnection of the rod of the connecting plate to the spring clip of the push rod during trigger release;
图82至图83均是轴组件的纵向截面图，图示了在扳机松开期间楔形板的进一步移动以及连接板的杆与楔形板的弹簧夹子上的再次接合；Figures 82 to 83 are each longitudinal cross-sectional views of the shaft assembly illustrating further movement of the wedge plate and re-engagement of the rod of the connecting plate with the spring clip of the wedge plate during trigger release;
图84是当施夹器处于闭锁状态时轴组件的远端的前视立体图；Figure 84 is a front perspective view of the distal end of the shaft assembly when the clip applier is in the locked state;
图85是当施夹器处于闭锁状态时图34显示的细节表示区域42的放大视图；以及Figure 85 is an enlarged view of the detail showing area 42 shown in Figure 34 when the clip applier is in the locked state; and
图86是当施夹器处于闭锁状态时图70显示的细节表示区域71的放大视图。Fig. 86 is an enlarged view of the detail showing area 71 shown in Fig. 70 when the clip applier is in the locked state.
具体实施方式Detailed ways
现将参照附图详细说明根据本公开的手术施夹器的实施方式，附图中相似的附图标记表示相似或相同的部件。如图所示及以下说明书通篇所描述的，按照传统，当涉及手术器械上的相对位置时，术语“近侧”指装置的靠近用户的一端，术语“远侧”指装置的远离用户的一端。Embodiments of surgical clip appliers according to the present disclosure will now be described in detail with reference to the accompanying drawings, in which like reference numerals indicate similar or identical components. As shown in the figures and described throughout the following specification, by convention, when referring to relative positions on a surgical instrument, 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 that is remote from the user. one end.
现参照图1至图5，根据本公开的一个实施例的手术施夹器总体上用100来指代。施夹器100包括手柄组件102和内窥镜部，该内窥镜部包括从手柄组件102向远侧延伸的轴组件104。Referring now to FIGS. 1-5 , a surgical clip applier is generally designated 100 in accordance with one embodiment of the present disclosure. Clip applier 100 includes a handle assembly 102 and an endoscopic portion including a shaft assembly 104 extending distally from handle assembly 102 .
轴组件104具有约10mm的外径。取决于预计的用途诸如肥胖病手术，轴组件104可以具有各种伸长的或缩短的长度。Shaft assembly 104 has an outer diameter of about 10 mm. Shaft assembly 104 may have various lengths, elongated or shortened, depending on the intended use, such as bariatric surgery.
如图1至图5所示，手术施夹器100包括安装在轴组件104的远端并可由手柄组件102的扳机108致动的一对钳口106。一对钳口106由合适的生物相容的材料诸如不锈钢或钛制成，该一对钳口限定了在其之间用于将手术夹子“C”容纳在其中的通道106a。当一对钳口106处于相对于彼此打开或非接近的状态时，测得一对钳口106的宽度大于轴组件104的外径。As shown in FIGS. 1-5 , surgical clip applier 100 includes a pair of jaws 106 mounted at the distal end of shaft assembly 104 and actuatable by trigger 108 of handle assembly 102 . A pair of jaws 106, made of a suitable biocompatible material such as stainless steel or titanium, define a channel 106a therebetween for receiving a surgical clip "C" therein. The width of the pair of jaws 106 is measured to be greater than the outer diameter of the shaft assembly 104 when the pair of jaws 106 are in an open or non-proximate state relative to each other.
一对钳口106安装于轴组件104的远端以使它们相对该处纵向固定。旋钮110可以可旋转地安装在手柄组件102的远端，并连接于轴组件104以向轴组件104和一对钳口106传输和/或提供绕其纵轴的360°旋转（参见图2）。A pair of jaws 106 are mounted to the distal end of the shaft assembly 104 such that they are longitudinally fixed relative thereto. Knob 110 may be rotatably mounted at the distal end of handle assembly 102 and coupled to shaft assembly 104 to transmit and/or provide 360° rotation about its longitudinal axis to shaft assembly 104 and pair of jaws 106 (see FIG. 2 ) .
现参照图1至图8，示出了手术施夹器100的手柄组件102。手柄组件102包括壳体103，该壳体具有第一或右侧半部103a和第二或左侧半部103b。手柄组件102包括可枢转地支撑在右侧半部103a和左侧半部103b之间的扳机108。如以下将更详细讨论的，手柄组件102限定了形成于壳体103中的用于支撑和显示计数机构的窗口103c。手柄组件102的壳体103可由合适的塑料制成。Referring now to FIGS. 1-8 , a handle assembly 102 of a surgical clip applier 100 is shown. The handle assembly 102 includes a housing 103 having a first or right half 103a and a second or left half 103b. The handle assembly 102 includes a trigger 108 pivotally supported between a right half 103a and a left half 103b. As will be discussed in greater detail below, the handle assembly 102 defines a window 103c formed in the housing 103 for supporting and displaying the counting mechanism. The housing 103 of the handle assembly 102 may be made of suitable plastic.
壳体103将驱动组件120支撑在右侧半部103a和左侧半部103b之间。驱动组件120包括叉形连杆122，该叉形连杆具有枢转地连接于扳机108的第一端和枢转地连接于曲柄板124的第二端。如图6至图9所示，驱动组件120进一步包括可旋转地连接于曲柄板124的驱动连接器134、与驱动连接器134相互连接的柱塞135和支撑在驱动连接器134上的弹簧136。柱塞135限定了纵向狭槽135a，该纵向狭槽配置成并适于将驱动杆140的近端容纳在其中。The housing 103 supports the drive assembly 120 between the right half 103a and the left half 103b. Drive assembly 120 includes a yoke link 122 having a first end pivotally connected to trigger 108 and a second end pivotally connected to crank plate 124 . As shown in FIGS. 6 to 9 , the drive assembly 120 further includes a drive connector 134 rotatably connected to the crank plate 124 , a plunger 135 interconnected with the drive connector 134 and a spring 136 supported on the drive connector 134 . Plunger 135 defines a longitudinal slot 135a configured and adapted to receive the proximal end of drive rod 140 therein.
驱动杆140通过整体销135b连接于柱塞135（参见图9）。设置了帽144，柱塞135贯穿该帽。设置密封件（seal）（未示出）来建立柱塞135和外管150之间的气密性密封。The drive rod 140 is connected to the plunger 135 by an integral pin 135b (see FIG. 9 ). A cap 144 is provided through which the plunger 135 passes. A seal (not shown) is provided to establish an airtight seal between the plunger 135 and the outer tube 150 .
如图6至图8所示，手柄组件102进一步包括形成于曲柄板124中/上的齿条124a以便齿条124a可随曲柄板124移动。齿条124a包括置于曲柄板124中限定的远侧凹槽124b和近侧凹槽124c之间的多个齿。设置凹槽124b和124c以允许棘爪224翻转并当曲柄板124在近侧和远侧移动之间变化时提升至齿条124a的齿上。As shown in FIGS. 6-8 , the handle assembly 102 further includes a rack 124 a formed in/on the crank plate 124 so that the rack 124 a can move with the crank plate 124 . Rack 124a includes a plurality of teeth interposed between a distal groove 124b and a proximal groove 124c defined in crank plate 124 . Recesses 124b and 124c are provided to allow pawl 224 to flip over and lift onto the teeth of rack 124a as crank plate 124 changes between proximal and distal movement.
手柄组件102进一步包括棘爪224，在棘爪224与曲柄板124的齿条124a大体上操作的接合的位置处，棘爪224通过棘爪销226枢转地连接于壳体103。棘爪224包括棘爪齿224a，该棘爪齿可选择地与曲柄板124的齿条124a的齿接合。棘爪齿224a可与齿条齿接合以限制齿条124a并且依次地限制曲柄板124在手柄组件102内的纵向移动。设置爪簧228以使棘爪224偏入到与曲柄板124的齿条124a操作的接合。The handle assembly 102 further includes a pawl 224 pivotally connected to the housing 103 by a pawl pin 226 at a position where the pawl 224 is in substantially operative engagement with the rack 124a of the crank plate 124 . The pawl 224 includes pawl teeth 224 a that selectively engage the teeth of the rack 124 a of the crank plate 124 . The pawl teeth 224a are engageable with the rack teeth to limit the longitudinal movement of the rack 124a and, in turn, the crank plate 124 within the handle assembly 102 . A claw spring 228 is provided to bias the pawl 224 into operative engagement with the rack 124 a of the crank plate 124 .
如图6至图8所示，曲柄板124通过销123可枢转地连接于叉形连杆122。曲柄板124限定了形成于其中的一系列棘轮齿124a以与棘爪224选择的接合。As shown in FIGS. 6-8 , the crank plate 124 is pivotally connected to the wishbone link 122 by a pin 123 . Crank plate 124 defines a series of ratchet teeth 124 a formed therein for selective engagement with pawl 224 .
如图8、图8A和图8B所示，手柄组件102进一步包括听觉/触觉反馈构件126，该反馈构件与扳机108操作地相关以便与其一起旋转并且当扳机108致动时绕着共同的轴旋转。反馈构件126限定了滚道126a，滚道126a限定了多个棘轮齿或梯级126b。设置有可偏转臂127，该可偏转臂包括操作的连接或布置在反馈元件126的滚道126a中并与梯级126b接触的第一端和连接于壳体103的第二端。在操作中，当致动扳机108时，臂127通过和/或沿着形成于反馈构件126中的滚道126a移动。如以下将更详细讨论的，随着臂127在反馈构件126的梯级126b上移动，臂127弹锁住梯级126b，并产生可听到的声音/喀哒声和/或可感觉到的振动。As shown in FIGS. 8 , 8A and 8B, the handle assembly 102 further includes an audible/tactile feedback member 126 operatively associated with the trigger 108 for rotation therewith and about a common axis when the trigger 108 is actuated. . Feedback member 126 defines a raceway 126a that defines a plurality of ratchet teeth or steps 126b. A deflectable arm 127 is provided comprising a first end operatively connected or arranged in raceway 126a of feedback element 126 and in contact with step 126b and a second end connected to housing 103 . In operation, when the trigger 108 is actuated, the arm 127 moves through and/or along the raceway 126a formed in the feedback member 126 . As will be discussed in more detail below, as the arm 127 moves over the step 126b of the feedback member 126, the arm 127 snaps onto the step 126b and produces an audible sound/click and/or a palpable vibration.
