CN104434245B - End effector, surgical operating instrument and purse-string forceps - Google Patents
End effector, surgical operating instrument and purse-string forceps Download PDFInfo
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- CN104434245B CN104434245B CN201310438924.5A CN201310438924A CN104434245B CN 104434245 B CN104434245 B CN 104434245B CN 201310438924 A CN201310438924 A CN 201310438924A CN 104434245 B CN104434245 B CN 104434245B
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- 239000012636 effector Substances 0.000 title claims abstract description 65
- 230000007246 mechanism Effects 0.000 claims abstract description 164
- 230000009471 action Effects 0.000 claims description 25
- 230000006835 compression Effects 0.000 claims description 7
- 238000007906 compression Methods 0.000 claims description 7
- 230000001960 triggered effect Effects 0.000 claims description 6
- 238000000034 method Methods 0.000 abstract description 9
- 230000008569 process Effects 0.000 abstract description 7
- 238000001356 surgical procedure Methods 0.000 abstract description 4
- 208000014674 injury Diseases 0.000 abstract description 2
- 230000008733 trauma Effects 0.000 abstract description 2
- 230000000149 penetrating effect Effects 0.000 description 8
- 238000010304 firing Methods 0.000 description 6
- 230000000903 blocking effect Effects 0.000 description 5
- 208000027418 Wounds and injury Diseases 0.000 description 4
- 238000002674 endoscopic surgery Methods 0.000 description 4
- 230000003902 lesion Effects 0.000 description 4
- 238000012797 qualification Methods 0.000 description 4
- 238000012986 modification Methods 0.000 description 3
- 230000004048 modification Effects 0.000 description 3
- 238000011084 recovery Methods 0.000 description 3
- 230000003872 anastomosis Effects 0.000 description 2
- 238000005516 engineering process Methods 0.000 description 2
- 230000014759 maintenance of location Effects 0.000 description 2
- 230000036285 pathological change Effects 0.000 description 2
- 231100000915 pathological change Toxicity 0.000 description 2
- 230000001360 synchronised effect Effects 0.000 description 2
- 230000000694 effects Effects 0.000 description 1
- 238000001839 endoscopy Methods 0.000 description 1
- 210000001035 gastrointestinal tract Anatomy 0.000 description 1
- 238000003384 imaging method Methods 0.000 description 1
- 230000002980 postoperative effect Effects 0.000 description 1
- 238000009958 sewing Methods 0.000 description 1
- 230000000451 tissue damage Effects 0.000 description 1
- 231100000827 tissue damage Toxicity 0.000 description 1
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07228—Arrangement of the staples
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B2017/1142—Purse-string sutures
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
Abstract
The invention relates to the technical field of medical equipment, and discloses an end effector, a surgical operating instrument and purse-string forceps. By means of the end effector, the surgical operating instrument and the purse-string forceps, purse-string nails can be made to be connected with lumen tissue firmly, and the risk that the lumen tissue is pierced through is completely avoided; the end effector and the surgical operating instrument can further simplify the operation process of an operation and relieve trauma brought to a surgery patient. The end effector comprises a first forceps arm, a second forceps arm, a suture mechanism, a purse-string suture mechanism and a cutting mechanism, wherein the suture mechanism is arranged on one side of the longitudinal direction of the two forceps arms, the purse-string suture mechanism is arranged on the other side of the longitudinal direction of the two forceps arms and the cutting mechanism is arranged between the suture mechanism and the purse-string suture mechanism. The purse-string suture mechanism comprises a first purse-string nail box arranged on the first forceps arm, a second purse-string nail box arranged on the second forceps arm and a double-sided nail anvil located between the two purse-string nail boxes, the purse-string nails are arranged in the two purse-string nail boxes respectively, and the surfaces, facing the double-sided nail anvil, of the two purse-string nail boxes are provided with purse-string lines.
Description
Technical Field
The invention relates to the technical field of medical instruments, in particular to an end effector, a surgical operation instrument and purse-string forceps.
Background
Gastrointestinal tract surgery usually requires cutting off a closed tissue lumen and performing purse string suture at the disconnected lumen, wherein the purse string suture is used for being matched with a nail anvil of a circular anastomat to perform subsequent anastomosis and other operations by using the circular anastomat.
Purse-string sutures are a common suturing technique in surgical operations, and two main ways of purse-string suturing are known. One way is to manually perform a purse string suture, as shown in fig. 1a and 1b, the physician first passes the purse string 58 through the tissue surface around the incision in the luminal tissue 59 with a purse string needle, and then tightens the purse string 58 to complete the purse string suture. The manual suture mode is complex to operate, the operation precision is difficult to grasp, and the suture is easy to fail due to thread off, so that the manual suture mode is rarely adopted in the surgical operation at present.
Another way is to use purse-string forceps to assist in making a purse-string suture. As shown in FIG. 2a, a purse-string forceps is also used to perform purse-string suture by threading a needle (i.e., a purse-string needle) with a string (i.e., a purse-string 58). As shown in FIG. 2b, there is also a purse-string forceps that performs a purse-string suture by attaching a purse-string 58 to the surface of the lumen tissue 59 by means of a purse-string 57, typically by firing the purse-string 57 to pierce and secure it to the lumen tissue 59, and the purse-string 58 is either interconnected with the purse-string 57 or pressed between the lumen tissue 59 and the purse-string 57 by the purse-string 57 to attach the purse-string 58 to the lumen tissue 59 to perform the purse-string suture.
