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WO2017190304A1 - Pince chirurgicale destinée au traitement et à la découpe d'un tissu - Google Patents

Pince chirurgicale destinée au traitement et à la découpe d'un tissu Download PDF

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Publication number
WO2017190304A1
WO2017190304A1 PCT/CN2016/081095 CN2016081095W WO2017190304A1 WO 2017190304 A1 WO2017190304 A1 WO 2017190304A1 CN 2016081095 W CN2016081095 W CN 2016081095W WO 2017190304 A1 WO2017190304 A1 WO 2017190304A1
Authority
WO
WIPO (PCT)
Prior art keywords
outer shaft
jaw
jaw member
drive
drive pin
Prior art date
Application number
PCT/CN2016/081095
Other languages
English (en)
Inventor
Weijiang Ding
Mingfeng Xu
Original Assignee
Covidien Lp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Covidien Lp filed Critical Covidien Lp
Priority to PCT/CN2016/081095 priority Critical patent/WO2017190304A1/fr
Priority to CN201680085376.4A priority patent/CN109069172B/zh
Publication of WO2017190304A1 publication Critical patent/WO2017190304A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/295—Forceps for use in minimally invasive surgery combined with cutting implements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/2812—Surgical forceps with a single pivotal connection
    • A61B17/282—Jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2933—Transmission of forces to jaw members camming or guiding means
    • A61B2017/2936—Pins in guiding slots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00607—Coagulation and cutting with the same instrument
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting

Definitions

  • the present disclosure relates generally to surgical instruments and, more particularly, to surgical forceps for grasping tissue, treating the grasped tissue with energy, and cutting the grasped and/or treated tissue.
  • a surgical forceps is a pliers-like instrument that relies on mechanical action between its jaw members to grasp, clamp, and constrict tissue.
  • Energy-based surgical forceps utilize both mechanical clamping action and energy, e.g., radiofrequency (RF) energy, microwave energy, ultrasonic energy, light energy, thermal energy, etc., to heat tissue to treat, e.g., coagulate, cauterize, or seal, tissue.
  • RF radiofrequency
  • distal refers to the portion that is being described that is further from a user
  • proximal refers to the portion that is being described that is closer to a user
  • a forceps including a housing, an outer shaft extending distally from the housing, a movable handle operably coupled to the housing, a trigger operably coupled to the housing, an end effector assembly disposed at a distal end of the outer shaft, and first and second drive bars extending through the outer shaft.
  • the end effector assembly includes first and second jaw members at least one of which is pivotable relative to the other and the outer shaft between a spaced-apart position and an approximated position. The first jaw member is translatable relative to the outer shaft and the second jaw member between a grasping position and a cut position, while the second jaw member is inhibited from translation relative to the outer shaft and the first jaw member.
  • the first drive bar is operably coupled between the movable handle and the first and second jaw members such that actuation of the movable handle translates the first drive bar through the outer shaft to pivot the first jaw member and/or the second jaw member from the spaced-apart position to the approximated position.
  • the second drive bar is operably coupled between the trigger and the first and second jaw members such that actuation of the trigger translates the second drive bar through the outer shaft to translate the first jaw member from the grasping position to the cut position.
  • each of the first and second jaw members includes a proximal flange and a distal jaw body.
  • the proximal flanges are operably coupled to the first and second drive bars.
  • the distal jaw bodies define curved configurations such that, upon translation of the first jaw member from the grasping position to the cut position, the distal jaw bodies are misaligned with one another.
  • the distal jaw bodies define stepped tissue-contacting portions such that, upon translation of the first jaw member from the grasping position to the cut position, the stepped tissue-contacting portions move in sheering action relative to one another.
  • each of the first and second jaw members defines a cam slot through the proximal flange thereof.
  • the first drive bar supports a first drive pin configured for translation through the cam slots to pivot the first jaw member and/or the second jaw member between the spaced-apart and approximated positions.
  • the first jaw member defines a pivot aperture
  • the second jaw member defines a pivot slot
  • the second drive bar supports a second drive pin configured for receipt within the pivot aperture and the pivot slot such that translation of the second drive pin translates the first jaw member between the grasping position and the cut position, and such that translation of the second drive pin moves the second drive pin through the pivot slot.
  • the second drive pin defines a first height in a first orientation and a second height in a second orientation.
