CN103429182B - Surgical instrument with jaw members - Google Patents

Abstract

A surgical instrument for providing energy to tissue may include a handle, a trigger, an electrical input, and a shaft extending from the handle. The surgical instrument can include an end effector having first and second tissue engaging surfaces that are inclined relative to a transverse plane. The end effector may, for example, have electrodes defining a V-shaped cross-sectional profile. The end effector may include a plurality of raised surfaces that are received by a plurality of indentations when the end effector is in the closed position. The end effector may include a cutting member having a plurality of bands. A surgical instrument for providing energy to tissue may include a handle, a trigger, an electrical input, and a shaft extending from the handle. The surgical instrument may include an end effector. The end effector may include a cam compression surface. The end effector may include an electrode having a tapered tissue contacting surface. Some surgical instruments may include an overload member.

Description

Translated fromChinese

具有钳口构件的外科器械Surgical instrument with jaw members

背景技术Background technique

在各种情况下，外科器械能够向组织施加能量以便处理和/或破坏该组织。在某些情况下，外科器械可包括一个或多个电极，所述电极可抵靠组织定位和/或相对于组织定位，使得电流可流过该电极并且流入组织中。所述外科器械还可包括电输入端、与电极电联接的供电导体和/或返回导体，该返回导体能够例如允许电流从电输入端流过供电导体，流过电极和组织，然后流过返回导体，流到电输出端。在各种情况下，能量可在所捕获组织内产生热以在组织内形成一个或多个止血密封。此类实施例可尤其用于例如密封血管。所述外科器械还可包括切割构件，所述切割构件可相对于组织和电极运动，以便横切组织。In various circumstances, surgical instruments are capable of applying energy to tissue in order to treat and/or destroy the tissue. In some cases, a surgical instrument can include one or more electrodes that can be positioned against and/or relative to tissue such that electrical current can flow through the electrodes and into the tissue. The surgical instrument may also include an electrical input, a supply conductor electrically coupled to the electrode, and/or a return conductor capable of, for example, allowing electrical current to flow from the electrical input through the supply conductor, through the electrode and tissue, and then through the return conductor. conductor, which flows to the electrical output. In various instances, the energy can generate heat within the captured tissue to form one or more hemostatic seals within the tissue. Such embodiments are particularly useful for sealing blood vessels, for example. The surgical instrument may also include a cutting member movable relative to the tissue and the electrodes to transect the tissue.

上述讨论仅仅为了举例说明本发明的技术领域中相关技术目前的各个方面，而不应当视为对权利要求范围的否定。The above discussion is only for the purpose of illustrating the current aspects of the related art in the technical field of the present invention, and should not be regarded as a negation of the scope of the claims.

发明内容Contents of the invention

根据各种实施例，用于向组织提供能量的外科器械可包括柄部。柄部可包括触发器、电输入端、以及从柄部延伸的轴。轴可包括导体。触发器可为能够选择性地致动的以电联接电输入端和导体。外科器械可包括限定纵向轴线和横断平面的端部执行器。端部执行器可包括第一钳口构件和第二钳口构件。第一钳口构件和第二钳口构件中的至少一者能够相对于第一钳口构件和第二钳口构件中的另一者运动，以夹持第一钳口构件和第二钳口构件中间的组织。端部执行器还可包括与导体电联接的电极以及第一组织接合表面和第二组织接合表面，所述第一组织接合表面和第二组织接合表面联接到第一钳口构件和第二钳口构件中的一者并且沿纵向轴线延伸。第一组织接合表面和第二组织接合表面中的每个均可具有内部和外部，其中第一组织接合表面和第二组织接合表面相对于横断平面为倾斜的。According to various embodiments, a surgical instrument for providing energy to tissue may include a handle. The handle may include a trigger, an electrical input, and a shaft extending from the handle. The shaft may include a conductor. The trigger may be selectively actuatable to electrically couple the electrical input and the conductor. A surgical instrument can include an end effector defining a longitudinal axis and a transverse plane. The end effector may include a first jaw member and a second jaw member. At least one of the first jaw member and the second jaw member is movable relative to the other of the first jaw member and the second jaw member to clamp the first jaw member and the second jaw Organization among components. The end effector may also include electrodes electrically coupled to the conductors and first and second tissue-engaging surfaces coupled to the first jaw member and the second jaw member. One of the mouth members and extends along the longitudinal axis. Each of the first tissue-engaging surface and the second tissue-engaging surface may have an interior and an exterior, wherein the first tissue-engaging surface and the second tissue-engaging surface are sloped relative to the transverse plane.

根据各种实施例，用于向组织提供能量的外科器械可包括柄部。柄部可包括触发器和电输入端。轴可从柄部延伸，其中轴包括导体，并且其中触发器能够选择性地致动以电联接电输入端和导体。外科器械可包括端部执行器，所述端部执行器限定纵向轴线并且包括第一钳口构件和第二钳口构件。第一钳口构件和第二钳口构件中的至少一者能够相对于第一钳口构件和第二钳口构件中的另一者在打开位置与闭合位置之间运动，以在处于闭合位置时夹持第一钳口构件和第二钳口构件中间的组织。端部执行器可包括具有无源电极组织接触表面的无源电极以及具有第一有源电极组织接触表面和第二有源电极组织接触表面的有源电极。有源电极可与导体电联接，并且当处于闭合位置时第一有源电极组织接触表面可大致平行于无源电极组织接触表面。当处于闭合位置时，第二有源电极组织接触表面相对于无源电极组织接触表面可为大致倾斜的。According to various embodiments, a surgical instrument for providing energy to tissue may include a handle. The handle may include a trigger and an electrical input. A shaft may extend from the handle, wherein the shaft includes a conductor, and wherein the trigger is selectively actuatable to electrically couple the electrical input and the conductor. The surgical instrument can include an end effector defining a longitudinal axis and including first and second jaw members. At least one of the first jaw member and the second jaw member is movable relative to the other of the first jaw member and the second jaw member between an open position and a closed position, such that in the closed position While clamping the tissue between the first jaw member and the second jaw member. The end effector may include a passive electrode having a passive electrode tissue contacting surface and an active electrode having a first active electrode tissue contacting surface and a second active electrode tissue contacting surface. The active electrode can be electrically coupled to the conductor, and the first active electrode tissue contacting surface can be substantially parallel to the passive electrode tissue contacting surface when in the closed position. When in the closed position, the second active electrode tissue contacting surface may be generally sloped relative to the passive electrode tissue contacting surface.

根据各种实施例，用于向组织提供能量的外科器械可包括柄部，所述柄部包括触发器和电输入端。外科器械可包括从柄部延伸的轴，其中所述轴包括导体，并且其中触发器能够选择性地致动以电联接电输入端和导体。外科器械可包括限定纵向轴线的端部执行器。端部执行器可包括第一钳口构件和第二钳口构件。第一钳口构件和第二钳口构件中的至少一者能够相对于第一钳口构件和第二钳口构件中的另一者在打开位置与闭合位置之间运动，以在处于闭合位置时夹持第一钳口构件和第二钳口构件中间的组织。端部执行器还可包括与导体联接的第一电极。第一电极可包括多个凸起表面。当处于闭合位置时，组织接触表面可与第一电极相对，其中组织接触表面可限定多个凹痕。凹痕可被定位成当第一钳口构件和第二钳口构件处于闭合位置时容纳多个凸起表面。According to various embodiments, a surgical instrument for providing energy to tissue may include a handle including a trigger and an electrical input. The surgical instrument can include a shaft extending from the handle, wherein the shaft includes a conductor, and wherein the trigger is selectively actuatable to electrically couple the electrical input and the conductor. A surgical instrument may include an end effector defining a longitudinal axis. The end effector may include a first jaw member and a second jaw member. At least one of the first jaw member and the second jaw member is movable relative to the other of the first jaw member and the second jaw member between an open position and a closed position, such that in the closed position While clamping the tissue between the first jaw member and the second jaw member. The end effector may also include a first electrode coupled to the conductor. The first electrode may include a plurality of raised surfaces. When in the closed position, the tissue-contacting surface can oppose the first electrode, wherein the tissue-contacting surface can define a plurality of indentations. The indentations may be positioned to accommodate the plurality of raised surfaces when the first and second jaw members are in the closed position.

根据各种实施例，用于向组织提供能量的外科器械可包括触发器、电输入端、以及从柄部延伸的轴。轴可包括导体，并且触发器能够选择性地致动以电联接电输入端和导体。外科器械还可包括限定纵向轴线的端部执行器。端部执行器可包括第一钳口构件和第二钳口构件。第一钳口构件和第二钳口构件中的至少一者能够相对于第一钳口构件和第二钳口构件中的另一者在打开位置与闭合位置之间运动，以在处于闭合位置时夹持第一钳口构件和第二钳口构件中间的组织。第一钳口构件和第二钳口构件可限定通道。端部执行器可包括具有远端的切割构件，其中切割构件的尺寸和构造被设定成至少部分地装配在通道内。切割构件能够在回缩位置与完全推进位置之间沿通道平移。切割构件可包括至少第一带、第二带和第三带，其中第二带被设置在第一带和第三带的中间并且包括锐利的远侧切割元件。端部执行器还可包括从切割构件延伸的至少一个压缩元件，其中至少一个压缩元件接合第一钳口和第二钳口中的一者以当切割构件相对于第一钳口构件平移到回缩位置之外时使第一钳口和第二钳口从打开位置运动到闭合位置。According to various embodiments, a surgical instrument for providing energy to tissue may include a trigger, an electrical input, and a shaft extending from a handle. The shaft may include a conductor, and the trigger is selectively actuatable to electrically couple the electrical input and the conductor. The surgical instrument may also include an end effector defining a longitudinal axis. The end effector may include a first jaw member and a second jaw member. At least one of the first jaw member and the second jaw member is movable relative to the other of the first jaw member and the second jaw member between an open position and a closed position, such that in the closed position While clamping the tissue between the first jaw member and the second jaw member. The first jaw member and the second jaw member may define a channel. The end effector may include a cutting member having a distal end, wherein the cutting member is sized and configured to fit at least partially within the channel. The cutting member is translatable along the channel between a retracted position and a fully advanced position. The cutting member may include at least a first band, a second band, and a third band, wherein the second band is disposed intermediate the first band and the third band and includes a sharpened distal cutting element. The end effector may also include at least one compression element extending from the cutting member, wherein the at least one compression element engages one of the first jaw and the second jaw to retract when the cutting member translates relative to the first jaw member. out of position to move the first jaw and the second jaw from the open position to the closed position.

根据各种实施例，用于向组织提供能量的外科器械可包括柄部、触发器、电输入端、以及从柄部延伸的轴。轴可包括导体，并且触发器能够选择性地致动以电联接电输入端和导体。外科器械可包括限定纵向轴线的端部执行器。端部执行器可包括第一钳口构件和第二钳口构件，所述第一钳口构件包括沿纵向轴线的凸轮压缩表面，其中第一钳口构件和第二钳口构件中的至少一者能够相对于第一钳口构件和第二钳口构件中的另一者在打开位置与闭合位置之间运动，以在处于闭合位置时夹持第一钳口构件和第二钳口构件中间的组织。第一钳口构件和第二钳口构件可限定通道。端部执行器可包括具有远端的切割构件，其中切割构件的尺寸和构造被设定成至少部分地装配在通道内。切割构件能够在回缩位置与完全推进位置之间沿通道平移。端部执行器可包括从切割构件延伸并且接触凸轮压缩表面的至少一个压缩元件，其中所述至少一个压缩元件接合凸轮压缩表面以当切割构件相对于第一钳口构件和第二钳口构件平移到回缩位置之外时使第一钳口和第二钳口从打开位置运动到闭合位置。According to various embodiments, a surgical instrument for providing energy to tissue may include a handle, a trigger, an electrical input, and a shaft extending from the handle. The shaft may include a conductor, and the trigger is selectively actuatable to electrically couple the electrical input and the conductor. A surgical instrument may include an end effector defining a longitudinal axis. The end effector may include a first jaw member and a second jaw member, the first jaw member including a cammed compression surface along the longitudinal axis, wherein at least one of the first jaw member and the second jaw member One is movable relative to the other of the first jaw member and the second jaw member between an open position and a closed position to clamp the first jaw member and the second jaw member intermediate the first jaw member and the second jaw member when in the closed position. organization. The first jaw member and the second jaw member may define a channel. The end effector may include a cutting member having a distal end, wherein the cutting member is sized and configured to fit at least partially within the channel. The cutting member is translatable along the channel between a retracted position and a fully advanced position. The end effector may include at least one compression element extending from the cutting member and contacting the cam compression surface, wherein the at least one compression element engages the cam compression surface to Moving the first and second jaws from the open position to the closed position when out of the retracted position.

根据各种实施例，用于向组织提供能量的外科器械可包括柄部、触发器和电输入端。外科器械可包括从柄部延伸的轴，其中轴包括导体，并且其中触发器能够选择性地致动以电联接电输入端和导体。外科器械可包括限定纵向轴线的端部执行器。端部执行器可包括第一钳口构件和第二钳口构件，所述第一钳口构件包括沿纵向轴线的凸轮压缩表面。第一钳口构件和第二钳口构件中的至少一者能够相对于第一钳口构件和第二钳口构件中的另一者在打开位置与闭合位置之间运动，以在处于闭合位置时夹持第一钳口构件和第二钳口构件中间的组织。第一钳口构件和第二钳口构件可限定通道。端部执行器还可包括具有远端的切割构件，其中切割构件的尺寸和构造被设定成至少部分地装配在通道内。切割构件能够在回缩位置与完全推进位置之间沿通道平移，其中切割构件限定横断平面。端部执行器还可包括具有锥形组织接触表面的电极。According to various embodiments, a surgical instrument for providing energy to tissue may include a handle, a trigger, and an electrical input. The surgical instrument can include a shaft extending from the handle, wherein the shaft includes a conductor, and wherein the trigger is selectively actuatable to electrically couple the electrical input and the conductor. A surgical instrument may include an end effector defining a longitudinal axis. The end effector may include a first jaw member including a cammed compression surface along the longitudinal axis and a second jaw member. At least one of the first jaw member and the second jaw member is movable relative to the other of the first jaw member and the second jaw member between an open position and a closed position, such that in the closed position While clamping the tissue between the first jaw member and the second jaw member. The first jaw member and the second jaw member may define a channel. The end effector may also include a cutting member having a distal end, wherein the cutting member is sized and configured to fit at least partially within the channel. The cutting member is translatable along the channel between a retracted position and a fully advanced position, wherein the cutting member defines a transverse plane. The end effector may also include an electrode having a tapered tissue contacting surface.

根据各种实施例，用于向组织提供能量的外科器械可包括柄部，所述柄部包括触发器、操作地联接到触发器的过载构件、以及电输入端。外科器械还可包括从柄部延伸的轴，其中轴包括导体，并且其中触发器能够选择性地致动以电联接电输入端和导体。外科器械可包括端部执行器，所述端部执行器限定纵向轴线并且包括第一钳口构件和第二钳口构件。第一钳口构件和第二钳口构件中的至少一者能够相对于第一钳口构件和第二钳口构件中的另一者运动，以夹持第一钳口构件和第二钳口构件中间的组织。端部执行器还可包括与导体电联接的电极。According to various embodiments, a surgical instrument for providing energy to tissue may include a handle including a trigger, an overload member operatively coupled to the trigger, and an electrical input. The surgical instrument may also include a shaft extending from the handle, wherein the shaft includes a conductor, and wherein the trigger is selectively actuatable to electrically couple the electrical input and the conductor. The surgical instrument can include an end effector defining a longitudinal axis and including first and second jaw members. At least one of the first jaw member and the second jaw member is movable relative to the other of the first jaw member and the second jaw member to clamp the first jaw member and the second jaw Organization among components. The end effector may also include electrodes electrically coupled to the conductors.

根据各种实施例，用于向组织提供能量的外科器械可包括柄部、触发器、电输入端、以及从柄部延伸的轴。轴可包括导体，并且触发器能够选择性地致动以电联接电输入端和导体。外科器械可包括限定纵向轴线的端部执行器。端部执行器可包括第一钳口构件和第二钳口构件，所述第一钳口构件包括沿纵向轴线的凸轮压缩表面。第一钳口构件和第二钳口构件中的至少一者能够相对于第一钳口构件和第二钳口构件中的另一者在打开位置与闭合位置之间运动，以在处于闭合位置时夹持第一钳口构件和第二钳口构件中间的组织。第一钳口构件和第二钳口构件可限定通道。端部执行器可包括具有远端的切割构件，其中切割构件的尺寸和构造被设定成至少部分地装配在通道内。切割构件能够在回缩位置与完全推进位置之间沿通道平移。切割构件可包括间隔开一距离的第一压缩元件和第二压缩元件。第一压缩元件可为能够接合到第一钳口构件并且第二压缩元件可为能够接合到第二钳口构件，其中第一压缩元件能够相对于切割构件运动。According to various embodiments, a surgical instrument for providing energy to tissue may include a handle, a trigger, an electrical input, and a shaft extending from the handle. The shaft may include a conductor, and the trigger is selectively actuatable to electrically couple the electrical input and the conductor. A surgical instrument may include an end effector defining a longitudinal axis. The end effector may include a first jaw member including a cammed compression surface along the longitudinal axis and a second jaw member. At least one of the first jaw member and the second jaw member is movable relative to the other of the first jaw member and the second jaw member between an open position and a closed position, such that in the closed position While clamping the tissue between the first jaw member and the second jaw member. The first jaw member and the second jaw member may define a channel. The end effector may include a cutting member having a distal end, wherein the cutting member is sized and configured to fit at least partially within the channel. The cutting member is translatable along the channel between a retracted position and a fully advanced position. The cutting member may include first and second compression elements spaced apart by a distance. The first compression element may be engageable to the first jaw member and the second compression element may be engageable to the second jaw member, wherein the first compression element is movable relative to the cutting member.

附图说明Description of drawings

本文所述的实施例的各种结构在所附权利要求书中进行了详细描述。然而，根据结合如下附图的以下描述，可以理解各种实施例（对手术的组织和方法来说皆是如此）连同其优点。Various structures of the embodiments described herein are set forth in the appended claims. However, various embodiments, both as to the organization and method of surgery, together with advantages thereof, can be understood from the following description when taken in conjunction with the following figures.

图1为根据至少一个实施例示出的外科器械的透视图。Figure 1 is a perspective view of a surgical instrument shown in accordance with at least one embodiment.

图2为图1的外科器械的柄部的侧视图，其中移除了柄部主体的一半以示出其内的一些组件。2 is a side view of the handle of the surgical instrument of FIG. 1 with half of the handle body removed to show some components therein.

图3为图1的外科器械的端部执行器的透视图，其示出为处于打开构型；闭合梁的远端示出为处于回缩位置。3 is a perspective view of the end effector of the surgical instrument of FIG. 1, shown in an open configuration; the distal end of the closure beam is shown in a retracted position.

图4为图1的外科器械的端部执行器的透视图，其示出为处于闭合构型；闭合梁的远端示出为处于部分推进位置。4 is a perspective view of the end effector of the surgical instrument of FIG. 1, shown in a closed configuration; the distal end of the closure beam is shown in a partially advanced position.

图5为图1的外科器械的端部执行器的一部分的透视剖视图。5 is a perspective cross-sectional view of a portion of the end effector of the surgical instrument of FIG. 1 .

图6为根据一个非限制性实施例的端部执行器的剖视图。Figure 6 is a cross-sectional view of an end effector according to one non-limiting embodiment.

图6A为示出根据一个非限制性实施例的当端部执行器处于闭合位置时第一钳口与第二钳口之间的相互作用的剖视图。6A is a cross-sectional view illustrating the interaction between a first jaw and a second jaw when the end effector is in a closed position, according to one non-limiting embodiment.

图7为示出于图6中的端部执行器的第一钳口的放大剖视图。7 is an enlarged cross-sectional view of the first jaw of the end effector shown in FIG. 6 .

图7A为根据一个非限制性实施例的示出于图7中的齿状物的放大视图。Figure 7A is an enlarged view of the tooth shown in Figure 7, according to one non-limiting embodiment.

图8为根据一个非限制性实施例的端部执行器的放大视图。Figure 8 is an enlarged view of an end effector according to one non-limiting embodiment.

图8A为示出于图8中的第一钳口的近侧部分的放大视图。8A is an enlarged view of a proximal portion of the first jaw shown in FIG. 8 .