Generally, when a surgical operation is performed on a lumen tissue, besides a purse-string suture is required to be performed on an incision of a remaining end of the lumen tissue, a lesion end of the lumen tissue also needs to be cut and sutured. The existing purse-string forceps have single function, can only complete purse-string suture on the remaining end, and cannot cut and suture the pathological change end. Therefore, at least other surgical instruments such as cutting and suturing devices need to be used in a matched manner, and the operation of replacing the surgical instruments is complicated, so that the operation time is long, the operation risk is increased, and the pain of an operation patient is caused.
In the prior art shown in fig. 2b, the purse string 57 needs to be fixed on the surface of the lumen tissue 59 by a non-staple anvil forming technology, and the use of the purse-string forceps often causes the phenomenon that the purse string is torn off or the lumen tissue is penetrated, thereby causing the failure of purse-string suture, which also increases the operation risk and the pain for the operation patient.
Moreover, endoscopic surgery has emerged in the eighties of the twentieth century, a technique that allows surgeons to perform surgery without causing significant trauma to the patient, primarily through endoscopy and various imaging techniques. Compared with open surgery, endoscopic surgery has the remarkable advantages of small tissue damage, quick postoperative recovery and the like, thereby becoming a development trend. In this case, purse-string forceps for endoscopic surgery appeared, and the existing purse-string forceps for endoscopic surgery also had the problem of single function as described above.
Disclosure of Invention
The first purpose of the present invention is to provide an end effector, which can simplify the operation process of the surgical operation on the lumen tissue, reduce the operation time, and the connection between the purse-string nail and the lumen tissue is relatively firm, without the risk of penetrating the lumen tissue, and the operation safety is relatively high.
The end effector includes: the first clamp arm and the second clamp arm can move relatively under the action of the opening and closing mechanism so as to open or close a clamp mouth formed by the first clamp arm and the second clamp arm; the stitching mechanism is arranged on one side of the first clamp arm and the second clamp arm in the longitudinal direction; the pouch stitching mechanism is arranged on the other side of the first clamp arm and the second clamp arm in the longitudinal direction; the cutting mechanism is arranged between the stitching mechanism and the pouch stitching mechanism; the purse-string suture mechanism comprises: the nail-loading device comprises a first pouch nail box arranged on a first clamp arm, a second pouch nail box arranged on a second clamp arm, and a double-faced nail anvil positioned between the first pouch nail box and the second pouch nail box, wherein pouch nails are respectively arranged in the first pouch nail box and the second pouch nail box, the pouch nails are triggered by a pouch nail pushing mechanism, and pouch lines positioned between two nail legs of the pouch nails are arranged on the surfaces of the first pouch nail box and the second pouch nail box, which face the double-faced nail anvil.
In the technical scheme, the suture mechanism on one side of the end effector can realize tissue suture, the purse-string suture mechanism on the other side can realize tissue purse-string suture, and the cutting mechanism between the suture mechanism and the purse-string suture mechanism can realize tissue cutting. In the end effector, the purse-string nails of the purse-string suturing mechanism are formed under the action of the double-faced nail anvil, the forming qualification rate is high, the purse-string suturing mechanism can be firmly connected with the lumen tissue, the risk of penetrating the lumen tissue is thoroughly eliminated due to the blocking of the double-faced nail anvil, and the operation safety is high.
A second object of the present invention is to provide a surgical instrument comprising: a handle and an end effector as in the previous solution driven by the handle. Because the end effector has the effects, the surgical operation instrument can greatly simplify the operation process of performing surgical operation on the lumen tissue, reduce the operation time, reduce the wound brought to an operation patient, enable the purse-string nail to be firmly connected with the lumen tissue, avoid the risk of penetrating the lumen tissue and have higher operation safety.
The third purpose of the invention is to provide a purse-string forceps, which can ensure that the purse-string nail is firmly connected with the lumen tissue, the purse-string nail is not easy to tear off, and the safety of the operation is greatly improved. The purse-string forceps comprises: the first clamp arm and the second clamp arm can move relatively under the action of the opening and closing mechanism so as to open or close a clamp mouth formed by the first clamp arm and the second clamp arm; purse-string suture mechanism includes: the nail-loading device comprises a first pouch nail box arranged on a first clamp arm, a second pouch nail box arranged on a second clamp arm, and a double-faced nail anvil positioned between the first pouch nail box and the second pouch nail box, wherein pouch nails are respectively arranged in the first pouch nail box and the second pouch nail box, the pouch nails are triggered by a pouch nail pushing mechanism, and pouch lines positioned between two nail legs of the pouch nails are arranged on the surfaces of the first pouch nail box and the second pouch nail box, which face the double-faced nail anvil.
The pouch nail is formed under the action of the double-sided nail anvil, the forming qualification rate is high, the pouch nail can be firmly connected with the lumen tissue, the risk of penetrating the lumen tissue is thoroughly eliminated due to the blocking of the double-sided nail anvil, and the safety of the operation is high.