  • the pivot slot includes a first portion and a second portion defining a height less than that of the first height and greater than that of the second height such that movement of the second drive pin into the second portion of the pivot slot is inhibited when the second drive pin is disposed in the first orientation and permitted when the second drive pin is disposed in the second orientation.
  • the first orientation of the second drive pin may correspond to the spaced-apart position of the first and second jaw members such that the first jaw member is inhibited from translating to the cut position when the first and second jaw members are disposed in the spaced-apart position.
  • first and second drive shafts extend through the outer shaft adjacent one another.
  • the first jaw member and/or second jaw member is adapted to connect to a source of energy.
  • distal translation of the first drive bar through the outer shaft pivots the first jaw member and/or the second jaw member from the spaced-apart position to the approximated position. Additionally or alternatively, proximal translation of the second drive bar through the outer shaft translates the first jaw member from the grasping position to the cut position.
  • Another forceps provided in accordance with aspects of the present disclosure includes an outer shaft, an end effector assembly disposed at a distal end of the outer shaft, first and second drive bars extending through the outer shaft, and first and second drive pins.
  • the end effector assembly includes first and second jaw members each including a proximal flange and a distal body.
  • the proximal flange of the first jaw member defines a pivot aperture and a cam slot
  • the proximal flange of the second jaw member defines a pivot slot and a cam slot.
  • the first drive pin is supported towards a distal end of the first drive bar and extends through the cam slots such that translation of the first drive bar through the outer shaft moves the first drive pin through the cam slots to pivot the first jaw member and/or the second jaw member relative to the outer shaft and the other between a spaced-apart position and an approximated position.
  • the second drive pin is supported towards a distal end of the second drive shaft and extends through the pivot aperture and the pivot slot such that translation of the second drive bar through the outer shaft moves the second drive pin through the pivot slot and translates the first jaw member relative to the outer shaft and the second jaw member between a grasping position and a cut position.
  • the distal jaw bodies define curved configurations such that, upon translation of the first jaw member from the grasping position to the cut position, the distal jaw bodies are misaligned with one another.
  • the distal jaw bodies may define stepped tissue-contacting portions such that, upon translation of the first jaw member from the grasping position to the cut position, the stepped tissue-contacting portions move in sheering action relative to one another
  • the second drive pin defines a first height in a first orientation and a second height in a second orientation
  • the pivot slot includes a first portion and a second portion.
  • the second potion of the pivot slot defines a height less than that of the first height and greater than that of the second height such that movement of the second drive pin into the second portion of the pivot slot is inhibited when the second drive pin is disposed in the first orientation and permitted when the second drive pin is disposed in the second orientation.
  • the first orientation may correspond to the spaced-apart position of the first and second jaw members, thus inhibiting the first jaw member from translating to the cut position when disposed in the spaced-apart position.
  • first and second drive shafts extend through the outer shaft adjacent to one another.
  • distal translation of the first drive bar through the outer shaft pivots the first jaw member and/or the second jaw member from the spaced-apart position to the approximated position. Additionally or alternatively, proximal translation of the second drive bar through the outer shaft translates the first jaw member from the grasping position to the cut position.
  • Fig. 1 is a perspective view of an endoscopic surgical forceps provided in accordance with the present disclosure:
  • Fig. 2A is an exploded, perspective view of the forceps of Fig. 1;
  • Fig. 2B is a side view of the forceps of Fig. 1 with a portion of the housing removed to illustrate the internal components therein;
  • Fig. 3A is a perspective view of the distal end of the forceps of Fig. 1 with the outer shaft removed to illustrate the internal components therein;
  • Fig. 3B is an exploded, perspective view of the distal end of the forceps of Fig. 1, with the outer shaft removed;
  • Fig. 4A is a perspective view of the first jaw member of the end effector assembly of the forceps of Fig. 1;
  • Fig. 4B is a perspective view of the second jaw member of the end effector assembly of the forceps of Fig. 1;
  • Fig. 5A is a side view of the distal end of the forceps of Fig. 1 with the outer shaft removed and the end effector assembly disposed in a spaced-apart position;
  • Fig. 5B is a side view of the distal end of the forceps of Fig. 1 with the outer shaft removed and the end effector assembly disposed in an approximated position;
  • Fig. 5C is a side view of the distal end of the forceps of Fig. 1 with the outer shaft removed and the end effector assembly disposed in a cut position;
  • Fig. 6A is a perspective, partial cross-sectional view of the distal end of the forceps of Fig. 1 with the end effector assembly disposed in the approximated position grasping tissue therebetween for treatment of the grasped tissue;
  • Fig. 6B is a perspective, partial cross-sectional view of the distal end of the forceps of Fig. 1 with the end effector assembly disposed in the cut position having divided the grasped tissue.