听觉/触觉反馈构件126包括足够的梯级126b以便在夹子已经被完全装入手术施夹器100的钳口中后、在装入的夹子已经由手术施夹器100钳口形成后、并且当手术施夹器100被复位到原位并准备发射/形成另一夹子时产生听觉/触觉指示。The audible/tactile feedback member 126 includes sufficient steps 126b so that after the clip has been fully loaded into the jaws of the surgical clip applier 100, after the loaded clip has been formed by the jaws of the surgical clip applier 100, and when the surgical applier An audible/tactile indication is generated when the clipper 100 is reset to its original position and is ready to fire/form another clip.
如图6、图7、图8和图8A所示，手术施夹器100的手柄组件102进一步包括支撑在壳体103中并通过限定在壳体103中的窗口103c可见的计数机构132。计数机构132包括显示器132a、处理器132b和使用电池等形式的能源（未示出）。As shown in FIGS. 6 , 7 , 8 and 8A , the handle assembly 102 of the surgical clip applier 100 further includes a counting mechanism 132 supported in the housing 103 and visible through a window 103c defined in the housing 103 . The counting mechanism 132 includes a display 132a, a processor 132b and uses an energy source in the form of a battery (not shown).
显示器132a可以是本领域已知的任何器件以提供事件的指示。事件可以涉及施夹器100的程序或操作。显示器132a是液晶显示器（LCD）。Display 132a may be any device known in the art to provide an indication of an event. Events may relate to procedures or operations of clip applier 100 . The display 132a is a liquid crystal display (LCD).
显示器132a向外科医生显示施夹器100的一个或多个操作参数。由显示器132a显示的操作参数包括剩下的夹子的数量（amount）或数目（number）、已经使用的夹子的数目、位置参数、使用的手术时间或程序的任何其它参数。Display 132a displays one or more operating parameters of clip applier 100 to the surgeon. The operating parameters displayed by the display 132a include the amount or number of clips remaining, the number of clips already used, positional parameters, operative time used, or any other parameter of the procedure.
在电池或能源和处理器132b的触头之间布置聚酯薄膜（Mylar）或另一聚合绝缘材料，该材料防止电池或能源在存储过程中被耗尽。凸起从手术施夹器100的壳体103伸出以允许凸起易于从那里移开。一旦凸起被移开，电池或能源与处理器132b的触头电接触，而使显示器132a通电。Mylar or another polymeric insulating material is disposed between the battery or energy source and the contacts of the processor 132b, which prevents the battery or energy source from being drained during storage. The protrusion protrudes from the housing 103 of the surgical clip applier 100 to allow the protrusion to be easily removed therefrom. Once the protrusion is removed, the battery or power source makes electrical contact with the contacts of the processor 132b, energizing the display 132a.
如图6、图7、图8和图8A所示，手术施夹器100的手柄组件102进一步包括计数致动机构，该机构包括具有配置成并适于操作地、选择性地接合计数机构132的处理器132b的计数致动杠杆130。计数致动杠杆130进一步包括第二臂130b，该臂配置成并适于操作地、可滑动地接合形成在致动板128中的狭槽128a，致动板128可滑动地支撑在壳体103中。As shown in FIGS. 6 , 7 , 8 and 8A, the handle assembly 102 of the surgical clip applier 100 further includes a counting actuation mechanism comprising a counting mechanism 132 configured and adapted to operatively and selectively engage The count of the processor 132b actuates the lever 130 . Counting actuation lever 130 further includes a second arm 130b configured and adapted to operatively and slidably engage slot 128a formed in actuation plate 128 slidably supported in housing 103 middle.
在操作中，如以下将更详细说明的，随着扳机108被挤压，扳机108使得叉形连杆122向远侧推进，使得曲柄板124向远侧推进。当曲柄板124的臂124d推进预定距离时，臂124d接合或接触致动板128的指部128b。随着曲柄板124进一步向远侧推进，曲柄板124向远侧方向推动或拉动触发板128，从而致动计数致动杠杆130以致动计数机构132。In operation, as will be described in more detail below, as the trigger 108 is squeezed, the trigger 108 advances the fork link 122 distally, causing the crank plate 124 to advance distally. When the arm 124d of the crank plate 124 is advanced a predetermined distance, the arm 124d engages or contacts the finger 128b of the actuation plate 128 . As crank plate 124 is advanced further distally, crank plate 124 pushes or pulls trigger plate 128 in the distal direction, thereby actuating count actuation lever 130 to actuate count mechanism 132 .
特别地，当致动板128向远侧移动足够的距离时，在其狭槽128b内用凸轮带动计数致动杠杆130的第二臂130b并使计数致动杠杆130旋转导致第一臂130a旋转。当致动板128向近侧移动足够的距离时，计数致动杠杆130的第二臂130b返回原位，导致计数致动杠杆130的第一臂130a脱离计数机构132。In particular, when the actuating plate 128 moves far enough to the far side, the second arm 130b of the counting actuation lever 130 is cammed within its slot 128b and the rotation of the counting actuation lever 130 causes the first arm 130a to rotate. . When the actuation plate 128 moves proximally a sufficient distance, the second arm 130b of the counting actuation lever 130 returns to its original position, causing the first arm 130a of the counting actuation lever 130 to disengage from the counting mechanism 132 .
现转至图9至图31A，手术施夹器100的轴组件104被示出并在下文中加以描述。轴组件104及其组件可由合适的生物相容的材料诸如不锈钢、钛、塑料等制成。轴组件104包括外管150，外管150具有支撑在壳体103内的近端150a、远端150b和贯穿其中的内腔150c。外管150通过从其外表面突出的凸缘被固定在壳体103内。轴组件104进一步包括均布置在外管150的内腔150c内的上壳体152a和下壳体152b。后部上壳体154布置在外管150内和上壳体152a的近侧。Turning now to FIGS. 9-31A , the shaft assembly 104 of the surgical clip applier 100 is shown and described below. Shaft assembly 104 and its components may be fabricated from suitable biocompatible materials such as stainless steel, titanium, plastic, and the like. Shaft assembly 104 includes an outer tube 150 having a proximal end 150a supported within housing 103, a distal end 150b, and a lumen 150c extending therethrough. The outer tube 150 is secured within the housing 103 by flanges protruding from its outer surface. The shaft assembly 104 further includes an upper housing 152a and a lower housing 152b each disposed within the inner cavity 150c of the outer tube 150 . Rear upper housing 154 is disposed within outer tube 150 and proximally of upper housing 152a.
如图9、图12和图13所示，轴组件104进一步包括可滑动地布置在上壳体152a和后部上壳体154内的推杆156。推杆156包括限定了窄形推动器156c的远端156a，推动器156c配置成并适于选择性地接合/移动（即向远侧推进）一堆夹子“C”的最远侧的夹钳“C1”，并在其最初形成期间与最远侧的夹钳“C1”保持接触。推杆156进一步包括近端156b。推杆156限定了具有窗钩156e的远侧窗口156d、位于远侧窗口156d的近侧并形成在其每侧边缘的一对凹槽156f、位于侧凹槽156f的近侧的细长狭槽156g和位于狭槽156g的近侧的最近侧窗口156h。As shown in FIGS. 9 , 12 and 13 , the shaft assembly 104 further includes a push rod 156 slidably disposed within the upper housing 152 a and the rear upper housing 154 . The push rod 156 includes a distal end 156a defining a narrow pusher 156c configured and adapted to selectively engage/move (i.e., advance distally) the distal-most jaw of the stack "C" "C1", and remains in contact with the most distal clamp "C1" during its initial formation. The push rod 156 further includes a proximal end 156b. The push rod 156 defines a distal window 156d having a window hook 156e, a pair of grooves 156f proximal to the distal window 156d and formed in each side edge thereof, an elongated slot proximal to the side grooves 156f 156g and a proximal-most window 156h located proximally of the slot 156g.
如图9和图14所示，推杆156在侧凹槽156f的远侧位置处沿着推杆156的上表面支撑第一弹簧夹子157a。第一弹簧夹子157a以这样的方式配置：其尖头突出或与推杆156的上表面间隔一定量。As shown in Figures 9 and 14, the push rod 156 supports the first spring clip 157a along the upper surface of the push rod 156 at a location distal to the side groove 156f. The first spring clip 157a is configured in such a way that its prong protrudes or is spaced a certain amount from the upper surface of the push rod 156 .
如图9和图15所示，推杆156在其最近侧窗口156h的近侧位置处沿着推杆156的下表面支撑第二弹簧夹子157b。第二弹簧夹子157b以这样的方式定位：其尖头突出足以压在推杆156的最近侧窗口156h上的量。第二弹簧夹子157b的尖头彼此隔开一定量，该量小于推杆156的最近侧窗口156h的宽度。As shown in FIGS. 9 and 15 , the push rod 156 supports the second spring clip 157b along the lower surface of the push rod 156 at a position proximal to its proximal-most window 156h. The second spring clip 157b is positioned in such a way that its prong protrudes a sufficient amount to press against the proximal-most window 156h of the push rod 156 . The prongs of the second spring clip 157b are spaced apart from each other by an amount that is less than the width of the proximal-most window 156h of the push rod 156 .