Drawings
FIG. 1a is a schematic cross-sectional view of a purse string suture of luminal tissue;
FIG. 1b is a front view of luminal tissue after tightening of the purse wire;
FIG. 2a is a schematic view illustrating a conventional purse-string suture principle of a purse-string forceps;
FIG. 2b is a schematic view of another conventional purse-string forceps purse-string suture principle;
FIG. 3a is a schematic perspective view of an end effector according to an embodiment of the present invention;
FIG. 3b is a schematic view of a double-sided anvil inserted into a cut-out of luminal tissue in an embodiment of the present invention;
FIG. 3c is a schematic view of a double-faced anvil fixing manner according to an embodiment of the present invention;
FIG. 3d is a schematic cross-sectional view of an end effector of an embodiment of the present invention;
FIG. 4 is a schematic structural view of a first jawarm in accordance with an embodiment of the present invention;
FIG. 5a is a three-dimensional schematic view of the internal structure of an end effector (tissue stapling side, staples unfired) according to an embodiment of the present invention;
FIG. 5b is a three-dimensional schematic view of the internal structure of an end effector (tissue stapling side, staple partially fired) according to an embodiment of the present invention;
FIG. 6 is a three-dimensional schematic view of the internal structure of an end effector of an embodiment of the present invention (purse string suture side, with the purse string staples unfired);
FIG. 7 is a schematic view of luminal tissue after cutting, tissue stapling, and purse string stapling;
fig. 8 is a schematic structural view of a surgical instrument according to an embodiment of the present invention.
Reference numerals:
57-purse-string nail 58-purse-string 59-lumen tissue
10 a-first jawarm 10 b-second jawarm 11-suturing mechanism
12-pouch stapling mechanism 13-cutting mechanism 14 a-first pouch magazine
14 b-second pouch staple magazine 56-double anvil 59 a-slit
15-line clamp 16-pouch nail pushing slide block 17-pouch nail pusher
18-staple anvil 19-staple magazine 20-staple
21-staple pushing slider 22-staple pusher 23-cutting knife
24-knife slot 25-closing flange 26-handle
27-end effector 28-elongated body 29-transmission mechanism
30-articulated shaft
Detailed Description
In order to accomplish purse-string suturing, cutting and suturing using the same instrument, simplify the operation process of performing surgical operation on the tissues (particularly lumen tissues) needing purse-string suturing, reduce operation time, risks and pain of patients, and further be capable of being used for endoscopic operation, the embodiment of the invention provides an end effector and a surgical instrument. In the technical scheme of the invention, the suturing mechanism on one side of the end effector can realize tissue suturing, the purse-string suturing mechanism on the other side can realize tissue purse-string suturing, and the cutting mechanism between the suturing mechanism and the purse-string suturing mechanism can realize tissue cutting. In order to make the objects, technical solutions and advantages of the present invention more apparent, the present invention is further described in detail by referring to the following examples.
Referring to fig. 3a to 3d, an end effector according to an embodiment of the present invention includes:
the first forceps arm 10a and the second forceps arm 10b can move relatively under the action of an opening and closing mechanism, so that a jaw formed by the first forceps arm 10a and the second forceps arm 10b is opened or closed;
a suturing mechanism 11, the suturing mechanism 11 being provided on one side in the longitudinal direction of the first and second forceps arms 10a and 10 b;
a purse-string suture mechanism 12, the purse-string suture mechanism 12 being provided on the other side of the first and second forceps arms 10a and 10b in the longitudinal direction;
the cutting mechanism 13, the cutting mechanism 13 is set up between stitching mechanism 11 and the purse string stitching mechanism 12;
the purse string device 12 includes:
the stapler comprises a first pouch nail box 14a arranged on a first forceps arm 10a, a second pouch nail box 14b arranged on a second forceps arm 10b, and a double-faced anvil 56 positioned between the first pouch nail box 14a and the second pouch nail box 14b, wherein pouch nails 57 are respectively arranged in the first pouch nail box 14a and the second pouch nail box 14b, the pouch nails 57 are triggered by a pouch nail pushing mechanism, and a pouch line 58 positioned between two nail legs of the pouch nails 57 is arranged on the surface of the first pouch nail box 14a and the surface of the second pouch nail box 14b facing the double-faced anvil.
In various embodiments of the invention, "distal" refers to the side of the instrument that is distal to the user when the instrument is operated, and "proximal" refers to the side of the instrument that is proximal to the user when the instrument is operated. "forward" refers to movement away from the user and "backward" refers to movement closer to the user. The end effector provided by the embodiment of the invention can be matched with a driving mechanism for use, and the driving mechanism provides driving force. The specific structural form of the driving mechanism is not limited, for example, the end effector at the front end of the existing cutting and suturing device can be directly detached, the end effector provided by the embodiment of the invention is installed, and the driving mechanism of the existing cutting and suturing device provides driving force for the opening and closing mechanism, the suturing mechanism, the purse string suturing mechanism and the cutting mechanism. In addition, a driving mechanism may be additionally designed for the end effector provided by the embodiment of the present invention.
The end effector provided by the embodiment of the invention can be divided into an opening and closing mechanism, a suturing mechanism, a purse string suturing mechanism and a cutting mechanism according to functions. When the opening and closing mechanism is used for opening and closing the jaws formed by the two forceps arms of the end effector, the jaws can be driven to open so as to place the tubular cavity tissue to be operated in the opening, the double-sided nail anvil is transversely inserted into the incision of the tubular cavity tissue, then the jaws are driven to close so as to clamp the tubular cavity tissue to perform surgical actions such as purse-string suture, cutting, suturing and the like, and after the surgical actions are finished, the jaws can be driven to open again so as to release the tissue. The cutting mechanism is used for realizing the cutting function of the tissue and can cut and separate the lesion end and the remaining end of the lumen tissue. The suturing mechanism is used for realizing the function of suturing the tissues and can suture at the incision of the lesion end of the lumen tissues. The purse string suture mechanism is used for realizing the purse string suture function of the tissue, can carry out purse string suture at the incision of the lumen tissue retention end, and is matched with a nail anvil of a circular anastomat to be installed in the subsequent operation, and the circular anastomat is used for carrying out the operations of anastomosis and the like. The structures of these four sections will be described in further detail below.