图9为示出于图6中的端部执行器的第二钳口的放大剖视图。9 is an enlarged cross-sectional view of the second jaw of the end effector shown in FIG. 6 .

图9A为图9的一部分的放大视图。FIG. 9A is an enlarged view of a portion of FIG. 9 .

图10为根据一个非限制性实施例的结合偏心式电极的端部执行器的剖面透视图。Figure 10 is a cutaway perspective view of an end effector incorporating an eccentric electrode according to one non-limiting embodiment.

图11示出了根据一个非限制性实施例的端部执行器。Figure 11 illustrates an end effector according to one non-limiting embodiment.

图11A为示出于图11中的端部执行器的第二钳口的远侧部分的放大视图。11A is an enlarged view of the distal portion of the second jaw of the end effector shown in FIG. 11 .

图12为根据一个非限制性实施例的图11的端部执行器的第一钳口的局部透视图。Figure 12 is a partial perspective view of a first jaw of the end effector of Figure 11, according to one non-limiting embodiment.

图13A和13B为示出于图11中的端部执行器的远端在两种操作状态期间的横截面侧视图。13A and 13B are cross-sectional side views of the distal end of the end effector shown in FIG. 11 during two states of operation.

图14示出了根据一个非限制性实施例的具有结合华夫图案的电极的端部执行器。Figure 14 illustrates an end effector having electrodes incorporating a waffle pattern, according to one non-limiting embodiment.

图15示出了根据一个非限制性实施例的示出于图14中的端部执行器的第一钳口的组织接触表面。Figure 15 illustrates the tissue contacting surface of the first jaw of the end effector shown in Figure 14, according to one non-limiting embodiment.

图16示出了根据一个非限制性实施例的可运动切割构件的远端。Figure 16 illustrates the distal end of the movable cutting member according to one non-limiting embodiment.

图17为可与示出于图16中的可运动切割构件一起使用的端部执行器的远端的视图。17 is a view of the distal end of an end effector usable with the movable cutting member shown in FIG. 16 .

图18为根据一个非限制性实施例的处于打开位置的端部执行器的剖视图。18 is a cross-sectional view of an end effector in an open position, according to one non-limiting embodiment.

图19和20示出了图18中所示的在第一钳口已朝向第二钳口枢转之后的端部执行器。Figures 19 and 20 show the end effector shown in Figure 18 after the first jaw has been pivoted towards the second jaw.

图21为根据一个非限制性实施例的第一闭合销轨道的轮廓。Figure 21 is an outline of a first closure pin track according to one non-limiting embodiment.

图22为根据一个非限制性实施例的钳口的剖视图。Figure 22 is a cross-sectional view of a jaw according to one non-limiting embodiment.

图23A和23B示出了根据一个非限制性实施例的在两种操作状态过程中附连到可运动切割构件的闭合销。23A and 23B illustrate a closure pin attached to a movable cutting member during two operating states, according to one non-limiting embodiment.

图24示出了根据一个非限制性实施例的具有平移带的可运动切割构件。Figure 24 illustrates a movable cutting member with a translating belt, according to one non-limiting embodiment.

图25示出了在回缩/返回期间图24的可运动切割构件。Figure 25 shows the movable cutting member of Figure 24 during retraction/return.

图26和28为根据一个非限制性实施例的操作地联接到推块的击发杆的剖视图。26 and 28 are cross-sectional views of a firing rod operatively coupled to a push block, according to one non-limiting embodiment.

图27和29为根据一个非限制性实施例的可运动切割构件的透视图。27 and 29 are perspective views of a movable cutting member according to one non-limiting embodiment.

图30为根据一个非限制性实施例的包括闭合销组件的可运动切割构件的分解透视图。Figure 30 is an exploded perspective view of a movable cutting member including a closure pin assembly, according to one non-limiting embodiment.

图31为处于组装构型的图30的可运动切割构件的透视图。31 is a perspective view of the movable cutting member of FIG. 30 in an assembled configuration.

图31A为图31的可运动切割构件的剖视图。31A is a cross-sectional view of the movable cutting member of FIG. 31 .

图32为根据一个非限制性实施例的包括滚针轴承的闭合销的分解图。Figure 32 is an exploded view of a closure pin including a needle bearing, according to one non-limiting embodiment.

图33为图32的经组装的闭合销的剖视图。33 is a cross-sectional view of the assembled closure pin of FIG. 32 .

图34为根据一个非限制性实施例的端部执行器的透视图。Figure 34 is a perspective view of an end effector according to one non-limiting embodiment.

图35为示出于图34中的端部执行器的一部分的剖视图。35 is a cross-sectional view of a portion of the end effector shown in FIG. 34 .

图36示出了根据一个非限制性实施例的台阶式销。Figure 36 illustrates a stepped pin according to one non-limiting embodiment.

图37A和37B示出了根据一个非限制性实施例的可运动切割构件的外带。37A and 37B illustrate an outer band of a movable cutting member, according to one non-limiting embodiment.

图38A和38B示出了处于组装位置的图33A和33B的外带。Figures 38A and 38B show the outer strap of Figures 33A and 33B in an assembled position.

图39为在已附连第一钳口闭合销之后的可运动切割构件的顶部远端的透视图。Figure 39 is a perspective view of the top distal end of the movable cutting member after the first jaw closure pin has been attached.

图40示出了根据一个非限制性实施例的剪切销。Figure 40 illustrates a shear pin according to one non-limiting embodiment.

图41示出了根据一个非限制性实施例的包括剪切销的触发器组件的简化版本。Figure 41 shows a simplified version of a trigger assembly including a shear pin, according to one non-limiting embodiment.

图42示出了根据一个非限制性实施例的外科器械，其中移除了外壳的部分以示出多个内部组件。Figure 42 illustrates a surgical instrument with portions of the housing removed to show various internal components, according to one non-limiting embodiment.

图43为触发器组件的一部分的放大视图，其中为清楚起见已移除了多个组件。Figure 43 is an enlarged view of a portion of the trigger assembly with various components removed for clarity.

图44为图43的触发器组件的多个组件的分解图，其中为清楚起见已移除了多个组件。44 is an exploded view of various components of the trigger assembly of FIG. 43 with various components removed for clarity.

图45示出了根据一个非限制性实施例的安装到外科器械的驱动轴的内部的压缩构件。Figure 45 illustrates a compression member mounted to the interior of a drive shaft of a surgical instrument, according to one non-limiting embodiment.

图45A为图45的剖视图。FIG. 45A is a cross-sectional view of FIG. 45 .

在所述多个视图中，对应的参考符号表示对应的部件。本文示出的范例以一种形式示出了本发明的各种实施例，不应将这种范例理解为是以任何方式限制本发明的范围。Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set forth herein illustrate various embodiments of the invention in one form and should not be construed as limiting the scope of the invention in any way.

具体实施方式detailed description

各种实施例涉及用于处理组织的设备、系统和方法。示出了许多特定的细节，从而得到对说明书中所述和附图中所示的实施例的整体结构、功能、制造和用途的彻底理解。然而，本领域技术人员将会理解，可在没有这样的特定细节的情况下实施所述实施例。在其它实例中，未详细描述熟知的操作、组件和元件，以免使说明书中描述的实施例模糊不清。本领域普通技术人员将会理解，本文所述和所示的实施例是非限制性例子，并因此可以认识到，本文所公开的特定结构和功能细节可能是代表性的，并且不必限制实施例的范围，实施例的范围仅由所附权利要求限定。Various embodiments relate to devices, systems and methods for treating tissue. Numerous specific details are shown to provide a thorough understanding of the general structure, function, manufacture and use of the embodiments described in the specification and shown in the drawings. However, one skilled in the art would understand that the described embodiments may be practiced without such specific details. In other instances, well-known operations, components and elements have not been described in detail so as not to obscure the embodiments described in the specification. Those of ordinary skill in the art will understand that the embodiments described and illustrated herein are non-limiting examples, and thus can recognize that the specific structural and functional details disclosed herein may be representative and do not necessarily limit the scope of the embodiments. Scope, the scope of the embodiments is limited only by the appended claims.

本说明书通篇引用的“各种实施例”、“一些实施例”、“一个实施例”或“实施例”等，是指结合所述实施例描述的具体特征、结构或特性包括在至少一个实施例中。因此，本说明书通篇出现的短语“在各种实施例中”、“在一些实施例中”、“在一个实施例中”或“在实施例中”等并不一定均指相同的实施例。此外，在一个或多个实施例中，具体特征、结构或特性可按任何合适的方式组合。因此，在无限制的情况下，结合一个实施例示出或描述的具体特征、结构或特性可全部或部分地与一个或多个其它实施例的特征、结构或特性结合。References throughout this specification to "various embodiments," "some embodiments," "one embodiment," or "an embodiment" mean that specific features, structures, or characteristics described in connection with the embodiments are included in at least one Examples. Thus, appearances of the phrases "in various embodiments," "in some embodiments," "in one embodiment," or "in an embodiment" etc. throughout this specification do not necessarily all refer to the same embodiment. . Furthermore, the particular features, structures or characteristics may be combined in any suitable manner in one or more embodiments. Thus, a particular feature, structure or characteristic shown or described in connection with one embodiment may be combined in whole or in part with features, structures or characteristics of one or more other embodiments without limitation.

应当理解，可结合临床医生操纵用来于治疗患者的器械的一端在说明书中通篇使用术语“近侧”和“远侧”。术语“近侧”是指器械的最靠近临床医生的部分，术语“远侧”是指离临床医生最远的部分。还应当理解，为简明和清楚起见，本文可参考所示实施例使用空间术语例如“竖直”、“水平”、“上”和“下”。然而，外科器械可在多个方向和位置中使用，并且这些术语并不意味着是限制性的且绝对的。It should be understood that the terms "proximal" and "distal" are used throughout the specification in connection with the end of an instrument that a clinician manipulates for treating a patient. The term "proximal" refers to the part of the device that is closest to the clinician, and the term "distal" refers to the part that is farthest from the clinician. It should also be understood that spatial terms such as "vertical," "horizontal," "upper," and "lower" may be used herein with reference to the illustrated embodiments for the sake of brevity and clarity. However, surgical instruments can be used in a variety of orientations and positions, and these terms are not meant to be limiting and absolute.

下列非临时性美国专利的全部公开内容据此以引用方式并入本文：The entire disclosures of the following non-provisional U.S. patents are hereby incorporated by reference:

美国专利7,381,209，名称为ELECTROSURGICALINSTRUMENT；US Patent 7,381,209, entitled ELECTROSURGICALINSTRUMENT;

美国专利7,354,440，名称为ELECTROSURGICALINSTRUMENTANDMETHODOFUSE；US Patent 7,354,440, titled ELECTROSURGICALINSTRUMENTANDMETHODOFUSE;

美国专利7,311,709，名称为ELECTROSURGICALINSTRUMENTANDMETHODOFUSE；US Patent 7,311,709, titled ELECTROSURGICALINSTRUMENTANDMETHODOFUSE;

美国专利7,309,849，名称为POLYMERCOMPOSITIONSEXHIBITINGAPTCPROPERTYANDMETHODSOFFABRICATION；US Patent 7,309,849, titled POLYMER COMPOSITION SEX HIBITINGAPTCPROPERTYANDMETHODSOFFABRICATION;

美国专利7,220,951，名称为SURGICALSEALINGSURFACESANDMETHODSOFUSE；US Patent 7,220,951, titled SURGICALSEALINGSURFACESANDMETHODSOFUSE;

美国专利7,189,233，名称为ELECTROSURGICALINSTRUMENT；US Patent 7,189,233, titled ELECTROSURGICALINSTRUMENT;

美国专利7,186,253，名称为ELECTROSURGICALJAWSTRUCTUREFORCONTROLLEDENERGYDELIVERY；US Patent 7,186,253, entitled ELECTROSURGICALJAWSTRUCTUREFORCONTROLLEDENERGYDELIVERY;

美国专利7,169,146，名称为ELECTROSURGICALPROBEANDMETHODOFUSE；US Patent 7,169,146, titled ELECTROSURGICAL PROBEAND METHODOFUSE;

美国专利7.125.409，名称为ELECTROSURGICALWORKINGENDFORCONTROLLEDENERGYDELIVERY；和US Patent 7.125.409, entitled ELECTROSURGICALWORKINGENDFORCONTROLLEDENERGYDELIVERY; and

美国专利7,112,201，名称为ELECTROSURGICALINSTRUMENTANDMETHODOFUSE。US Patent 7,112,201, entitled ELECTROSURGICALINSTRUMENTANDMETHODOFUSE.

这些系统和方法的各种实施例涉及在自然组织块内形成热“焊接”或“熔合”。组织“焊接”和组织“熔合”的替代术语在本文中可互换使用，以描述对目标组织块进行热处理，从而产生大体上均匀的熔合在一起的组织块，在例如焊接的血管内后处理立即表现出较强的破裂强度。此类焊接的强度尤其可用于(i)在血管横切手术中永久性密封血管；(ii)在切除手术中焊接器官边缘；(iii)焊接其中需要永久性闭合的其它解剖导管；并且另外(iv)可用于执行血管吻合术、血管闭合术或者将解剖结构或其部分接合在一起的其它手术。本文所公开的组织焊接或熔合区别于“凝结”、“止血”以及通常涉及减少和阻塞小血管或血管化组织内的血流的其它类似的描述性术语。例如，向任何表面施加热能均可能导致凝结或止血，但却不属于本文所用术语“焊接”的范畴。此类表面凝结不会产生提供处理的组织任何显著强度的焊接。Various embodiments of these systems and methods involve forming a thermal "weld" or "fusion" within a mass of native tissue. The alternative terms tissue "welding" and tissue "fusion" are used interchangeably herein to describe the thermal treatment of a mass of tissue of interest to produce a substantially homogeneous mass of tissue fused together, e.g. post-processing within a welded vessel Immediately exhibits strong bursting strength. The strength of such welds is especially useful for (i) permanent sealing of vessels during vascular transection procedures; (ii) welding of organ edges during resection procedures; (iii) welding of other anatomical conduits where permanent closure is required; and additionally ( iv) Can be used to perform vascular anastomosis, vascular closure, or other procedures that join together anatomical structures or parts thereof. Tissue welding or fusion as disclosed herein is distinguished from "coagulation," "hemostasis," and other similar descriptive terms that generally refer to reducing and occluding blood flow within small blood vessels or vascularized tissue. For example, the application of thermal energy to any surface may cause coagulation or hemostasis, but does not fall within the scope of the term "welding" as used herein. Such surface condensation does not create a weld that provides the treated tissue with any appreciable strength.

在分子水平，如本文所公开的真正“焊接”组织的现象可能源于由热引起的目标组织块中胶原和其它蛋白分子的变性，以形成瞬态液态或凝胶状蛋白质性混合物。在目标组织内提供所选能量密度，可使胶原和其它蛋白质内的分子内和分子间氢键交联的水热分解。在可为非常短的所选时间间隔内将变性的蛋白质混合物保持在所选的水合程度（不脱水）。保持目标组织块处于所选极高程度的机械压缩状态，以确保解链的变性蛋白质彼此接近，以便进行交织和缠结。在热驰豫时，随再交联和复性的发生，混杂的蛋白质混合物使蛋白质缠结，从而产生均匀熔合在一起的块体。At the molecular level, the phenomenon of true "welding" of tissue as disclosed herein may arise from heat-induced denaturation of collagen and other protein molecules in the target tissue mass to form a transient liquid or gel-like proteinaceous mixture. Delivering selected energy densities within the target tissue enables the hydrothermal breakdown of intramolecular and intermolecular hydrogen bond cross-links within collagen and other proteins. The denatured protein mixture is maintained at a selected level of hydration (without dehydration) for a selected time interval, which may be very short. The target tissue block is maintained at a selected extreme degree of mechanical compression to ensure that unzipped denatured proteins are in close proximity to each other for intertwining and entanglement. During thermal relaxation, the promiscuous protein mixture entangles the proteins as recrosslinking and renaturation occur, resulting in homogeneously fused-together blocks.

外科器械能够例如向患者的组织提供能量，例如电能、超声能、和/或热能。例如，本文所公开的各种实施例提供下述电外科钳口结构，所述电外科钳口结构适于横切钳口之间的捕获的组织，并且适于通过可控地施加射频能量而同时焊接或密封所捕获组织的边缘。外科器械还能够夹紧、切断和缝合组织。Surgical instruments can, for example, provide energy, such as electrical energy, ultrasonic energy, and/or thermal energy, to tissue of a patient. For example, various embodiments disclosed herein provide electrosurgical jaw structures adapted to transect captured tissue between the jaws and adapted to Simultaneously weld or seal the edges of the captured tissue. Surgical instruments are also capable of clamping, severing and stapling tissue.

更详细地，在各种实施例中，现在参见图1，示出了电外科器械100。外科器械或电外科器械100可包括近侧柄部105、远侧工作端或端部执行器110、以及设置在这两者之间并将柄部105至少部分操作地联接到端部执行器110的导引器或细长轴108。端部执行器110可包括一组可打开/可闭合的钳口，具有直的或弯曲的钳口—上部第一钳口120A和下部第二钳口120B。钳口120A和120B可被操作地联接在一起，使得第一钳口120A可相对于第二钳口120B在打开位置与闭合位置之间运动。第一钳口120A和第二钳口120B可各自包括沿它们相应的中间部分分别向外设置的细长狭槽或通道142A和142B（参见图3）。第一钳口120A和第二钳口120B可通过缆线152中的电引线联接到电源145和控制器150。控制器150可用于启动电源145。在各种实施例中，电源145可包括例如射频源、超声波源、直流电源、和/或任何其它合适类型的电能源。In more detail, in various embodiments, referring now to FIG. 1 , an electrosurgical instrument 100 is shown. Surgical or electrosurgical instrument 100 may include a proximal handle 105, a distal working end or end effector 110, and an end effector disposed therebetween and at least partially operatively coupling handle 105 to end effector 110. An introducer or elongated shaft 108. The end effector 110 may include a set of openable/closable jaws, either straight or curved - an upper first jaw 120A and a lower second jaw 120B. Jaws 120A and 120B are operatively coupled together such that first jaw 120A is movable relative to second jaw 120B between an open position and a closed position. The first jaw 120A and the second jaw 120B may each include elongated slots or channels 142A and 142B (see FIG. 3 ) respectively disposed outwardly along their respective intermediate portions. First jaw 120A and second jaw 120B may be coupled to power source 145 and controller 150 by electrical leads in cable 152 . Controller 150 may be used to activate power supply 145 . In various embodiments, power source 145 may include, for example, a radio frequency source, an ultrasonic source, a DC power source, and/or any other suitable type of electrical energy source.