如图9和图16至图20所示，轴组件104进一步包括可往复运动地支撑在推杆156下方的推进板162。如图16和图17所示，第四弹簧夹子157d支撑在推进板162的近端。弹簧夹子157d包括一对尖头，该尖头可拆卸地连接于形成于上壳体152a中的近侧保持槽152m和远侧保持槽152n。这样，在使用中，弹簧夹子157d可拆卸地接合保持槽152m和远侧保持槽152n以使推进板162保持在近侧或远侧位置。在推进板162向远侧推进时，用凸轮向内带动弹簧夹子157d的尖头并使得推进板162继续向远侧移动。As shown in FIGS. 9 and 16-20 , the shaft assembly 104 further includes a pusher plate 162 reciprocally supported below the push rod 156 . As shown in FIGS. 16 and 17 , the fourth spring clip 157d is supported on the proximal end of the pusher plate 162 . The spring clip 157d includes a pair of prongs that are detachably connected to a proximal retaining groove 152m and a distal retaining groove 152n formed in the upper housing 152a. Thus, in use, the spring clip 157d releasably engages the retaining slot 152m and the distal retaining slot 152n to retain the pusher plate 162 in either the proximal or the distal position. As the pusher plate 162 is advanced distally, the prongs of the spring clips 157d are cammed inwardly and the pusher plate 162 continues to move distally.
如图18至图20所示，推进板162包括形成于其中并沿着其长度延伸的一系列窗口162a。如图19所示，每个窗口162a限定了近侧边缘，该边缘在推进板162的表面下方延伸以便限定唇缘或凸耳162c。推进板162进一步包括一对侧翼片162b，该侧翼片从其侧边缘在朝着上壳体152a的方向上延伸。如图15所示，一对侧翼片162b可滑动地布置在推杆156的侧凹槽156f中。As shown in Figures 18-20, the pusher plate 162 includes a series of windows 162a formed therein and extending along its length. As shown in FIG. 19, each window 162a defines a proximal edge that extends below the surface of the pusher plate 162 to define a lip or lug 162c. The pusher plate 162 further includes a pair of side flaps 162b extending from side edges thereof in a direction toward the upper housing 152a. As shown in FIG. 15 , a pair of side wings 162 b are slidably disposed in side grooves 156 f of push rod 156 .
如图9和图21至图22所示，轴组件104进一步包括布置在上壳体152a中并位于推进板162下方的夹子载体164。夹子载体164一般是具有上壁、一对侧壁和限定通过其的通道的下壁的盒状结构。夹子载体164包括形成于下壁中并沿着其长度纵向延伸的多个隔开的窗口164a（参见图9）。夹子载体164包括形成于上壁中并沿着其长度纵向延伸的细长窗口。As shown in FIGS. 9 and 21 - 22 , the shaft assembly 104 further includes a clip carrier 164 disposed in the upper housing 152 a below the pusher plate 162 . Clip carrier 164 is generally a box-like structure having an upper wall, a pair of side walls, and a lower wall defining a passage therethrough. Clip carrier 164 includes a plurality of spaced apart windows 164a formed in the lower wall and extending longitudinally along its length (see FIG. 9 ). Clip carrier 164 includes an elongated window formed in the upper wall and extending longitudinally along its length.
如图9和图21所示，一堆手术夹子“C”被以便于在其中和/或沿其滑动的方式装入和/或保持在夹子载体164的通道中。夹子载体164的通道配置并定尺寸成以头对尾的方式可滑动地保持一堆或多个手术夹子“C”。As shown in FIGS. 9 and 21 , a stack of surgical clips "C" is loaded and/or retained in the channel of the clip carrier 164 in a manner to facilitate sliding therein and/or therealong. The channels of clip carrier 164 are configured and dimensioned to slidably hold a stack or multiple surgical clips "C" in an end-to-end fashion.
如图19所示，夹子载体164的远端包括一对隔开的弹性柄脚164b。柄脚164b配置成并适于可拆卸地接合保持在夹子载体164内的该堆手术夹子“C”的最远侧手术夹子“C1”的后跨部（backspan）。As shown in FIG. 19, the distal end of the clip carrier 164 includes a pair of spaced apart resilient tangs 164b. Tang 164b is configured and adapted to releasably engage the backspan of the distal-most surgical clip “C1 ” of the stack of surgical clips “C” held within clip carrier 164 .
如图9和图21至图24所示，施夹器100的轴组件104进一步包括可滑动地布置在夹子载体164的通道内的夹子输出器166。如以下将更详细说明的，夹子输出器166位于该堆手术夹子“C”的后方并设置为在施夹器100的致动期间向前推动该堆夹子“C”。如将在下文中更详细说明的，夹子输出器166通过推进板162的向前和向后往复移动来致动。As shown in FIGS. 9 and 21-24 , the shaft assembly 104 of the clip applier 100 further includes a clip follower 166 slidably disposed within a channel of the clip carrier 164 . As will be described in greater detail below, the clip follower 166 is located behind the stack of surgical clips "C" and is configured to push the stack of clips "C" forward during actuation of the clip applier 100 . As will be described in more detail below, clip follower 166 is actuated by forward and rearward reciprocating movement of pusher plate 162 .
如图23、图23A和图24所示，夹子输出器166包括主体部166a、大体上从主体部166a向上和向后延伸的远侧凸起166b、及大体上从主体部166a向下和向后延伸的近侧凸起166c。23, 23A and 24, clip output device 166 includes a main body portion 166a, a distal projection 166b extending generally upwardly and rearwardly from main body portion 166a, and a distal protrusion 166b extending generally downwardly and outwardly from main body portion 166a. Rear extending proximal protrusion 166c.
夹子输出器166的远侧凸起166b配置并定尺寸成选择性地接合推进板162的窗口162a的凸耳162c。在使用中，随着推进板162向远侧方向推进或移动，夹子输出器166的远侧凸起166b面向推进板162的窗口162a的凸耳162c的接合使得夹子输出器166朝着远侧方向逐步推进或行进。Distal projection 166b of clip follower 166 is configured and dimensioned to selectively engage lug 162c of window 162a of pusher plate 162 . In use, as the pusher plate 162 is pushed or moved in the distal direction, engagement of the distal protrusion 166b of the clip follower 166 facing the lug 162c of the window 162a of the pusher plate 162 causes the clip follower 166 to move in the distal direction. Advance or march step by step.
近侧凸起166c配置并定尺寸成选择性地接合形成在夹子载体164中的窗口164a。在使用中，夹子输出器166的近侧凸起166c在形成夹子载体164的窗口164a中的接合防止夹子输出器166向近侧方向行进或移动。Proximal projection 166c is configured and dimensioned to selectively engage window 164a formed in clip carrier 164 . In use, engagement of the proximal protrusion 166c of the clip follower 166 in the window 164a forming the clip carrier 164 prevents advancement or movement of the clip follower 166 in a proximal direction.
夹子输出器166包括支撑在其上或可选择地与其整体形成的闭锁板165。闭锁板165包括以从夹子输出器166的主体部166a向上和向后的方向从闭锁板165延伸的弹性尾部165a，该弹性尾部限定了窗口165b。Clip follower 166 includes a latch plate 165 supported thereon or optionally integrally formed therewith. The latch plate 165 includes a resilient tail 165a extending from the latch plate 165 in an upward and rearward direction from the main body portion 166a of the clip follower 166, the resilient tail defining a window 165b.
如图9、图25和图38所示，轴组件104进一步包括在夹子载体164下方的位置处可往复运动地支撑在通道组件104中的驱动通道168。驱动通道168是大体U形的通道，该通道包括从其后跨部168c在离开夹子载体164并朝着下壳体152b的方向上延伸的一对隔开的侧壁168b。驱动通道168进一步包括在狭槽168a的近侧的位置处从后跨部168c突出并在侧壁168b的方向上延伸的凸起168d。如图41所示，驱动通道168限定了形成于侧壁168b中的一个侧壁中的狭槽或窗口168e以选择性地容纳楔形板释放装置194的齿194c。As shown in FIGS. 9 , 25 and 38 , shaft assembly 104 further includes a drive channel 168 reciprocally supported in channel assembly 104 at a location below clip carrier 164 . Drive channel 168 is a generally U-shaped channel including a pair of spaced side walls 168b extending from its rear span 168c in a direction away from clip carrier 164 and toward lower housing 152b. Drive channel 168 further includes a protrusion 168d protruding from backspan 168c at a location proximal to slot 168a and extending in the direction of sidewall 168b. As shown in FIG. 41 , the drive channel 168 defines a slot or window 168e formed in one of the side walls 168b to selectively accommodate the teeth 194c of the wedge plate release 194 .
如图9和图25所示，施夹器100的轴组件104包括固定到驱动通道168上的驱动通道带箍167。带箍167固定到驱动通道168的侧壁168b上以便横跨驱动通道168的侧壁168b横向延伸。带箍167在细长槽168a的远侧位置处固定到驱动通道168上。带箍167固定到驱动通道168上以使楔形板172在驱动通道168的后跨部168c和钳口106之间延伸。As shown in FIGS. 9 and 25 , the shaft assembly 104 of the clip applier 100 includes a drive channel band 167 secured to a drive channel 168 . Strap 167 is secured to side wall 168b of drive channel 168 so as to extend laterally across side wall 168b of drive channel 168 . Strap 167 is secured to drive channel 168 at a location distal to elongated slot 168a. Strap 167 is secured to drive channel 168 such that wedge plate 172 extends between rear span 168c of drive channel 168 and jaws 106 .
如图9、图26和图27所示，施夹器100包括安装在轴组件104上或安装在轴组件104的远端处并可由扳机108致动的一对钳口106。钳口106由合适的生物相容性材料诸如不锈钢或钛形成。As shown in FIGS. 9 , 26 and 27 , clip applier 100 includes a pair of jaws 106 mounted on or at a distal end of shaft assembly 104 and actuatable by trigger 108 . Jaws 106 are formed from a suitable biocompatible material such as stainless steel or titanium.