In the end effector of the embodiment of the present invention, at least two of the opening and closing mechanism, the suturing mechanism, the purse string suturing mechanism, and the cutting mechanism may be driven in synchronization; alternatively, the opening and closing mechanism, the suturing mechanism, the purse string suturing mechanism, and the cutting mechanism may be driven separately. The specific structure of the end effector can be designed according to different driving modes.
An opening and closing mechanism:
in various embodiments of the present invention, the first and second jawarms 10a, 10b are each movable jawarms that are rotatable relative to the double-sided anvil 56. The opening and closing mechanism of the end effector of the cutting stitching instrument can be realized by adopting various technical schemes of the opening and closing mechanism of the end effector of the existing cutting stitching instrument, such as a sleeve type opening and closing scheme, an I-shaped beam type opening and closing scheme and the like.
For example, the opening and closing mechanism may include a closure bar having a closure flange disposed at a distal end thereof, a compression spring disposed between the first and second jawarms, the closure flange engaging a closure surface on the first and/or second jawarms when the closure bar is actuated to move longitudinally distally so that the jawarms close against the force of the compression spring, and the jaws may open upon return of the closure bar under the force of the compression spring. The closure flange may only engage the closure surface on the first or second jawarm when the closure bar is actuated to move longitudinally distally, but to achieve a more balanced force, it is preferred that the closure flange simultaneously engage the closure surfaces on the first and second jawarms.
The closing rod can be connected with a staple pushing rod for firing staples, a pouch nail pushing rod for firing pouch nails or a cutter rod for driving a cutting knife into an integral structure or different components; the closing rod, the staple pushing rod, the cutter rod or the purse-string staple pushing rod can also be different parts respectively; the closing rod can be integrated with any two of the staple pushing rod, the cutter rod and the pouch staple pushing rod or connected with different components; in addition, the closing rod may be an integral structure (may be referred to as a driving rod) with the staple pusher bar, the knife bar and the purse string pusher bar or may be connected to each other by different components.
Referring to fig. 3a, 5a and 5b, in an embodiment of the present invention, the cutting blade 23 and the blade bar are an integral structure and serve as a closing rod of the opening and closing mechanism, a compression spring (not shown) is disposed between the first forceps arm 10a and the second forceps arm 10b, and a closing flange 25 parallel to the cutting direction is fixed at the distal end of the closing rod on the side of the movable forceps arm away from the jaws; when the closing rod moves forward, the closing flange 25 pushes the movable clamp arm to rotate until the jaws are closed, and when the closing rod moves backward, the pressure spring pushes the movable clamp arm to rotate until the jaws are opened. It should be noted here that the stroke taken by the closing flange 25 when closing the jaws need not be very large.
The cutting mechanism comprises:
the cutting mechanism of the end effector of the present invention may be implemented using various solutions of the cutting mechanisms of end effectors of existing cutting staplers.
For example, as shown in fig. 4, 5a and 5b, the cutting mechanism may include a cutting blade 23, the cutting blade 23 is capable of moving between the suturing mechanism and the purse string suturing mechanism under the action of a push-type cutter mechanism, such as a push-type cutter rod or other component, to separate the sutured and purse string sutured tissues, respectively, and the cutting blade 23 and the push-type cutter mechanism may be integrated or separated (in this case, the cutting blade 23 is disposed at the far side of the push-type cutter mechanism). The first and second jawarms are provided with a knife slot 24 (shown in fig. 4) for accommodating the movement of the cutting knife 23, so as to provide guidance for the movement of the cutting knife 23, and make the cutting movement more stable and accurate.
A sewing mechanism:
the suturing mechanism of the end effector of the present invention can be realized by various technical solutions of the suturing mechanism of the end effector of the existing cutting suturing device.
For example, as shown in fig. 5a and 5b, the stapling mechanism may be arranged on one side in the longitudinal direction of two jawarms, one arranged with a staple anvil 18 and the other arranged with a staple magazine 19, in which magazine 19 staples 20 are arranged, which staples 20 may be arranged in one or more rows in the longitudinal direction, which staples 20 can be fired by a staple pusher mechanism. The staple pusher mechanism for firing the staples 20 may comprise a staple pusher bar (in this embodiment, the knife bar of the cutting knife 23 acts as a staple pusher bar), a staple pusher shoe 21 and a staple pusher 22. The firing process may be that the staple pusher bar moves longitudinally distally to drive the staple pusher shoe 21, the inclined surface of the staple pusher shoe 21 acts on the staple pusher 22 to move it laterally, and then the staples 20 are pushed out of the staple magazine 19 by the staple pusher 22, pass through the lumen tissue 59, and press against the staple anvil 18, and the staples 20 are formed into a B-shape by the staple anvil 18, thereby completing the stapling.
The number of rows of staples 20 is not limited, but should be at least one row, and preferably at least two rows, so that at least two sutures can be placed at the diseased end of the luminal tissue, greatly reducing the risk of suture failure. When the staples 20 are arranged in a plurality of longitudinal rows, only one staple pusher shoe 21 may be provided to push the forward plurality of staple pushers 22.