  • forceps 10 is configured to facilitate grasping tissue, treating the grasped tissue with energy, and cutting the grasped and/or treated tissue.
  • forceps 10 is configured to facilitate grasping tissue, treating the grasped tissue with energy, and cutting the grasped and/or treated tissue.
  • forceps 10 generally includes a housing 20 formed from first and second housing portions 22a, 22b, a handle assembly 30, a trigger assembly 60, an activation button 70, an outer shaft 90, an end effector assembly 100, a first drive assembly 130, and second drive assembly 140, and a rotating assembly 150.
  • Housing portions 22a, 22b of housing 20 are substantially similar to one another and each includes a distal aperture portion 23, a rotation wheel window 24, a trigger pivot 25, a movable handle pivot 26, a plurality of engagement members 27, a button compartment portion 28, and a cable aperture portion 29.
  • Distal aperture portions 23 (only distal aperture portion 23 of housing portion 22a is shown) cooperate to define a distal aperture enabling outer shaft 90 to extend therethrough.
  • Rotation wheel windows 24 enable rotation wheel 152 of rotating assembly 150 to extend therethrough to enable manipulation thereof by a user.
  • Trigger pivots 25 are configured to pivotably support trigger 62 of trigger assembly 60 therebetween to enable pivoting of trigger 62 relative to housing 20.
  • Movable handle pivots 26 are configured to pivotably support movable handle 32 therebetween to enable pivoting of movable handle 32 relative to housing 20.
  • Engagement members 27 enable the engagement of first and second housing portions 22a, 22b to one another to form housing 20, e.g., via pin-aperture engagement, screws, etc., although other suitable engagements, e.g., ultrasonic welding, are also contemplated.
  • Button compartment portions 28 (only button compartment portion 28 of housing portion 22a is shown) cooperate to define a button compartment for receipt of activation button 70.
  • Cable aperture portions 29 cooperate to define a cable aperture for receipt of an electrosurgical cable (not shown) therethrough.
  • the electrosurgical cable includes wires (not shown) extending therethrough to operably couple a source of energy, e.g., an electrosurgical generator (not shown) , to activation button 70 and end effector assembly 100 to enable the selective supply of energy to end effector assembly 100 in response to actuation of activation button 70.
  • a source of energy e.g., an electrosurgical generator (not shown)
  • forceps 10 may be configured as a hand-held device including battery and generator components disposed on or within housing 20.
  • Handle assembly 30 includes a movable handle 32, a first linkage 42, and a second linkage 46.
  • Movable handle 32 includes a grasping portion 34 extending from housing 20 and defining a finger hole 36 to facilitate grasping by a user, an extension portion 38 extending from grasping portion 34 into housing 20, and a protrusion 40 protruding from grasping portion 34 towards activation button 70 to facilitate actuation of activation button 70 in response to actuation of movable handle 32.
  • First linkage 42 is fixed relative to extension portion 38 of movable handle 32 at an engagement point 43 and extends therefrom.
  • Engagement point 43 furthe defines a pair of outwardly-facing pivot apertures (only one of which is shown) configured to receive movable handle pivots 26 of housing portions 22a, 22b to pivotably couple movable handle 32 relative to housing 20.
  • movable handle 32 is pivotable relative to housing 20 between an initial position, wherein movable handle 32 is spaced-apart from a fixed handle portion 50 of housing 20, and an actuated position, wherein movable handle 32 is disposed in close proximity to fixed handle portion 50.
  • Protrusion 40 of movable handle 32 may be configured to actuate activation button 70 in the actuated position of movable handle 32, or may require movement of movable handle 32 to a second actuated position, wherein movable handle 32 is disposed even closer to fixed handle portion 50 such that protrusion 40 actuates activation button 70.
  • Second linkage 46 defines a bifurcated configuration (only one arm of which is shown) and is pivotably coupled to first linkage 42 via a floating pivot 47 at a first end of second linkage 46. Second linkage 46 further includes a drive pin 49 disposed at a second end thereof that is configured for receipt within first mandrel 134 of first drive assembly 130 such that pivoting of movable handle 32 between the initial and actuated positions translates first drive bar 132 of first drive assembly 130 through and relative to housing 20 and outer shaft 90.
