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CN104602624B - 具有定位在远侧的钳口组件的超声外科器械 - Google Patents

具有定位在远侧的钳口组件的超声外科器械 Download PDF

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CN104602624B
CN104602624B CN201380044999.3A CN201380044999A CN104602624B CN 104602624 B CN104602624 B CN 104602624B CN 201380044999 A CN201380044999 A CN 201380044999A CN 104602624 B CN104602624 B CN 104602624B
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CN104602624A (zh
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O·J·瓦克哈利亚
J·D·梅瑟利
D·斯蒂芬奇克
S·P·斯莫利克
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Ethicon Endo Surgery Inc
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Abstract

本发明涉及外科器械的各种实施例，所述外科器械包括端部执行器、轴和钳口组件。所述端部执行器可包括超声刀，所述超声刀基本上平行于纵向轴线朝远侧延伸。所述轴可沿所述纵向轴线从所述端部执行器朝近侧延伸。所述钳口组件可包括第一钳口构件和第二钳口构件。所述钳口组件能够围绕基本上垂直于所述纵向轴线的第一轴线从所述第一钳口构件和所述第二钳口构件基本上平行于所述超声刀的第一位置枢转到第二位置。另外，所述第一钳口构件和所述第二钳口构件能够围绕基本上垂直于所述第一轴线的第二轴线枢转。

Description

具有定位在远侧的钳口组件的超声外科器械
相关申请的交叉引用
本申请涉及下列同时提交的美国专利申请，这些美国专利申请全文以引用方式并入本文：
美国申请序列号_________________，名称为“Haptic Feedback Devices forSurgical Robot”，代理人案卷号END7042USNP/110388；
美国申请序列号_________________，名称为“Lockout Mechanism for Use withRobotic Electrosurgical Device”，代理人案卷号END7043USNP/110389；
美国申请序列号_________________，名称为“Closed Feedback Control forElectrosurgical Device”，代理人案卷号END7044USNP/110390；
美国申请序列号_________________，名称为“Surgical Instruments withArticulating Shafts”，代理人案卷号END6423USNP/110392；
美国申请序列号_________________，名称为“Ultrasonic SurgicalInstruments with Distally Positioned Transducers”，代理人案卷号END6819USNP/110393；
美国申请序列号_________________，名称为“Surgical Instruments withArticulating Shafts”，代理人案卷号END7047USNP/110394；
美国申请序列号_________________，名称为“Surgical Instruments withArticulating Shafts”，代理人案卷号END7049USNP/110396；
美国申请序列号_________________，名称为“Ultrasonic SurgicalInstruments with Control Mechanisms”，代理人案卷号END7050USNP/110397；和
美国申请序列号_________________，名称为“Surgical Instruments WithFluid Management System”，代理人案卷号END7051USNP/110399。
背景技术
各种实施例涉及包括超声器械和定位在远侧的钳口组件的外科器械。
超声外科装置(诸如超声刀)因其独特的性能特性而用于外科手术的多种应用中。根据具体的装置构型和操作参数，超声外科装置能够基本上同时进行组织的横切和通过凝结作用的止血，从而有利地最大程度减轻患者创伤。超声外科装置包括定位在近侧的超声换能器和联接到超声换能器的器械，该器械具有安装在远侧的端部执行器，该端部执行器包括用于切割和密封组织的超声刀。端部执行器通常经由轴联接到柄部和/或机器人外科工具。刀经由延伸穿过轴的波导而在声学上联接至换能器。具有该性质的超声外科装置能够用于开放性外科用途、腹腔镜式外科手术、或内窥镜式外科手术，包括机器人辅助的手术。