When the cutter arbor of cutting knife 23 pushed out the nail pole as the staple, the position of cutting knife 23 can set up to pushing out the nail slider 21 for the staple and leaning on more (being close to near side more promptly) for sew up earlier the back cutting, can reduce pathological change end internal tissue outflow like this, improve the success rate of operation. In one embodiment, the staple pusher shoe 21 is pushed by the knife bar of the cutting knife 23, and before the cutting blade of the cutting knife 23 cuts the tissue, the inclined surface of the staple pusher shoe 21 already pushes the front staple pusher 22 to fire the staples 20, i.e., to suture the front lumen tissue, so that the cutting knife 23 always cuts after the tissue is sutured.
The purse-string suture mechanism comprises:
the purse string suture mechanism may be provided on the other side of the longitudinal direction of the two forceps arms, that is, on the side opposite to the suture mechanism.
As shown in fig. 3a and 3b, the double-sided anvil 56 has two anvil faces. When the end effector is used for purse string suture, a cut 59a needs to be formed along the length direction of a lumen tissue 59 (as shown in fig. 3b, the length of the cut 59a is usually 8-10 mm), the double-sided nail anvil 56 is inserted into the cut 59a to abut against the inner wall of the lumen tissue, then the jaw is closed, and the purse nails in the first purse-string nail box and the second purse-string nail box are fired, so that the purse nails are formed under the action of the double-sided nail anvil 56 (namely, the purse nails in the first purse-string nail box are formed under the action of the first nail anvil surface of the double-sided nail anvil, and the purse nails in the second purse-string nail box are formed under the action of the second nail anvil surface of the double-sided nail anvil), thereby completing purse string suture. Preferably, the anvil structures of the two anvil faces are staggered so as to improve the overall strength of the double-sided anvil 56.
The double-sided anvil 56 can be fixed in any way, as shown in fig. 3c, in the preferred embodiment, the first and second forceps arms 10a and (not shown) are rotatable movable forceps arms, the double-sided anvil 56 and the hinge shaft 30 of the first and second forceps arms 10a and 30 are fixed relative to each other by other structural members (the double-sided anvil can also be directly and fixedly connected with the hinge shaft), and when the first and second forceps arms 10a and 10b are rotated to close the jaws, the double-sided anvil 56 is clamped between the first and second forceps arms 10a and 10 b.
In the prior art, the pouch nail is formed by a non-staple anvil forming technology, the pouch nail is often torn off or the lumen tissue is penetrated (namely, the pouch nail on one side penetrates through two layers of tissues), in the scheme, the pouch nail penetrates through one layer of lumen tissue and is formed under the action of the anvil surface (for example, the pouch nail is formed into a B shape), the pouch nail is firmly connected with the lumen tissue, the pouch nail is rarely torn off, and the risk of penetrating the lumen tissue is completely eradicated due to the blocking of the double-faced nail anvil.
As shown in fig. 6, the pouch nail pushing mechanism includes: a pouch nail pushing rod, a pouch nail pushing slider 16 and a pouch nail pusher 17 which are arranged aiming at each pouch nail box; for each pouch nail magazine, when the pouch nail pushing rod longitudinally drives the pouch nail pushing slider 16 towards the far side, the inclined surface of the pouch nail pushing slider 16 transversely drives the pouch nail pusher 17, so that the pouch nail pusher 17 pushes the pouch nails 57 out of the pouch nail magazine and forms the pouch nails under the action of the double-faced nail anvil 56.
The pouch nail pushing mechanism and the staple pushing mechanism can be two mechanisms which are independent from each other and driven respectively, at this time, the pouch nail pushing rod and the staple pushing rod are different parts respectively, the pouch nail pushing slider and the staple pushing slider are different parts respectively, in addition, the pouch nail pushing mechanism and the staple pushing mechanism can be driven synchronously, as shown in fig. 5b, the pouch nail pushing rod and the staple pushing rod are integrated with a cutter bar of the cutting knife (the pouch nail pushing rod, the staple pushing rod and the cutter bar can also be different parts connected with each other), the pouch nail pushing slider 16 and the staple pushing slider 21 are integrated (or different parts are connected with each other), for example, when the staple pushing slider is driven longitudinally, the inclined surface of the staple pushing slider can drive the pouch nail pusher 17 and the staple pusher 22 transversely, so that the pouch nails and the staples are fired respectively.
As shown in fig. 4, the positioning manner of the purse wire 58 on the surface of the staple box is not limited, preferably, the surfaces of the first purse-string staple box and the second purse-string staple box facing the double-sided nail anvil are respectively provided with a line card 15, and the purse wire 58 is clamped on the line card 15. The purse string is arranged between the two nail legs of the purse-string nail, when the purse-string nail is fired to pierce into the lumen tissue and is formed under the action of the double-sided nail anvil, the purse string is pressed between the crown of the purse-string nail and the lumen tissue, when the firing of the purse-string nails of the first purse-string nail box and the second purse-string nail box is finished and the jaw of the end effector is opened, the purse string is separated from the first purse-string nail box and the second purse-string nail box, and the purse-string suture can be finished by tightening the purse string, so that the operation is very simple and convenient.
In order to ensure that the purse string 58 is smoothly and reliably positioned on the surface of the nail box, at least two line cards 15 are preferably arranged between two adjacent purse nails of the first purse nail box, and at least two line cards 15 are preferably arranged between two adjacent purse nails of the second purse nail box. The specific number of the line cards 15 may be determined according to the arrangement interval of the purse nails, and is not particularly limited herein.