  • Trigger assembly 60 includes a trigger 62 defining a toggle portion 64 extending from housing 20 to facilitate manipulation by a user, a pivot portion 66 disposed within housing 20, and drive portion 68 extending between toggle portion 64 and pivot portion 66.
  • Pivot portion 66 defines a pair of outwardly-facing pivot apertures (only one of which is shown) configured to receive trigger pivots 25 of housing portions 22a, 22b to pivotably couple trigger 62 relative to housing 20.
  • trigger 62 is pivotable relative to housing 20 between a first, more-distal position and a second, more-proximal position.
  • Drive portion 68 of trigger 62 defines an opening 69a and a pair of opposed drive pin portions 69b extending inwardly into opening 69a.
  • drive pin potions 69b are configured for receipt within second mandrel 144 of second drive assembly 140 such that pivoting of trigger 62 between the first position and the second position translates second drive bar 142 of second drive assembly 140 through and relative to housing 20 and outer shaft 90.
  • outer shaft 90 includes a ring 92 engaged thereabout towards the proximal end thereof. Ring 92 is configured for receipt within an annular recess 93 defined within each housing portion 22a, 22b (only annular recess 93 of housing portion 22a is shown) to longitudinal fix outer shaft 90 relative to housing 20 while permitting rotation of outer shaft 90 relative to housing 20. Outer shaft 90 further defines a pair of opposed apertures 94 (only one of which is shown) and a pair of opposed longitudinally-extending slots 96 (only one of which is shown) . As detailed below, apertures 94 and slots 96 facilitate the operable coupling of end effector assembly 100 at the distal end of outer shaft 90.
  • end effector assembly 100 includes first and second jaw members 110, 120 pivotably coupled to one another and outer shaft 90 to enable movement of first and second jaw members 110, 120 relative to one another and outer shaft 90 between a spaced-apart position and an approximated position for grasping tissue therebetween.
  • end effector assembly 100 may define a unilateral configuration, e.g., wherein jaw member 120 is fixed relative to outer shaft 90 and jaw member 110 is pivotable relative to jaw member 120 and outer shaft 90 between the spaced-apart and approximated positions.
  • Each jaw member 110, 120 of end effector assembly 100 includes a proximal flange 111, 121 and a distal jaw body 112, 122.
  • Proximal flange 111 of jaw member 110 defines a cam slot 113 having proximal and distal slot sections 114a, 114b, respectively.
  • Distal slot section 114b extends generally longitudinally along proximal flange 111 of jaw member 110, although distal slot section 114b may be angled relative to a longitudinal axis of proximal flange 111.
  • Proximal slot section 114a is angled relative to distal slot section 114b (at an angle greater than the angle of distal slot section 114b in embodiments where distal slot section 114b is angled) and the longitudinal axis of proximal flange 111 of jaw member 110.
  • Proximal flange 111 of jaw member 110 further defines a first pivot aperture 115 therethrough that is disposed proximally of cam slot 113.
  • Proximal flange 121 of jaw member 120 defines a bifurcated configuration formed from a pair of spaced-apart flange segments configured to receive proximal flange 111 of jaw member 110 therebetween.
  • proximal flange 111 of jaw member 110 may be bifurcated and configured to receive a singular proximal flange 121 of jaw member 120
  • both proximal flanges 111, 121 may be singular and arranged in side-by-side relation
  • both proximal flanges 111, 121 may be bifurcated and arranged in an offset configuration or a nestled.
  • both flange segments of proximal flange 121 are similar, the flange segments will be collectively referred to hereinbelow as proximal flange 121, unless otherwise noted.
  • Proximal flange portion 121 of jaw member 120 defines a cam slot 123, a first pivot aperture 124a disposed proximally of cam slot 123, and a second pivot aperture 125 generally positioned between cam slot 123 and first pivot aperture 124a.
  • Cam slot 123 defines a generally linear (although arced configurations are also contemplated) and is angled relative to a longitudinal axis of proximal flange 121 of jaw member 120 in an opposite direction relive to the angling of proximal slot section 114a of cam slot 113 of proximal flange 111 of jaw member 110.
  • a first drive pin 103 is configured for slidable positioning within opposed longitudinally-extending slots 96 of outer shaft 90, cam slot 113 of proximal flange 111 of jaw member 110, and cam slot 123 of proximal flange 121 of jaw member 120.