现在转到图2，其示出了柄部105的侧视图，其中第一柄部主体106A（参见图1）的一半被移除以示出第二柄部主体106B内的一些组件。柄部105可包括从柄部主体106A和/或106B延伸的杠杆臂或触发器128。可沿路径129牵拉触发器128，使得触发器128相对于主体106A和/或106B运动。触发器128还可通过往复运动件146操作地联接到设置在细长轴108内的可运动切割构件140，所述往复运动件操作地接合到触发器128的延伸部127。因此，触发器128相对柄部主体106A和/或106B的运动可使切割构件140相对于钳口120A和120B（参见图1）中的一者或两者平移。另外，如下文更详细所述，切割构件140可与闭合梁170（参见图3-4）可释放地接合，所述闭合梁还与钳口120A,120B可运动地相关联。往复运动件146还可连接到偏置装置，例如弹簧141，所述偏置装置也可连接到第二柄部主体106B以偏置往复运动件146并因此偏置切割构件140和/或闭合梁170（图3），从而将钳口120A和120B推压到打开位置，如图1所示。另外，参见图1和2，锁定构件131（参见图2）可以通过锁定开关130（参见图1）在锁定位置与解锁位置之间运动，在该锁定位置，如图所示基本上防止往复运动件146朝远侧运动，在该解锁位置，可以允许往复运动件146自由地沿远侧方向朝向细长轴108运动。柄部105可为任何类型的手枪式握把或本领域中已知的其它类型的柄部，其能够承载致动器杠杆、触发器或滑动件，以用于致动第一钳口120A和第二钳口120B。细长轴108可具有圆柱形或矩形横截面，并且可包括从柄部105延伸的薄壁管状套筒。细长轴108可包括贯穿延伸的孔，以用于承载例如用于致动钳口的致动器机构（例如切割构件140和/或闭合梁170），并且用于承载将电能递送到端部执行器110的电外科组件的电引线。Turning now to FIG. 2 , a side view of the handle 105 is shown with half of the first handle body 106A (see FIG. 1 ) removed to show some of the components within the second handle body 106B. The handle 105 may include a lever arm or trigger 128 extending from the handle body 106A and/or 106B. Trigger 128 may be pulled along path 129 such that trigger 128 moves relative to body 106A and/or 106B. The trigger 128 is also operatively coupled to a movable cutting member 140 disposed within the elongated shaft 108 by a shuttle 146 operatively engaged to the extension 127 of the trigger 128 . Accordingly, movement of trigger 128 relative to handle bodies 106A and/or 106B may translate cutting member 140 relative to one or both of jaws 120A and 120B (see FIG. 1 ). Additionally, as described in greater detail below, the cutting member 140 is releasably engageable with a closure beam 170 (see FIGS. 3-4 ), which is also movably associated with the jaws 120A, 120B. The reciprocator 146 may also be connected to a biasing device, such as a spring 141, which may also be connected to the second handle body 106B to bias the reciprocator 146 and thus the cutting member 140 and/or closure beam 170 ( FIG. 3 ), thereby pushing the jaws 120A and 120B into the open position, as shown in FIG. 1 . Additionally, referring to Figures 1 and 2, locking member 131 (see Figure 2) is movable by locking switch 130 (see Figure 1) between a locked position and an unlocked position in which reciprocation is substantially prevented as shown The reciprocating member 146 moves distally, and in the unlocked position, the reciprocating member 146 is allowed to move freely in the distal direction toward the elongated shaft 108. The handle 105 may be any type of pistol grip or other type of handle known in the art capable of carrying an actuator lever, trigger or slide for actuating the first jaw 120A and Second jaw 120B. The elongated shaft 108 may have a cylindrical or rectangular cross-section and may include a thin-walled tubular sleeve extending from the handle 105 . The elongated shaft 108 may include a bore extending therethrough for carrying, for example, an actuator mechanism (eg, cutting member 140 and/or closure beam 170 ) for actuating the jaws, and for carrying electrical energy delivered to the ends. Electrical leads of the electrosurgical components of the actuator 110 .

端部执行器110可适于捕获、焊接或密封、和横切组织。第一钳口120A和第二钳口120B可闭合以由此围绕由切割构件140限定的纵向轴线125来捕获或接合组织。第一钳口120A和第二钳口120B还可对组织施加压缩。细长轴108，连同第一钳口120A和第二钳口120B，可通过例如旋转三重触头而相对于柄部105旋转完整的360度，如箭头117所示。第一钳口120A和第二钳口120B可在旋转的同时保持为可打开和/或可闭合的。在一些实施例中，可由使用者操纵箍119或其它旋转控制装置以使端部执行器110旋转。End effector 110 may be adapted to capture, weld or seal, and transect tissue. First jaw 120A and second jaw 120B are closable to thereby capture or engage tissue about longitudinal axis 125 defined by cutting member 140 . The first jaw 120A and the second jaw 120B can also apply compression to the tissue. The elongated shaft 108 , together with the first jaw 120A and the second jaw 120B, can be rotated a full 360 degrees relative to the handle 105 by, for example, rotating the triple contact, as indicated by arrow 117 . The first jaw 120A and the second jaw 120B may remain openable and/or closable while rotating. In some embodiments, the hoop 119 or other rotational control device may be manipulated by the user to rotate the end effector 110 .

图3和4示出了端部执行器110的透视图。图3示出了处于打开构型的端部执行器110并且图4示出了处于闭合构型的端部执行器110。如上所述，端部执行器110可包括上部第一钳口120A和下部第二钳口120B。另外，第一钳口120A和第二钳口120B可各自具有设置在第一钳口120A和第二钳口120B的内部上的组织抓握元件，例如齿状物143。第一钳口120A可包括例如上部第一钳口主体161A，所述上部第一钳口主体具有上部第一向外表面162A和第一电极的上部第一能量递送表面175A。第二钳口120B可包括例如下部第二钳口主体161B，所述下部第二钳口主体具有下部第二向外表面162B和第二电极的下部第二能量递送表面175B。第一能量递送表面175A和第二能量递送表面175B均可围绕端部执行器110的远端以“U”形延伸。能量递送表面175A,175B可提供用于接触、抓握和/或操纵两者间的组织的组织接触表面。3 and 4 show perspective views of the end effector 110 . FIG. 3 shows the end effector 110 in an open configuration and FIG. 4 shows the end effector 110 in a closed configuration. As noted above, the end effector 110 may include an upper first jaw 120A and a lower second jaw 120B. Additionally, first jaw 120A and second jaw 120B may each have tissue grasping elements, such as teeth 143 , disposed on the interior of first jaw 120A and second jaw 120B. The first jaw 120A may include, for example, an upper first jaw body 161A having an upper first outward facing surface 162A and an upper first energy delivery surface 175A of the first electrode. The second jaw 120B may include, for example, a lower second jaw body 161B having a lower second outward facing surface 162B and a lower second energy delivery surface 175B of the second electrode. Both the first energy delivery surface 175A and the second energy delivery surface 175B can extend in a “U” shape around the distal end of the end effector 110 . Energy delivery surfaces 175A, 175B may provide tissue contacting surfaces for contacting, grasping and/or manipulating tissue therebetween.

参见图3-5，在至少一个实施例中，闭合梁170和切割构件140的尺寸和构造可设定成至少部分地装配在第一钳口120A的通道142A内。如图5所示，切割构件140的尺寸和构造也可设定成至少部分地装配在第二钳口120B的通道142B内。在任何情况下，闭合梁170和切割构件140可沿通道142A在第一、回缩位置与第二、推进位置之间平移，所述第一、回缩位置与处于打开位置的第一钳口（图3）相关，所述第二、推进位置与处于闭合位置的第二钳口（参见例如图4）相关。柄部105的触发器128（参见图2）可适于致动切割构件140并随后致动也用作钳口闭合机构的闭合梁170。例如，当沿路径129朝近侧牵拉触发器128时，可经由往复运动件146朝远侧推压切割构件140和/或闭合梁170，如图2所示且如上所述。切割构件140和闭合梁170可各自包括一个或多个部件，但在任何情况下，可各自相对于细长轴108和/或钳口120A,120B运动或平移。另外，在至少一个实施例中，切割构件140可例如由17-4沉淀硬化不锈钢制成。在一个实施例中，切割构件140的至少一部分为716不锈钢。切割构件140的远侧部分可包括带凸缘的“I”形梁，其能够在钳口120A和120B中的通道142A和142B内滑动。在至少一个实施例中，闭合梁170的远侧部分可包括“C”形梁，其能够在通道142A和142B中的一者内滑动。如图3-5所示，闭合梁示出为位于第一钳口120A的通道142A之内和/或之上。闭合梁170可在通道142A内滑动例如以相对于第二钳口120B来打开和闭合第一钳口120A。闭合梁170的远侧部分还可限定凸轮表面174，以用于例如接合第一钳口120A的向外表面162A。因此，当闭合梁170穿过通道142A从例如第一位置（图3）朝远侧推进到第二位置（图4）时，可将第一钳口120A推压成闭合的（图4）。也可通过第一钳口120A的上壁165引导闭合梁170，如图5所示，所述上壁可至少部分地包封闭合梁170。为清楚起见，已从图3-4中省略了上壁165。3-5, in at least one embodiment, closure beam 170 and cutting member 140 may be sized and configured to fit at least partially within channel 142A of first jaw 120A. As shown in FIG. 5 , cutting member 140 may also be sized and configured to fit at least partially within channel 142B of second jaw 120B. In any event, the closure beam 170 and cutting member 140 are translatable along the channel 142A between a first, retracted position with the first jaw in the open position and a second, advanced position. ( FIG. 3 ), the second, advanced position is associated with the second jaw in the closed position (see eg FIG. 4 ). The trigger 128 of the handle 105 (see FIG. 2 ) may be adapted to actuate the cutting member 140 and subsequently the closure beam 170 which also acts as a jaw closure mechanism. For example, when trigger 128 is pulled proximally along path 129, cutting member 140 and/or closure beam 170 may be urged distally via shuttle 146, as shown in FIG. 2 and described above. Cutting member 140 and closure beam 170 may each comprise one or more components, but in any event may each move or translate relative to elongate shaft 108 and/or jaws 120A, 120B. Additionally, in at least one embodiment, cutting member 140 may be made, for example, from 17-4 precipitation hardened stainless steel. In one embodiment, at least a portion of cutting member 140 is 716 stainless steel. The distal portion of cutting member 140 may comprise a flanged "I" beam that is slidable within channels 142A and 142B in jaws 120A and 120B. In at least one embodiment, the distal portion of closure beam 170 can comprise a "C" shaped beam that can slide within one of channels 142A and 142B. As shown in FIGS. 3-5 , the closure beam is shown positioned within and/or over the channel 142A of the first jaw 120A. Closure beam 170 is slidable within channel 142A, for example, to open and close first jaw 120A relative to second jaw 120B. The distal portion of the closure beam 170 may also define a cam surface 174 for engaging the outwardly facing surface 162A of the first jaw 120A, for example. Accordingly, first jaw 120A may be urged closed ( FIG. 4 ) as closure beam 170 is advanced distally through channel 142A, eg, from a first position ( FIG. 3 ) to a second position ( FIG. 4 ). The closure beam 170 may also be guided by the upper wall 165 of the first jaw 120A, which may at least partially enclose the closure beam 170 as shown in FIG. 5 . The upper wall 165 has been omitted from FIGS. 3-4 for clarity.

另外，在各种实施例中，切割构件140的尺寸和构造可设定成至少部分地装配或滑动在闭合梁170内，例如闭合梁170的内部通道171内。在至少一个实施例中，如图5所示，尽管切割构件140的部件可定位在闭合梁170内，但切割构件140的一部分可沿横向于由闭合梁170限定的纵向轴线172的方向从闭合梁170突出。切割构件140的凸缘144A和144B可限定内部凸轮表面，以用于接合闭合梁170的内部通道171和第二钳口120B的向外表面162B。如下文更详细所述，钳口120A和120B的打开和闭合可利用凸轮机构和钳口120A,120B的向外表面162A,162B将极高的压缩力施加到组织上，凸轮机构可包括往复式“C形梁”闭合梁170和/或“I形梁”切割构件140。Additionally, in various embodiments, cutting member 140 may be sized and configured to at least partially fit or slide within closure beam 170 , such as within interior passage 171 of closure beam 170 . In at least one embodiment, while portions of cutting member 140 may be positioned within closure beam 170, as shown in FIG. Beam 170 protrudes. Flanges 144A and 144B of cutting member 140 may define interior cam surfaces for engaging interior passage 171 of closure beam 170 and outward surface 162B of second jaw 120B. As described in more detail below, the opening and closing of jaws 120A and 120B can apply extremely high compressive forces to tissue using a cam mechanism, which can include a reciprocating The "C-beam" closure beam 170 and/or the "I-beam" cutting member 140 .

更具体地讲，仍参见图3-5，切割构件140的远端的凸缘144A和144B可共同地适于分别可滑动地接合闭合梁170的内部通道171和第二钳口120B的第二向外表面162B。第一钳口120A内的通道142A和第二钳口120B内的通道142B的尺寸和构造可设定成适应闭合梁170和/或切割构件140的运动，所述切割构件可包括组织切割元件，例如锐利的远侧边缘和/或表面。例如，图4示出了至少部分地穿过通道142A推进的闭合梁170的远端178。推进闭合梁170可将端部执行器110从图3所示的打开构型闭合成图4所示的闭合构型。闭合梁170可沿通道142A在第一、回缩位置和第二、完全推进位置之间运动或平移。回缩位置可如图3所示，其中钳口120A,120B处于打开位置并且闭合梁170的远端178被定位成邻近上部向外表面162A。尽管未示出，但当闭合梁170的远端178推进到通道142A的远端164并且钳口处于闭合位置时，可形成完全推进位置，参见图4。同样，切割构件140（图5）能够相对于第一钳口在回缩位置与完全推进位置平移，在回缩位置中钳口120A,120B处于打开位置（图3），在完全推进位置中切割构件推进到例如通道142A的远端164，其中钳口处于闭合位置（图4）。如上所述，当闭合梁170穿过钳口120A,120B推进时，切割构件140也可相对于闭合梁170平移。More specifically, still referring to FIGS. 3-5 , the flanges 144A and 144B of the distal end of the cutting member 140 may be collectively adapted to slidably engage the inner passage 171 of the closure beam 170 and the second jaw 120B, respectively. outward facing surface 162B. The channel 142A in the first jaw 120A and the channel 142B in the second jaw 120B can be sized and configured to accommodate movement of the closure beam 170 and/or the cutting member 140, which can include tissue cutting elements, For example sharp distal edges and/or surfaces. For example, FIG. 4 shows the distal end 178 of the closure beam 170 advanced at least partially through the channel 142A. Advancing the closure beam 170 may close the end effector 110 from the open configuration shown in FIG. 3 to the closed configuration shown in FIG. 4 . Closure beam 170 is movable or translatable along channel 142A between a first, retracted position and a second, fully advanced position. The retracted position may be as shown in FIG. 3 , wherein the jaws 120A, 120B are in the open position and the distal end 178 of the closure beam 170 is positioned adjacent the upper outward facing surface 162A. Although not shown, when the distal end 178 of the closure beam 170 is advanced to the distal end 164 of the channel 142A and the jaws are in the closed position, a fully advanced position may be achieved, see FIG. 4 . Likewise, the cutting member 140 ( FIG. 5 ) is translatable relative to the first jaw between a retracted position in which the jaws 120A, 120B are in the open position ( FIG. 3 ) and a fully advanced position in which the cutting The member is advanced, for example, to the distal end 164 of the channel 142A, with the jaws in the closed position (FIG. 4). As noted above, the cutting member 140 may also translate relative to the closure beam 170 as the closure beam 170 is advanced through the jaws 120A, 120B.

在至少一个实施例中，闭合梁170和切割构件140的远侧部分可被定位在端部执行器110的钳口120A和120B中的一者或两者的内部和/或附近、和/或细长轴108的远侧。此外，在图4所示的闭合位置，上部第一钳口120A和下部第二钳口120B分别限定第一钳口120A的第一能量递送表面175A与第二钳口120B的第二能量递送表面175B之间的间隙或尺寸D。尺寸D可等于例如约0,0005"至约0,040"，并且在一些实施例中可等于例如约0,001"至约0,010"。另外，第一能量递送表面175A和第二能量递送表面175B的边缘可设置成圆形以防止切开组织。In at least one embodiment, the closure beam 170 and the distal portion of the cutting member 140 can be positioned within and/or near one or both of the jaws 120A and 120B of the end effector 110, and/or The distal side of the elongated shaft 108. Furthermore, in the closed position shown in FIG. 4, the upper first jaw 120A and the lower second jaw 120B define a first energy delivery surface 175A of the first jaw 120A and a second energy delivery surface of the second jaw 120B, respectively. Gap or dimension D between 175B. Dimension D can be equal to, for example, about 0,0005" to about 0,040", and in some embodiments can be equal to, for example, about 0,001" to about 0,010". Additionally, the edges of the first energy delivery surface 175A and the second energy delivery surface 175B may be rounded to prevent dissection of tissue.

现在参见图1和3，端部执行器110可联接到电源145和控制器150。第一能量递送表面175A和第二能量递送表面175B同样可各自联接到电源145和控制器150。第一能量递送表面175A和第二能量递送表面175B能够接触组织并且将适于密封或焊接组织的电外科能量递送到接合的组织。控制器150可调节由电源145递送的电能，继而向第一能量递送表面175A和第二能量递送表面175B递送电外科能量。可通过启动按钮124来开始能量递送，所述启动按钮与触发器128操作地接合并且经由电缆152与控制器150电连通。如上文所述，由电源145递送的电外科能量可包括射频(RF)能量、或其它合适形式的能量。此外，在一些实施例中，相对的第一能量递送表面175A和第二能量递送表面175B中的至少一者可承载可变电阻正温度系数(PTC)主体。在一个实施例中，第一能量递送表面175A包括无源电极并且第二能量递送表面175B包括有源电极。有关电外科端部执行器、钳口闭合机构、以及电外科能量递送表面的附加细节在以下的美国专利和公开的专利申请中有所描述，所有这些专利和专利申请均全文以引用方式并入本文中并形成本说明书的一部分：美国专利7.381.209；7,311,709；7,220,951；7,189,233；7,186,253；7,125,409；7,112,201；7,087,054；7,083,619；7,070,597；7,041,102；7,011,657；6,929,644；6,926,716；6,913,579；6,905,497；6,802,843；6,770,072；6,656,177；6,533,784；和6.500.176；以及美国专利申请公开2010/0036370和2009/0076506。Referring now to FIGS. 1 and 3 , end effector 110 may be coupled to power source 145 and controller 150 . First energy delivery surface 175A and second energy delivery surface 175B may also be coupled to power source 145 and controller 150 , respectively. The first energy delivery surface 175A and the second energy delivery surface 175B are capable of contacting tissue and delivering electrosurgical energy suitable for sealing or welding tissue to the engaged tissue. The controller 150 can regulate the electrical energy delivered by the power source 145, which in turn delivers electrosurgical energy to the first energy delivery surface 175A and the second energy delivery surface 175B. Energy delivery may be initiated by activating button 124 , which is operatively engaged with trigger 128 and in electrical communication with controller 150 via cable 152 . As noted above, the electrosurgical energy delivered by the power source 145 may include radio frequency (RF) energy, or other suitable forms of energy. Furthermore, in some embodiments, at least one of the opposing first energy delivery surface 175A and second energy delivery surface 175B may carry a variable resistance positive temperature coefficient (PTC) body. In one embodiment, the first energy delivery surface 175A includes a passive electrode and the second energy delivery surface 175B includes an active electrode. Additional details regarding electrosurgical end effectors, jaw closure mechanisms, and electrosurgical energy delivery surfaces are described in the following U.S. patents and published patent applications, all of which are incorporated by reference in their entirety本文中并形成本说明书的一部分：美国专利7.381.209；7,311,709；7,220,951；7,189,233；7,186,253；7,125,409；7,112,201；7,087,054；7,083,619；7,070,597；7,041,102；7,011,657；6,929,644；6,926,716；6,913,579；6,905,497；6,802,843；6,770,072；6,656,177 6,533,784; and 6.500.176; and US Patent Application Publications 2010/0036370 and 2009/0076506.

对于一些电外科装置而言，可能难以在单个脉管和大脉管束上获得有效的结扎。一种通常观察到的失效为组织沿密封部的内边缘和外边缘破裂。组织破裂可归因于被拉近的血管壁之间的不等压缩。此外，由于高浓度的电流，一个或多个有源电极接触区域内侧向紧邻该区域的组织熔化成凝结材料。当钳口拉近血管壁时，完整的“未受影响”组织抵制压力同时无定形凝结物破裂。另外，钳口外边缘处的高应力浓度、刀狭槽的内边缘处的高应力浓度、有源电极与上钳口和下钳口上的外壁及内壁接触表面之间的区域处的不等热活性也可导致组织破裂。With some electrosurgical devices, it can be difficult to obtain effective ligation on individual vessels and large vessel bundles. One commonly observed failure is tissue rupture along the inner and outer edges of the seal. Tissue rupture can be attributed to unequal compression between vessel walls being drawn closer. In addition, due to the high concentration of electrical current, the tissue within the area of one or more active electrode contacts and immediately lateral to the area melts into a coagulated material. When the jaws are drawn closer to the vessel wall, intact "unaffected" tissue resists the pressure and the amorphous coagulum ruptures. In addition, high stress concentration at the outer edge of the jaws, high stress concentration at the inner edge of the knife slot, unequal thermal activity at the area between the active electrode and the outer and inner wall contact surfaces on the upper and lower jaws It can also cause tissue rupture.