In the technical solution of the embodiment of the present invention, the closing rod, the staple pushing rod, the knife bar and the purse-string nail pushing rod may be an integral structure or different components are connected to each other to achieve synchronous driving. When the surgical forceps are used, the driving rod moves to the far side to drive, the opening and closing mechanism is driven to close the forceps arms firstly, the suturing mechanism and the pouch suturing mechanism are driven along with further movement of the driving rod, the suturing nails are sequentially fired to realize suturing, the pouch nails are sequentially fired to penetrate into tissues to realize pouch suturing, and meanwhile the cutting knife cuts the tissues between the suturing mechanism and the pouch suturing mechanism under the pushing of the driving rod, so that the cutting, the suturing and the pouch suturing are simultaneously completed (the lumen tissues after the cutting, the tissue suturing and the pouch suturing are shown in figure 7, wherein the direction shown by an arrow is the length direction of the lumen tissues)), the operation process of performing the surgical operation on the lumen tissues is further simplified, the operation time is reduced, and the wound brought to a surgical patient is further relieved.
In summary, in the technical scheme of the invention, the suture mechanism on one side of the end effector can realize tissue suture, the purse-string suture mechanism on the other side can realize tissue purse-string suture, and the cutting mechanism between the suture mechanism and the purse-string suture mechanism can realize tissue cutting. In the end effector, the purse-string nails of the purse-string suturing mechanism are formed under the action of the double-faced nail anvil, the forming qualification rate is high, the purse-string suturing mechanism can be firmly connected with the lumen tissue, the risk of penetrating the lumen tissue is thoroughly eliminated due to the blocking of the double-faced nail anvil, and the operation safety is high.
In various embodiments of the present invention, the size of the end effector is not limited, and may be designed according to the specific surgical needs. For example, when the end effector is an end effector with an endoscope specification, the end effector can be used together with an endoscope, so that the operation has the advantages of high safety, small wound surface, less pain, quick recovery and the like.
As shown in fig. 8, embodiments of the present invention also provide a surgical instrument including: a handle 26 and an end effector 27 as in any of the previous embodiments driven by the handle 26.
Also included in this embodiment is an elongated body 28 having a drive mechanism 29 disposed therein, the distal side of handle 26 being connected to end effector 27 by elongated body 28, handle 26 driving drive mechanism 29, drive mechanism 29 in turn transmitting drive to end effector 27 to provide drive for its opening and closing, stapling, cutting and purse string suturing. The surgical operation instrument with the structure can be matched with an endoscope for use, so that the operation has the advantages of high safety, small wound surface, less pain, quick recovery and the like.
Compared with the prior art, the surgical operation instrument provided by the embodiment of the invention can realize the purse-string suture of the lumen retention end tissue and the cutting and suture of the lesion end tissue, greatly simplifies the operation process of performing the surgical operation on the lumen tissue, reduces the operation time, can firmly connect the purse-string nail with the lumen tissue, has no risk of penetrating the lumen tissue, has higher operation safety, and can be further used for the endoscopic operation.
The embodiment of the invention also provides a purse-string forceps, which comprises:
the first clamp arm and the second clamp arm can move relatively under the action of the opening and closing mechanism so as to open or close a clamp opening formed by the first clamp arm and the second clamp arm;
purse-string suture mechanism includes: the nail-loading device comprises a first pouch nail box arranged on a first clamp arm, a second pouch nail box arranged on a second clamp arm, and a double-faced nail anvil positioned between the first pouch nail box and the second pouch nail box, wherein pouch nails are respectively arranged in the first pouch nail box and the second pouch nail box, the pouch nails are triggered by a pouch nail pushing mechanism, and pouch lines positioned between two nail legs of the pouch nails are arranged on the surfaces of the first pouch nail box and the second pouch nail box, which face the double-faced nail anvil.
When the purse-string forceps are used for purse-string suture, an incision is required to be formed along the length direction of a lumen tissue, the double-sided nail anvil is inserted into the incision to abut against the inner wall of the lumen tissue, then the jaw is closed, and the purse-string nails in the first purse-string nail box and the second purse-string nail box are triggered to be formed under the action of the double-sided nail anvil, so that the purse-string suture is completed. The pouch nail is formed under the action of the double-sided nail anvil, the forming qualification rate is high, the pouch nail can be firmly connected with the lumen tissue, the risk of penetrating the lumen tissue is thoroughly eliminated due to the blocking of the double-sided nail anvil, and the safety of the operation is high.
The pouch nail pushing mechanism comprises: the nail pushing rod of the pouch nail, and a pouch nail pushing slider and a pouch nail pusher which are arranged aiming at each pouch nail box; for each pouch nail box, when the pouch nail pushing rod longitudinally drives the pouch nail pushing slider towards the far side, the inclined surface of the pouch nail pushing slider transversely drives the pouch nail pusher, so that the pouch nail pusher pushes the pouch nails out of the pouch nail box and the pouch nails are molded under the action of the double-faced nail anvil.
Preferably, the surfaces of the first pouch nail box and the second pouch nail box, which face the double-faced nail anvil, are respectively provided with a line card, and the pouch lines are clamped on the line cards. At least two line cards are arranged between two adjacent purse nails of the first purse-string nail box, and at least two line cards are arranged between two adjacent purse-string nails of the second purse-string nail box. The advantages of the embodiments are as before, and the description is not repeated here.