通过形成于下壳体152b中的与形成于钳口106中的容纳狭槽接合的凸台，将钳口106安装在邻近驱动通道168的远端，以使钳口106相对于驱动通道168保持固定。如图25所示，钳口106限定了在其之间用于将手术夹子“C”容纳在其中的通道106a。Jaws 106 are mounted adjacent the distal end of drive channel 168 by bosses formed in lower housing 152b that engage receiving slots formed in jaws 106 so that jaws 106 are retained relative to drive channel 168. fixed. As shown in FIG. 25, the jaws 106 define a channel 106a therebetween for receiving a surgical clip "C" therein.
如图9、图25和图26所示，施夹器100的轴组件104进一步包括楔形板172，楔形板172具有置于驱动通道168和钳口106之间的远端和贯穿轴组件104的近端。楔形板172包括大体锥形的远端172a以在钳口106之间选择性的操作的插入。如图26所示，楔形板172限定了从其下表面突出的翼片或凸起172b。如图22所示，楔形板172限定了形成在其中的最远侧狭槽172c以将连接板174的第二杆174c可滑动地容纳在其中。As shown in FIGS. 9 , 25 and 26 , the shaft assembly 104 of the clip applier 100 further includes a wedge plate 172 having a distal end disposed between the drive channel 168 and the jaw 106 and extending through the shaft assembly 104 . near end. Wedge plate 172 includes a generally tapered distal end 172 a for selectively operative insertion between jaws 106 . As shown in Figure 26, the wedge plate 172 defines tabs or protrusions 172b protruding from its lower surface. As shown in FIG. 22 , the wedge plate 172 defines a distal-most slot 172c formed therein to slidably receive the second rod 174c of the connecting plate 174 therein.
如图22所示，第三弹簧夹子157c支撑在楔形板172的近端处。第三弹簧夹子157c以这样的方式定位：其尖头突出足以压在形成于楔形板172中的最近侧窗口172c上的量。第三弹簧夹子157c的尖头彼此隔开一定量，该量小于楔形板172的最近侧窗口172c的宽度。As shown in FIG. 22 , the third spring clip 157c is supported at the proximal end of the wedge plate 172 . The third spring clip 157c is positioned in such a way that its prong protrudes a sufficient amount to press against the proximal-most window 172c formed in the wedge plate 172 . The prongs of the third spring clip 157c are spaced apart from each other by an amount that is less than the width of the proximal-most window 172c of the wedge plate 172 .
如图9、图18、图20和图36所示，施夹器100的轴组件104进一步包括连接板174，连接板174可滑动地置于推杆156和楔形板172之间并且可拆卸地可连接于推杆156和楔形板172中的每一个。连接板174包括锥形远端174a、从其上表面延伸的第一杆174b和从其下表面延伸的第二杆174c。杆174b、174c中的每一个均具有大体泪珠形的轮廓，其中杆174b、174c中的每一个的远端均大于其近端。As shown in FIGS. 9 , 18 , 20 and 36 , the shaft assembly 104 of the clip applier 100 further includes a connecting plate 174 , which is slidably disposed between the push rod 156 and the wedge plate 172 and detachably Each of push rod 156 and wedge plate 172 may be connected. The connecting plate 174 includes a tapered distal end 174a, a first stem 174b extending from an upper surface thereof, and a second stem 174c extending from a lower surface thereof. Each of the rods 174b, 174c has a generally teardrop-shaped profile, wherein the distal end of each of the rods 174b, 174c is larger than its proximal end.
在操作中，连接板174的第一杆174b配置并定尺寸成与固定到推杆156上的第二弹簧夹子157b可拆卸的连接，连接板174的第二杆174c配置并定尺寸成与固定到楔形板172上的第三弹簧夹子157c可拆卸的连接。In operation, the first rod 174b of the connecting plate 174 is configured and dimensioned to be detachably connected to the second spring clip 157b fixed to the push rod 156, and the second rod 174c of the connecting plate 174 is configured and dimensioned to be fixed to the push rod 156. A third spring clip 157c to the wedge plate 172 is detachably attached.
如图22、图36和图37所示，连接板174的第二杆174c延伸到限定在驱动杆140的窗口140b中。这样，随着驱动杆140往复运动，连接板174随其往复运动。As shown in FIGS. 22 , 36 and 37 , the second rod 174c of the connecting plate 174 extends into the window 140b defined in the drive rod 140 . Thus, as the drive rod 140 reciprocates, the connecting plate 174 reciprocates therewith.
如图31A所示，保护装置198被支撑在下壳体152b中在其最初远侧推进期间在便于保持第三弹簧夹子157c的尖头之间的相对距离的位置处。这样，连接板174的第二杆174b不能过早地脱离第三弹簧夹子157c直到第三弹簧夹子157c已经越过保护装置198。As shown in FIG. 31A , the guard 198 is supported in the lower housing 152b during its initial distal advancement at a location that facilitates maintaining the relative distance between the prongs of the third spring clip 157c. In this way, the second rod 174b of the connecting plate 174 cannot prematurely disengage the third spring clip 157c until the third spring clip 157c has cleared the guard 198 .
如图9、图27、图29和图41所示，施夹器100的轴组件104进一步包括可滑动地支撑在下壳体152b的通道中的滑动接头180。滑动接头180包括主体部182和从其延伸的杆184。当合适地定位在下壳体152b的通道中时，滑动接头180的杆184在大体远侧的方向上延伸。滑动接头180的杆184可滑动地通过形成在下壳体152b中并从下壳体152b的通道延伸的短轴152d（参见图29）。轴组件104进一步包括偏置构件186，该偏置元件以压缩弹簧的形式支撑在杆184上并置于下壳体152b的短轴152d和滑动接头180的主体部182之间。As shown in FIGS. 9 , 27 , 29 and 41 , the shaft assembly 104 of the clip applier 100 further includes a sliding joint 180 slidably supported in the channel of the lower housing 152b. Slip joint 180 includes a body portion 182 and a stem 184 extending therefrom. When properly positioned in the channel of lower housing 152b, stem 184 of slip joint 180 extends in a generally distal direction. The rod 184 of the sliding joint 180 slides through a stub shaft 152d formed in and extending from a channel of the lower housing 152b (see FIG. 29 ). The shaft assembly 104 further includes a biasing member 186 supported in the form of a compression spring on the rod 184 and interposed between the stub shaft 152d of the lower housing 152b and the main body portion 182 of the sliding joint 180 .
滑动接头180的主体部182包括凸台182a，该凸台靠近主体部182的近端形成，且配置成并适于在驱动杆140的细长狭槽140a中可滑动的接合（参见图29）。滑动接头180的主体部182进一步包括窝眼182b，该窝眼靠近主体部182的远端形成，且配置成并适于将驱动通道168的凸起168d容纳在其中（参见图38和图39）。The main body portion 182 of the sliding joint 180 includes a boss 182a formed near the proximal end of the main body portion 182 and configured and adapted for slidable engagement within the elongated slot 140a of the drive rod 140 (see FIG. 29 ). . The main body portion 182 of the sliding joint 180 further includes a socket 182b formed near the distal end of the main body portion 182 and configured and adapted to receive the protrusion 168d of the drive channel 168 therein (see FIGS. 38 and 39 ) .
如图9、图27和图28所示，施夹器100的轴组件104进一步包括可滑动地支撑在下壳体152b的通道中和驱动通道168中的楔形板锁190。楔形板锁190包括主体部190a、从主体部190a向远侧延伸的杆190b、从主体部190a向近侧延伸的尾部190c、形成于主体部190a的上表面中的窝眼190d和从尾部190c延伸的杆或齿190e。轴组件104进一步包括偏置构件192，该偏置构件以压缩弹簧的形式支撑在杆190b上并置于下壳体152b和楔形板锁190的主体部190a之间。As shown in FIGS. 9 , 27 and 28 , the shaft assembly 104 of the clip applier 100 further includes a wedge plate lock 190 slidably supported in the channel of the lower housing 152 b and in the drive channel 168 . Wedge plate lock 190 includes a body portion 190a, a stem 190b extending distally from body portion 190a, a tail portion 190c extending proximally from body portion 190a, a socket 190d formed in an upper surface of body portion 190a, and a tail portion 190c extending proximally from body portion 190a. Extended rod or tooth 190e. Shaft assembly 104 further includes a biasing member 192 supported in the form of a compression spring on rod 190b and interposed between lower housing 152b and body portion 190a of wedge plate lock 190 .
施夹器100的轴组件104进一步包括可旋转地支撑在下壳体152b的通道中的楔形板释放装置194。楔形板释放装置194包括杆194a，该杆配置为与从楔形板锁190的尾部190c延伸的齿190e接合；槌194b，该槌在朝着楔形板锁190的尾部190c的方向上从杆194a向外延伸；及齿194c，该齿在离开楔形板锁190的尾部190c的方向上从杆194a向外延伸。The shaft assembly 104 of the clip applier 100 further includes a wedge plate release 194 rotatably supported in the channel of the lower housing 152b. Wedge plate release 194 includes a rod 194a configured to engage a tooth 190e extending from tail 190c of wedge plate lock 190; extending outwardly; and a tooth 194c extending outwardly from the rod 194a in a direction away from the tail 190c of the wedge plate lock 190 .
现将对操作手术施夹器100以在诸如脉管的目标组织的周围形成或卷曲手术夹子进行描述。参照图32至图43，表示在任何操作或使用之前的手术施夹器100。如图32和图33所示，在使用或发射施夹器100之前，扳机108一般处于非承压或非致动状态。这样，驱动组件120的曲柄板124处于缩回或最近侧的位置，因此，柱塞135和驱动杆140也处于缩回位置。当曲柄板124处于缩回位置时，棘爪224布置在限定在曲柄板124中的远侧凹槽124b中。Operation of surgical clip applier 100 to form or crimp a surgical clip around target tissue, such as a vessel, will now be described. Referring to Figures 32-43, the surgical clip applier 100 is shown prior to any manipulation or use. As shown in FIGS. 32 and 33 , prior to using or firing the clip applier 100 , the trigger 108 is generally in an uncompressed or non-actuated state. As such, the crank plate 124 of the drive assembly 120 is in the retracted or proximal-most position, and therefore, the plunger 135 and drive rod 140 are also in the retracted position. The pawl 224 is disposed in a distal groove 124b defined in the crank plate 124 when the crank plate 124 is in the retracted position.