超声能量使用比用在电外科手术中的温度低的温度来切割和凝结组织。通过高频振动(例如，每秒55,500次)，超声刀使组织中的蛋白质变性以形成粘性凝结物。刀表面施加在组织上的压力使血管塌缩并使所述凝结物能够形成止血密封。外科医生能够通过由端部执行器施加至组织的力、施加该力的时间、以及端部执行器的选定偏移水平来控制切割速度和凝结。
临床医生通常期望使器械轴的远侧部分进行关节运动以便引导超声和/或射频能量的施用。这种关节运动具有挑战性，并且通常限于其中超声波导从定位在近侧的换能器延伸到定位在远侧的超声刀的实施例中。
附图说明
各种实施例的特征结构在所附权利要求书中进行了详细描述。然而，参考结合如下附图的下列描述可最好地理解各种实施例(有关手术的组织和方法两者)及其优点：
图1示出包括外科器械和超声发生器的外科系统的一个实施例。
图2示出图1所示的外科器械的一个实施例。
图3示出超声端部执行器的一个实施例。
图4示出超声端部执行器的另一个实施例。
图5示出图1所示的外科器械的一个实施例的分解图。
图6示出图1所示的外科器械的一个实施例的剖视图。
图7示出图1所示的外科器械的一个实施例的各种内部部件。
图8示出包括外科器械和超声发生器的外科系统的一个实施例的顶视图。
图9示出图1的外科器械的一个示例性实施例中包括的旋转组件的一个实施例。
图10示出包括外科器械的外科系统的一个实施例，该外科器械具有单元件端部执行器。
图11示出机器人外科系统的一个实施例的框图。
图12示出机械臂车的一个实施例。
图13示出图12的机械臂车的机器人操纵器的一个实施例。
图14示出具有另选的装置接头结构的机械臂车的一个实施例。
图15示出可与机械臂车(诸如图11-图14的机械臂车)结合使用的控制器的一个实施例。
图16示出适于与机器人系统一起使用的超声外科器械的一个实施例。图25示出适于与机器人系统一起使用的电外科器械的一个实施例。
图17示出器械驱动组件的一个实施例，该器械驱动组件可联接到外科操纵器以接收和控制图16所示的外科器械。
图18示出包括图16的外科器械的图26的器械驱动组件实施例的另一个视图。
图19-图21示出图26的器械驱动组件实施例的适配器部分的附加视图。
图22-图24示出图16的器械安装部分的一个实施例，显示了用于将从动元件的运动转化成外科器械的运动的部件。
图25-图27示出图16的器械安装部分的另选实施例，显示了用于将从动元件的旋转转化成围绕轴的轴线的旋转运动的另选示例性机构，以及用于生成一个或多个构件沿轴的轴线的往复式平移的另选示例性机构。
图28-图32示出图16的器械安装部分的另选实施例，显示了用于将从动元件的旋转转化成围绕轴的轴线的旋转运动的另一个另选示例性机构。
图33-图36A示出器械安装部分的另选实施例，显示了用于使构件沿轴的轴线发生差动平移(例如，用于进行关节运动)的另选示例性机构。
图36B-图36C示出包括内部功率源和能量源的工具安装部分的一个实施例。
图37-图38示出包括定位在远侧的钳口组件的外科器械远侧部分的一个实施例。
图39示出图37-图38的外科器械远侧部分的一个实施例的正面图。
图40-图41示出图37-图38的外科器械远侧部分的一个实施例，其联接到与机器人外科系统一起使用的器械安装部分。
图42-图44示出图37-图38的外科器械远侧部分的一个实施例，显示了附加控制机构。
图45A示出器械安装部分的一个实施例，显示了用于致动图37-图38的外科器械的各种控制线的示例性机构。
图45B示出引导器的一个实施例的侧视图。
图46-图47示出图37-图38的外科器械远侧部分的一个实施例，其具有可缩回的超声刀。
图48示出图37-图38的外科器械远侧部分的一个实施例，该远侧部分联接到机器人外科系统的能够使超声刀伸展和回缩的器械安装部分。
图49示出图37-图38的外科器械远侧部分的另选实施例，该远侧部分联接到机器人外科系统的具有外部换能器的器械安装部分。
图50示出如图49所示的图37-图38的外科器械远侧部分的附加视图。
图51示出包括夹持垫的钳口组件的一个实施例。
图52-图56示出外科器械远侧部分的一个实施例，其包括具有U形钳口构件的钳口组件。
具体实施方式
本文所述的各种实施例涉及包括定位在远侧的可进行关节运动的钳口组件的外科器械。所述钳口组件可用于替代轴关节运动或对轴关节运动进行补充。例如，钳口组件可用于夹持组织并将其朝着超声刀、射频电极或用于处理组织的其他部件移动。