另一种通常观察到的失效包括刀狭槽内的组织在完成射频能量循环之后仍保持未受影响。此类失效可导致难以切割组织以获得适当的横切并且还可不利地影响密封完整性。此外，在一些情况下，直接接触有源电极表面的区域处的组织可局部无意地炭化。局部加热可导致有限的凝结物形成和较大密封体积的后续脱水。这种局部加热区域内的组织在电流并且因此温度分配到密封体积的剩余部分之前过快地变为脱水的。Another commonly observed failure involves tissue within the knife slot remaining unaffected after completion of the RF energy cycle. Such failures can make it difficult to cut tissue to achieve proper transection and can also adversely affect seal integrity. Furthermore, in some cases, tissue at areas directly in contact with the active electrode surface can be locally inadvertently charred. Localized heating can result in limited condensate formation and subsequent dehydration of larger seal volumes. Tissue within such a locally heated region becomes dehydrated too quickly before the electrical current, and thus temperature, is distributed to the remainder of the sealed volume.

当夹紧和操纵组织时，端部执行器可包括齿状物以防止滑动和挤出。齿状物的形状和图案可被设计成使对组织的损害最小化。当将齿状物与例如RF双极装置结合时，它们需要与装置的电性能和压缩性能协作以有助于组织密封和组织夹紧。因此，需要不仅无创而且与RF密封或其它类型的能量型密封一起适当起作用的齿状物。图6为根据一个非限制性实施例的具有无创齿状物的处于闭合位置的端部执行器210的剖视图。类似于图3-5中所示的端部执行器110，端部执行器210包括第一钳口220A和第二钳口220B。第一钳口220A和第二钳口220B每个可分别限定用于容纳闭合梁（未示出）的通道242A和242B。可限定刀狭槽272以在操作行程期间容纳切割元件（未示出）。内部通道272（图6）限定端部执行器210的横断平面233（图10），所述横断平面为切割元件在操作行程期间穿过的平面。在图6中，横断平面233的剖视端视图通过平面边缘281示意性地示出。应当理解，在一些实施例中，如果端部执行器210中的切割构件的路径为弯曲的，则横断平面可为弯曲的。第一钳口220A和第二钳口220B中的至少一者可具有齿状物243，所述齿状物被定位成有助于夹紧、操纵、能量递送、和/或压缩所捕获组织。在一些实施例中，第一钳口220A和第二钳口220B中的至少一者承载可变电阻正温度系数(PTC)主体275。当处于闭合位置时，在一个实施例中，PTC主体275的至少一部分通常与电极277相对。电极277可跨置在绝缘主体279上以避免电极277与射频源145（图1）的返回路径（例如第二钳口220B的导电部分）之间的接触。The end effector may include teeth to prevent slippage and extrusion when clamping and manipulating tissue. The shape and pattern of the teeth can be designed to minimize tissue damage. When incorporating teeth with, for example, RF bipolar devices, they need to cooperate with the electrical and compressive properties of the device to aid in tissue sealing and tissue clamping. Accordingly, there is a need for teeth that are not only non-invasive but also function properly with RF seals or other types of energy-based seals. FIG. 6 is a cross-sectional view of end effector 210 in a closed position with atraumatic teeth, according to one non-limiting embodiment. Similar to end effector 110 shown in FIGS. 3-5 , end effector 210 includes a first jaw 220A and a second jaw 220B. The first jaw 220A and the second jaw 220B may each define a channel 242A and 242B, respectively, for receiving a closure beam (not shown). A knife slot 272 may be defined to accommodate a cutting element (not shown) during an operating stroke. Internal passage 272 ( FIG. 6 ) defines a transverse plane 233 ( FIG. 10 ) of end effector 210 , which is the plane traversed by the cutting elements during the operating stroke. In FIG. 6 , a cross-sectional end view of transverse plane 233 is schematically illustrated by plane edge 281 . It should be understood that in some embodiments, if the path of the cutting member in end effector 210 is curved, the transverse plane may be curved. At least one of the first jaw 220A and the second jaw 220B can have teeth 243 positioned to facilitate clamping, manipulation, energy delivery, and/or compression of captured tissue. In some embodiments, at least one of the first jaw 220A and the second jaw 220B carries a variable resistance positive temperature coefficient (PTC) body 275 . When in the closed position, in one embodiment, at least a portion of the PTC body 275 is generally opposite the electrode 277 . The electrode 277 may straddle the insulating body 279 to avoid contact between the electrode 277 and the return path of the RF source 145 ( FIG. 1 ), such as the conductive portion of the second jaw 220B.

图7为示出于图6中的端部执行器210的第一钳口220A的放大剖视图。第一钳口220A通常可限定横断区域204，所述横断区域被设置在第一侧向部分202和第二侧向部分206的中间并且平行于端部执行器210的横断平面。第一侧向部分202可承载第一齿状物243A并且第二侧向部分可承载第二齿状物243B。齿状物243可与第一钳口220A的上壁265A和265B形成整体或一体，如图所示。在其它实施例中，齿状物243可利用合适的附接方式接合到或换句话讲联接到第一钳口220A。侧向设置的齿状物（例如齿状物243A和243B）可共同具有大致“V形的”横截面轮廓。例如，第一齿状物243A可具有斜面245A并且第二齿状物243B可具有斜面245B。斜面245A可包括内部245AA和外部245AB。斜面245A可为倾斜的，使得内部245AA被定位成比外部245AB更靠近横断区域204。相似地，斜面245B可包括内部245BA和外部245BB。斜面245B可为倾斜的，使得内部245BA被定位成比外部245BB更靠近横断区域204。第一齿状物243A可具有第一横断区域表面247A并且第二齿状物243B可具有与第一横断区域表面247A侧向相对的第二横断区域表面247B。尽管斜面245A和245B被示出为平面的，但应当理解在一些实施例中，斜面245A和/或245B可为弯曲的、或平面与弯曲组件的组合。FIG. 7 is an enlarged cross-sectional view of first jaw 220A of end effector 210 shown in FIG. 6 . First jaw 220A may generally define a transverse region 204 disposed intermediate first lateral portion 202 and second lateral portion 206 and parallel to a transverse plane of end effector 210 . The first lateral portion 202 may carry a first tooth 243A and the second lateral portion may carry a second tooth 243B. The teeth 243 may be integral or integral with the upper walls 265A and 265B of the first jaw 220A, as shown. In other embodiments, the teeth 243 may be engaged or otherwise coupled to the first jaw 220A using suitable attachment means. The laterally disposed teeth, such as teeth 243A and 243B, may collectively have a generally "V-shaped" cross-sectional profile. For example, the first tooth 243A may have a slope 245A and the second tooth 243B may have a slope 245B. The ramp 245A may include an inner portion 245AA and an outer portion 245AB. The ramp 245A may be sloped such that the inner portion 245AA is positioned closer to the transverse region 204 than the outer portion 245AB. Similarly, ramp 245B may include an inner portion 245BA and an outer portion 245BB. The ramp 245B may be sloped such that the inner portion 245BA is positioned closer to the transverse region 204 than the outer portion 245BB. The first tooth 243A may have a first transverse area surface 247A and the second tooth 243B may have a second transverse area surface 247B laterally opposite the first transverse area surface 247A. Although ramps 245A and 245B are shown as planar, it should be understood that in some embodiments, ramps 245A and/or 245B may be curved, or a combination of planar and curved components.

图7A为根据一个非限制性实施例的第一齿状物243A和第一钳口220A的一部分的放大视图。第一齿状物243A可包括下表面249A，所述下表面将斜面245A接合到第一横断区域表面247A以有助于无创接合所捕获的组织。斜面245A具有倾斜角θ。在一个实施例中，倾斜角θ为大约42度。倾斜角θ可基于应用而有所不同。在一些实施例中，组织斜面的倾斜角θ可基于被端部执行器210捕获的组织的类型或可基于端部执行器210的尺寸。在一些实施例中，倾斜角θ可在例如约10度至约80度的范围内。FIG. 7A is an enlarged view of a portion of first teeth 243A and first jaw 220A, according to one non-limiting embodiment. The first teeth 243A can include a lower surface 249A that joins the chamfer 245A to the first transverse area surface 247A to facilitate atraumatic engagement of captured tissue. The inclined surface 245A has an inclination angle θ. In one embodiment, the tilt angle θ is about 42 degrees. The tilt angle θ may vary based on the application. In some embodiments, the inclination angle θ of the tissue bevel may be based on the type of tissue being captured by the end effector 210 or may be based on the size of the end effector 210 . In some embodiments, the tilt angle θ may range, for example, from about 10 degrees to about 80 degrees.

图8为端部执行器210的透视图并且图8A为端部执行器210的第一钳口的近侧部分的放大视图。如图8和8A所示，端部执行器210可具有多个齿状物243，所述多个齿状物每个具有充当组织接合表面的斜面245。齿状物243在纵向上可为细长的，其中前表面251位于远侧上并且后表面253位于近侧上。前表面251可为倾斜的，使得其相对于第一钳口220A的纵向轴线215为大致倾斜的。后表面253可大致垂直于第一钳口220A的纵向轴线215。在一些实施例中，后表面253可与前表面251倾斜成相同或不同的角度。一般来讲，倾斜的前表面251允许组织相对容易地运动到钳口220A和220B内，而一旦钳口闭合时，方形背部（例如，后表面253）则有助于将组织锁定就位。从前表面251到下表面249和后表面253的过渡部分为圆形的以降低对所捕获组织的创伤。8 is a perspective view of end effector 210 and FIG. 8A is an enlarged view of a proximal portion of the first jaw of end effector 210 . As shown in FIGS. 8 and 8A , the end effector 210 may have a plurality of teeth 243 each having a ramp 245 that acts as a tissue engaging surface. The teeth 243 may be longitudinally elongated with the front surface 251 on the distal side and the rear surface 253 on the proximal side. The front surface 251 may be sloped such that it is generally sloped relative to the longitudinal axis 215 of the first jaw 220A. The rear surface 253 can be generally perpendicular to the longitudinal axis 215 of the first jaw 220A. In some embodiments, rear surface 253 may be inclined at the same or a different angle than front surface 251 . In general, the sloped front surface 251 allows relatively easy movement of tissue into the jaws 220A and 220B, while the squared-off back (eg, rear surface 253 ) helps lock the tissue in place once the jaws are closed. The transitions from the front surface 251 to the lower surface 249 and rear surface 253 are rounded to reduce trauma to captured tissue.

在一些实施例中，齿状物243的相对较长的侧面轮廓提供组织压缩以当RF（或其它类型的能量）对组织供能时最大化密封。例如，在一个实施例中，各个齿状物243沿由箭头241指示的方向的纵向长度可为齿状物243的深度（如通过后表面253的长度测定）的约3至约5倍。在一个实施例中，各个齿状物243沿由箭头241指示的方向的纵向长度可为齿状物的深度的约2至约7倍。在一些实施例中，相邻齿状物之间的纵向间距可比齿状物243的纵向长度小约2至约3倍以增加齿状物的导电性质和压缩性质。在一些实施例中，至少一个齿状物243的纵向长度可不同于不同齿状物243的纵向长度。此外，尽管齿状物243被示出为第一钳口220A的组件，但应当理解，齿状物243可能被设置在第二钳口220B上、或第一钳口220A和第二钳口220B两者上。在一些实施例中，齿状物243为导电的并且为用于射频源145（图1）的返回路径的一部分，其中所述齿状物的相对较大的表面积有助于压缩所捕获的组织并且将能量递送到所捕获的组织以用于密封。In some embodiments, the relatively longer side profile of teeth 243 provides tissue compression to maximize sealing when RF (or other type of energy) energizes tissue. For example, in one embodiment, the longitudinal length of each tooth 243 in the direction indicated by arrow 241 may be about 3 to about 5 times the depth of the tooth 243 (as measured by the length of the rear surface 253 ). In one embodiment, the longitudinal length of each tooth 243 in the direction indicated by arrow 241 may be about 2 to about 7 times the depth of the tooth. In some embodiments, the longitudinal spacing between adjacent teeth may be about 2 to about 3 times smaller than the longitudinal length of teeth 243 to increase the conductive and compressive properties of the teeth. In some embodiments, the longitudinal length of at least one tooth 243 may be different than the longitudinal length of a different tooth 243 . Furthermore, although the teeth 243 are shown as components of the first jaw 220A, it should be understood that the teeth 243 may be provided on the second jaw 220B, or on both the first jaw 220A and the second jaw 220B. on both. In some embodiments, the teeth 243 are conductive and are part of the return path for the RF source 145 ( FIG. 1 ), where the relatively large surface area of the teeth helps to compress the captured tissue And energy is delivered to the captured tissue for sealing.

图9为示出于图6中的端部执行器210的第二钳口220B的放大剖视图。电极277可具有由横断区域204隔开的第一侧向部分277A和第二侧向部分277B。第一侧向部分277A和第二侧向部分277B可共同具有大致“V形的”横截面轮廓。电极277的具体轮廓可与齿状物243的轮廓相协调。例如，电极倾斜角Φ可基本上类似于斜面245A（图7A）的倾斜角θ。一般来讲，V形电极轮廓用于增加与所捕获的组织的接触量，从而例如降低使组织炭化的可能性。FIG. 9 is an enlarged cross-sectional view of second jaw 220B of end effector 210 shown in FIG. 6 . Electrode 277 may have a first lateral portion 277A and a second lateral portion 277B separated by transverse region 204 . The first lateral portion 277A and the second lateral portion 277B may collectively have a generally "V-shaped" cross-sectional profile. The specific profile of electrode 277 may be coordinated with the profile of tooth 243 . For example, electrode slope angle Φ may be substantially similar to slope angle θ of ramp 245A ( FIG. 7A ). In general, a V-shaped electrode profile is used to increase the amount of contact with captured tissue, for example, to reduce the likelihood of charring the tissue.

图9A为图9的一部分的放大视图。电极277包括多个不同的部分，例如四个部分。邻近横断平面定位的是内部竖直部分260，其过渡到倾斜部分262。从倾斜部分262向外的过渡产生水平部分264，其随后过渡到外部竖直部分266。如图所示，电极277的多个部分之间的过渡可为圆形的，以便降低对所捕获的组织的附带损害。应当理解，其它实施例可利用具有不同横截面轮廓的电极277。在任何情况下，齿状物243（图7A）可具有提供与电极277的有利相互作用的横截面轮廓。例如，在闭合位置中，第一齿状物243A的斜面245A可大致平行于电极的倾斜部分262。FIG. 9A is an enlarged view of a portion of FIG. 9 . Electrode 277 includes a plurality of different sections, for example four sections. Positioned adjacent to the transverse plane is an inner vertical portion 260 that transitions into a sloped portion 262 . The outward transition from the sloped portion 262 creates a horizontal portion 264 which then transitions into an outer vertical portion 266 . As shown, transitions between portions of electrode 277 may be rounded in order to reduce collateral damage to captured tissue. It should be understood that other embodiments may utilize electrodes 277 having different cross-sectional profiles. In any event, teeth 243 ( FIG. 7A ) may have a cross-sectional profile that provides favorable interaction with electrodes 277 . For example, in the closed position, the sloped surface 245A of the first tooth 243A may be substantially parallel to the sloped portion 262 of the electrode.

图6A为示出根据一个非限制性实施例的处于闭合位置的第一钳口和第二钳口220A,220B之间的相互作用的剖视图。在图示实施例中，第一钳口220A包括齿状物243A和243B。应当理解，在一些实施例中，第一钳口220A可包括或可不包括齿状物并且第二钳口220B可包括或可不包括齿状物。此外，第一钳口220A被示出为承载可变电阻PTC主体275。应当理解，在一些实施例中，PTC主体275可比图示实施例更宽、更窄、更薄、或更厚。如本文所用，有源电极接触长度被测定为当从垂直于横断平面的横截面平面观察时接触所捕获组织的电极277的周长。在一些实施例中，有源电极接触长度可在例如约0.088"至约0.269"的范围内。在一些实施例中，有源电极接触长度可在例如约0.050"至约0.400"的范围内。如本文所用，无源电极接触长度被测定为当从垂直于横断平面的横截面平面观察时接触所捕获组织的第一钳口220A和第二钳口220B部分。在一些实施例中，无源电极接触长度可在例如约0.113"至约0.804"的范围内。在一些实施例中，无源电极接触长度可在例如约0.080"至约1.000"的范围内。如本文所用，接触区域比为有源电极接触长度与无源电极接触长度之间的比率。在一些实施例中，接触区域比在例如约0.145至约2.382的范围内。在一些实施例中，接触区域比在例如约0.080至约3.000的范围内。Figure 6A is a cross-sectional view illustrating the interaction between the first and second jaws 220A, 220B in a closed position, according to one non-limiting embodiment. In the illustrated embodiment, first jaw 220A includes teeth 243A and 243B. It should be understood that in some embodiments, the first jaw 220A may or may not include teeth and the second jaw 220B may or may not include teeth. Additionally, the first jaw 220A is shown carrying a variable resistance PTC body 275 . It should be appreciated that in some embodiments, the PTC body 275 may be wider, narrower, thinner, or thicker than the illustrated embodiment. As used herein, the active electrode contact length is measured as the perimeter of the electrode 277 in contact with captured tissue when viewed from a cross-sectional plane perpendicular to the transverse plane. In some embodiments, the active electrode contact length may range, for example, from about 0.088" to about 0.269". In some embodiments, the active electrode contact length may range, for example, from about 0.050" to about 0.400". As used herein, the passive electrode contact length is measured as the portion of the first jaw 220A and the second jaw 220B that contacts captured tissue when viewed from a cross-sectional plane perpendicular to the transverse plane. In some embodiments, the passive electrode contact length may range, for example, from about 0.113" to about 0.804". In some embodiments, the passive electrode contact length may range, for example, from about 0.080" to about 1.000". As used herein, the contact area ratio is the ratio between the active electrode contact length and the passive electrode contact length. In some embodiments, the contact area ratio ranges, for example, from about 0.145 to about 2.382. In some embodiments, the contact area ratio ranges, for example, from about 0.080 to about 3.000.