如图35至图37所示，当驱动组件120和驱动杆140处于缩回位置时，连接板174位于缩回或最近侧位置。当连接板174位于缩回或最近侧位置时，推杆156也处于缩回或最近侧位置，连接板174的第一泪珠形杆174b布置在推杆156的最近侧窗口156h的近端并保持与第二弹簧夹子157b的尖头搭扣配合的接合。并且，当连接板174位于缩回或最近侧位置时，楔形板172也位于缩回或最近侧位置，且连接板174的第二泪珠形杆174c布置在楔形板172的最近侧窗口172c的近端，并保持与第三弹簧夹子157c的尖头搭扣配合的接合。As shown in FIGS. 35-37 , when the drive assembly 120 and drive rod 140 are in the retracted position, the connecting plate 174 is in the retracted or proximal-most position. When the connecting plate 174 is in the retracted or proximal-most position, the push rod 156 is also in the retracted or proximal-most position, and the first teardrop-shaped rod 174b of the connecting plate 174 is disposed at the proximal end of the proximal-most window 156h of the push rod 156 and held therein. Snap-fit engagement with the prongs of the second spring clip 157b. Also, when the web 174 is in the retracted or proximal-most position, the wedge plate 172 is also in the retracted or proximal-most position, and the second teardrop-shaped stem 174c of the web 174 is disposed proximal to the proximal-most window 172c of the wedge plate 172. end and remain in snap-fit engagement with the prongs of the third spring clip 157c.
如图36和图37所示，当驱动组件120和驱动杆140处于缩回位置时，滑动接头182的凸起182a位于驱动杆140的细长狭槽140a中的最远侧位置处。As shown in FIGS. 36 and 37 , when the drive assembly 120 and drive rod 140 are in the retracted position, the protrusion 182a of the sliding joint 182 is located in the most distal position in the elongated slot 140a of the drive rod 140 .
如图38和图39所示，当驱动组件120和驱动杆140处于缩回位置时，夹子输出器166位于夹子载体164的通道的最近端，其中夹子输出器166的远侧凸起166b操作地布置在推进板162的最近侧窗口162a中，近侧凸起166c操作地布置在夹子载体164的最近侧窗口164a中。As shown in FIGS. 38 and 39 , when the drive assembly 120 and the drive rod 140 are in the retracted position, the clip follower 166 is located at the proximal-most end of the channel of the clip carrier 164 with the distal projection 166b of the clip follower 166 operatively Disposed in the proximal-most window 162a of the pusher plate 162 , the proximal projection 166c is operatively disposed in the proximal-most window 164a of the clip carrier 164 .
继续参照图38和图39，当驱动组件120和驱动杆140处于缩回位置时，滑动接头180位于最近侧位置，并且因为驱动通道168的凸起168d布置在滑动接头180的窝眼182b中，所以驱动通道168也位于最近侧位置。如图38和图39所示，滑动接头180紧靠从下壳体152b突出的物理止挡152e（参见图30）。With continued reference to FIGS. 38 and 39 , when the drive assembly 120 and drive rod 140 are in the retracted position, the sliding joint 180 is in the proximal-most position, and because the protrusion 168d of the drive channel 168 is disposed in the socket 182b of the sliding joint 180, The drive channel 168 is therefore also in the proximal-most position. As shown in Figures 38 and 39, the sliding joint 180 abuts against a physical stop 152e (see Figure 30) protruding from the lower housing 152b.
如图40和图41所示，当驱动组件120和驱动杆140处于缩回位置时，楔形板锁190位于最近侧位置以使从其尾部190c延伸的齿190e布置在形成于下壳体152b中的倾斜凸耳152f的近侧（参见图30和图31）。如图41所示，楔形板锁190紧靠从下壳体152b突出的物理止挡152g。同样如图41所示，楔形板释放装置194布置在第一位置处以便其齿194c突入到形成于驱动通道168的侧壁168b中的窗口168e中。40 and 41, when the drive assembly 120 and drive rod 140 are in the retracted position, the wedge plate lock 190 is in the most proximal position so that the teeth 190e extending from its tail 190c are disposed in the lower housing 152b. The proximal side of the angled lug 152f (see FIGS. 30 and 31 ). As shown in Figure 41, the wedge plate lock 190 abuts against a physical stop 152g protruding from the lower housing 152b. As also shown in FIG. 41 , the wedge plate release 194 is arranged in a first position such that its teeth 194 c protrude into windows 168 e formed in the side walls 168 b of the drive channel 168 .
如图42和图43所示，当驱动组件120和驱动杆140处于缩回位置时，推杆156的推动器156c布置在保持在夹子载体164中的最远侧夹子“C”的后跨部的近侧。最远侧夹子“C”通过其柄脚164b保持在夹子载体164的通道中。并且，如上所述，在此位置处，楔形板172位于最近侧位置以便其远端172a位于钳口106的近侧。As shown in FIGS. 42 and 43 , when the drive assembly 120 and drive rod 140 are in the retracted position, the pusher 156c of the push rod 156 is disposed on the rear span of the distal-most clip "C" held in the clip carrier 164 the near side. The distal-most clip "C" is retained in the channel of clip carrier 164 by its tang 164b. Also, as described above, in this position, the wedge plate 172 is in a proximal-most position such that its distal end 172a is proximal of the jaws 106 .
如图43所示，当驱动通道168位于最近侧位置时，其远端从钳口106的近侧凸轮表面106b脱离。As shown in FIG. 43, when the drive channel 168 is in the proximal-most position, its distal end disengages from the proximal cam surface 106b of the jaws 106. As shown in FIG.
现转到图44至图54，在初始行程的第一阶段中，随着扳机108从初始位置被挤压或致动，扳机108使得叉形连杆122向着远侧方向移动曲柄板124，而这将使得驱动连接器134和柱塞135向远侧移动并使得驱动杆140向远侧移动。当随着柱塞135向远侧移动，弹簧136被压缩初始量。Turning now to FIGS. 44-54 , during the first stage of the initial stroke, as the trigger 108 is squeezed or actuated from the initial position, the trigger 108 causes the fork link 122 to move the crank plate 124 in the distal direction, and This will move drive connector 134 and plunger 135 distally and drive rod 140 distally. As the plunger 135 moves distally, the spring 136 is compressed an initial amount.
与此同时，随着曲柄板124向远侧移动，齿条124a的齿与棘爪224的齿224a接合，棘爪224移出或旋转出曲柄板124的远侧凹槽124a。这样，在没有完成完整的远侧行程的情况下，曲柄板124不能回到最近侧位置。At the same time, as the crank plate 124 moves distally, the teeth of the rack 124 a engage the teeth 224 a of the pawl 224 , and the pawl 224 moves or rotates out of the distal groove 124 a of the crank plate 124 . As such, the crank plate 124 cannot be returned to the proximal-most position without completing a full distal stroke.
如图44所示，随着扳机108被挤压初始量，臂127开始平移通过反馈构件126的滚道126a。As shown in FIG. 44 , as the trigger 108 is squeezed an initial amount, the arm 127 begins to translate through the raceway 126a of the feedback member 126 .
如图46所示，随着驱动杆140向着远侧方向移动，驱动杆140向着远侧方向推动连接板174。因为推杆156通过第二弹簧夹子157b选择性地连接于连接板174，推杆156被向着远侧方向推进或拉动。并且，因为楔形板172通过第三弹簧夹子157c选择性地连接于连接板174，楔形板172也被向着远侧方向推进或拖动。As shown in FIG. 46 , as the drive rod 140 moves in the distal direction, the drive rod 140 pushes the connecting plate 174 in the distal direction. Because the push rod 156 is selectively connected to the connecting plate 174 via the second spring clip 157b, the push rod 156 is pushed or pulled in the distal direction. Also, because the wedge plate 172 is selectively connected to the connecting plate 174 by the third spring clip 157c, the wedge plate 172 is also pushed or pulled in the distal direction.
随着驱动杆140向着远侧方向移动，其细长狭槽140a也向着远侧方向移动以使滑动接头182的凸起182a在相对于其的近侧方向上平移。As the drive rod 140 moves in the distal direction, its elongated slot 140a also moves in the distal direction to translate the protrusion 182a of the sliding joint 182 in the proximal direction relative thereto.
如图47至图49所示，随着楔形板172向着远侧方向移动，因为楔形板172的凸起172b保持在楔形板锁190的窝眼190d中，楔形板锁190被向着远侧方向移动或拖动，这使得其尾部190c的齿190e被用凸轮带动越过形成于下壳体152b中的倾斜凸耳152f，从而从倾斜凸耳152f的近侧位置移动到倾斜凸耳152f的远侧位置。随着楔形板锁190向着远侧方向移动，偏置构件192被压缩初始量。如图49所示，楔形板锁190向着远侧方向移动直至楔形板锁190紧靠形成于下壳体152b中的物理止挡。47-49, as the wedge plate 172 is moved in the distal direction, the wedge plate lock 190 is moved in the distal direction because the protrusion 172b of the wedge plate 172 is retained in the socket 190d of the wedge plate lock 190. Or drag, and this makes the tooth 190e of its tail 190c be driven over the inclined lug 152f that is formed in the lower housing 152b with cam, thereby moves from the proximal position of inclined lug 152f to the distal position of inclined lug 152f . As wedge plate lock 190 is moved in the distal direction, biasing member 192 is compressed an initial amount. As shown in FIG. 49, wedge plate lock 190 is moved in a distal direction until wedge plate lock 190 abuts a physical stop formed in lower housing 152b.
如图47A所示，随着推杆156向着远侧方向移动，推进板162的翼片162b在推杆156的侧凹槽156f中平移预定距离，直到翼片162b接触或接合推杆156的侧凹槽156f的近端。As shown in FIG. 47A , as push rod 156 moves in the distal direction, tab 162b of pusher plate 162 translates a predetermined distance in side groove 156f of push rod 156 until tab 162b contacts or engages the side of push rod 156. The proximal end of the groove 156f.