根据一个示例性实施例，外科器械可包括端部执行器，该端部执行器具有从其朝远侧延伸的超声刀。钳口组件可进行关节运动，并且可围绕至少两条轴线枢转。第一轴线或腕枢转轴线可基本上垂直于器械轴的纵向轴线。钳口组件可围绕腕枢转轴线从钳口组件基本上平行于超声刀的第一位置枢转到钳口组件基本上不平行于超声刀的第二位置。此外，钳口组件可包括可围绕第二轴线或钳口枢转轴线枢转的第一钳口构件和第二钳口构件。钳口枢转轴线可基本上垂直于腕枢转轴线。在一些实施例中，钳口枢转轴线自身可在钳口组件围绕腕枢转轴线枢转时枢转。第一钳口构件和第二钳口构件可相对于彼此围绕钳口枢转轴线枢转，使得第一钳口构件和第二钳口构件可以“打开”和“闭合”。另外，在一些实施例中，第一钳口构件和第二钳口构件也可围绕钳口枢转轴线一起枢转，使得第一钳口构件和第二钳口构件的方向可以改变。
在各种实施例中，钳口组件受到一系列的线和/或缆线的控制，所述一系列的线和/或缆线从钳口组件朝近侧延伸到机器人外科系统的手动柄部和/或器械安装部分。第一线和第二线可以控制钳口组件围绕腕枢转轴线的枢转。第一线可以在与腕枢转轴线偏置的位置处联接到钳口组件。第二线可以在与腕枢转轴线偏置并且基本上与第一位置相对的第二位置处联接到钳口组件。第一线和第二线的差动平移可以致使钳口组件围绕腕枢转轴线枢转。例如，所述线中的一者的近侧平移可致使钳口组件向朝近侧平移的线枢转远离轴的纵向轴线。在一些实施例中，钳口组件可包括围绕腕枢转轴线定位的滑轮。第一线和第二线可以是缠绕在滑轮周围的单条线的第一端部和第二端部。
第一钳口构件和第二钳口构件可以类似地受到控制。例如，在一些实施例中，每个钳口构件联接到两条控制线，所述两条控制线从钳口组件朝近侧延伸穿过轴，直到机器人外科系统的手动柄部和/或器械安装部分。每个钳口构件的控制线可在钳口枢转轴线周围彼此偏置，使得一条控制线的近侧平移使钳口围绕钳口枢转轴线以第一方向枢转，而另一条控制线的近侧平移使钳口围绕钳口枢转轴线以与第一方向相反的第二方向枢转。在一些实施例中，第一钳口构件和第二钳口构件包括围绕钳口枢转轴线定位的滑轮，并且每个钳口构件的第一控制线和第二控制线是缠绕在相应滑轮周围的单条控制线的端部。在一些实施例中，所述钳口构件可被单独控制。例如，所述钳口构件可围绕钳口枢转轴线打开和闭合，并且此外可围绕钳口枢转轴线一起枢转。
现在将详细提及若干实施例，包括显示具有端部执行器的手动外科器械和机器人外科器械的示例性具体实施的实施例，所述端部执行器包括超声元件和/或电外科元件。只要可行，相似或相同的参考编号可用于多个附图并可指示相似或相同的功能。附图仅出于举例说明的目的描绘了本发明所公开的外科器械和/或使用方法的示例性实施例。本领域的技术人员将通过以下描述容易地认识到：可在不脱离本文所述原理的情况下采用本文所示的结构和方法的另选的示例性实施例。
图1为超声外科器械10的一个实施例的右侧视图。在该例示的实施例中，超声外科器械10可用于各种外科手术，包括内窥镜式外科手术或传统的开放式外科手术。在一个示例性实施例中，超声外科器械10包括柄部组件12、细长轴组件14和超声换能器16。柄部组件12包括触发器组件24、远侧旋转组件13和开关组件28。细长轴组件14包括端部执行器组件26，该端部执行器组件包括用于解剖组织或相互抓紧、切割并凝结血管和/或组织的元件，以及用于致动端部执行器组件26的致动元件。柄部组件12适于在近侧端部处接收超声换能器16。超声换能器16机械地接合到细长轴组件14和端部执行器组件26的多个部分。超声换能器16经由缆线22电耦合至发生器20。虽然大部分附图描绘了结合腹腔镜式外科手术使用的多端部执行器组件26，但是超声外科器械10可用于更传统的开放式外科手术中，并且在其他实施例中，能够用于内窥镜式手术中。出于本文的目的，从内窥镜式器械的角度来描述超声外科器械10；然而，可以设想，超声外科器械10的开放式和/或腹腔镜式型式也可包括如本文所述的相同或相似的操作部件和特征结构。
在各种实施例中，发生器20包括若干功能性元件，诸如模块和/或块。不同的功能性元件或模块能够用于驱动不同种类的外科装置。例如，超声发生器模块21可以驱动超声装置，诸如超声外科器械10。在一些示例性实施例中，发生器20还包括用于驱动电外科装置(或超声外科器械10的电外科实施例)的电外科手术/射频发生器模块23。在图1所示的示例性实施例中，发生器20包括与发生器20成一整体的控制系统25，以及经由缆线27连接至发生器的脚踏开关29。发生器20还可以包括用于激活外科器械(诸如器械10)的触发机构。触发机构可以包括电源开关(未示出)以及脚踏开关29。当由脚踏开关29激活时，发生器20可提供能量来驱动外科器械10的声学组件并以预定的偏移水平来驱动端部执行器18。发生器20以声学组件的任何合适的共振频率来驱动或激发声学组件，以及/或者形成治疗/亚治疗电磁/射频能量。
在一个实施例中，电外科/射频发生器模块23可作为电外科手术单元(ESU)来实施，该电外科手术单元能够使用射频(RF)能量来供应足以执行双极电外科手术的功率。在一个实施例中，ESU可以是由ERBE USA,Inc.(Marietta,Ga.)销售的双极ERBE ICC 350。如此前所论述，在双极电外科手术应用中，可以使用具有有源电极和返回电极的外科器械，其中所述有源电极和所述返回电极可抵靠或邻近待处理的组织定位，使得电流可从有源电极通过组织流至返回电极。因此，电外科/射频发生器模块23能够为通过将足以处理组织T(例如，烧灼)的电能施加到组织而用于治疗目的。例如，在一些实施例中，有源电极和/或返回电极可定位在本文所述的钳口组件上。