仍参见图6A，由距离“A”标识的距离为刀狭槽272与第二钳口220B上的有源电极277之间的内部水平间距。在一个实施例中，距离A在例如约0.0"至约0.044"的范围内。在另一个实施例中，距离A在例如约0.0"至约0.060"的范围内。由距离“B”标识的距离为相对的有源电极277接触区域之间的水平间距。在一个实施例中，距离B在例如约0.0"至约0.034"的范围内。在另一个实施例中，距离B在例如约0.0"至约0.112"的范围内。由距离“C”标识的距离为第一钳口220A所限定的刀狭槽272与第二钳口220B上的有源电极277之间的内部水平间距。在一个实施例中，距离C在例如约0.0"至约0.044"的范围内。在另一个实施例中，距离C在例如约0.0"至约0.060"的范围内。由距离“D”标识的距离为第二钳口220B上的有源电极与无源电极之间的内部水平间距。在一个实施例中，距离D在例如约0.0"至约0.013"的范围内。在另一个实施例中，距离D在例如约0.0"至约0.025"的范围内。由距离“E”标识的距离为第二钳口220B上的有源电极与第一钳口220A上的无源电极之间的内部水平间距。在一个实施例中，距离E在例如约0.0"至约0.012"的范围内。在另一个实施例中，距离E在例如约0.0"至约0.025"的范围内。由距离“F”标识的距离为第二钳口220B上的有源电极与无源电极之间的外部竖直间距。在一个实施例中，距离F在例如约0.0"至约0.023"的范围内。在另一个实施例中，距离F在例如约0.0"至约0.035"的范围内。由距离“G”标识的距离为第二钳口220B上的有源电极与第一钳口220A上的无源电极之间的外部竖直间距。在一个实施例中，距离G在例如约0.0"至约0.028"的范围内。在另一个实施例中，距离G在例如约0.0"至约0.040"的范围内。由距离“J”标识的距离为第二钳口220B上的压缩消除间距。在一个实施例中，距离J为例如约0.002"。在另一个实施例中，距离J为例如约0.005"。由距离“K”标识的距离为有源电极277暴露于刀狭槽272的竖直距离。在一个实施例中，距离K在例如约0.006"至约0.058"的范围内。在另一个实施例中，距离K在例如约0.005"至约0.060"的范围内。由距离“L”标识的距离为有源电极277的上边缘/拐角与第一钳口220A的外壁的下边缘/拐角之间的直线间距。在一个实施例中，距离L在例如约0.008"至约0.031"的范围内。在另一个实施例中，距离L在例如约0.005"至约0.040"的范围内。由距离“M”标识的距离为有源电极277的下边缘/拐角与第二钳口200B的外壁的上边缘/拐角之间的直线间距。在一个实施例中，距离M在例如约0.005"至约0.037"的范围内。在另一个实施例中，距离M在例如约0.002"至约0.045"的范围内。由距离“N”标识的距离为第二钳口220B的组织接触表面与第一钳口220A的表面之间的直线距离。在一个实施例中，距离N在例如约0.0"至约0.031"的范围内。在一个实施例中，距离N在例如约0.0"至约0.045"的范围内。由距离“P”标识的距离为第一钳口220A上的压缩消除间距。在一个实施例中，距离P为例如约0.002"。在另一个实施例中，距离P为例如约0.005"。Still referring to FIG. 6A , the distance identified by distance "A" is the internal horizontal spacing between the knife slot 272 and the active electrode 277 on the second jaw 220B. In one embodiment, distance A is, for example, in the range of about 0.0" to about 0.044". In another embodiment, distance A is, for example, in the range of about 0.0" to about 0.060". The distance identified by distance "B" is the horizontal spacing between opposing active electrode 277 contact areas. In one embodiment, distance B is, for example, in the range of about 0.0" to about 0.034". In another embodiment, distance B is, for example, in the range of about 0.0" to about 0.112". The distance identified by distance "C" is the internal horizontal spacing between the knife slot 272 defined by the first jaw 220A and the active electrode 277 on the second jaw 220B. In one embodiment, distance C is, for example, in the range of about 0.0" to about 0.044". In another embodiment, the distance C is in the range of, for example, about 0.0" to about 0.060". The distance identified by distance "D" is the internal horizontal spacing between the active and passive electrodes on the second jaw 220B. In one embodiment, the distance D is, for example, in the range of about 0.0" to about 0.013". In another embodiment, the distance D is, for example, in the range of about 0.0" to about 0.025". The distance identified by distance "E" is the internal horizontal spacing between the active electrode on the second jaw 220B and the passive electrode on the first jaw 220A. In one embodiment, the distance E is, for example, in the range of about 0.0" to about 0.012". In another embodiment, the distance E is, for example, in the range of about 0.0" to about 0.025". The distance identified by distance "F" is the outer vertical spacing between the active and passive electrodes on the second jaw 220B. In one embodiment, the distance F is, for example, in the range of about 0.0" to about 0.023". In another embodiment, the distance F is in the range of, for example, about 0.0" to about 0.035". The distance identified by distance "G" is the outer vertical separation between the active electrode on the second jaw 220B and the passive electrode on the first jaw 220A. In one embodiment, the distance G is, for example, in the range of about 0.0" to about 0.028". In another embodiment, the distance G is, for example, in the range of about 0.0" to about 0.040". The distance identified by distance "J" is the compression relief spacing on the second jaw 220B. In one embodiment, the distance J is, for example, about 0.002". In another embodiment, the distance J is, for example, about 0.005". The distance identified by distance “K” is the vertical distance that active electrode 277 is exposed to knife slot 272 . In one embodiment, the distance K is, for example, in the range of about 0.006" to about 0.058". In another embodiment, the distance K is, for example, in the range of about 0.005" to about 0.060". The distance identified by distance "L" is the linear distance between the upper edge/corner of the active electrode 277 and the lower edge/corner of the outer wall of the first jaw 220A. In one embodiment, the distance L is, for example, in the range of about 0.008" to about 0.031". In another embodiment, the distance L is, for example, in the range of about 0.005" to about 0.040". The distance identified by distance "M" is the linear distance between the lower edge/corner of the active electrode 277 and the upper edge/corner of the outer wall of the second jaw 200B. In one embodiment, the distance M is, for example, in the range of about 0.005" to about 0.037". In another embodiment, the distance M is, for example, in the range of about 0.002" to about 0.045". The distance identified by distance "N" is the linear distance between the tissue contacting surface of the second jaw 220B and the surface of the first jaw 220A. In one embodiment, the distance N is, for example, in the range of about 0.0" to about 0.031". In one embodiment, the distance N is, for example, in the range of about 0.0" to about 0.045". The distance identified by distance "P" is the compression relief pitch on the first jaw 220A. In one embodiment, the distance P is, for example, about 0.002". In another embodiment, the distance P is, for example, about 0.005".

一般来讲，电极277的V形横截面轮廓提供多个有益效果，例如为有源电极表面增加附加接触长度、允许有源电极表面与刀狭槽的较紧密接近度、允许密封区域之间的较紧密接近度和密封区域之间的较好热连通性、以及允许引入提供所需压缩和夹紧能力的无创齿状物。In general, the V-shaped cross-sectional profile of the electrode 277 provides several benefits, such as adding additional contact length to the active electrode surface, allowing closer proximity of the active electrode surface to the knife slot, allowing closer proximity between the sealing areas. The closer proximity and better thermal communication between the sealing areas, and allows the introduction of atraumatic teeth that provide the required compression and clamping capabilities.

图10为根据一个非限制性实施例的结合偏心式电极的端部执行器210的剖面透视图。示出的横断平面233大致平行于切割元件（未示出）在操作行程期间行进的路径。如图所示，横断平面233为弯曲的，以匹配第一钳口220A和第二钳口220B的曲线。应当理解，在例如具有直钳口的实施例中，横断平面233将也为直的。Figure 10 is a cross-sectional perspective view of an end effector 210 incorporating an eccentric electrode, according to one non-limiting embodiment. The illustrated transverse plane 233 is generally parallel to the path traveled by a cutting element (not shown) during an operating stroke. As shown, the transverse plane 233 is curved to match the curve of the first jaw 220A and the second jaw 220B. It should be understood that in embodiments having straight jaws, for example, the transverse plane 233 will also be straight.

图11为根据一个非限制性实施例的端部执行器310。图11A为图11的一部分的放大视图。端部执行器310可具有类似于图1所示的端部执行器110的结构，使得其具有第一钳口320A和第二钳口320B。钳口320A和320B中的至少一者可具有齿状物343以有助于操纵和夹紧组织。在一些实施例中，齿状物343可具有例如类似于图7所示的齿状物243的结构。当使用包括具有密封钳口的端部执行器的双极RF装置（例如示出于图1中的电外科器械100）时，重要的是在组织未存在于端部执行器的钳口之间时两个单独导电路径（例如，能量供应路径和能量返回路径）并不接触，否则将导致短路。如图11A所示，第二钳口320B可包括第一导电性止挡件322。第一导电性止挡件322通过绝缘体326与供电电极324绝缘，所述供电电极与能量供应路径连通。在一个实施例中，第一导电性止挡件322可被定位在刀狭槽327的远端处。图12为根据一个非限制性实施例的端部执行器310的第一钳口320A的局部透视图。第一钳口320A可包括例如与能量返回路径电连通的可变电阻正温度系数(PTC)主体375。第一钳口320A还可包括第二导电性止挡件328。第一导电性止挡件322可具有表面330，当端部执行器310处于闭合位置并且在钳口中间不存在任何组织时，所述表面可接触第二导电性止挡件328的表面332。这种相互作用防止在电外科器械未进行使用时产生不需要的能量流（例如，射频能量），因为电极324将被阻止接触PTC主体375或能量返回路径的任何其它部分。另外，第一导电性止挡件322与第二导电性止挡件328之间的这种相互作用防止将可能损害性的强力施加到PTC主体375。如图11A和12所示，第一导电性止挡件322和第二导电性止挡件328可与端部执行器310的其它部分由相同的材料制成，从而便于制造。Figure 11 is an end effector 310 according to one non-limiting embodiment. FIG. 11A is an enlarged view of a portion of FIG. 11 . The end effector 310 may have a structure similar to the end effector 110 shown in FIG. 1 such that it has a first jaw 320A and a second jaw 320B. At least one of jaws 320A and 320B may have teeth 343 to facilitate manipulation and clamping of tissue. In some embodiments, the teeth 343 may have, for example, a structure similar to the teeth 243 shown in FIG. 7 . When using a bipolar RF device that includes an end effector with sealed jaws, such as the electrosurgical instrument 100 shown in Figure 1, it is important that no tissue is present between the jaws of the end effector When two separate conductive paths (for example, energy supply path and energy return path) do not touch, otherwise a short circuit will result. As shown in FIG. 11A , the second jaw 320B may include a first conductive stop 322 . The first conductive stopper 322 is insulated by the insulator 326 from the power supply electrode 324 which communicates with the energy supply path. In one embodiment, the first conductive stop 322 may be positioned at the distal end of the knife slot 327 . FIG. 12 is a partial perspective view of first jaw 320A of end effector 310 according to one non-limiting embodiment. The first jaw 320A may include, for example, a variable resistance positive temperature coefficient (PTC) body 375 in electrical communication with the energy return path. The first jaw 320A may also include a second conductive stop 328 . The first conductive stop 322 can have a surface 330 that can contact the surface 332 of the second conductive stop 328 when the end effector 310 is in the closed position and no tissue is present intermediate the jaws. This interaction prevents unwanted energy flow (eg, RF energy) when the electrosurgical instrument is not in use, as the electrodes 324 will be prevented from contacting the PTC body 375 or any other portion of the energy return path. Additionally, this interaction between the first conductive stop 322 and the second conductive stop 328 prevents the application of potentially damaging forces to the PTC body 375 . As shown in FIGS. 11A and 12 , first conductive stopper 322 and second conductive stopper 328 may be made of the same material as the rest of end effector 310 for ease of manufacture.

如图11所示，第一导电性止挡件322可被定位在端部执行器310的远侧末端附近。尽管示出于图11中的导电性止挡件322为圆柱形的，但应当理解，可使用任何合适的结构。在一个实施例中，第一导电性止挡件322与第二导电性止挡件328之间的相互作用并非设定用于密封的组织间隙，而是仅防止当在钳口320A和320B中间不存在组织时在端部执行器310的供电电极与返回电极之间产生不需要的接触。例如，与切割元件相关的I形梁可设定用于密封的组织间隙，而导电性止挡件322用于当在端部执行器的钳口之间不存在组织时形成供电电极324与PTC主体375之间的间隙。在任何情况下，由于第一导电性止挡件322与第二导电性止挡件328可为导电的，因此它们可在将能量递送到被捕获在钳口320A与320B之间的组织时充当返回路径并因此可有助于组织的密封。As shown in FIG. 11 , first conductive stop 322 may be positioned near the distal tip of end effector 310 . Although the conductive stop 322 is shown in FIG. 11 as being cylindrical, it should be understood that any suitable structure may be used. In one embodiment, the interaction between the first conductive stop 322 and the second conductive stop 328 does not set the tissue gap for sealing, but only prevents The absence of tissue creates unwanted contact between the powered and return electrodes of end effector 310 . For example, the I-beam associated with the cutting element can be configured to seal the tissue gap, while the conductive stop 322 is used to form the powered electrode 324 and PTC when no tissue is present between the jaws of the end effector. Gap between bodies 375 . In any event, since the first conductive stop 322 and the second conductive stop 328 can be conductive, they can act as The return path and thus may aid in the sealing of the tissue.

图13A和13B为示出于图11中的端部执行器310的远端在两种不同操作状态期间的横截面侧视图。在图13A中，当I形梁（未示出）朝远侧推进穿过端部执行器310时，通过所述I形梁来设定第一钳口302A相对于第二钳口302B的放置。在此状态下，除了在电极324与PTC主体375之间存在间隔，还在第一导电性止挡件322与第二导电性止挡件328之间存在间隔。换句话讲，在标准操作状态下，第一导电性止挡件322可不必接触第二导电性止挡件328。作为比较，图13B示出了处于“过闭合”状态的端部执行器。过闭合状态可由多种因素引起，例如，松散的配合组件、超过公差的组件、或重力。在此过闭合状态下，在第一导电性止挡件322与第二导电性止挡件328之间存在接触。在此状态下，仍阻止电极324与PTC主体375形成物理接触。13A and 13B are cross-sectional side views of the distal end of end effector 310 shown in FIG. 11 during two different operating states. In FIG. 13A , the placement of the first jaw 302A relative to the second jaw 302B is set by the I-beam (not shown) as it is advanced distally through the end effector 310 . . In this state, there is a space between the first conductive stopper 322 and the second conductive stopper 328 in addition to the space between the electrode 324 and the PTC body 375 . In other words, under standard operating conditions, the first conductive stopper 322 may not need to contact the second conductive stopper 328 . For comparison, Figure 13B shows the end effector in an "overclosed" state. An overclosed condition can be caused by a variety of factors, such as loose fitting components, out-of-tolerance components, or gravity. In this overclosed state, there is contact between the first conductive stop 322 and the second conductive stop 328 . In this state, the electrodes 324 are still prevented from making physical contact with the PTC body 375 .

图14为具有结合华夫图案的电极477的端部执行器410。如本文所用，华夫图案包括网格状图案以及非网格状图案。如图所示，将华夫图案结合到第二钳口420B上。然而，应当理解，可将华夫图案结合到第一钳口420A。一般来讲，电极477上的华夫图案可增加表面积和边缘的数量，从而在捕获组织时可增加接触电极477的组织的量。锐利边缘还可有助于集中电能以改善电极477的传送效率。图15示出了第一钳口420A的组织接触表面422。如图所示，可将第二钳口420B的华夫图案的反向图案结合到第一钳口420A。可例如通过PTC主体475来产生反向华夫图案。在一些实施例中，可使用电极上的凸起表面通过如下方式来形成对应凹痕：加热这两种元件并且压缩至期望深度。Figure 14 is an end effector 410 having electrodes 477 incorporating a waffle pattern. As used herein, waffle patterns include grid-like patterns as well as non-grid-like patterns. Bond the waffle pattern to the second jaw 420B as shown. However, it should be understood that a waffle pattern could be incorporated into the first jaw 420A. In general, the waffle pattern on the electrodes 477 can increase the surface area and the number of edges, thereby increasing the amount of tissue that contacts the electrodes 477 when capturing the tissue. The sharp edges can also help concentrate electrical energy to improve the transfer efficiency of the electrodes 477 . FIG. 15 shows the tissue contacting surface 422 of the first jaw 420A. As shown, the reverse pattern of the waffle pattern of the second jaw 420B may be bonded to the first jaw 420A. A reverse waffle pattern can be created, for example, by the PTC body 475 . In some embodiments, the raised surfaces on the electrodes can be used to form corresponding indentations by heating both elements and compressing to the desired depth.

结合到端部执行器410的华夫图案可为任何合适的图案，例如凸起表面479（图14）的网格。在一些实施例中，华夫图案可包括无规放置的凸起表面、或可包括位于网格中的凸起表面和位于无规位置处的凸起表面的组合。华夫图案可覆盖基本上整个电极477、或小于基本上整个电极477。凸起表面可为任何合适的形状，例如方形（如图所示）、椭圆形、圆形、或任何其它的有界形状。对应凹痕481可与凸起表面479具有类似的形状。在一些实施例中，凸起表面479可结合多个不同的形状。跨接凸起表面479和基部表面485的连接表面483可为向外倾斜的以增加表面积的值（如图所示）或者大致垂直于基部表面485。凸起表面479可大致均匀地分布在整个电极477之上或者可在电极477的不同部分中具有较高或较低的浓度。在一些实施例中，端部执行器410可包括多于5个凸起表面479。在一些实施例中，端部执行器410可包括多于20个凸起表面479。在一些实施例中，端部执行器410可包括多于10个凸起表面479。在一些实施例中，端部执行器410可包括多于100个凸起表面479。可通过任何合适的制造技术（例如，铣削或压印）来产生华夫图案。另外，在一些实施例中，凸起表面可结合到PTC主体475（或其它返回电极）并且凹痕可结合到有源电极277。在一些实施例中，凸起表面479可具有约0.020"的高度并且凹痕可具有约0.020"的深度。The waffle pattern incorporated into end effector 410 may be any suitable pattern, such as a grid of raised surfaces 479 (FIG. 14). In some embodiments, the waffle pattern may include randomly placed raised surfaces, or may include a combination of raised surfaces in a grid and raised surfaces at random locations. The waffle pattern may cover substantially the entire electrode 477 , or less than substantially the entire electrode 477 . The raised surface may be of any suitable shape, such as square (as shown), oval, circular, or any other bounded shape. The corresponding indentation 481 may have a similar shape as the raised surface 479 . In some embodiments, raised surface 479 may incorporate a number of different shapes. The connecting surface 483 bridging the raised surface 479 and the base surface 485 may be sloped outwardly to increase the value of the surface area (as shown) or generally perpendicular to the base surface 485 . Raised surface 479 may be distributed substantially evenly across electrode 477 or may have a higher or lower concentration in different portions of electrode 477 . In some embodiments, end effector 410 may include more than 5 raised surfaces 479 . In some embodiments, end effector 410 may include more than twenty raised surfaces 479 . In some embodiments, end effector 410 may include more than ten raised surfaces 479 . In some embodiments, end effector 410 may include more than 100 raised surfaces 479 . The waffle pattern may be produced by any suitable manufacturing technique, such as milling or embossing. Additionally, in some embodiments, a raised surface may be bonded to the PTC body 475 (or other return electrode) and an indentation may be bonded to the active electrode 277 . In some embodiments, the raised surface 479 can have a height of about 0.020" and the indentation can have a depth of about 0.020".

图16为根据一个非限制性实施例的可运动切割构件540的远端。可运动切割构件540可包括多个侧向延伸的元件，例如第一钳口闭合销542和第二钳口闭合销544。可运动切割构件540的一些实施例可具有钳口打开销546。应当理解，销可从可运动切割构件540的两个侧面侧向延伸。可运动切割构件540可由多个带构成，例如第一支承带548、第二支承带550、以及设置在支承带548与550之间的刀带552。刀带552可具有锐利的远侧切刃554。支承带548和550可为可运动切割构件540提供刚度并且保护锐利的远侧切刃554以免遭遇刀狭槽530（图17）的壁，从而避免远侧切刃554上的非预期磨损。Figure 16 is the distal end of the movable cutting member 540 according to one non-limiting embodiment. The movable cutting member 540 may include a plurality of laterally extending elements, such as a first jaw closure pin 542 and a second jaw closure pin 544 . Some embodiments of the movable cutting member 540 may have a jaw open pin 546 . It should be appreciated that the pins may extend laterally from both sides of the movable cutting member 540 . Movable cutting member 540 may be comprised of multiple belts, such as a first support belt 548 , a second support belt 550 , and a knife belt 552 disposed between support belts 548 and 550 . The knife band 552 may have a sharpened distal cutting edge 554 . The support straps 548 and 550 can provide stiffness to the movable cutting member 540 and protect the sharp distal cutting edge 554 from encountering the walls of the knife slot 530 ( FIG. 17 ), thereby avoiding unintended wear on the distal cutting edge 554 .

在一些实施例中，可运动切割构件540可限定穿过至少一个带的至少一个切口556。至少一个切口556可改善可运动切割构件540的侧向柔韧性。第一支承带548和第二支承带550还可限定例如远侧切口558，例如凹口。切口558可为关于纵向轴线552大致对称的或者可为不对称的（如图所示）。在横切期间，远侧切口558对组织提供漏斗作用以将组织推压到切刃554的中心。另外，可运动切割构件540可电联接到能量源以充当能量返回路径的一部分（例如，无源电极）。In some embodiments, the movable cutting member 540 can define at least one cut 556 through at least one band. The at least one notch 556 can improve the lateral flexibility of the movable cutting member 540 . The first support strip 548 and the second support strip 550 can also define, for example, a distal cutout 558, such as a notch. The cutout 558 may be generally symmetrical about the longitudinal axis 552 or may be asymmetrical (as shown). The distal incision 558 provides a funnel action to the tissue to push the tissue into the center of the cutting edge 554 during transection. Additionally, the movable cutting member 540 may be electrically coupled to an energy source to serve as part of the energy return path (eg, a passive electrode).