如图47B和图47C所示，随着楔形板172向着远侧方向移动，由于连接板174的第二杆174c与第三弹簧夹子157c的连接，通过保护装置防止了连接板174的第二杆174c过早地从第三夹钳157c脱离。特别地，随着连接板174向着远侧方向移动，保护装置198作用于第三弹簧夹子157c的尖头的尖端以防止尖头由于第二杆174c所产生的远侧力作用于其上的力而向外张开。As shown in FIGS. 47B and 47C, as the wedge plate 172 moves in the distal direction, due to the connection of the second rod 174c of the connecting plate 174 with the third spring clip 157c, the second rod of the connecting plate 174 is prevented by the guard. 174c prematurely disengages from the third clamp 157c. In particular, as the connecting plate 174 moves in the distal direction, the guard 198 acts on the tip of the prong of the third spring clip 157c to prevent the force of the prong acting on it due to the distal force generated by the second rod 174c. And open outward.
如图50所示，随着推杆156向着远侧方向移动，其推动器156c接合最远侧夹子“C”的后跨部并开始向着远侧方式推动最远侧夹子“C”。随着推杆156向着远侧方向移动最远侧夹子“C”，最远侧夹子“C”从夹子载体164的柄脚164b的后方脱离并开始进入到钳口106的通道106a中。As shown in FIG. 50, as the pusher rod 156 moves in the distal direction, its pusher 156c engages the rear span of the most distal clip "C" and begins pushing the most distal clip "C" in a distal manner. As push rod 156 moves distal-most clip "C" in the distal direction, distal-most clip "C" disengages from behind tang 164b of clip carrier 164 and begins to enter channel 106a of jaw 106 .
如图51所示，随着楔形板172向着远侧方向移动，其远端172a进入钳口106之间，使得钳口106向外张开。As shown in FIG. 51 , as the wedge plate 172 moves in a distal direction, its distal end 172a enters between the jaws 106 causing the jaws 106 to flare outward.
如图52至图54所示，一旦楔形板锁190紧靠形成于下壳体152b中的物理止挡，则防止了楔形板172向着远侧方向进一步移动。然而，驱动杆140继续向着远侧方向移动连接板174。因为连接板174被继续向远侧推动，所以一旦第三弹簧夹子157c的尖头的尖端向远侧移动到超过保护装置198，则作用于第二杆174c上的力足够使得第三弹簧夹子157c的尖头向外张开并使得第二杆174c从其间脱开，从而使得连接板174继续向着远侧方向移动。As shown in FIGS. 52-54, once wedge plate lock 190 abuts a physical stop formed in lower housing 152b, further movement of wedge plate 172 in the distal direction is prevented. However, the drive rod 140 continues to move the connecting plate 174 in the distal direction. Because the connecting plate 174 is continued to be pushed distally, once the tip of the prong of the third spring clip 157c moves distally beyond the guard 198, the force acting on the second rod 174c is sufficient to make the third spring clip 157c The prongs of the second rod 174c are flared outwards and the second rod 174c is disengaged therefrom, so that the connecting plate 174 continues to move in the distal direction.
现转到图55至图69，随着扳机108从初始行程的第一阶段被进一步挤压或致动通过初始行程的第二阶段，扳机108使得叉形连杆122进一步向着远侧方向移动曲柄板124，而这使得驱动连接器134并随后使得柱塞135进一步向远侧移动且进一步向着远侧移动驱动杆140。随着柱塞135向远侧移动，弹簧136被压缩进一步的量。Turning now to FIGS. 55-69 , as the trigger 108 is further squeezed or actuated from the first stage of initial travel through the second stage of initial travel, the trigger 108 causes the fork link 122 to move the crank further in the distal direction. Plate 124, which in turn causes drive connector 134 and subsequently plunger 135 to move further distally and drive rod 140 further distally. As the plunger 135 moves distally, the spring 136 is compressed a further amount.
与此同时，随着曲柄板124向着远侧移动，其齿条124a的齿相对于棘爪224的齿224a进一步向着近侧移动。这样，在没有完成完整的远侧行程的情况下，曲柄板124仍不能返回到最近侧位置。At the same time, as the crank plate 124 moves distally, the teeth of its rack 124a move further proximally relative to the teeth 224a of the pawl 224 . As such, the crank plate 124 still cannot return to the proximal-most position without completing a full distal stroke.
如图55所示，随着曲柄板124向着远侧移动预定距离之后，其臂124d接合或接触致动板128的指部128b。随着曲柄板124进一步向着远侧推进，曲柄板124向着远侧方向推动或拉动致动板128，从而致动计数致动杠杆130以激活计数机构132。As shown in FIG. 55 , as crank plate 124 moves distally a predetermined distance, arm 124d thereof engages or contacts finger 128b of actuation plate 128 . As crank plate 124 is advanced further distally, crank plate 124 pushes or pulls actuation plate 128 in the distal direction, thereby actuating count actuation lever 130 to activate count mechanism 132 .
特别地，当致动板128向着远侧移动足够距离时，在其槽128b中用凸轮带动计数致动杠杆130的第二臂130b并促使其旋转，导致计数致动杠杆130的第一臂130a接合计数机构132，从而实现其显示器中的变化。特别地，显示手术施夹器100中剩余的夹子的数目的显示器将减少一个。可选择地，夹子计数机构将增加一个或产生某些其他变化。In particular, when the actuating plate 128 moves far enough to the far side, the second arm 130b of the counting actuating lever 130 is cammed in its groove 128b and caused to rotate, causing the first arm 130a of the counting actuating lever 130 to rotate. The counting mechanism 132 is engaged, effecting a change in its display. In particular, the display showing the number of clips remaining in surgical clip applier 100 will decrease by one. Optionally, the clip count mechanism would add one or make some other change.
随着扳机108被进一步挤压时，臂127继续平移通过反馈构件126的滚道126a。在这一点上，在扳机108的挤压中，手术夹子被装入钳口106中。相应地，臂127将与形成于反馈构件126的滚道126a中的梯级126b相互作用并产生告知用户夹子已被装入钳口中的听觉/触觉指示。Arm 127 continues to translate through race 126a of feedback member 126 as trigger 108 is squeezed further. At this point, the surgical clip is loaded into the jaws 106 in the squeeze of the trigger 108 . Accordingly, arm 127 will interact with step 126b formed in raceway 126a of feedback member 126 and produce an audible/tactile indication to the user that the clip has been loaded into the jaws.
如图57所示，随着驱动杆140向着远侧方向进一步移动，驱动杆140继续向着远侧方向推动连接板174。因为推杆156仍通过第二弹簧夹子157b选择性地连接于连机板174，所以推杆156被进一步向着远侧方向推进或拖动。然而，因为楔形板172的第三弹簧夹子157c被从连接板174的第二杆174c脱离，所以楔形板172不被向着远侧方向进一步推进或拖动。As shown in FIG. 57 , as the drive rod 140 moves further in the distal direction, the drive rod 140 continues to push the connecting plate 174 in the distal direction. Because the push rod 156 is still selectively connected to the connecting plate 174 by the second spring clip 157b, the push rod 156 is further advanced or drawn in the distal direction. However, because the third spring clip 157c of the wedge plate 172 is disengaged from the second rod 174c of the connecting plate 174, the wedge plate 172 is not further advanced or dragged in the distal direction.
如图56A至图56C所示，随着推杆156向着远侧方向继续移动，推杆156的侧凹槽156f的近端接合推进板162的一对翼片162b，推杆156向着远侧方向推进或拖动推进板162。56A to 56C, as the push rod 156 continues to move in the distal direction, the proximal end of the side groove 156f of the push rod 156 engages the pair of fins 162b of the pusher plate 162, and the push rod 156 moves in the distal direction. Push or pull push plate 162 .
如图56B和图56C所示，随着推动板162向着远侧推进，弹簧夹子157d脱离近侧保持槽152m并接合形成于上壳体152a中的远侧保持槽152n。56B and 56C, as pusher plate 162 is advanced distally, spring clip 157d disengages proximal retention slot 152m and engages distal retention slot 152n formed in upper housing 152a.
如图57所示，驱动杆140向着远侧方向移动，直到滑动接头182的凸起182a选择性地平移至驱动杆140的细长狭槽140a中的最近侧位置。As shown in FIG. 57 , the drive rod 140 is moved in a distal direction until the protrusion 182 a of the sliding joint 182 is selectively translated to a proximal-most position within the elongated slot 140 a of the drive rod 140 .
随着推杆156继续向着远侧方向移动，推杆156通过翼片162b继续向着远侧方向推动推进板162。如图58所示，随着推进板162向着远侧方向移动，夹子输出器166的远侧凸起166b被容纳夹子输出器166的远侧凸起166b的窗口162a的近侧边缘接合以便相对于夹子载体164向着远侧方向推动夹子输出器166，从而使该堆夹钳“C”推进增加的量。随着夹子输出器166向着远侧方向移动，使得其近侧凸起166c从夹子载体164的相对近侧窗口164a到夹子载体164的相对远侧窗口164a向远侧推进一个窗口164a。As the push rod 156 continues to move in the distal direction, the push rod 156 continues to push the pusher plate 162 in the distal direction through the fins 162b. As shown in FIG. 58, as the pusher plate 162 moves in the distal direction, the distal projection 166b of the clip follower 166 is engaged by the proximal edge of the window 162a receiving the distal projection 166b of the clip follower 166 so as to relatively Clip carrier 164 pushes clip follower 166 in the distal direction, thereby advancing the stack of clips "C" an increasing amount. As the clip follower 166 is moved in the distal direction, its proximal protrusion 166c advances distally one window 164a from the opposite proximal window 164a of the clip carrier 164 to the opposite distal window 164a of the clip carrier 164 .