In the purse-string forceps provided by the embodiment of the present invention, the specific form of the forceps arm opening and closing mechanism is not limited, for example, the forceps arm opening and closing mechanism may adopt a structural form similar to that of the aforementioned end effector, or may adopt a structural form of a common surgical forceps, where the first forceps arm and the second forceps arm are hinged, and the two handles are manually operated by an operator to close the jaws. When a similar structure to the end effector described above is adopted, the opening and closing mechanism and the purse string suturing mechanism may be driven synchronously, in which case the closing lever and the purse string pushing lever may be of an integral structure or different parts may be connected to each other to achieve synchronous driving, and further, the opening and closing mechanism and the purse string suturing mechanism may be driven separately.
It will be apparent to those skilled in the art that various changes and modifications may be made in the present invention without departing from the spirit and scope of the invention. Thus, if such modifications and variations of the present invention fall within the scope of the claims of the present invention and their equivalents, the present invention is also intended to include such modifications and variations.
Claims (18)
1. An end effector, comprising:
a first clamp arm (10a) and a second clamp arm (10b), wherein the first clamp arm (10a) and the second clamp arm (10b) can move relatively under the action of an opening and closing mechanism so as to open or close a jaw formed by the first clamp arm (10a) and the second clamp arm (10 b);
a suturing mechanism (11), the suturing mechanism (11) being provided on one side of the longitudinal direction of the first and second forceps arms (10a, 10 b);
a purse-string suture mechanism (12), wherein the purse-string suture mechanism (12) is arranged on the other side of the first forceps arm (10a) and the second forceps arm (10b) in the longitudinal direction;
a cutting mechanism (13), the cutting mechanism (13) being disposed between the suturing mechanism (11) and the purse string suturing mechanism (12);
the purse string device (12) comprises:
the nail-loading mechanism comprises a first pouch nail box (14a) arranged on a first clamp arm (10a), a second pouch nail box (14b) arranged on a second clamp arm (10b), and a double-faced nail anvil (56) positioned between the first pouch nail box (14a) and the second pouch nail box (14b), wherein pouch nails (57) are respectively arranged in the first pouch nail box (14a) and the second pouch nail box (14b), the pouch nails (57) are fired by a pouch nail pushing mechanism, and pouch threads (58) positioned between two nail legs of the pouch nails (57) are arranged on the surfaces, facing the double-faced nail anvil (56), of the first pouch nail box (14a) and the second pouch nail box (14 b).
2. The end effector as claimed in claim 1, characterized in that the surfaces of the first and second magazines (14a, 14b) facing the double-sided anvil (56) are each provided with a line card (15), the purse wire (58) being clipped to the line card (15).
3. The end effector as claimed in claim 2, wherein at least two of said line cards (15) are provided between two adjacent said purse nails (57) of said first purse nail magazine (14a), and at least two of said line cards (15) are provided between two adjacent said purse nails (57) of said second purse nail magazine (14 b).
4. The end effector as claimed in claim 1, wherein said purse-string staple pushing mechanism comprises: a pouch nail pushing rod, a pouch nail pushing slider (16) and a pouch nail pusher (17) which are arranged aiming at each pouch nail box;
aiming at each pouch nail box, when the pouch nail pushing rod longitudinally drives the pouch nail pushing slider (16) towards the far side, the inclined plane of the pouch nail pushing slider (16) transversely drives the pouch nail pusher (17), so that the pouch nail (57) is pushed out of the pouch nail box by the pouch nail pusher (17) and is formed under the action of the double-faced nail anvil (56).
5. The end effector as claimed in claim 1, characterized in that said stapling mechanism (11) comprises:
the nail anvil (18) is arranged on the first clamp arm (10a), the nail magazine (19) is arranged at a position, corresponding to the nail anvil (18), of the second clamp arm (10b) when the clamp is closed, the nail (20) is arranged in the nail magazine (19), the nail (20) can be fired by the nail pushing mechanism, and the nail pushing mechanism comprises:
the staple pushing mechanism comprises: the nail pushing device comprises a nail pushing rod, a nail pushing slider (21) and a nail pusher (22), when the nail pushing rod longitudinally drives the nail pushing slider (21) towards the far side, the inclined surface of the nail pushing slider (21) transversely drives the nail pusher (22), so that the nail pusher (22) pushes the nail (20) out of the nail box (19) and is formed under the action of the nail anvil (18).
6. The end effector as claimed in claim 1, characterized in that said cutting mechanism (13) comprises: a cutting knife (23) which can move between the stitching mechanism (11) and the purse string stitching mechanism (12) under the action of the push knife mechanism.
7. The end effector as claimed in claim 6, wherein said first and second jawarms (10a, 10b) have a slot (24) to accommodate movement of said cutting blade (23).
8. The end effector as claimed in claim 1, wherein said first and second jawarms (10a, 10b) are each movable jawarms rotatable relative to said double-sided anvil (56).
9. The end effector as claimed in claim 8, wherein said opening and closing mechanism includes a closure bar having a closure flange (25) disposed at a distal end thereof, said first and second jawarms (10a, 10b) having a compression spring disposed therebetween, said closure flange (25) engaging a closure surface on said first and/or second jawarms (10a, 10b) and closing said jaws against a spring force of said compression spring when said closure bar is actuated to move longitudinally distally, said jaws being openable upon return of said compression spring when said closure bar is retracted.
10. The end effector as claimed in any one of claims 1 to 9,
at least two of the opening and closing mechanism, the suturing mechanism (11), the purse string suturing mechanism (12) and the cutting mechanism (13) are synchronously driven; or,
the opening and closing mechanism, the suturing mechanism (11), the purse string suturing mechanism (12) and the cutting mechanism (13) are driven respectively.
11. The end effector as claimed in claim 10, wherein the end effector is an end effector having endoscopic specifications.