图17为与可运动切割构件540一起使用的端部执行器510的远端的视图。端部执行器具有第一钳口520A和第二钳口520B。第一钳口520A限定刀狭槽530，其中可运动切割构件540平移穿过该刀狭槽。第一钳口520A还可在刀狭槽530的任一侧面上限定闭合销轨道532。闭合销止挡件534位于闭合销轨道532中的至少一者的远端处，以阻止第一钳口闭合销542在操作行程期间的远端运动。应当理解，第二钳口520B可包括类似的闭合销轨道和闭合销止挡件以容纳第二钳口闭合销544。刀狭槽530可比闭合销轨道532朝远侧延伸得更远，因为第一钳口闭合销542和第二钳口闭合销544相比锐利的远侧切刃554略靠近侧定位。在横切行程期间，第一钳口闭合销542和第二钳口闭合销544跨置在销闭合轨道中以同时闭合端部执行器510和压缩组织。当可运动切割构件540朝远侧前进时，锐利的远侧切刃554横切组织。可运动切割构件540可朝远侧前进，直至钳口闭合销542和544中的至少一者接合销止挡件，例如销止挡件534。在一些实施例中，销止挡件534的使用可提供可重复的切割长度并且可通过阻止锐利的远侧切刃554接触刀狭槽530的远端来阻止对锐利的远侧切刃554造成损害。FIG. 17 is a view of the distal end of end effector 510 in use with movable cutting member 540 . The end effector has a first jaw 520A and a second jaw 520B. The first jaw 520A defines a knife slot 530 through which the movable cutting member 540 translates. The first jaw 520A may also define a closure pin track 532 on either side of the knife slot 530 . A closure pin stop 534 is located at the distal end of at least one of the closure pin tracks 532 to prevent distal movement of the first jaw closure pin 542 during the operating stroke. It should be appreciated that the second jaw 520B may include a similar closure pin track and closure pin stop to accommodate the second jaw closure pin 544 . The knife slot 530 can extend farther distally than the closure pin track 532 because the first jaw closure pin 542 and the second jaw closure pin 544 are positioned slightly proximally compared to the sharp distal cutting edge 554 . During the transection stroke, the first jaw closure pin 542 and the second jaw closure pin 544 straddle the pin closure track to simultaneously close the end effector 510 and compress tissue. As the movable cutting member 540 is advanced distally, the sharpened distal cutting edge 554 transects tissue. Movable cutting member 540 may be advanced distally until at least one of jaw closure pins 542 and 544 engages a pin stop, such as pin stop 534 . In some embodiments, the use of the pin stop 534 can provide repeatable cut lengths and can prevent damage to the sharp distal cutting edge 554 by preventing the sharp distal cutting edge 554 from contacting the distal end of the knife slot 530 .

当使用例如I形梁在组织上闭合端部执行器的钳口时，存在高起始负荷。此高起始负荷部分地归因于组织远离端部执行器的枢轴以及靠近端部执行器的枢轴来闭合钳口的I形梁或其它闭合构件。组织在被压缩时通常起到弹簧的作用。组织的压缩程度越高，则压缩组织所需的力就越大。一旦流体已被压出组织，组织就变得甚至更加难以压缩。一般来讲，压缩负荷越高，则击发I形梁的力就越大。甚至相对较小的钳口闭合高度变化（小至.001英寸）例如可显著地改变从组织到I形梁的压缩负荷。另外，对于包括具有相对较小拉幅（例如，小于约40mm）的单个触发器的实施例而言，触发器不得不利用相对较小的行程（例如，图2中的路径129）来执行大量的工作。如下文更详细所述，本文提供了系统和方法以降低执行操作行程所需的力（例如，“击发力”）。When closing the jaws of the end effector on tissue using, for example, an I-beam, there is a high initial load. This high initial load is due in part to the tissue away from the pivot of the end effector and close to the pivot of the end effector to close the I-beam or other closure member of the jaws. Tissue normally acts as a spring when compressed. The more compressed the tissue, the greater the force required to compress the tissue. Once fluid has been forced out of the tissue, the tissue becomes even more difficult to compress. In general, the higher the compressive load, the greater the force to fire the I-beam. Even relatively small changes in jaw closure height (as little as .001 inches), for example, can significantly change the compressive load from tissue to the I-beam. Additionally, for embodiments that include a single trigger with a relatively small tenter (eg, less than about 40mm), the trigger has to perform a large number of work. As described in more detail below, systems and methods are provided herein to reduce the force (eg, "fire force") required to perform an operating stroke.

在一个实施例中，可通过改变闭合构件（例如I形梁）在操作行程期间行进的路径的形状（例如，斜坡）来降低在组织已被夹持之后朝远侧推进切割构件所需的力的总量。在各种实施例中，斜坡轮廓的形状可为凸轮形以大致降低总组织压缩力。图18示出了根据一个非限制性实施例的处于打开位置的端部执行器610的剖视图。类似于在前所述的实施例，端部执行器610可具有可在操作行程期间朝第二钳口620B枢转的第一钳口620A。联接到可运动切割构件（未示出）的多个销可与端部执行器610内的多个斜坡接合以打开和/或闭合钳口620A和620B。In one embodiment, the force required to advance the cutting member distally after tissue has been clamped can be reduced by changing the shape (e.g., ramp) of the path that the closure member (e.g., an I-beam) travels during the operating stroke. total amount. In various embodiments, the ramp profile may be cammed in shape to substantially reduce total tissue compressive force. FIG. 18 illustrates a cross-sectional view of end effector 610 in an open position, according to one non-limiting embodiment. Similar to the previously described embodiments, the end effector 610 may have a first jaw 620A that is pivotable towards a second jaw 620B during an operating stroke. A plurality of pins coupled to a movable cutting member (not shown) can engage with a plurality of ramps within end effector 610 to open and/or close jaws 620A and 620B.

在一个实施例中，为了打开端部执行器610的钳口620A和620B，当朝近侧牵拉近侧销646时（例如，在操作行程结束时）近侧销646可接合打开斜坡660。打开斜坡660可具有弯曲尾段662，所述弯曲尾段在与近侧销646接合时能够使第一钳口620A沿由箭头647指示的方向快速地枢转。应当理解，打开斜坡660的横截面形状将影响钳口620A和620B打开的相对速度。例如，包括具有相对缓变斜率的打开斜坡的端部执行器将比具有较陡打开斜坡的端部执行器打开地更为缓慢。如图所示，当第二钳口620B保持相对固定而第一钳口620A的远端远离第二钳口620A的远端枢转时，钳口620A和620B可“打开”。然而，在一些实施例中，第二钳口620B也可包括打开斜坡，所述打开斜坡类似于第一钳口620A的打开斜坡660。在其它实施例中，仅第二钳口620B包括打开斜坡，所述打开斜坡能够使第二钳口620B的远端远离第一钳口620A的远端枢转。In one embodiment, to open jaws 620A and 620B of end effector 610 , proximal pin 646 may engage opening ramp 660 when proximal pin 646 is pulled proximally (eg, at the end of the operating stroke). Opening ramp 660 may have a curved tail section 662 that, when engaged with proximal pin 646 , enables rapid pivoting of first jaw 620A in the direction indicated by arrow 647 . It should be appreciated that the cross-sectional shape of opening ramp 660 will affect the relative speed at which jaws 620A and 620B open. For example, an end effector that includes an opening ramp with a relatively gradual slope will open more slowly than an end effector with a steeper opening ramp. As shown, the jaws 620A and 620B can be "opened" when the second jaw 620B is held relatively stationary while the distal end of the first jaw 620A is pivoted away from the distal end of the second jaw 620A. However, in some embodiments, the second jaw 620B may also include an opening ramp that is similar to the opening ramp 660 of the first jaw 620A. In other embodiments, only the second jaw 620B includes an opening ramp that enables the distal end of the second jaw 620B to pivot away from the distal end of the first jaw 620A.

端部执行器610可包括附加凸轮压缩通道以在操作行程期间容纳第一钳口闭合销642和第二钳口闭合销644。在一个实施例中，第一钳口620A具有第一闭合销轨道632并且第二钳口620B具有第二闭合销轨道633。第二闭合销轨道633可为基本线性的（如图所示），或者可包括多个倾斜或弯曲部分。在图示实施例中，第一闭合销轨道632具有多个倾斜轮廓以影响第一钳口620A在操作行程期间的动作并且减小击发力。图19示出了已通过可运动切割构件的远端推进而使第一钳口620A枢转到第二钳口620B之后的端部执行器。在第一闭合销轨道632的近端处为相对陡峭的闭合斜坡650。当第一钳口闭合销642从图18所示的位置朝远侧平移时，其接合闭合斜坡650以使第一钳口620A朝向第二钳口620B相对快速地枢转。第一钳口闭合销642随后遇到位于闭合斜坡650顶部处的脊652。脊652可具有向下过渡到斜坡部分654的平坦部分。在一些实施例中，第一钳口620A的组织接触表面可为倾斜的，以降低在推进可运动切割构件之前对端部执行器610的远端处的组织的压缩冲击。图20示出了接合到斜坡部分654的第一钳口闭合销642。斜坡部分654过渡到定位在斜坡部分654和端部执行器610的远端中间的平坦部分656。平坦部分656的相对高度可基本上类似于脊652的平坦部分的相对高度。在各种实施例中，近侧销646可被定位在可运动切割构件上，使得其不接触第一闭合销轨道632。第二钳口闭合销644可在操作行程期间沿第二闭合销轨道633前进。The end effector 610 may include additional cam compression channels to accommodate the first jaw closure pin 642 and the second jaw closure pin 644 during the operating stroke. In one embodiment, the first jaw 620A has a first close pin track 632 and the second jaw 620B has a second close pin track 633 . The second closure pin track 633 can be substantially linear (as shown), or can include multiple sloped or curved sections. In the illustrated embodiment, the first closure pin track 632 has a plurality of sloped profiles to affect the motion of the first jaw 620A during the operating stroke and reduce firing force. Figure 19 shows the end effector after the first jaw 620A has been pivoted to the second jaw 620B by distal advancement of the movable cutting member. At the proximal end of the first closure pin track 632 is a relatively steep closure ramp 650 . As the first jaw closure pin 642 translates distally from the position shown in FIG. 18 , it engages the closure ramp 650 to relatively quickly pivot the first jaw 620A toward the second jaw 620B. The first jaw closure pin 642 then encounters a ridge 652 at the top of the closure ramp 650 . Ridge 652 may have a flat portion that transitions down to ramp portion 654 . In some embodiments, the tissue-contacting surface of first jaw 620A can be sloped to reduce compressive impact on tissue at the distal end of end effector 610 prior to advancing the movable cutting member. FIG. 20 shows the first jaw closure pin 642 engaged to the ramp portion 654 . Ramp portion 654 transitions into flat portion 656 positioned intermediate ramp portion 654 and the distal end of end effector 610 . The relative height of the flat portion 656 may be substantially similar to the relative height of the flat portion of the ridge 652 . In various embodiments, the proximal pin 646 can be positioned on the movable cutting member such that it does not contact the first closure pin track 632 . The second jaw close pin 644 is advanceable along the second close pin track 633 during the operating stroke.

为清楚起见，根据一个非限制性实施例的第一闭合销轨道632的轮廓示出于图21中。闭合斜坡650通向具有全闭合平坦部分的脊652。脊652的平坦部分通向朝下的斜坡部分654。朝下的斜坡部分654通常在最高负荷的情况下减轻闭合压力。斜坡部分654向后倾斜直到全闭合平坦部分656以用于最终压缩。通过具有多斜坡轨道，可较好地利用柄部的机械效益并且当柄部产生低机械效益时可减小击发力。用以返回可运动切割构件的力也因其返回时的较小压缩力而得到降低。应当理解，在各种实施例中可修改轨道的轮廓。例如，可修改斜坡部分654的斜坡长度，或可修改平坦部分656以具有斜坡，或可作出其它修改。此外，第二闭合销轨道633可被修改为具有类似于第一闭合销轨道632的结构。For clarity, the outline of the first closure pin track 632 according to one non-limiting embodiment is shown in FIG. 21 . A closed ramp 650 leads to a ridge 652 with a fully closed flat section. The flat portion of the ridge 652 leads to a downwardly facing sloped portion 654 . The downwardly facing ramp portion 654 generally relieves closure pressure under the highest load conditions. The ramp portion 654 slopes back until it fully closes the flat portion 656 for final compression. By having a multi-ramp track, the mechanical advantage of the handle can be better utilized and the firing force can be reduced when the handle produces low mechanical advantage. The force to return the movable cutting member is also reduced due to the lower compressive force upon return. It should be understood that the profile of the track may be modified in various embodiments. For example, the ramp length of ramp portion 654 could be modified, or flat portion 656 could be modified to have a ramp, or other modifications could be made. Additionally, the second closure pin track 633 may be modified to have a similar structure to the first closure pin track 632 .

在一些实施例中，各种饰层、涂层、和/或润滑剂可用于通过降低端部执行器的运动组件之间的摩擦力来降低触发力。在一些实施例中，第一钳口闭合销642和第二钳口闭合销644中的至少一者涂覆有减摩物质。销从中行进的轨道也可涂覆有减摩物质。在一些实施例中，减摩物质可包括例如硼铝锰(BAM)、氮化铝钛(AlTiN)、氮化钛、类金刚石碳(DLC)、二硫化钼钛、或碳化钒(VC)。可运动切割构件的侧面也可涂覆有减摩物质例如氮化钛(TiN)以例如有助于降低抵靠钳口轨道的摩擦。另外，可使用任何合适的润滑物质来降低击发力以及改善外科器械的操作。合适润滑剂的不完全和非限制性列表包括例如KRYTOX、硬脂酸钠、DOW360、和NUSIL。也可修改端部执行器610的多个组件的表面光洁度以降低摩擦。例如，可对端部执行器的多个组件之间的界面进行电解抛光并且可利用研磨剂进行二次机械抛光。在一些实施例中，目标被定为获得约4至16微英寸的平均表面粗糙度。In some embodiments, various finishes, coatings, and/or lubricants may be used to reduce trigger force by reducing friction between moving components of the end effector. In some embodiments, at least one of the first jaw closure pin 642 and the second jaw closure pin 644 is coated with a friction reducing substance. The track along which the pins travel may also be coated with an antifriction substance. In some embodiments, antifriction substances may include, for example, boron aluminum manganese (BAM), aluminum titanium nitride (AlTiN), titanium nitride, diamond-like carbon (DLC), molybdenum titanium disulfide, or vanadium carbide (VC). The sides of the movable cutting member may also be coated with a friction reducing substance such as titanium nitride (TiN) to help reduce friction against the jaw rails, for example. Additionally, any suitable lubricating substance may be used to reduce firing force and improve handling of the surgical instrument. A non-exhaustive and non-limiting list of suitable lubricants includes, for example, KRYTOX, sodium stearate, DOW360, and NUSIL. The surface finish of various components of end effector 610 may also be modified to reduce friction. For example, the interface between the various components of the end effector may be electropolished and may be mechanically polished a second time with an abrasive. In some embodiments, an average surface roughness of about 4 to 16 microinches is targeted.

在一些实施例中，多个组件可由有助于降低摩擦力的特定材料制成。如上所述，降低接合组件的摩擦力可降低端部执行器的击发力。在一个实施例中，可使用亚稳铜（spinodalbronze）来帮助降低摩擦力。一般来讲，亚稳铜包含铜和镍并且能够在具有高负荷和低速度的应用中良好地操作。端部执行器610的多个部件（例如销642,644和646）可由亚稳铜构成。亚稳铜可购自ANCHORBRONZE（例如，NICOMET）和BRUSH-WELLMAN（例如，TOUGHMET）。由亚稳铜构成的部件可被用于多种外科器械中，例如直线切割器、缝合器、射频装置、和超声装置。In some embodiments, various components may be made of specific materials that help reduce friction. As noted above, reducing the friction of the engagement components reduces the firing force of the end effector. In one embodiment, spinodal bronze may be used to help reduce friction. In general, metastable copper contains copper and nickel and is able to operate well in applications with high loads and low speeds. Various components of end effector 610, such as pins 642, 644, and 646, may be constructed of metastable copper. Metastable copper is commercially available from ANCHORBRONZE (eg, NICOMET) and BRUSH-WELLMAN (eg, TOUGHMET). Components composed of metastable copper can be used in a variety of surgical instruments such as linear cutters, staplers, radio frequency devices, and ultrasonic devices.

在一些实施例中，使用其它技术来降低在触发器处的力以及使较高的密封成功机率成为可能。例如，可通过将被压缩的组织的量降低到相对较小的厚度（例如，0.006"）来降低压缩组织所需力的量。图22为根据一个非限制性实施例的钳口720的剖视图。类似于在前所述的钳口，钳口720可限定用于容纳压缩元件（例如I形梁）的腔体724以及从中可穿过切割元件的刀腔体722。钳口720还具有被定位在绝缘体779上的锥形电极777。锥形电极777具有朝向锥形电极777的内边缘定位的内部区域780。在一个实施例中，在完全压缩时，内部区域780与被定位在相对钳口（未示出）上的无源电极之间存在约0.006"的间隙。此狭窄区域为旨在具有最大密封强度的区域。随着向外运动，锥形电极777远离内部区域780渐缩并且增大间隙。随着间隙的增大，组织压缩的量会降低。锥角β可为任何合适的角度，例如，在例如约1至约30度的范围内。在一个实施例中，锥角β为约10度。在一个实施例中，外部区域782从内部区域780下降距离d。在一个实施例中，距离d为约0.007"。在一些实施例中，距离d可在例如约0.002"至约0.020"的范围内。通过使用锥形表面，钳口中的组织负荷可降低约30%至约50%的范围。在一些实施例中，无源电极可被替代地为锥形的，或者有源电极和无源电极均可为锥形的。一般来讲，使电极逐渐变细会有效地降低组织被钳口压缩的量，其中邻近切割元件的组织接收最大的压缩。在一些实施例中，可实施其它电极构型以实现在电极的整个接触表面上的组织压缩变化。在一个实施例中，例如电极为圆柱形的以在沿钳口长度的狭窄线接触处来压缩组织。所有此类具体实施均旨在被本发明所涵盖。In some embodiments, other techniques are used to reduce the force at the trigger and enable a higher chance of successful sealing. For example, the amount of force required to compress tissue can be reduced by reducing the amount of tissue being compressed to a relatively small thickness (eg, 0.006"). FIG. 22 is a cross-sectional view of jaws 720 according to one non-limiting embodiment Similar to the previously described jaws, jaw 720 may define a cavity 724 for receiving a compression element (eg, an I-beam) and a knife cavity 722 through which a cutting element may pass. Jaw 720 also has a Tapered electrode 777 positioned on insulator 779. Tapered electrode 777 has an inner region 780 positioned toward the inner edge of tapered electrode 777. In one embodiment, when fully compressed, inner region 780 is positioned against the clamp There is a gap of about 0.006" between the passive electrodes on the ports (not shown). This narrow area is the area intended to have the greatest seal strength. As it moves outward, the tapered electrode 777 tapers away from the inner region 780 and increases the gap. As the gap increases, the amount of tissue compression decreases. Taper angle β may be any suitable angle, eg, in the range of, for example, about 1 to about 30 degrees. In one embodiment, taper angle β is about 10 degrees. In one embodiment, the outer region 782 descends a distance d from the inner region 780 . In one embodiment, distance d is about 0.007". In some embodiments, distance d can range, for example, from about 0.002" to about 0.020". By using tapered surfaces, tissue loading in the jaws can be reduced by about 30 % to about 50%. In some embodiments, the passive electrodes may instead be tapered, or both active and passive electrodes may be tapered. In general, tapering the electrodes will effectively reduce the amount of tissue compressed by the jaws, with tissue adjacent to the cutting element receiving the greatest compression. In some embodiments, other electrode configurations may be implemented to achieve varying tissue compression across the contact surface of the electrode. In In one embodiment, for example, the electrodes are cylindrical to compress tissue at narrow line contacts along the length of the jaws. All such implementations are intended to be encompassed by the present invention.