在一个实施例中，电外科/射频发生器模块23能够递送亚治疗射频信号，以实施组织阻抗测量模块。在一个实施例中，电外科/射频发生器模块23包括如下文所详述的双极射频发生器。在一个实施例中，电外科/射频发生器模块12能够监控组织T的电阻抗Z，并通过在端部执行器组件26的夹持构件上提供的返回电极来控制基于组织T的时间和功率电平特性。因此，电外科/射频发生器模块23可出于亚治疗目的能够用于测量组织T的阻抗或其他电特性。用于测量组织T的阻抗或其他电特性的技术和电路配置在共同转让的名称为“Electrosurgical Generator for Ultrasonic Surgical Instrument”的美国专利公布No.2011/0015631中有更详细的讨论，该美国专利公布的公开内容全文以引用方式并入本文。
合适的超声发生器模块21能够在功能上以与Ethicon Endo-Surgery,Inc.(Cincinnati,Ohio)销售的GEN300相似的方式运作，如在以下美国专利中的一者或多者中所公开，所有这些专利均以引用方式并入本文：美国专利6,480,796(“Method forImproving the Start Up of an Ultrasonic System Under Zero Load Conditions”)；美国专利6,537,291(“Method for Detecting Blade Breakage Using Rate and/orImpedance Information”)；美国专利6,662,127(“Method for Detecting Presence of aBlade in an Ultrasonic System”)；美国专利6,977,495(“Detection Circuitry forSurgical Handpiece System”)；美国专利7,077,853(“Method for CalculatingTransducer Capacitance to Determine Transducer Temperature”)；美国专利7,179,271(“Method for Driving an Ultrasonic System to Improve Acquisition of BladeResonance Frequency at Startup”)；以及美国专利7,273,483(“Apparatus and Methodfor Alerting Generator Function in an Ultrasonic Surgical System”)。
应当理解，在各种实施例中，发生器20能够以若干模式运作。在一种模式中，发生器20能够成使得超声发生器模块21和电外科/射频发生器模块23可被独立地操作。
例如，可将超声发生器模块21激活以向端部执行器组件26施加超声能量，随后，可通过电外科/射频发生器模块23向端部执行器组件26施加治疗或亚治疗射频能量。如此前所论述，可向夹持在端部执行器组件26的受权利要求保护元件(claim element)之间的组织施加亚治疗电外科/射频能量以测量用于控制超声发生器模块21的激活或改变其激活的组织阻抗。从施加亚治疗能量获得的组织阻抗反馈还可用于激活电外科/射频发生器模块23的治疗电平，从而将夹持在端部执行器组件26的受权利要求保护元件之间的组织(例如，血管)密封。
在另一个实施例中，超声发生器模块21和电外科/射频发生器模块23可被同时激活。在一个示例中，超声发生器模块21与用于测量组织阻抗的亚治疗射频能级被同时激活，与此同时，端部执行器组件26的超声刀切割并凝结夹持在端部执行器组件26的夹持元件之间的组织(或血管)。这种反馈可用于(例如)改变超声发生器模块21的驱动输出。在另一个示例中，超声发生器模块21可与电外科/射频发生器模块23被同时驱动，使得在将端部执行器组件26的超声刀部分用于切割受损组织的同时，电外科/射频能量被施加到端部执行器夹持组件26的电极部分以便将组织(或血管)密封。
当发生器20经由触发机构激活时，电能由发生器20连续地施加到声学组件的换能器叠堆件或组件上。在另一个实施例中，电能由发生器20以间歇方式施加(例如，为脉冲的)。发生器20的控制系统中的锁相环路可监控来自声学组件的反馈。锁相环路调节由发生器20发送的电能的频率，使其与声学组件的选定纵向振动模式的共振频率匹配。此外，控制系统25中的第二反馈回路将提供给声学组件的电流维持在预选的恒定水平，以便在声学组件的端部执行器18处实现基本上恒定的偏移。在又一个实施例中，控制系统25中的第三反馈回路监控位于端部执行器组件26中的电极之间的阻抗。虽然图1-图9显示了手动操作的超声外科器械，但是应当理解，超声外科器械还可以用于(例如)如本文所述的机器人应用中，以及手动应用和机器人应用的组合中。