  • First drive pin 103 is further configured to operably couple to first drive bar 132 of first drive assembly 130 such that translation of first drive bar 132 through outer shaft 90, e.g., in response to pivoting of movable handle 32 (Fig. 1) , pivots jaw members 110, 120 relative to one another between the spaced-apart position (Fig. 5A) and the approximated position (Fig. 5B) .
  • First pivot aperture 124a of proximal flange 121 of jaw member 120 includes a tail slot 124b in communication therewith and extending proximally therefrom longitudinally relative to the longitudinal axis of proximal flange 121 of jaw member 120.
  • Tail slot 124b defines a reduced height as compared to the diameter of first pivot aperture 124a.
  • a second drive pin 105 is configured for receipt within pivot aperture 115 of proximal flange 111 of jaw member 110 and first pivot aperture 124a of proximal flange 121 of jaw member 120 to pivotably couple jaw members 110, 120 relative to one another.
  • Second drive pin 105 is also captured, rotatably fixed, within a pair of recesses 143 defined at the distal end of second drive bar 142 of second drive assembly 140.
  • proximal translation of second drive bar 142 moves second drive pin 105 proximally from first pivot aperture 124a into tail slot 124b, thus allowing jaw member 120 to remain stationary upon proximal translation of second drive bar 142.
  • second drive pin 105 With respect to jaw member 110, however, with second drive pin 105 extending through pivot aperture 115 of proximal flange 111 of jaw member 110, proximal translation of second drive bar 142 pulls jaw member 110 to slide proximally relative to jaw member 120 to a cut position.
  • Second drive pin 105 is configured to inhibit entry thereof into tail slot 124b when jaw members 110, 120 are disposed in the spaced-apart position, thereby inhibiting jaw member 110 from moving to the cut position when jaw members 110, 120 are disposed in the spaced-apart position.
  • Second drive pin 105 defines a center portion 106a configured for receipt within pivot aperture 115 of proximal flange 111 of jaw member 110 and a pair of opposed outer portions 106b, each of which is configured for receipt within the first pivot aperture 124a of one of the flange segments of proximal flange 121 of jaw member 120.
  • Center portion 106a defines a circular cross-sectional configuration such that rotation of jaw member 110 about center portion 106a of second drive pin 105 is uninhibited by second drive pin 105, regardless of the orientation thereof.
  • Outer portions 106b define semi-circular configurations such that, in a first orientation, e.g., wherein the semi-circle faces proximally or distally, outer portions 106b define a height equal to a full diameter of second drive pin 105, while, in a second orientation, e.g., wherein the semi-circle faces up or down, outer portions 106b define a height equal to a half diameter of second drive pin 105.
  • Tail slot 124b defines a height that is slightly larger than the half diameter of second drive pin 105 and less than the full diameter of second drive pin 105.
  • proximal flange 121 of jaw member 120 is oriented such that tail slot 124b is aligned with the half-diameter height of second drive pin 105, thus permitting translation of second drive pin 105 therethrough.
  • tail slot 124b of proximal flange 121 of jaw member 120 is aligned with a height of second drive pin 105 that is greater than the height of tail slot 124b, thus inhibiting translation of second drive pin 105 therethrough.
  • the particular height of tail slot 124b relative to the diameter of second drive pin 105 may be selected in accordance with the desired position of jaw members 110, 120 at which movement of jaw member 110 to the cut position is permitted. This may correspond, for example, to the approximated position or a position sufficiently close to the approximated position, e.g., to enable movement of jaw member 110 to the cut position where larger tissue structures are grasped between jaw members 110, 120 inhibiting jaw members 110, 120 from reaching the approximated position.
  • a pair of pivot-pin components are configured for receipt within second pivot apertures 125 of the flange segments of proximal flange 121 of jaw member 120 and opposed apertures 94 of outer shaft 90 (see FIG. 1) so as to pivotably couple jaw member 120 to outer shaft 90 on either side of proximal flange 111 of jaw member 110.
  • This configuration inhibits translation of jaw member 120.
  • jaw member 120 is only movable in pivoting fashion relative to outer shaft 90.
  • distal jaw bodies 112, 122 of jaw members 110, 120 each define a curved configuration, wherein distal jaw bodies 112, 122 curve laterally in similar directions.