12. A surgical instrument, comprising: a handle (26) and an end effector (27) according to any of claims 1 to 11 driven by the handle (26).
13. The surgical instrument according to claim 12, further comprising an elongated body (28) having a drive mechanism (29) disposed therein, a distal side of the handle (26) being coupled to the end effector (27) through the elongated body (28), the handle (26) providing drive for opening and closing, stapling, cutting, and purse string suturing of the end effector (27) through the drive mechanism (29).
14. Purse-string forceps, characterized in that it comprises:
the first clamp arm and the second clamp arm can move relatively under the action of an opening and closing mechanism so as to open or close a clamp opening formed by the first clamp arm and the second clamp arm;
purse-string suture mechanism includes: the nail-driving device comprises a first purse-string nail box arranged on a first clamp arm, a second purse-string nail box arranged on a second clamp arm, and a double-faced nail anvil positioned between the first purse-string nail box and the second purse-string nail box, wherein purse-string nails are respectively arranged in the first purse-string nail box and the second purse-string nail box, the purse-string nails are triggered by a purse-string nail pushing mechanism, and the surfaces of the first purse-string nail box and the second purse-string nail box facing the double-faced nail anvil are provided with purse-string lines positioned between two nail legs of the purse-string nails.
15. The purse-string forceps according to claim 14, wherein the first and second purse-string nail magazines have respective line clips on their surfaces facing the double-sided anvil, the purse-string being clipped to the line clips.
16. The purse-string forceps according to claim 15, wherein at least two of the line cards are disposed between adjacent two of the purse nails of the first purse-string nail magazine, and at least two of the line cards are disposed between adjacent two of the purse nails of the second purse-string nail magazine.
17. Purse-string forceps according to any one of claims 14 to 16,
the opening and closing mechanism and the purse string mechanism are synchronously driven; alternatively, the opening and closing mechanism and the purse string suturing mechanism are driven separately.
18. The purse-string forceps according to claim 17, wherein the purse-string nail pushing mechanism comprises: the nail pushing rod of the pouch nail, and a pouch nail pushing slider and a pouch nail pusher which are arranged aiming at each pouch nail box;
aiming at each pouch nail box, when the pouch nail pushing rod longitudinally drives the pouch nail pushing slider towards the far side, the inclined plane of the pouch nail pushing slider transversely drives the pouch nail pusher, so that the pouch nail pusher pushes the pouch nails out of the pouch nail box and is formed under the action of the double-faced nail anvil.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201310438924.5A CN104434245B (en) | 2013-09-23 | 2013-09-23 | End effector, surgical operating instrument and purse-string forceps |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201310438924.5A CN104434245B (en) | 2013-09-23 | 2013-09-23 | End effector, surgical operating instrument and purse-string forceps |
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| CN104434245A CN104434245A (en) | 2015-03-25 |
| CN104434245B true CN104434245B (en) | 2017-01-11 |
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Families Citing this family (7)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN107320144B (en) * | 2017-07-28 | 2023-06-13 | 广西壮族自治区人民医院 | Linear purse-string suture cutting closer |
| CN108433768A (en) * | 2018-04-17 | 2018-08-24 | 重庆邮电大学 | A kind of 3-degree-of-freedom electrical type stapler driving device |
| CN109199500B (en) * | 2018-10-24 | 2023-09-26 | 汕头大学 | Nail pushing device of endoscopic purse-string suture device |
| US11779342B2 (en) | 2020-02-19 | 2023-10-10 | Covidien Lp | Laparoscopic purse string suture device |
| CN113749714A (en) * | 2021-10-19 | 2021-12-07 | 四川大学华西第二医院 | Clamping arm component for closer |
| CN114305559B (en) * | 2022-02-23 | 2023-08-04 | 四川大学华西第二医院 | Closer provided with separated push-type knife assembly |
| CN114343761A (en) * | 2022-02-23 | 2022-04-15 | 四川大学华西第二医院 | Non-closed closer |
Family Cites Families (7)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5242457A (en) * | 1992-05-08 | 1993-09-07 | Ethicon, Inc. | Surgical instrument and staples for applying purse string sutures |
| EP0625335B1 (en) * | 1993-04-20 | 1997-11-19 | United States Surgical Corporation | Surgical stapler |
| CN101669833A (en) * | 2008-09-11 | 2010-03-17 | 苏州天臣国际医疗科技有限公司 | Automatic purse-string device |
| CN202313536U (en) * | 2011-09-28 | 2012-07-11 | 潘凯 | Cutting and closing pouch suture instrument for laparoscopic surgery |
| CN202740058U (en) * | 2012-04-13 | 2013-02-20 | 北京中法派尔特医疗设备有限公司 | Nail warehouse component and suture instrument with knife using same |
| CN202982106U (en) * | 2012-12-29 | 2013-06-12 | 苏州天臣国际医疗科技有限公司 | Surgical operating instrument |
| CN203564294U (en) * | 2013-09-23 | 2014-04-30 | 瑞奇外科器械(中国)有限公司 | End effector, surgical operating instrument and purse-string forceps |
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Address after: 300457 Tianjin Binhai New Area Economic and Technological Development Zone, Fourth Street, No. 5, block B, floor 4 Patentee after: Tianjin Ricky surgical instruments Limited by Share Ltd Address before: 300457 Tianjin Binhai New Area Economic and Technological Development Zone, Fourth Street, No. 5, block B, floor 4 Patentee before: Reach Surgical Instrument (China) Co.,Ltd. |
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