在超声操作模式下，提供给声学组件的电信号可使端部执行器18的远侧端部在例如大约20kHz至250kHz的范围内纵向振动。根据各种实施例，刀22可在约54kHz至56kHz的范围内振动，例如以约55.5kHz振动。在其他实施例中，刀22可以其他频率振动，包括例如约31kHz或约80kHz。可通过例如控制由发生器20施加到声学组件的换能器组件的电信号的振幅来控制刀的振动偏移。如上所述，发生器20的触发机构允许使用者激活发生器20，以便可将电能连续地或间歇地提供给声学组件。发生器20还具有电源线以便插入电外科单元或常规电插座。据设想，还可以通过直流(DC)源诸如电池对发生器20供电。发生器20可包括任何合适的发生器，诸如可得自Ethicon Endo-Surgery,Inc的GEN04型和/或GEN11型发生器。
图2是超声外科器械10的一个示例性实施例的左侧透视图，显示了柄部组件12、远侧旋转组件13、细长轴组件14和端部执行器组件26。在该例示的实施例中，细长轴组件14包括尺寸被设计为机械地接合端部执行器组件26的远侧端部52，以及机械地接合柄部组件12和远侧旋转组件13的近侧端部50。细长轴组件14的近侧端部50接收在柄部组件12和远侧旋转组件13内。关于细长轴组件14、柄部组件12和远侧旋转组件13之间的连接的更多细节在图5和图7的描述中提供。
在该例示的实施例中，触发器组件24包括与固定柄部34结合操作的触发器32。固定柄部34和触发器32以符合人体工程学的方式形成，并且适于与使用者舒适地交接。固定柄部34与柄部组件12整体地相关联。触发器32可相对于固定柄部34以枢转方式运动，如在下文相对于超声外科器械10的操作更详细地解释。触发器32可在使用者施加相对于触发器32的挤压力时沿朝着固定柄部34的方向33A以枢转方式运动。弹簧元件98(图5)致使触发器32在使用者释放相对于触发器32的挤压力时沿方向33B以枢转方式运动。
在一个示例性实施例中，触发器32包括细长触发器钩36，其在细长触发器钩36与触发器32之间限定孔38。孔38的大小被设计成适于接收使用者的从中穿过的一根或多根手指。触发器32还可以包括在触发器32基底的上方模塑的弹性部分32a。形成重叠注塑的弹性部分32a，从而得到更加舒适的接触表面，用于沿向外方向33B控制触发器32。在一个示例性实施例中，可在细长触发器钩36的一部分的上方提供重叠注塑的弹性部分32a。细长触发器钩32的近侧表面保持未涂布状态或用非弹性基材进行涂布，以便使用者能够轻易地将其手指滑入和滑出孔38。在另一个实施例中，触发器的几何形状形成完全闭合的套环，其限定大小被设计成适于接收使用者的从中穿过的一根或多根手指的孔。完全闭合的套环触发器还可以包括在触发器基底的上方模塑的弹性部分。
在一个示例性实施例中，固定柄部34包括近侧接触表面40和握持锚定件或鞍形表面42。鞍形表面42倚靠在手上拇指和食指结合的指蹼上。近侧接触表面40具有手枪式握把轮廓，其在没有环或孔的普通手枪式握把上接收手掌。近侧接触表面40的轮廓曲线可为波状外形以适应或接收手掌。稳定化尾部44位于朝向柄部组件12的更近侧的部分。稳定化尾部44可以与手的位于拇指与食指之间的最上方指蹼部分接触，以稳定柄部组件12并使柄部组件12更易于控制。
在一个示例性实施例中，开关组件28可包括拨动开关30。拨动开关30可以作为位于柄部组件12内部的具有中心枢轴304的单个部件来实施，以消除同时激活的可能性。在一个示例性实施例中，拨动开关30包括第一突出旋钮30a和第二突出旋钮30b，用于将超声换能器16的功率设置设定在最小功率电平(例如，MIN)和最大功率电平(例如，MAX)之间。在另一个实施例中，摇臂开关可在标准设置和特殊设置之间枢转。特殊设置可允许由装置执行一个或多个特殊程序。当第一突出旋钮30a和第二突出旋钮30b被致动时，拨动开关30围绕中心枢轴旋转。一个或多个突出旋钮30a、30b联接到一个或多个臂，所述一个或多个臂运动通过一小段弧并且使电触点根据第一突出旋钮30a或第二突出旋钮30b的启动情况闭合或断开电路从而以电方式为超声换能器16供能或使超声换能器16去能。拨动开关30联接到发生器20以控制超声换能器16的启动。拨动开关30包括用于启动超声换能器16的一个或多个电功率设置开关，旨在为超声换能器16设定一项或多项功率设置。启动拨动开关30所需的力被导向为大致朝向鞍形点42，由此避免了在启动拨动开关30时器械在手中旋转的任何趋势。
在一个示例性实施例中，第一突出旋钮30a和第二突出旋钮30b位于柄部组件12的远侧端部上，使得它们能被使用者轻易地触及，从而在最低程度或基本上无需重新定位握把的情况下激活电源，因此适于在启动拨动开关30的同时维持控制并将注意力集中在手术部位(例如，腹腔镜式手术中的监视器)上。突出旋钮30a、30b能够卷绕柄部组件12的侧面至一定程度，以便更易于被不同长度的手指触及，并且允许不顺手位置或手指较短时具有较大的触及自由度用于启动。