  • Distal jaw bodies 112, 122 each further define opposing tissue-contacting portions 116, 126.
  • Tissue-contacting portion 116 of distal jaw body 112 of jaw member 110 is defined by protruding and recessed tissue-contacting surfaces 117a, 117b offset by a step 117c.
  • tissue-contacting portion 126 of distal jaw body 122 of jaw member 120 is defined by protruding and recessed tissue-contacting surfaces 127a, 127b offset by a step 127c.
  • Tissue-contacting portions 116, 126 define complementary configurations such that the steps 117c, 127c thereof inter-fit with one another when jaw members 110, 120 are disposed in the approximated position (see Fig. 6A) , e.g., with protruding surface 117a of jaw member 120 opposed to recessed surface 127b of jaw member 120 and recessed surface 117b of jaw member 110 opposed to protruding surface 127a of jaw member 120.
  • tissue-contacting portions 116, 126 of jaw members 110, 120 proximal sliding of jaw member 110 to the cut position causes tissue-contacting portions 116, 126 to at least partially move out of inter-fit position to a stacked configuration, wherein steps 117c, 127c, in a sheering action, slide laterally over one another to cut tissue disposed therebetween.
  • Tissue-contacting portions 116, 126 are formed at least partially from an electrically-conductive material and either or both are adapted to connect to a source of energy as well as activation button 70 (Fig. 1) to enable the selective supply of energy thereto for treating tissue grasped therebetween.
  • one or both of distal jaw bodies 112, 122 of jaw members 110, 120 includes an outer insulative jaw housing 118, 128.
  • one or both of distal jaw bodies 112, 122 may be formed entirely from an electrically-conductive material.
  • first drive assembly 130 includes a first drive bar 132 that extends from housing 20 through outer shaft 90 to end effector assembly 100.
  • first drive bar 132 supports first drive pin 103 at the distal end thereof.
  • First drive pin 103 operably coupled first drive bar 132 with jaw members 110, 120, as mentioned above, such that translation of first drive bar 132 through outer shaft 90, e.g., in response to pivoting of movable handle 32 (Fig. 1) , pivots jaw members 110, 120 relative to one another between the spaced-apart position (Fig. 5A) and the approximated position (Fig. 5B) .
  • a first mandrel 134 of drive assembly 130 is slidably disposed about first drive bar 132 towards the proximal end thereof.
  • Drive pin 49 of handle assembly 30 is configured for receipt within the annular recess defined by first mandrel 134 such that pivoting of movable handle 32 between the initial and actuated positions translates mandrel 134 relative to housing 20.
  • a first biasing member 136 is disposed about first drive bar 132 and engaged between first mandrel 134 and a proximal washer 138 that is fixedly engaged about first drive bar 132, e.g., via welding or a pin-aperture engagement.
  • This configuration establishes a force-limiting mechanism whereby first biasing member 136 resists extension up to a threshold force such that, below the threshold force, pivoting of movable handle 32 from the initial position towards the actuated position urges first mandrel 134 and first drive bar 132 distally to thereby move jaw members 110, 120 from the spaced-apart position towards the approximated position.
  • First drive assembly 130 further includes a second biasing member 139 operably positioned to bias first drive bar 132 proximally, thereby biasing jaw members 110, 120 towards the spaced-apart position and movable handle 32 towards the initial position.
  • Second drive assembly 140 includes a second drive bar 142 that extends from housing 20 through outer shaft 90 to end effector assembly 100.
  • Second drive bar 142 extends adjacent first drive bar 132 within outer shaft 90.
  • Second drive bar 142 supports second drive pin 105 within recesses 143 thereof to thereby operably coupled second drive bar 142 to jaw members 110, 120.
  • translation of second drive bar 142 through outer shaft 90 e.g., in response to pivoting of trigger 62, slides jaw member 110 relative to jaw member 120 between the grasping position (Figs. 5A and 5B) and the cut position (Fig. 5C) .
  • Second drive assembly 140 includes a second mandrel 144 slidably disposed about first drive bar 132 of first drive assembly 130 and fixedly engaged to second drive bar 142 of second drive assembly 140 towards the proximal end thereof, e.g., via welding or a pin-aperture engagement.
  • Second mandrel 144 is configured to receive drive pin potions 69b of trigger assembly 60 within the annular recess defined by second mandrel 144 such that pivoting of trigger 62 between the first position and the second position urges second mandrel 144 proximally, thereby translating second drive bar 142 proximally to slide jaw member 110 from the grasping position (Figs. 5A and 5B) to the cut position (Fig. 5C) .