如图58至图60所示，随着推杆156向着远侧方向移动，支撑于推杆156上的第一弹簧夹子157a弹锁在上壳体152a的凸台152h上，因而将推杆156保持在向前的位置处。As shown in Figures 58 to 60, as the push rod 156 moves toward the distal direction, the first spring clip 157a supported on the push rod 156 snaps onto the boss 152h of the upper housing 152a, thus pushing the push rod 156 Stay in the forward position.
此外，如图61所示，随着推杆156继续向着远侧方向移动，使得该堆夹钳“C”向着远侧方向移动。Additionally, as shown in FIG. 61 , as the push rod 156 continues to move in the distal direction, the stack of clamps "C" moves in the distal direction.
如图62所示，随着推杆156向着远侧方向移动，其推动器156c继续向着远侧方向移动最远侧夹子“C1”直到最远侧夹子“C1”完全进入到钳口106的通道106a中。在操作中，推杆156的推动器156c在所述夹子“C”的形成期间与装入的夹子“C”的后跨部保持接触以便为其提供稳定性并将其保持在合适的位置。As shown in FIG. 62 , as the push rod 156 moves in the distal direction, its pusher 156c continues to move the most distal clip "C1" in the distal direction until the most distal clip "C1" fully enters the channel of the jaws 106. 106a. In operation, the pusher 156c of the push rod 156 remains in contact with the rear span of the loaded clip "C" during formation of said clip "C" to provide it with stability and hold it in place.
如图63所示，随着驱动杆140进一步向着远侧方向移动，其肩部140c接触驱动通道168的最近端。这样，随着驱动杆140进一步向着远侧方向移动，驱动杆140向着远侧方向移动或推动驱动通道168。As shown in FIG. 63 , as the drive rod 140 is moved further in the distal direction, its shoulder 140c contacts the proximal-most end of the drive channel 168 . As such, as drive rod 140 is moved further in the distal direction, drive rod 140 moves or pushes drive channel 168 in the distal direction.
如图64所示，随着驱动通道168向着远侧方向移动，形成于驱动通道168的侧壁168b中的窗口168e的近侧边缘接触楔形板释放装置194的齿194c，使得楔形板释放装置194旋转。随着楔形板释放装置194旋转，其槌194b挤压楔形板锁190的齿190e以将齿190e从倾斜凸耳152f的后方推出或撞出。在这种情况下，如图65所示，允许偏置构件192减压，从而向着近侧方向移动楔形板锁190。如图66所示，随着楔形板锁190向着近侧方向移动，因为楔形板172连接到楔形板锁190上，所以楔形板172向着近侧方向移动以使其远端172a从与钳口106退出脱离接合。64, as drive channel 168 moves in the distal direction, the proximal edge of window 168e formed in sidewall 168b of drive channel 168 contacts teeth 194c of wedge plate release 194 such that wedge plate release 194 rotate. As wedge plate release 194 is rotated, its mallet 194b squeezes tooth 190e of wedge plate lock 190 to push or knock tooth 190e out from behind angled lug 152f. In this case, as shown in FIG. 65, biasing member 192 is allowed to decompress, thereby moving wedge plate lock 190 in a proximal direction. As shown in FIG. 66 , as wedge plate lock 190 moves in a proximal direction, because wedge plate 172 is connected to wedge plate lock 190 , wedge plate 172 moves in a proximal direction to disengage distal end 172 a from jaw 106 . Exit disengage.
如图58和图67至图69所示，因为推杆156通过第一弹簧夹子157a与凸台152h的连接而保持在远侧位置，所以随着驱动杆140进一步向着远侧方向移动，作用于连接板174的力使得第二弹簧夹子157b从连接板174的第一杆174b脱离，从而允许连接板174继续向着远侧方向移动。As shown in FIGS. 58 and 67 to 69, since the push rod 156 is maintained in the distal position by the connection of the first spring clip 157a to the boss 152h, as the drive rod 140 moves further in the distal direction, the The force of the connecting plate 174 disengages the second spring clip 157b from the first rod 174b of the connecting plate 174, thereby allowing the connecting plate 174 to continue to move in the distal direction.
如图67A至图69A所示，在一个实施方式中，第二弹簧夹子157b的尖头的尖端可以配置成向外突出以便接合后上部壳体154的表面（参见图9），从而防止第二弹簧夹子157b从连接板174的第一杆174b的过早脱离。在该实施方式中，凹槽可以形成于后部上壳体154的表面中，与第二弹簧夹子157b的尖头可能向外张开的位置一致，从而允许连接板174的第一杆174b脱离并继续向着远侧方向移动。As shown in FIGS. 67A-69A , in one embodiment, the tip of the prong of the second spring clip 157b may be configured to protrude outwardly so as to engage the surface of the rear upper housing 154 (see FIG. 9 ), thereby preventing the second Premature disengagement of the spring clip 157b from the first rod 174b of the connecting plate 174 . In this embodiment, a groove may be formed in the surface of the upper rear housing 154 to coincide with where the prongs of the second spring clip 157b may flare outward, thereby allowing the first rod 174b of the connecting plate 174 to disengage. And continue to move in the distal direction.
如图70至图75所示，随着扳机108被致动进入初始行程的最后阶段，扳机108使得叉形连杆122进一步向着远侧方向移动曲柄板124，而这使得驱动连接器134和柱塞135进一步向着远侧移动并进一步向着远侧移动驱动杆140。随着驱动连接器134向着远侧移动，弹簧136被压缩进一步的量。As shown in FIGS. 70-75 , as the trigger 108 is actuated into the final stage of the initial stroke, the trigger 108 causes the fork link 122 to move the crank plate 124 further in the distal direction, which in turn causes the drive connector 134 and post Plug 135 moves further distally and drives drive rod 140 further distally. As drive connector 134 is moved distally, spring 136 is compressed a further amount.
与此同时，随着曲柄板124向着远侧移动，其齿条124a的齿相对于棘爪224的齿224a进一步向着近侧移动至这样一个位置：在该位置处，随着棘爪224的齿224a进入曲柄板124的近侧凹槽124c，齿条124a的齿从棘爪224的齿224a脱离，从而使其本身复位。这样，当扳机108松开时，曲柄板124可以返回至最近侧位置。At the same time, as the crank plate 124 moves distally, the teeth of its rack 124a move further proximally relative to the teeth 224a of the pawl 224 to a position where, as the teeth of the pawl 224 224a enters the proximal groove 124c of the crank plate 124, and the teeth of the rack 124a disengage from the teeth 224a of the pawl 224, thereby resetting itself. In this way, when the trigger 108 is released, the crank plate 124 can return to the most proximal position.
如图72至图74所示，在扳机108的初始行程的最后阶段期间，驱动通道168和带箍167相对于钳口106向着远侧方向移动，以使驱动通道168的远侧边缘接合钳口106的凸轮表面106b，使得钳口106关闭并形成位于其间的夹钳“C1”。如图74所示，推杆156的推动器156c保持在远侧位置处，在所述夹子“C”的形成期间与所述夹子“C”的后跨部接触。72-74, during the final stage of the initial stroke of trigger 108, drive channel 168 and band 167 are moved in a distal direction relative to jaws 106 such that the distal edge of drive channel 168 engages the jaws. 106, such that jaws 106 close and form clamp "C1" therebetween. As shown in FIG. 74, the pusher 156c of the push rod 156 remains in a distal position in contact with the rear span of the clip "C" during formation of the clip "C".
如图55所示，随着扳机108被挤压最后的量，臂127继续平移通过反馈构件126的滚道126a。在这一点上，在扳机108的挤压中，手术夹子“C1”已经由钳口106完全形成。相应地，臂127将与形成于反馈构件126的滚道126a中的另一梯级126b相互作用，并产生告知用户手术夹子“C1”已由钳口106形成的听觉/触觉指示。As shown in FIG. 55 , arm 127 continues to translate through raceway 126a of feedback member 126 as trigger 108 is squeezed the final amount. At this point, surgical clip “C1” has been fully formed by jaws 106 in the squeeze of trigger 108. Accordingly, arm 127 will interact with another step 126b formed in raceway 126a of feedback member 126 and produce an audible/tactile indication to the user that surgical clip “C1” has been formed by jaws 106.
如图75所示，手术夹子“C1”可以形成或卷曲到脉管“V”或任何其他生物组织上。As shown in Figure 75, a surgical clip "Cl" can be formed or crimped onto a vessel "V" or any other biological tissue.
现转到图76至图84，表示随着扳机108返回至未挤压或未致动位置时的施夹器100的操作。如图76所示，随着扳机返回到未挤压位置，弹簧被允许解除压缩，从而推动曲柄板124向着近侧方向移动，而这使得柱塞向着近侧移动并向着近侧移动驱动杆。因为棘爪224已经复位，现允许曲柄板124向近侧移动直到棘爪224的齿224a再次进入曲柄板124的远侧凹槽。Turning now to FIGS. 76-84 , operation of the clip applier 100 is shown as the trigger 108 is returned to the unsqueezed or unactuated position. As shown in FIG. 76, as the trigger returns to the unsqueezed position, the spring is allowed to decompress, thereby pushing the crank plate 124 in the proximal direction, which in turn moves the plunger proximally and the drive rod proximally. Since the pawl 224 has been reset, the crank plate 124 is now allowed to move proximally until the teeth 224a of the pawl 224 enter the distal groove of the crank plate 124 again.
如图76A所示，随着曲柄板124向着近侧移动，其臂124d脱离致动板128的指部128b，使得致动板128向着近侧方向移动。随着致动板128向着近侧移动，在其槽128b中用凸轮带动计数致动杠杆130的第二臂130b，并促使第二臂130b旋转，导致计数致动杠杆130的第一臂130a从计数机构132脱离。As shown in FIG. 76A, as the crank plate 124 moves proximally, its arms 124d disengage the fingers 128b of the actuation plate 128, causing the actuation plate 128 to move in the proximal direction. As the actuating plate 128 moves proximally, it cams the second arm 130b of the counting actuation lever 130 in its slot 128b and impels the second arm 130b to rotate, causing the first arm 130a of the counting actuation lever 130 to move from The counting mechanism 132 is disengaged.