在该例示的实施例中，第一突出旋钮30a包括多个触觉元件30c，如该例示的实施例中的纹理突出部或“凸耳”，以允许使用者区分第一突出旋钮30a和第二突出旋钮30b。本领域的技术人员应当理解，可将若干人体工程学特征结构结合到柄部组件12中。此类人体工程学特征结构在名称为“Ergonomic Surgical Instruments”的美国专利申请公布No.2009/0105750中有所描述，该专利申请公布全文以引用方式并入本文。
在一个示例性实施例中，拨动开关30可以由使用者的手操作。使用者可以在任何点轻易地触及第一突出旋钮30a和第二突出旋钮30b，同时还避免在任何时间意外或无意启动。拨动开关30可以方便地由手指操作以控制传输至超声组件16和/或超声组件16的功率。例如，食指可用于启动第一接触部分30a以将超声组件16接通到最大(MAX)功率电平。食指可用于启动第二接触部分30b以将超声组件16接通到最小(MIN)功率电平。在另一个实施例中，摇臂开关可使器械10在标准设置和特殊设置之间枢转。特殊设置可允许由器械10执行一个或多个特殊程序。使用者无需观察第一突出旋钮30a或第二突出旋钮30b便可以操作拨动开关30。例如，第一突出旋钮30a或第二突出旋钮30b可以包括纹理或突出，因而无需观察便可以触觉方式区分第一突出旋钮30a和第二突出旋钮30b。
在一个示例性实施例中，远侧旋转组件13可绕纵向轴线“T”在任一方向上不受限制地旋转。远侧旋转组件13机械地接合到细长轴组件14。远侧旋转组件13位于柄部组件12的远侧端部上。远侧旋转组件13包括圆柱形毂46和在毂46的上方形成的旋钮48。毂46机械地接合细长轴组件14。旋钮48可包括带凹槽的聚合物特征结构，并可以用手指(例如，食指)接合以旋转细长轴组件14。毂46可以包括在主结构的上方模塑的用于形成旋钮48的材料。旋钮48可在毂46上方重叠注塑。毂46包括在远侧端部暴露的端盖部分46a。在腹腔镜式手术期间，毂46的端盖部分46a可以接触套管针的表面。毂46可以由硬质耐用塑料诸如聚碳酸酯形成，用于缓解端盖部分46a和套管针之间可能出现的任何摩擦。旋钮48可以包括由突肋48a形成的“扇形凹口”或凹槽以及位于肋48a之间的凹面部分48b，从而得到更加精确的旋转握持。在一个示例性实施例中，旋钮48可以包括多个凹槽(例如，三个或更多个凹槽)。在其他实施例中，可以采用任何合适数量的凹槽。旋钮48可以由在硬质塑性材料上重叠注塑的较软聚合材料形成。例如，旋钮48可以由柔韧的、有弹性的、柔性的聚合材料(包括例如GLS公司制造的TPE合金)形成。这种较软的重叠注塑材料可以提供更好的握持，以及对旋钮48的移动的更加精确的控制。应当理解，任何充分地耐受灭菌处理、具有生物相容性且对外科手套提供足够摩擦阻力的材料都可以用于形成旋钮48。
在一个示例性实施例中，柄部组件12由包括第一部分12a和第二部分12b的两(2)个外壳部分或护罩形成。从使用者的角度由远侧端部朝近侧端部观察柄部组件12，第一部分12a被视为右侧部分，第二部分12b被视为左侧部分。第一部分12a和第二部分12b中的每一个包括多个接合部69(图5)，接合部的尺寸被设计为彼此机械地对准并接合以形成柄部组件12并且封闭其内部工作部件。与柄部组件12整体地相关联的固定柄部34在组装柄部组件12的第一部分12a和第二部分12b后成形。可以在柄部组件12的第一部分12a和第二部分12b的周边周围的多个点处设置多个附加的接合部(未示出)，例如能量方向点/挠曲点，以用于超声焊接的目的。可以按本领域已知的任何方式将第一部分12a和第二部分12b(以及下文所述的其他部件)组装在一起。例如，定位销、按扣型接合部、舌状物接合部和沟槽接合部、锁定接片、粘结口可以单独或组合方式用于组装目的。
在一个示例性实施例中，细长轴组件14包括适于机械地接合柄部组件12和远侧旋转组件13的近侧端部50；以及适于机械地接合端部执行器组件26的远侧端部52。细长轴组件14包括外部管状护套56和位于外部管状护套56内的往复式管状致动构件58。管状往复式管状致动构件58的近侧端部机械地接合到柄部组件12的触发器32，以响应于触发器32的致动和/或释放而以方向60A或60B运动。可以枢转方式运动的触发器32可以生成沿着纵向轴线“T”的往复式运动。这种运动可用于例如致动端部执行器组件26的钳口或夹紧机构。一系列连杆将触发器32的枢转旋转转化成联接到致动机构的轭的轴向运动，该轴向运动控制端部执行器组件26的夹紧机构的钳口的打开和闭合。管状往复式管状致动构件58的远侧端部机械地接合到端部执行器组件26。在该例示的实施例中，管状往复式管状致动构件58的远侧端部机械地接合到可绕枢转点70枢转的夹持臂组件64，以响应于触发器32的致动和/或释放而打开和闭合夹持臂组件64。例如，在该例示的实施例中，当沿方向33A挤压触发器32时，夹持臂组件64可绕枢转点70沿方向62A从打开位置运动到闭合位置。当沿方向33B释放触发器32或使其向外接触时，夹持臂组件64可绕枢转点70沿方向62B从闭合位置运动到打开位置。