  • a control block 146 operably couples first and second drive bars 132, 142, respectively, so as to confine relative movement of first and second drive bars 132, 142, respectively, to longitudinal translation.
  • Control block 146 extends through a first slot 147 defined within first drive bar 132 and a second slot 148 defined within second drive bar 142 The length of first slot 147 generally approximates the length of control block 146 so as to establish a fixed engagement therebetween.
  • Second slot 148 is elongated relative to the length of control block 146 to allow control block 146 to translate along second slot 148 as first drive bar 132 is translated relative to second drive bar 142, and vice versa.
  • rotating assembly 150 includes a rotation wheel 152 fixedly mounted on outer shaft 90 within housing 20.
  • Rotation wheel 152 extends through rotation wheel windows 24 of housing 20 to enable manipulation of rotation wheel 152 from the exterior of housing 20.
  • rotation wheel 152 fixed about outer shaft 90, outer shaft 90 coupled to jaw members 110, 120, and jaw members 110, 120 coupled to first and second drive bars 132, 142, rotation of rotation wheel 152 relative to housing 20 thereby rotates outer shaft 90, end effector assembly 100, and first and second drive assemblies 130, 140, respectively, relative to housing 20.
  • movable handle 32 is disposed in the initial position and, accordingly, jaw members 110, 120 are disposed in the spaced-apart position (Fig. 5A) .
  • first drive bar 132 is disposed in a proximal-most position and second drive bar 142 is disposed in a distal-most position.
  • first drive pin 103 is disposed towards the proximal ends of slots 113, 123 (Figs. 4A and 4B) and second drive pin 105 is disposed within first pivot aperture 124a of proximal flange 121 of jaw member 120 (Figs. 4A and 4B) .
  • forceps 10 may be maneuvered and/or manipulated into position such that tissue to be grasped, treated, and or cut, is disposed between jaw members 110, 120. Such may include rotation of rotation wheel 152 to rotate jaw members 110, 120 to a desired orientation.
  • movable handle 32 is moved from the initial position to the actuated position. Movement of movable handle 32 to the actuated position translates first drive bar 132 distally such that first drive pin 132 is moved distally through slots 113, 123 (Figs.
  • tissue-contacting portions 116, 126 of jaw members 110, 120 may be supplied to either or both of tissue-contacting portions 116, 126 of jaw members 110, 120 to treat tissue “T. ”
  • protrusion 40 of handle assembly 30 may be configured to activate activation button 70 upon jaw members 110, 120 reaching the approximated position, or movable handle 32 may be moved from the actuated position further towards fixed handle 50 to activate activation button 70. In either configuration, energy is conducted through tissue “T” to treat tissue “T. ”
  • trigger 62 is moved from the first position to the second position to thereby translate second drive bar 142 proximally. Proximal translation of second drive bar 142 pulls second drive pin 105 proximally, thereby also pulling first jaw member 110 proximally from the grasping position (Figs. 5B and 6A) to the cut position (Figs. 5C and 6B) . As second drive pin 105 is moved proximally, second drive pin 105 enters proximal tail 124b of proximal flange 121 of jaw member 120 (Figs. 4A and 4B) , thus permitting jaw member 120 to remain stationary during proximal movement of jaw member 110 to the cut position (Figs. 5C and 6B) .
  • tissue-contacting portions 116, 126 are at least partially moved from an inter-fit position to a stacked configuration, wherein steps 117c, 127c, in a sheering action, slide laterally over one another to cut tissue “T” disposed therebetween (Fig. 6B) .
  • Steps 117c, 127c may define sharpened edges to facilitate cutting in this manner.
  • distal slot section 114b of jaw member 110 is angled
  • the angled configuration facilitates steps 117c, 127c sliding over one another by slightly lifting jaw member 110 (due to the interaction between first drive pin 103 and the angled distal slot section 114b) as jaw member 110 is pulled proximally.
  • trigger 62 may be returned to the first position and, thereafter, movable handle 32 returned to the initial position to release tissue “T. ” Forceps 10 may then be used, similarly as detailed above, to grasp, treat, and/or cut other tissue (s) .