在一些实施例中，可运动切割构件上的压缩销之间的相对距离可在操作行程的不同阶段期间而有所不同。例如，销可在行程的压缩/切割部分期间相对较为靠近并且在可运动切割构件从端部执行器的远端回缩并且朝端部执行器的近端平移时相对较为远离。具有可运动销的可运动切割构件840示出于图23A和23B中。尽管可运动切割构件840被示出为与图16所示的切割构件540相类似的带状切割构件，但应当理解可使用任何合适的可运动切割构件。可运动切割构件840具有第一钳口闭合销842、第二钳口闭合销844和近侧销846。第一钳口闭合销842和第二钳口闭合销844中的至少一者可跨置在狭槽或凸轮表面中以允许销842和844相对于彼此运动。如图所示，第一钳口闭合销842可定位在狭槽850中。狭槽850相对于可运动切割构件840的纵向轴线851可为倾斜的。在一个实施例中，狭槽角度α为约5度。在一些实施例中，狭槽角度α可在例如约2度至约30度的范围内。第一钳口闭合销842在狭槽850内的具体位置将取决于可运动切割构件840的动作。在图23A中，例如第一钳口闭合销842被示出为处于如下位置，所述位置对应于可运动切割构件840正沿由箭头852指示的方向平移（例如，在切割期间）。在此位置，向下驱使第一钳口闭合销842并且第一钳口闭合销842和第二钳口闭合销844之间的竖直间隔为距离d₁。相比而言，在图23B中，第一钳口闭合销842被示出为处于如下位置，所述位置对应于可运动切割构件840正沿由箭头854指示的方向平移（例如，在回缩期间）。在此位置，向上驱使第一钳口闭合销842并且第一钳口闭合销842和第二钳口闭合销844之间的竖直间隔增加到距离d₂，其中d₂>d₁。应当理解，d₂和d₁之间的差值至少部分地取决于狭槽角度α。换句话讲，狭槽角度α越大，则d₂和d₁之间的差值就越大。钳口闭合销842和844之间沿相反方向的附加间隔距离将增加压缩间隙，由此将降低回缩压缩系统所需的力。In some embodiments, the relative distance between compression pins on the movable cutting member may vary during different stages of the operating stroke. For example, the pins may be relatively closer during the compression/cutting portion of the stroke and relatively farther apart as the movable cutting member retracts from the distal end of the end effector and translates toward the proximal end of the end effector. A movable cutting member 840 with a movable pin is shown in Figures 23A and 23B. Although the movable cutting member 840 is shown as a band-shaped cutting member similar to the cutting member 540 shown in FIG. 16, it should be understood that any suitable movable cutting member may be used. The movable cutting member 840 has a first jaw closure pin 842 , a second jaw closure pin 844 and a proximal pin 846 . At least one of the first jaw closure pin 842 and the second jaw closure pin 844 may ride in a slot or cam surface to allow movement of the pins 842 and 844 relative to each other. As shown, the first jaw closure pin 842 can be positioned in the slot 850 . The slot 850 may be inclined relative to the longitudinal axis 851 of the movable cutting member 840 . In one embodiment, the slot angle α is about 5 degrees. In some embodiments, the slot angle α may range, for example, from about 2 degrees to about 30 degrees. The exact position of the first jaw closure pin 842 within the slot 850 will depend on the action of the movable cutting member 840 . In FIG. 23A , for example, first jaw closure pin 842 is shown in a position corresponding to movable cutting member 840 being translated in the direction indicated by arrow 852 (eg, during cutting). In this position, the first jaw closure pin 842 is driven downward and the vertical separation between the first jaw closure pin 842 and the second jaw closure pin 844 is a distance d₁ . In contrast, in FIG. 23B , first jaw closure pin 842 is shown in a position corresponding to movable cutting member 840 being translated in the direction indicated by arrow 854 (e.g., in a retracted position). period). In this position, the first jaw closure pin 842 is driven upward and the vertical separation between the first jaw closure pin 842 and the second jaw closure pin 844 increases to a distance d₂ , where d₂ >d₁ . It should be appreciated that the difference between d₂ and d₁ depends at least in part on the slot angle α._In other words, the greater the slot angle α, the greater the difference between_d2 and d1. The additional spacing distance in the opposite direction between jaw closure pins 842 and 844 will increase the compression gap, thereby reducing the force required to retract the compression system.

在一些实施例中，可运动切割构件的带中的附加结构（例如，狭槽、凹口、或切口）可用于确保闭合销在操作行程期间向后（向下）和向前（向上）运动。多个带可被定时以基于可运动切割构件的正向运动和反向运动来向上或向下推动开槽销。根据一个非限制性实施例的具有平移带的可运动切割构件940示出于图24中。中央带952具有竖直狭槽960。两个外带948各自具有倾斜的狭槽950。倾斜的狭槽950为相对于可运动切割构件940的纵向轴线951倾斜的。第一钳口闭合销942置于三个带之间。在切割行程期间，相对于中央带952朝远侧推动外带948并且促使第一钳口闭合销942朝着倾斜的狭槽950的近端和竖直狭槽960的底部运动。在此位置，第一钳口闭合销942和第二钳口闭合销944正将相对高数量的压缩力施加到所捕获组织上。图25示出了回缩/返回期间的可运动切割构件940。当相对于中央带952朝近侧牵拉外带948时，促使第一钳口闭合销942朝着倾斜的狭槽950的远端和竖直狭槽960的顶部运动，从而增加第一钳口闭合销942和第二钳口闭合销944之间的竖直间隔。在此位置，间隔销942和944的距离可降低组织压缩量并且减小回缩可运动切割构件940所需的力。In some embodiments, additional structures (e.g., slots, notches, or cutouts) in the band of the movable cutting member may be used to ensure the rearward (downward) and forward (upward) movement of the closure pin during the operating stroke . The plurality of belts may be timed to push the slotted pin up or down based on forward and reverse motion of the movable cutting member. A movable cutting member 940 with a translating band is shown in FIG. 24 according to one non-limiting embodiment. The central band 952 has vertical slots 960 . The two outer bands 948 each have a sloped slot 950 . The angled slot 950 is angled relative to the longitudinal axis 951 of the movable cutting member 940 . The first jaw closure pin 942 is placed between the three straps. During the cutting stroke, the outer band 948 is pushed distally relative to the central band 952 and causes the first jaw closure pin 942 to move towards the proximal end of the angled slot 950 and the bottom of the vertical slot 960 . In this position, the first jaw closure pin 942 and the second jaw closure pin 944 are applying a relatively high amount of compressive force to the captured tissue. Figure 25 shows the movable cutting member 940 during retraction/return. When the outer band 948 is pulled proximally relative to the central band 952, the first jaw closure pin 942 is urged to move toward the distal end of the angled slot 950 and the top of the vertical slot 960, thereby increasing the first jaw. The vertical spacing between the closure pin 942 and the second jaw closure pin 944. In this position, spacing pins 942 and 944 apart can reduce the amount of tissue compression and reduce the force required to retract movable cutting member 940 .

在一些实施例中，可使用推块来促进中央带952和外带948在操作行程的各个阶段期间的相对平移。图26示出了在切割行程期间操作地联接到推块922的击发杆920的剖视图。击发杆920操作地联接到外科器械的触发器（未示出），使得击发杆920可分别沿由箭头902和904指示的方向选择性地推进和/回缩。推块922具有远侧面924和近侧面926。在切割行程期间（例如，当击发杆920沿由箭头902指示的方向推进时），可运动切割构件940的三个带在远侧面924上对齐。可运动切割构件940在切割行程期间的透视图示出于图27中。在此位置，第一钳口闭合销942和第二钳口闭合销944之间的竖直间隔处于最小距离以产生最大的组织压缩。图28示出了击发杆920在可运动切割构件940的回缩期间（例如，当击发杆920沿由箭头904指示的方向回缩时）的剖视图。在回缩期间，可运动切割构件940的三个带在近侧面926上对齐。可运动切割构件940在回缩期间的透视图示出于图29中。在此位置，第一钳口闭合销942和第二钳口闭合销944之间的竖直间隔处于最大距离以提供减小的组织压缩量。In some embodiments, push blocks may be used to facilitate relative translation of the central belt 952 and outer belt 948 during various stages of the operating stroke. FIG. 26 shows a cross-sectional view of firing rod 920 operatively coupled to push block 922 during a cutting stroke. Firing rod 920 is operatively coupled to a trigger (not shown) of a surgical instrument such that firing rod 920 can be selectively advanced and/or retracted in the directions indicated by arrows 902 and 904, respectively. Push block 922 has a distal side 924 and a proximal side 926 . During a cutting stroke (eg, when firing rod 920 is advanced in the direction indicated by arrow 902 ), the three bands of movable cutting member 940 are aligned on distal side 924 . A perspective view of the movable cutting member 940 during a cutting stroke is shown in FIG. 27 . In this position, the vertical separation between the first jaw closure pin 942 and the second jaw closure pin 944 is at a minimum distance to produce maximum tissue compression. 28 shows a cross-sectional view of firing rod 920 during retraction of movable cutting member 940 (eg, when firing rod 920 is retracted in the direction indicated by arrow 904 ). During retraction, the three bands of movable cutting member 940 are aligned on proximal side 926 . A perspective view of the movable cutting member 940 during retraction is shown in FIG. 29 . In this position, the vertical separation between the first jaw closure pin 942 and the second jaw closure pin 944 is at a maximum distance to provide a reduced amount of tissue compression.

在一些实施例中，闭合销中的至少一个可为由两个或多个单独组件构成的组件。图30为包括闭合销组件的可运动切割构件960的分解透视图。图31为处于组装构型的图30的可运动切割构件960的透视图。图31A为可运动切割构件960的剖视图。在图示实施例中，第一闭合销962和第二闭合销964为组件，而近侧销966为一体的。第一闭合销962可包括轴968以及第一环970和第二环972。轴968以及第一环970和第二环972可由任何合适的材料制成。在一个实施例中，轴968为17-7PH不锈钢并且第一环970和第二环972为合金，例如TOUGHMET。第一环970和第二环972可例如压力配合到轴968上。如图所示，可按照类似于第一闭合销962的方式来组装第二闭合销964。例如，第二闭合销可包括轴974以及第一环976和第二环978。应当理解，在操作行程期间，环970,972,976,978接触相关端部执行器的多个闭合销轨道。In some embodiments, at least one of the closure pins may be an assembly of two or more separate components. Figure 30 is an exploded perspective view of the movable cutting member 960 including the closure pin assembly. FIG. 31 is a perspective view of the movable cutting member 960 of FIG. 30 in an assembled configuration. FIG. 31A is a cross-sectional view of movable cutting member 960 . In the illustrated embodiment, the first closure pin 962 and the second closure pin 964 are components, while the proximal pin 966 is integral. The first closure pin 962 may include a shaft 968 and a first ring 970 and a second ring 972 . Shaft 968 and first and second rings 970, 972 may be made of any suitable material. In one embodiment, shaft 968 is 17-7PH stainless steel and first ring 970 and second ring 972 are an alloy, such as TOUGHMET. The first ring 970 and the second ring 972 may be press fit onto the shaft 968, for example. As shown, the second closure pin 964 may be assembled in a similar manner to the first closure pin 962 . For example, the second closure pin may include a shaft 974 and a first ring 976 and a second ring 978 . It should be appreciated that during the operating stroke, the rings 970, 972, 976, 978 contact the plurality of closure pin tracks of the associated end effector.

轴968,974和环970,972,976,978的尺寸可基于端部执行器的尺寸而有所不同。在一个实施例中，例如，轴968,974具有约0.0400"（公差为+/-0.0002"）的外径。在一个实施例中，例如，环970,972,976,978具有约0.0394"（公差为+/-0.0003"）的内径。在一个实施例中，例如，环970,972,976,978具有约0.070"（公差为+/-0.0003"）的外径。在一个实施例中，第一闭合销962和第二闭合销064之间的距离d3（图31A）可为约0.148"（公差为约+/-0.001"）。The dimensions of the shafts 968, 974 and rings 970, 972, 976, 978 may vary based on the size of the end effector. In one embodiment, for example, the shafts 968, 974 have an outer diameter of approximately 0.0400" (tolerance +/- 0.0002"). In one embodiment, for example, the rings 970, 972, 976, 978 have an inner diameter of about 0.0394" (tolerance +/- 0.0003"). In one embodiment, for example, rings 970, 972, 976, 978 have an outer diameter of approximately 0.070" (tolerance +/- 0.0003"). In one embodiment, the distance d3 ( FIG. 31A ) between the first closure pin 962 and the second closure pin 064 may be about 0.148" (with a tolerance of about +/- 0.001").

一般来讲，根据一个实施例，环970,972,976,978允许具有相对较大的外径以将闭合销962,968捕获在端部执行器的轨道中。此外，环970,972,976,978的相对较大的外径可防止闭合销962,968在轨道内翘起（这样可导致阻塞）。如果轨道例如因高夹持负荷而变形，则环970,972,976,978的相对较大的外径也可有助于确保闭合销962,964仍与轨道接合。另外，在一些实施例中，可在无锤击过程（其可消除处理波动的源）的情况下制备闭合销962,964。In general, according to one embodiment, the rings 970, 972, 976, 978 are permitted to have a relatively large outer diameter to capture the closure pin 962, 968 in the track of the end effector. Additionally, the relatively large outer diameter of the rings 970, 972, 976, 978 prevents the closure pins 962, 968 from lifting within the track (which could cause jamming). The relatively larger outer diameter of the rings 970, 972, 976, 978 may also help ensure that the closure pins 962, 964 remain engaged with the track if the track deforms, eg, due to high clamping loads. Additionally, in some embodiments, the closure pins 962, 964 may be produced without a hammering process, which may eliminate a source of process fluctuations.

在一些实施例中，闭合销可结合轴承以降低击发时的摩擦问题。图32为包括滚针轴承的闭合销980的分解图。图33为组装后的闭合销980的剖视图。在一个实施例中，闭合销980包括轴982。轴可具有例如约1mm的直径。闭合销980可包括具有第一部分985和第二部分986的阶梯状箍984。第一部分985的外径可大于第二部分986的外径。闭合销980还可包括内部箍988。内部箍988和阶梯状箍984在组装时可限定凹口989。应当理解，凹口989容纳相关的可运动切割构件（未示出）。闭合销980还可包括第一组滚针轴承990和第二组滚针轴承991。在一个实施例中，滚针轴承990,991的每个滚针具有约0.010"的直径。第一轮992和第二轮993可分别容纳第一组滚针轴承990和第二组滚针轴承991。第一端箍994和第二端箍995可例如利用压力配合接合方式附接到轴982。In some embodiments, the closure pin may incorporate bearings to reduce friction issues during firing. Figure 32 is an exploded view of the closure pin 980 including needle bearings. Figure 33 is a cross-sectional view of the closed pin 980 after assembly. In one embodiment, closure pin 980 includes a shaft 982 . The shaft may have, for example, a diameter of about 1 mm. Closure pin 980 may include a stepped collar 984 having a first portion 985 and a second portion 986 . The outer diameter of the first portion 985 may be greater than the outer diameter of the second portion 986 . Closure pin 980 may also include an inner ferrule 988 . Inner ferrule 988 and stepped ferrule 984 may define notch 989 when assembled. It should be appreciated that notch 989 accommodates an associated movable cutting member (not shown). Closure pin 980 may also include a first set of needle bearings 990 and a second set of needle bearings 991 . In one embodiment, each needle of the needle bearings 990, 991 has a diameter of about 0.010". The first wheel 992 and the second wheel 993 may house the first set of needle bearings 990 and the second set of needle bearings 991, respectively. First end ferrule 994 and second end ferrule 995 may be attached to shaft 982, for example, using a press fit engagement.

当闭合销980的轮992,993在联接到端部执行器的可运动切割构件时可接合端部执行器的轨道。当可运动切割构件平移穿过端部执行器时，轮992,993可通过第一组滚针轴承990和第二组滚针轴承991而相对轴968旋转。因此，可降低可能在操作行程期间经受的摩擦力。The wheels 992, 993 of the closure pin 980 may engage the track of the end effector when coupled to the movable cutting member of the end effector. The wheels 992, 993 are rotatable relative to the shaft 968 by the first set of needle bearings 990 and the second set of needle bearings 991 as the movable cutting member translates through the end effector. Thus, frictional forces that may be experienced during the operating stroke may be reduced.

在一些实施例中，端部执行器可包括共同有助于降低击发力和/或返回力的多个结构。图34为根据一个非限制性实施例的端部执行器1010的放大视图。图35为端部执行器1010的一部分的剖视图。如图30和31所示，可运动切割构件1040具有第一钳口闭合销1042，所述第一钳口闭合销通过倾斜狭槽1050而相对于第二钳口闭合销1044平移以改变这两个销之间的间隔。另外，第一钳口1020A包括用于接合第一钳口闭合销1042和近侧销1046的多斜坡轨道。如图所示，第一钳口1020A包括打开斜坡1060、闭合斜坡1050、脊1052和斜坡部分1054，这类似于图19所示的端部执行器610。In some embodiments, an end effector may include multiple structures that collectively help reduce firing and/or return forces. Figure 34 is an enlarged view of end effector 1010 according to one non-limiting embodiment. FIG. 35 is a cross-sectional view of a portion of end effector 1010 . As shown in FIGS. 30 and 31 , the movable cutting member 1040 has a first jaw closure pin 1042 that translates relative to a second jaw closure pin 1044 via an angled slot 1050 to alter the relationship between the two. spacing between pins. Additionally, first jaw 1020A includes a multi-ramp track for engaging first jaw closure pin 1042 and proximal pin 1046 . As shown, first jaw 1020A includes opening ramp 1060 , closing ramp 1050 , ridge 1052 and ramp portion 1054 , similar to end effector 610 shown in FIG. 19 .

可利用任何合适的技术来附连与可运动切割构件相关的多个销。在一个实施例中，可利用键槽技术将销固定到多带式可运动切割构件。对于此类实施例，可使用如图36所示的台阶式销1142。台阶式销1142具有纵向轴线1130，所述台阶式销包括沿纵向轴线1130的具有不同外径的至少两个部分。在一个实施例中，中间部分1144具有小于第一外部1146和第二外部1152的直径。图37A和37B示出了根据一个非限制性实施例的外带1148和1149。每个外带1148和1149具有狭槽1150，所述狭槽在一端处具有较大的孔1151。相对于外带1149，外带1148上的孔1151位于狭槽1150的相对端上。孔1151具有宽度w1并且狭槽1150具有宽度w2。宽度w2可略大于台阶式销1142的第一外部1146和第二外部1152中的一者的外径。宽度w1可略大于中间部分1144的外径但略小于第一外部1146和第二外部1152的直径。为了组装可运动切割构件，两个外带1148和1149被定位成使得孔1151为对齐的。图38A示出了夹有中央带1152的两个带1148和1149，其中它们的孔1151为对齐的。为了附连台阶式销1142，将其通过对齐的孔1151插入（如图38B所示）并且沿相反的方向牵拉带1148，使得狭槽1150的较狭窄部分将台阶式销1142捕获在适当位置。图39为在已附连第一钳口闭合销1142之后的可运动切割构件1140的顶部远端的透视图。The plurality of pins associated with the movable cutting member may be attached using any suitable technique. In one embodiment, keyway technology may be used to secure the pin to the multi-band movable cutting member. For such embodiments, stepped pins 1142 as shown in FIG. 36 may be used. The stepped pin 1142 has a longitudinal axis 1130 and includes at least two portions along the longitudinal axis 1130 having different outer diameters. In one embodiment, middle portion 1144 has a smaller diameter than first outer portion 1146 and second outer portion 1152 . 37A and 37B illustrate outer straps 1148 and 1149 according to one non-limiting embodiment. Each outer band 1148 and 1149 has a slot 1150 with a larger hole 1151 at one end. Hole 1151 on outer band 1148 is located on the opposite end of slot 1150 relative to outer band 1149 . The hole 1151 has a width w1 and the slot 1150 has a width w2. The width w2 may be slightly larger than the outer diameter of one of the first outer portion 1146 and the second outer portion 1152 of the stepped pin 1142 . Width w1 may be slightly larger than the outer diameter of middle portion 1144 but slightly smaller than the diameters of first outer portion 1146 and second outer portion 1152 . To assemble the movable cutting member, the two outer bands 1148 and 1149 are positioned such that the holes 1151 are aligned. Figure 38A shows two straps 1148 and 1149 sandwiching a central strap 1152 with their holes 1151 aligned. To attach stepped pin 1142, it is inserted through aligned hole 1151 (as shown in FIG. 38B) and strap 1148 is pulled in the opposite direction so that the narrower portion of slot 1150 captures stepped pin 1142 in place. . 39 is a perspective view of the top distal end of the movable cutting member 1140 after the first jaw closure pin 1142 has been attached.