在一个示例性实施例中，端部执行器组件26附接在细长轴组件14的远侧端部52处，并且包括夹持臂组件64和刀66。端部执行器组件26的夹紧机构的钳口由夹持臂组件64和刀66形成。刀66可超声致动并在声学上联接至超声换能器16。柄部组件12上的触发器32最终连接至驱动组件，它们一起机械地配合以实现夹持臂组件64的运动。沿方向33A挤压触发器32使夹持臂组件64沿方向62A从打开位置运动到夹持或闭合位置，在打开位置，夹持臂组件64和刀66相对于彼此间隔设置，在夹持或闭合位置，夹持臂组件64和刀66配合以夹持其间的组织。夹持臂组件64可以包括夹持垫69以接合刀66和夹持臂64之间的组织。沿方向33B释放触发器32使夹持臂组件64沿方向62B从闭合关系运动到打开位置，在打开位置，夹持臂组件64和刀66相对于彼此间隔设置。
柄部组件12的近侧部分包括近侧开口68，用于接收超声组件16的远侧端部。超声组件16插入近侧开口68并且机械地接合到细长轴组件14。
在一个示例性实施例中，触发器32的细长触发器钩36部分提供较长的触发器杠杆以及较短的跨度和旋转行程。细长触发器钩36的较长杠杆允许使用者在孔38内使用多根手指来操作细长触发器钩36，并且使触发器32沿方向33B枢转以打开端部执行器组件26的钳口。例如，使用者可以将三根手指(例如，中指、无名指和小指)插入孔38中。多根手指使得外科医生可在触发器32和细长触发器钩326上施加较大的输入力来启动端部执行器组件26。当沿方向33A闭合或挤压触发器32或沿方向33B通过向外开启运动开启触发器32时，较短的跨度和旋转行程产生更舒适的握持，从而减少进一步向外伸出手指的需求。这将显著减轻与触发器32沿方向33B的向外开启运动相关联的手部疲劳和紧张。触发器的向外开启运动可以由弹簧元件98(图5)弹簧协助以有助于缓解疲劳。开启弹簧力足以协助轻易地开启，但不足以在展开解剖期间对组织张力的触觉反馈造成不利影响。
例如，在外科手术期间，任意食指可用于控制细长轴组件14的旋转，以使端部执行器组件26的钳口沿合适的取向定位。中指和/或其他较短手指可用于挤压触发器32和抓握钳口内的组织。一旦钳口位于所需位置并且钳口夹持住组织，食指就可用于启动拨动开关30，从而调整超声换能器16的用于处理组织的功率电平。一旦已经处理了组织，使用者就可以使用中指和/或较短手指抵靠细长触发器钩36沿远侧方向向外推动来释放触发器32，从而打开端部执行器组件26的钳口。使用者不必调整其对柄部组件12的握持即可执行此基本过程。
图3-图4示出细长轴组件14相对于端部执行器组件26的连接。如前所述，在该例示的实施例中，端部执行器组件26包括夹持臂组件64和刀66以形成夹紧机构的钳口。刀66可以是在声学上联接至超声换能器16的可超声致动的刀。触发器32机械地连接至驱动组件。触发器32和驱动组件共同机械地配合以使夹持臂组件64沿方向62A运动到打开位置，在该位置夹持臂组件64和刀66相对于彼此间隔设置，并且使夹持臂组件64沿方向62B运动到夹持或闭合位置，在该位置夹持臂组件64和刀66配合以夹持其间的组织。夹持臂组件64可以包括夹持垫69以接合刀66和夹持臂64之间的组织。管状往复式管状致动构件58的远侧端部机械地接合到端部执行器组件26。在该例示的实施例中，管状往复式管状致动构件58的远侧端部机械地接合到可绕枢转点70枢转的夹持臂组件64，以响应于触发器32的致动和/或释放而打开和闭合夹持臂组件64。例如，在该例示的实施例中，当沿方向33A挤压触发器32时，夹持臂组件64可绕枢转点70沿方向62B从打开位置运动到闭合位置。当沿方向33B释放触发器32或使其向外接触时，夹持臂组件64可绕枢转点70沿方向62A从闭合位置运动到打开位置。
如此前所论述，夹持臂组件64可包括电耦合至电外科/射频发生器模块23以接收治疗和/或亚治疗能量的电极，其中电外科/射频能量可在或不在超声能量施加至刀66的同时被施加到电极。此类能量激活可以任何合适的组合施加，以便与算法或其他控制逻辑相配合而实现所需的组织效应。
图5为图2所示超声外科器械10的分解图。在该例示的实施例中，分解图显示了柄部组件12的内部元件、柄部组件12、远侧旋转组件13、开关组件28和细长轴组件14。在该例示的实施例中，第一部分12a和第二部分12b配合形成柄部组件12。第一部分12a和第二部分12b各自包括多个接合部69，接合部的尺寸被设计为彼此机械地对准并接合以形成柄部组件12并且封闭超声外科器械10的内部工作部件。旋钮48机械地接合到外部管状护套56，使得其可以沿圆形方向54旋转最多360°。外部管状护套56位于往复式管状致动构件58之上，该往复式管状致动构件经由多个联接元件72机械地接合到柄部组件12并保留在其中。联接元件72可包括O形环72a、管套环帽72b、远侧垫圈72c、近侧垫圈72d和螺纹管套环72e。往复式管状致动构件58位于往复式轭84内，该往复式轭保留在柄部组件12的第一部分12a和第二部分12b之间。轭84是往复式轭组件88的一部分。一系列连杆将细长触发器钩32的枢转旋转转化成往复式轭84的轴向运动，该轴向运动控制超声外科器械10远侧端部处的端部执行器组件26的夹紧机构的钳口的打开和闭合。在一个示例性实施例中，四连接件设计提供例如在相对短的旋转跨度方面的机械优势。