  • the various embodiments disclosed herein may also be configured to work with robotic surgical systems and what is commonly referred to as “Telesurgery. ”
  • Such systems employ various robotic elements to assist the surgeon in the operating theatre and allow remote operation (or partial remote operation) of surgical instrumentation.
  • Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the surgeon during the course of an operation or treatment.
  • Such robotic systems may include remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc.
  • the transmission assemblies of the present disclosure may be configured for use with such robotic systems in addition to being used with manually-operated assemblies. That is, depending on the particular procedure, the transmission assembly may be coupled to a manually-operated assembly or a robotic system.
  • the transmission assemblies of the present disclosure are capable of being used in either configuration without the need for multiple transmission assemblies depending on whether robotic or manual surgery is desired.
  • the robotic system would include suitable components, such as those detailed above, capable of manipulating and actuating the transmission assembly.
  • the robotic surgical systems may further be employed with one or more consoles that are next to the operating theater or located in a remote location.
  • one team of surgeons or nurses may prep the patient for surgery and configure the robotic surgical system with one or more of the transmission assemblies while another surgeon (or group of surgeons) remotely control the transmission assembly (s) via the robotic surgical system.
  • a highly skilled surgeon may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients.
  • the robotic arms of the surgical system are typically coupled to a pair of master handles by a controller.
  • the handles can be moved by the surgeon to produce a corresponding movement, manipulation, and/or actuation of the transmission assembly (s) coupled thereto.
  • the movement of the master handles may be scaled so that the operably components of the transmission assembly (s) has a corresponding movement that is different, smaller or larger, than the movement performed by the operating hands of the surgeon.
  • the scale factor or gearing ratio may be user-adjustable so that the operator can control the resolution of the operable components of the transmission assembly (s) .
  • the master handles of the robotic system may further include various sensors to provide feedback to the surgeon relating to various tissue parameters or conditions, e.g., tissue resistance due to manipulation, cutting or otherwise treating, pressure by the instrument onto the tissue, tissue temperature, tissue impedance, etc. As can be appreciated, such sensors provide the surgeon with enhanced tactile feedback simulating actual operating conditions.
  • the master handles may also include a variety of different actuators for delicate tissue manipulation or treatment further enhancing the surgeon’s ability to mimic actual operating conditions.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Ophthalmology & Optometry (AREA)
  • Heart & Thoracic Surgery (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

La présente invention décrit une pince (10) comprenant un logement (20), une poignée mobile (30), un déclencheur (60), un arbre externe (90), un ensemble effecteur d'extrémité (100), et une première et une seconde barre d'entraînement (130, 140). L'ensemble effecteur d'extrémité (100), placé au niveau d'une extrémité distale de l'arbre externe (90), comprend un premier et un second élément formant mâchoire (112, 122) dont au moins l'un peut pivoter entre une position espacée/écartée et une position approximative. La première et la seconde barre d'entraînement (130, 140) s'étendent à travers l'arbre externe (90) et sont fonctionnellement couplées à la poignée mobile (30) et au déclencheur (60), respectivement, à l'ensemble effecteur d'extrémité (100). L'actionnement de la poignée mobile (30) produit la translation de la première barre d'entraînement (130) à travers l'arbre externe (90) de manière à faire pivoter le premier et/ou le second élément formant mâchoire (112, 122) depuis la position espacée/écartée vers la position approximative. L'actionnement du déclencheur (60) produit la translation de la seconde barre d'entraînement (140) à travers l'arbre externe (90) de manière à ce que le premier élément formant mâchoire (112) effectue une translation par rapport à l'arbre externe (90) et le second élément formant mâchoire (122) depuis une position de préhension vers une position de coupe.
PCT/CN2016/081095 2016-05-05 2016-05-05 Pince chirurgicale destinée au traitement et à la découpe d'un tissu WO2017190304A1 (fr)

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PCT/CN2016/081095 WO2017190304A1 (fr) 2016-05-05 2016-05-05 Pince chirurgicale destinée au traitement et à la découpe d'un tissu
CN201680085376.4A CN109069172B (zh) 2016-05-05 2016-05-05 用于处理和切割组织的外科夹钳

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CN113712629A (zh) * 2017-12-12 2021-11-30 捷锐士阿希迈公司(以奥林巴斯美国外科技术名义) 电外科装置
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GB2625760A (en) * 2022-12-22 2024-07-03 Cmr Surgical Ltd Surgical instrument with interlocking end effector elements

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CN109069172A (zh) 2018-12-21

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