如图77所示，随着驱动杆140向着近侧方向移动，驱动杆140通过第一杆174b拉动连接板174。随着连接板174向着近侧方向移动，第一杆174b与第二弹簧夹子157b的尖头接合并且通过第二弹簧夹子157b向着近侧方向推动推杆156。As shown in FIG. 77, as the driving rod 140 moves in the proximal direction, the driving rod 140 pulls the connecting plate 174 through the first rod 174b. As the connecting plate 174 moves in the proximal direction, the first rod 174b engages the prong of the second spring clip 157b and pushes the push rod 156 in the proximal direction through the second spring clip 157b.
如图78所示，随着力作用于推杆156上以向着近侧方向移动推杆156，所述力克服了第一弹簧夹子157a与上壳体152a的凸台152h的保持力，从而从凸台152h释放第一弹簧夹子157a并使得推杆156向着近侧方向移动。As shown in FIG. 78, as a force acts on the push rod 156 to move the push rod 156 in the proximal direction, the force overcomes the retaining force of the first spring clip 157a with the boss 152h of the upper housing 152a, thereby disengaging from the boss 152h. Stage 152h releases first spring clip 157a and moves push rod 156 in the proximal direction.
如图79所示，随着推杆156继续向着近侧方向移动，其侧凹槽156f的远端接合推进板162的翼片162b并使得推进板162向着近侧方向移动。随着推杆156向着近侧方向移动，推杆鼻部156c咬在余留的该堆夹子“C”的最远侧夹子的后方，从而变成新的最远侧夹子“C1”。As shown in FIG. 79, as the pusher rod 156 continues to move in the proximal direction, the distal end of its side groove 156f engages the tab 162b of the pusher plate 162 and moves the pusher plate 162 in the proximal direction. As push rod 156 moves in the proximal direction, push rod nose 156c snaps behind the distal-most clip of the remaining stack of clips "C", thereby becoming the new distal-most clip "C1".
如图80所示，随着推进板162向着近侧方向移动，夹子输出器166的近侧凸起166c接合夹子载体164的窗口164a的近侧边缘以便保持夹子输出器166在夹子载体164中的相对位置。当推进板162向着近侧方向移动，使得其远侧凸起166b从推进板162的相对近侧窗口162a到推进板162的相对远侧窗口162a向远侧推进一个窗口162a。As shown in FIG. 80 , as the pusher plate 162 moves in the proximal direction, the proximal protrusion 166c of the clip follower 166 engages the proximal edge of the window 164a of the clip carrier 164 to retain the clip follower 166 in the clip carrier 164. relative position. When the pusher plate 162 is moved in the proximal direction, its distal projection 166b pushes one window 162a distally from the opposite proximal window 162a of the pusher plate 162 to the relatively distal window 162a of the pusher plate 162 .
如图81所示，当推杆156停止其近侧移动时，当其与从上半壳体152a的内表面突出的凸台接合时，连接板174的持续的近侧移动将使得第一杆174b与第二弹簧夹子157b再次接合。随着推杆156的近侧移动停止，连接板174的持续的近侧移动将使得第一杆174b与第二弹簧夹子157b再次接合。As shown in FIG. 81 , when the push rod 156 ceases its proximal movement, continued proximal movement of the connecting plate 174 will cause the first rod to 174b again engages the second spring clip 157b. Continued proximal movement of the connecting plate 174 will reengage the first rod 174b with the second spring clip 157b as the proximal movement of the push rod 156 ceases.
如图82和图83所示，随着连接板174向着近侧方向移动，由于驱动杆140的近侧移动，第二杆174c与第三弹簧夹子157c的尖头接合并通过第三弹簧夹子157c向着近侧方向推动楔形板172。随着楔形板172向着近侧方向移动，楔形板锁190向着近侧方向移动直到楔形板锁190接触下半壳体152b中的物理止挡，从而阻止楔形板172的近侧移动。一旦第三弹簧夹子157c的尖头的尖端向着远侧移动超过保护装置198，则当楔形板172停止其近侧移动时，连接板174的持续的近侧移动将使得第二杆174c与第三弹簧夹子157c再次接合。As shown in FIGS. 82 and 83, as the connecting plate 174 moves in a proximal direction, due to the proximal movement of the drive rod 140, the second rod 174c engages the prong of the third spring clip 157c and passes through the third spring clip 157c. Wedge plate 172 is pushed in the proximal direction. As wedge plate 172 moves in the proximal direction, wedge plate lock 190 moves in the proximal direction until wedge plate lock 190 contacts a physical stop in lower housing half 152b, thereby preventing proximal movement of wedge plate 172 . Once the tip of the prong of the third spring clip 157c moves distally beyond the guard 198, when the wedge plate 172 stops its proximal movement, continued proximal movement of the connecting plate 174 will cause the second rod 174c to align with the third The spring clip 157c is engaged again.
当扳机108返回至未致动位置时，臂127将平移通过反馈构件126的滚道126a并与形成于反馈构件126的滚道126a中的另一梯级126b相互作用，且产生告知用户手术施夹器100已被复位并准备再次发射的听觉/触觉指示。When the trigger 108 is returned to the unactuated position, the arm 127 will translate through the raceway 126a of the feedback member 126 and interact with another step 126b formed in the raceway 126a of the feedback member 126, and generate a signal that informs the user of the surgical clip application. Audible/tactile indication that the device 100 has been reset and is ready to transmit again.
现转到图84至图85，表示手术施夹器100的构造其后是最后一个手术夹子“C”的应用。如图84和图85所示，当最后一个手术夹子已经被推进和形成时，推杆156仍处于推进或远侧位置，夹子输出器166已经通过刻度盘158被逐步推进足够的量，其闭锁板165向上偏置通过推进板162的窗口162a，并进入到推杆156的远侧窗口156d中。闭锁板165在推杆156的远侧窗口156d中的定位使得近侧窗口156d的窗钩156e进入并接合闭锁板165的窗口165b。这样，因为夹子输出器166通过在夹子载体164的远侧窗口164a中接合的其远侧凸起166c来保持在远侧位置，闭锁板165接合推杆156的窗钩156e，并防止推杆156返回到最近侧位置从而使棘爪224复位。Turning now to FIGS. 84-85, the configuration of the surgical clip applier 100 is shown followed by application of the last surgical clip "C". As shown in Figures 84 and 85, when the last surgical clip has been advanced and formed, the push rod 156 is still in the advanced or distal position, and the clip follower 166 has been progressively advanced through the dial 158 a sufficient amount that it locks. Plate 165 is biased upwardly through window 162a of pusher plate 162 and into distal window 156d of pusher rod 156 . The positioning of the lockout plate 165 in the distal window 156d of the push rod 156 causes the window hook 156e of the proximal window 156d to enter and engage the window 165b of the lockout plate 165 . Like this, because the clip follower 166 is held in the distal position by its distal protrusion 166c engaged in the distal window 164a of the clip carrier 164, the lockout plate 165 engages the window hook 156e of the push rod 156 and prevents the push rod 156 Returning to the most proximal position resets the pawl 224 .
如图86所示，因为推杆156不能或被防止移动到其完全近侧位置，棘爪224与曲柄板124的齿条124a保持接合并且不被允许进入近侧凹槽124c从而使其本身复位。因为棘爪224不能使其本身复位，所以曲柄板124被锁住或停止向远侧或近侧移动。As shown in Figure 86, because the push rod 156 cannot or is prevented from moving to its fully proximal position, the pawl 224 remains engaged with the rack 124a of the crank plate 124 and is not allowed to enter the proximal groove 124c to reset itself . Because the pawl 224 cannot reset itself, the crank plate 124 is locked or stopped from moving distally or proximally.
应该理解，以上描述仅仅是本公开的说明。本领域技术人员可以在不背离本公开的情况下做出各种替换和改进。相应地，本公开意在包含所有这些替换、改进和变化。参照附图所描述的实施方式仅为证明本公开的某些示例而出现。与上述的和/或所附权利要求无实质上不同的其它元件、步骤、方法和技术也在本公开的范围之内。It should be understood that the above description is only illustrative of the present disclosure. Various substitutions and improvements can be made by those skilled in the art without departing from the present disclosure. Accordingly, the present disclosure is intended to embrace all such alternatives, improvements and variations. The embodiments described with reference to the figures are presented merely to demonstrate some examples of the present disclosure. Other elements, steps, methods and techniques that are insubstantially different from those described above and/or appended hereto are also within the scope of the present disclosure.
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| US9279408P | 2008-08-29 | 2008-08-29 | |
| US61/092,794 | 2008-08-29 | ||
| US12/539,730US8419752B2 (en) | 2008-08-29 | 2009-08-12 | Endoscopic surgical clip applier with connector plate |
| US12/539,730 | 2009-08-12 |
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN200910171615XADivisionCN101744648B (en) | 2008-08-29 | 2009-08-31 | Endoscopic surgical clip applier with connecting plate |
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|---|---|
| CN103083059A CN103083059A (en) | 2013-05-08 |
| CN103083059Btrue CN103083059B (en) | 2015-03-18 |
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201310023275.2AExpired - Fee RelatedCN103083059B (en) | 2008-08-29 | 2009-08-31 | Endoscopic surgical clip applier with connector plate |
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| JP (2) | JP2014087648A (en) |
| CN (1) | CN103083059B (en) |
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| Date | Code | Title | Description |
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| C06 | Publication | ||
| PB01 | Publication | ||
| C10 | Entry into substantive examination | ||
| SE01 | Entry into force of request for substantive examination | ||
| C14 | Grant of patent or utility model | ||
| GR01 | Patent grant | ||
| CF01 | Termination of patent right due to non-payment of annual fee | Granted publication date:20150318 |