在某些操作状态下，外科器械可变为过载的。例如，如果正密封和切割大血管或大组织束，则夹持钳口并且朝远侧驱动切割构件所需的力可使装置的多个组件过载。在一个实施例中，为了防止装置的过载状态，则可使用在力达到负荷阈值时有意断裂的剪切销。图40示出了根据一个非限制性实施例的剪切销1200。剪切销1200可由任何合适的材料例如铝（例如，铝合金2024）或钢制成或构成。在一个实施例中，剪切销1200在过载状态期间可在两个点剪断。第一剪切凹槽1202被定位在剪切销1200的一端处并且第二剪切凹槽1204被定位在剪切销1200的另一端处。应当理解，在一些实施例中可使用位于任何合适位置处的单个剪切凹槽。剪切销1200的尺寸可由应用和操作阈值确定。在一些实施例中，剪切销1200可在约60lbf（其低于可损坏相关外科器械的组件的力）下剪断。可将剪切销组装到触发器组件中，从而允许触发器在发生剪断之后的自由运动。图41为包括剪切销1200的触发器组件1210的简化版本。触发器1210可围绕枢轴1212枢转以在击发杆1214上施加线性运动。击发杆1214可在其远端处操作地联接到端部执行器（未示出）。击发杆1214限定容纳剪切销1200的镗孔1216。触发器1210联接到支架1220，所述支架操作地联接到剪切销1200的剪切凹槽1202。来自触发器1210的力通过剪切销1200递送到端部执行器（未示出）。触发器1210可例如朝远侧推进端部执行器中的刀。在非过载状态期间，沿由箭头1222指示的方向旋转触发器1210可使击发杆1214朝远侧平移（例如，沿由箭头1224指示的方向）。然而，在过载情况期间，通过支架1220递送到剪切凹槽1202的力将在剪切凹槽1202处剪断剪切销1200并且使触发器1210与击发杆1214分离。Under certain operating conditions, surgical instruments can become overloaded. For example, if a large blood vessel or large tissue bundle is being sealed and cut, the force required to clamp the jaws and drive the cutting member distally can overload various components of the device. In one embodiment, to prevent an overload condition of the device, a shear pin that breaks intentionally when the force reaches a load threshold may be used. Figure 40 illustrates a shear pin 1200 according to one non-limiting embodiment. Shear pin 1200 may be made or constructed of any suitable material, such as aluminum (eg, Aluminum Alloy 2024) or steel. In one embodiment, shear pin 1200 may shear at two points during an overload condition. The first shear groove 1202 is positioned at one end of the shear pin 1200 and the second shear groove 1204 is positioned at the other end of the shear pin 1200 . It should be understood that a single shear groove at any suitable location may be used in some embodiments. The size of the shear pin 1200 can be determined by the application and operating thresholds. In some embodiments, the shear pin 1200 can shear at about 60 lbf, which is lower than the force that could damage components of an associated surgical instrument. A shear pin may be assembled into the trigger assembly to allow free movement of the trigger after shearing has occurred. FIG. 41 is a simplified version of trigger assembly 1210 including shear pin 1200 . Trigger 1210 is pivotable about pivot 1212 to impart linear motion on firing rod 1214 . Firing rod 1214 may be operatively coupled at its distal end to an end effector (not shown). The firing rod 1214 defines a bore 1216 that receives the shear pin 1200 . Trigger 1210 is coupled to bracket 1220 , which is operatively coupled to shear groove 1202 of shear pin 1200 . Force from trigger 1210 is delivered through shear pin 1200 to an end effector (not shown). Trigger 1210 may, for example, advance a knife in the end effector distally. During the non-overload state, rotating trigger 1210 in the direction indicated by arrow 1222 can translate firing rod 1214 distally (eg, in the direction indicated by arrow 1224 ). However, during an overload condition, the force delivered by bracket 1220 to shear groove 1202 will shear shear pin 1200 at shear groove 1202 and separate trigger 1210 from firing rod 1214 .

图42示出了外科器械1230，其中移除了外壳的部分以示出多个内部组件。外科器械1230结合作为过载构件的剪切销1240（图44）。图43为触发器组件1232的一部分的放大视图，其中为清楚起见已移除了多个组件。图44为触发器组件1232的多个组件的分解图，其中为清楚起见已移除了多个组件。参见图42-44，外科器械1230通常可按类似于上述实施例的方式工作。例如，触发器1234沿路径1236的运动可致动端部执行器（未示出）。例如，端部执行器可具有从中平移刀的钳口。可通过操作地联接到触发器1234和齿条1240的齿轮组件1238来驱动端部执行器的致动。当操作者沿路径1236运动触发器1234时，触发器组件1232可围绕枢转销1240枢转。触发器组件可包括第一侧面触发器板1242和第二侧面触发器板1244，其中在这两者间设有中央触发器板1246。中央触发器板1246可联接到触发器1234。如下文更详细所述，返回销1248可联接到中央触发器板1246并且跨置在由第一侧面触发器板1242限定的返回狭槽1250中。第二侧面触发器板1244可限定如下狭槽，所述狭槽类似于返回狭槽1250并且能够容纳返回销1240的一部分。在致动触发器1234时，致动板1252也可围绕枢转销1240枢转，使得齿条1254接合齿轮组件1238并最终致动端部执行器。Fig. 42 shows surgical instrument 1230 with portions of the housing removed to show various internal components. The surgical instrument 1230 incorporates a shear pin 1240 ( FIG. 44 ) as an overload member. FIG. 43 is an enlarged view of a portion of trigger assembly 1232 with various components removed for clarity. FIG. 44 is an exploded view of various components of trigger assembly 1232 with various components removed for clarity. 42-44, surgical instrument 1230 may generally operate in a manner similar to the embodiments described above. For example, movement of trigger 1234 along path 1236 may actuate an end effector (not shown). For example, the end effector may have jaws through which the knife is translated. Actuation of the end effector may be driven by a gear assembly 1238 operatively coupled to trigger 1234 and rack 1240 . Trigger assembly 1232 may pivot about pivot pin 1240 as an operator moves trigger 1234 along path 1236 . The trigger assembly may include a first side trigger plate 1242 and a second side trigger plate 1244 with a central trigger plate 1246 therebetween. Central trigger plate 1246 may be coupled to trigger 1234 . As described in more detail below, return pin 1248 may be coupled to central trigger plate 1246 and straddle within return slot 1250 defined by first side trigger plate 1242 . Second side trigger plate 1244 may define a slot similar to return slot 1250 and capable of receiving a portion of return pin 1240 . Upon actuation of trigger 1234, actuation plate 1252 may also pivot about pivot pin 1240 such that rack 1254 engages gear assembly 1238 and ultimately actuates the end effector.

如图44所示，第一侧面触发器板1242和第二侧面触发器板1244可各自分别限定第一剪切销镗孔1260和第二剪切销镗孔1262。剪切销1240可被第一剪切销镗孔1260和第二剪切销镗孔1262容纳。当被组装时，剪切销1240的中央部分1264可接合中央触发器板1246（图43）的镗孔。剪切销1240可具有分别接合第一侧面触发器板1242和第二侧面触发器板1244的第一端部1266和第二端部1268。剪切销1240可限定被定位在第一端部1266和中央部分12654中间的第一剪切凹槽1270以及被定位在中央部分12654和第一端部1266中间的第二剪切凹槽1272。As shown in FIG. 44 , the first side trigger plate 1242 and the second side trigger plate 1244 may each define a first shear pin bore 1260 and a second shear pin bore 1262 , respectively. The shear pin 1240 may be received by a first shear pin bore 1260 and a second shear pin bore 1262 . When assembled, the central portion 1264 of the shear pin 1240 can engage the bore of the central trigger plate 1246 ( FIG. 43 ). The shear pin 1240 can have a first end 1266 and a second end 1268 that engage the first side trigger plate 1242 and the second side trigger plate 1244 , respectively. The shear pin 1240 can define a first shear groove 1270 positioned intermediate the first end 1266 and the central portion 12654 and a second shear groove 1272 positioned intermediate the central portion 12654 and the first end 1266 .

现在参见图42-44，在一个实施例中，外科器械1230可用于在端部执行器中朝远侧推进刀，所述端部执行器包括用于夹紧组织的钳口（未示出）。当负荷变得过高时，第一侧面触发器板1242和第二侧面触发器板1244将过度的力施加到剪切销1240的第一端部1266和第二端部1268上。最终，剪切销1240在剪切凹槽1270,1272中的一者或两者处断裂。一旦剪切销1240断裂后，触发器1234就因第一侧面触发器板1242和第二侧面触发器板1244与中央触发器板1246的分离而不能再向前推动刀。然而，在剪切销1240断裂之后，返回销1248通过其与返回狭槽1250的接合而允许触发器1234向后牵拉刀。因此，在一个实施例中，即使触发器1234不能再朝远侧推进刀，但触发器1234仍可用于通过返回销1248与第一侧面触发器板1242和第二侧面触发器板1244的联接而回缩刀。一旦刀回缩后，就可打开端部执行器的钳口并且移除组织。因此，在一个实施例中，在已经经受过载状态之后，触发器1234被禁止向前推到刀但仍可收回刀以使端部执行器与所捕获组织脱离。尽管剪切销1240是在电外科器械的背景下示出的，但其也可用于其它类型的外科器械，例如用于夹持、切断和缝合组织的直线切割器。Referring now to FIGS. 42-44 , in one embodiment, a surgical instrument 1230 can be used to advance a knife distally in an end effector that includes jaws (not shown) for clamping tissue. . When the load becomes too high, first side trigger plate 1242 and second side trigger plate 1244 apply excessive force to first end 1266 and second end 1268 of shear pin 1240 . Eventually, the shear pin 1240 breaks at one or both of the shear grooves 1270,1272. Once the shear pin 1240 breaks, the trigger 1234 can no longer push the knife forward due to the separation of the first side trigger plate 1242 and the second side trigger plate 1244 from the central trigger plate 1246 . However, after shear pin 1240 breaks, return pin 1248 through its engagement with return slot 1250 allows trigger 1234 to pull the knife rearward. Thus, in one embodiment, even though the trigger 1234 can no longer advance the knife distally, the trigger 1234 can still be used to move the knife through the coupling of the return pin 1248 with the first side trigger plate 1242 and the second side trigger plate 1244. Retract the knife. Once the knife is retracted, the jaws of the end effector can be opened and tissue removed. Thus, in one embodiment, after the overload condition has been experienced, the trigger 1234 is inhibited from being pushed forward against the knife but can still retract the knife to disengage the end effector from captured tissue. Although shear pin 1240 is shown in the context of an electrosurgical instrument, it may also be used with other types of surgical instruments, such as linear cutters for clamping, severing, and stapling tissue.

在一些实施例中，可将其它结构装配到外科装置内以限制可施加到端部执行器的多个组件的力的最大量。在一个实施例中，例如弹簧或一系列弹簧可充当压缩装置以限制施加到端部执行器的最大力。弹簧可预载所需的最大压缩负载量并且仅在施加过载力时才改变（例如，压缩）。弹簧可具有轴向性质并且可为任何合适的类型，例如压缩型、贝氏(belleville)型、模具弹簧、或其它类型的线性弹簧构件。在正常的操作负载期间，压缩构件一般充当固体构件。压缩力通过例如击发杆直接从触发器传送到可运动切割构件。然而，当施加过载力时，压缩构件将压缩以吸收过量的力并且限制转移到端部执行器的力的量。在一个实施例中，使压缩构件压缩所需的力的量低于将引起端部执行器的组件失效的力的量。In some embodiments, other structures may be fitted into the surgical device to limit the maximum amount of force that may be applied to the various components of the end effector. In one embodiment, a spring or series of springs, for example, may act as a compression device to limit the maximum force applied to the end effector. The spring can be preloaded with a desired maximum amount of compressive load and only changes (eg, compresses) when an overload force is applied. The spring may be of axial nature and may be of any suitable type, such as compression, belleville, die spring, or other type of linear spring member. During normal operating loads, the compressive member generally acts as a solid member. The compressive force is transmitted directly from the trigger to the movable cutting member through, for example, the firing rod. However, when an overload force is applied, the compression member will compress to absorb the excess force and limit the amount of force transferred to the end effector. In one embodiment, the amount of force required to compress the compression member is lower than the amount of force that would cause a component of the end effector to fail.

图45示出了根据一个非限制性实施例的安装到外科器械的驱动轴内部的压缩构件1300。击发杆1302将来自触发器（未示出）的力传送到可运动切割构件1340。压缩构件1300被示出为一系列贝氏垫圈，但可使用任何合适的压缩构件。图45A为图45的剖视图。柱塞1304与推块1306操作地接合。当施加过载力时，击发杆1302将因压缩构件1300的压缩而相对于柱塞1304平移。在一些实施例中，击发杆1302可联接到销1308并且柱塞1304操作地联接到构件1310。构件1310可限定狭槽1312以容纳销1308。在过载状态期间，销1308可在压缩构件1300压缩时而相对于狭槽1312平移。因此，狭槽1312的纵向长度可限制击发杆1302相对柱塞1304的相对平移。Figure 45 illustrates a compression member 1300 mounted inside a drive shaft of a surgical instrument, according to one non-limiting embodiment. The firing rod 1302 transmits force from a trigger (not shown) to the movable cutting member 1340 . Compression member 1300 is shown as a series of Belleville washers, although any suitable compression member may be used. FIG. 45A is a cross-sectional view of FIG. 45 . Plunger 1304 is operatively engaged with push block 1306 . When an overload force is applied, the firing rod 1302 will translate relative to the plunger 1304 due to the compression of the compression member 1300 . In some embodiments, firing rod 1302 may be coupled to pin 1308 and plunger 1304 operatively coupled to member 1310 . Member 1310 may define a slot 1312 to receive pin 1308 . During the overload condition, the pin 1308 can translate relative to the slot 1312 as the compression member 1300 compresses. Accordingly, the longitudinal length of the slot 1312 can limit the relative translation of the firing rod 1302 relative to the plunger 1304 .

本文所述的装置的实施例可利用微创或开放外科手术技术引入患者体内。在某些情况下，可能有利的是使用微创和开放外科手术技术的组合来将装置引入患者体内。微创技术可更加精确和有效地触及用于诊断和治疗过程的治疗区域。为了到达患者体内的内部治疗区域，本文所述的装置可插入穿过身体的自然开口，例如嘴、肛门和/或阴道。借助将各种医疗装置通过患者的自然开口而引导至患者体内来实施的微创手术在本领域中已知为NOTES^TM手术。装置的某些部分可经由皮肤或通过小键孔切口而引导至组织处理区域。Embodiments of the devices described herein may be introduced into a patient using minimally invasive or open surgical techniques. In some cases, it may be advantageous to introduce the device into the patient using a combination of minimally invasive and open surgical techniques. Minimally invasive techniques allow more precise and efficient access to treatment areas for diagnostic and therapeutic procedures. To access internal treatment areas within a patient, the devices described herein may be inserted through natural openings in the body, such as the mouth, anus, and/or vagina. Minimally invasive procedures performed by introducing various medical devices into a patient's body through the patient's natural openings are known in the art as NOTES^™ procedures. Portions of the device may be directed percutaneously or through a small keyhole incision to the tissue treatment area.

内窥镜式微创外科手术和诊断医疗过程用来通过将小管插入体内来评估和治疗内部器官。内窥镜可具有刚性或柔性管。柔性内窥镜可通过自然身体开口（例如嘴、肛门和/或阴道）或经由套管针通过相对较小的键孔切口（通常为0.5-1.5cm）而引入。内窥镜可用来观察内部器官的表面状况，包括异常或患病的组织，例如病变和其它表面状况，并且捕获图像，以用于视觉检测和摄影。内窥镜可适于和能够具有工作通路，以用于将医疗器械引导至治疗区域来进行活组织检查、检查异物和/或执行外科手术。Endoscopic minimally invasive surgical and diagnostic medical procedures are used to evaluate and treat internal organs by inserting small tubes into the body. Endoscopes can have rigid or flexible tubes. The flexible endoscope can be introduced through a natural body opening (eg mouth, anus and/or vagina) or through a relatively small keyhole incision (typically 0.5-1.5 cm) via a trocar. Endoscopes can be used to observe surface conditions of internal organs, including abnormal or diseased tissue, such as lesions and other surface conditions, and capture images for visual inspection and photography. Endoscopes may be adapted and capable of having a working channel for guiding medical instruments to a treatment area to perform biopsies, inspect for foreign bodies, and/or perform surgical procedures.

优选地，在外科手术之前将对本文所述的装置的各种实施例进行处理。首先，获取新的或用过的器械，并在必要时对器械进行清洁。然后对器械进行消毒。在一种灭菌技术中，将器械置于封闭且密封的容器中，例如塑料或口袋中。然后将容器和器械置于能够穿透该容器的辐射区，例如γ辐射、x-射线或高能电子。辐射将器械上和容器中的细菌杀死。然后将灭菌后的器械保存在消毒容器中。该密封容器将器械保持无菌，直到在医疗设备中打开该容器。其它消毒技术可通过本领域技术人员已知的任何多种方式进行，包括β辐射、γ辐射、环氧乙烷和/或蒸汽。Preferably, the various embodiments of the devices described herein will be processed prior to surgery. First, obtain new or used instruments and, if necessary, clean them. The instruments are then sterilized. In one sterilization technique, the instruments are placed in a closed and airtight container, such as a plastic or in pocket. The container and instruments are then placed in a field of radiation capable of penetrating the container, such as gamma radiation, x-rays, or high energy electrons. Irradiation kills bacteria on instruments and in containers. The sterilized instruments are then stored in sterile containers. The sealed container keeps the instrument sterile until the container is opened in the medical facility. Other sterilization techniques can be performed by any number of means known to those skilled in the art, including beta radiation, gamma radiation, ethylene oxide, and/or steam.

虽然文中结合某些公开的实施例对装置的多种实施例作了描述，但这些实施例的许多修改形式和变型也可被实现。例如，可采用不同类型的端部执行器。另外，凡是公开了用于某些组件的材料的情形，均可使用其它材料。上述说明和以下权利要求旨在涵盖所有这类修改形式和变型。Although various embodiments of the apparatus have been described herein in connection with certain disclosed embodiments, many modifications and variations of these embodiments may be practiced. For example, different types of end effectors may be used. Additionally, where materials are disclosed for certain components, other materials may be used. The above description and the following claims are intended to cover all such modifications and variations.

以引用方式全文或部分地并入本文的任何专利、公布或其它公开材料均仅在所并入的材料不与本发明所述的现有定义、陈述或其它公开材料相冲突的范围内并入本文。由此，在必要的程度下，本文所明确阐述的公开内容将取代以引用方式并入本文的任何相冲突材料。如果据述以引用方式并入本文但与本文所述的现有定义、陈述或其它公开材料相冲突的任何材料或其部分，仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。Any patent, publication, or other disclosure material incorporated herein by reference, in whole or in part, is incorporated only to the extent that the incorporated material does not conflict with a prior definition, statement, or other disclosure material set forth herein. This article. Accordingly, to the extent necessary, the disclosure as expressly set forth herein supersedes any conflicting material incorporated herein by reference. To the extent that any material, or portion thereof, is said to be incorporated herein by reference but conflicts with existing definitions, statements, or other disclosed material stated herein, nothing arises solely between the incorporated material and the existing disclosed material. incorporated herein to the extent of conflict.

Claims (5)

1., for providing a surgical instruments for energy to tissue, comprising:

Trigger; With

Electrical input;

From the axle that shank extends, wherein said axle comprises conductor, and wherein said trigger can optionally activate to electrically connect described electrical input and described conductor; With

Limit the end effector of longitudinal axis, described end effector comprises:

First jaw member;

Second jaw member, at least one in wherein said first jaw member and described second jaw member can be moved between the open position and the closed position relative to the another one in described first jaw member and described second jaw member, to clamp the tissue in the middle of described first jaw member and described second jaw member when being in described make position;

Described first jaw member and the second jaw member limit passage;

Comprise the cutting element of far-end, the size of wherein said cutting element and structure are configured to be assemblied at least in part in described passage, described cutting element can along described passage at advanced position and advance translation between position completely, described cutting element comprises at least the first band, the second band and the 3rd band, wherein said second band be arranged on described first band and the 3rd band middle and comprise sharp keen distal incision element; With

From at least one compressing member that described cutting element extends, at least one compressing member wherein said engages the one in described first jaw member and the second jaw member, moves to described make position to make described first jaw member and the second jaw member when described cutting element moves to outside described advanced position relative to described first jaw member from described open position.

2. surgical instruments according to claim 1, described first jaw member comprises the first track and described second jaw member comprises the second track, and at least one compressing member wherein said comprises along the first compressing member of described first orbital motion and the second compressing member along described second orbital motion.

3. surgical instruments according to claim 2, wherein said first track comprises the first distally stop part to engage described first compressing member, and described second track comprises the second distally stop part to engage described second compressing member.

4. surgical instruments according to claim 2, wherein said passage extends farther than described first track and the second track along distal direction.

5. surgical instruments according to claim 1, wherein said first band and the 3rd band comprise the funnel shaped part of contiguous described sharp keen distal incision element.