在一个示例性实施例中，超声传输波导78设置在往复式管状致动构件58的内部。超声传输波导78的远侧端部52在声学上联接(例如，直接或间接机械联接)至刀66，并且超声传输波导78的近侧端部50接收在柄部组件12内。超声传输波导78的近侧端部50适于在声学上联接至超声换能器16的远侧端部，如下文更详细地讨论。超声传输波导78通过保护护套80和多个隔离元件82(诸如硅氧烷环)与细长轴组件14的其他元件隔离。外部管状护套56、往复式管状致动构件58和超声传输波导78通过销74机械地接合。开关组件28包括拨动开关30和电元件86a、86b，用于根据第一突出旋钮30a或第二突出旋钮30b的启动来以电方式为超声换能器16供能。
在一个示例性实施例中，外部管状护套56将使用者或患者与超声传输波导78的超声振动隔离。外部管状护套56通常包括毂76。外部管状护套56通过螺纹连接到柄部组件12的远侧端部上。超声传输波导78延伸穿过外部管状护套56的开口，而隔离元件82将超声传输波导24与外部管状护套56隔离。外部管状护套56可使用销74附接到波导78。波导78中用于接收销74的孔穴可以标称地出现在位移波节处。波导78可通过螺柱螺纹连接或卡合到手持式柄部组件12中。毂76上的平坦部分可以允许组件扭转至所需的程度。在一个示例性实施例中，外部管状护套56的毂76部分优选地由塑料构造，并且外部管状护套56的管状细长部分由不锈钢制成。作为另外一种选择，超声传输波导78可以包括围绕在其周围的聚合材料，以隔离其与外部接触。
在一个示例性实施例中，超声传输波导78的远侧端部可以通过内部螺纹连接而联接到刀66的近侧端部，优选地位于或靠近波腹。据设想，刀66可通过诸如焊接接头等任何合适的手段附接到超声传输波导78。虽然刀66可以与超声传输波导78分离，但另据设想，单元件端部执行器(例如，刀66)和超声传输波导78可形成为单个一体件。
在一个示例性实施例中，触发器32联接到连杆机构以将触发器32沿方向33A和33B的旋转运动转化为往复式管状致动构件58沿相应方向60A和60B的线性运动。触发器32包括其中形成有开口以接收第一轭销92a的第一组凸缘98。第一轭销92a还定位成穿过在轭84的远侧端部处形成的一组开口。触发器32还包括用于接收连接件92的第一端部92a的第二组凸缘96。触发器销90接收在形成于连接件92和第二组凸缘96中的开口中。触发器销90接收在形成于连接件92和第二组凸缘96中的开口中，并适于联接到柄部组件12的第一部分12a和第二部分12b以形成触发器32的触发器枢转点。连接件92的第二端部92b接收在形成于轭84的近侧端部中的狭槽384中，并通过第二轭销94b保留在其中。随着触发器32绕由触发器销90形成的枢转点190以枢转方式旋转，轭在箭头60A、B指示的方向上沿着纵向轴线“T”水平平移。
图8示出超声外科器械10的一个示例性实施例。在该例示的实施例中，在柄部组件12的局部剖面图内显示了超声换能器16的剖视图。超声外科器械10的一个示例性实施例包括：联接到超声换能器16的超声信号发生器20，该超声换能器16包括手持式外壳99；以及可超声致动的单元件或多元件端部执行器组件26。如此前所论述，端部执行器组件26包括可超声致动的刀66和夹持臂64。超声换能器16(被称为“Langevin叠堆件”)通常包括换能部分100、第一共振器部分或端罩102、第二共振器部分或前罩104、以及辅助部件。这些部件的总体构造为共振器。超声换能器16的长度优选地为整数个系统半波长(nλ/2；其中“n”为任何正整数；例如，n＝1、2、3…)，如下文将更详细地描述。声学组件106包括超声换能器16、鼻部锥108、速度变换器118和表面110。
在一个示例性实施例中，端罩102的远侧端部连接至换能部分100的近侧端部，而前罩104的近侧端部连接至换能部分100的远侧端部。前罩104和端罩102的长度由多个变量确定，这些变量包括换能部分100的厚度、用于制造端罩102和前罩22的材料的密度和弹性模量、以及超声换能器16的共振频率。前罩104可以与速度变换器118一样，从其近侧端部到其远侧端部向内成锥形以放大超声振动振幅，也可以不具有放大作用。合适的振动频率范围可以为约20Hz至32Hz，并且最合适的振动频率范围可以为约30-10kHz。例如，合适的工作振动频率可以为大约55.5kHz。
在一个示例性实施例中，压电元件112可由诸如锆钛酸铅、间铌酸铅、钛酸铅、钛酸钡或其他压电陶瓷材料等任何合适的材料制成。正电极114、负电极116和压电元件112中的每一个都具有延伸穿过中心的镗孔。正电极114和负电极116分别电耦合至电线120和122。电线120和122封闭在缆线22内，并且可电连接到超声信号发生器20。
声学组件106的超声换能器16将来自超声信号发生器20的电信号转化为机械能，该机械能主要致使超声换能器16以及端部执行器组件26的刀66部分出现以超声频率纵向振动运动的声学驻波。在另一个实施例中，超声换能器的振动运动可以在不同的方向起作用。例如，振动运动可包括细长轴组件14的尖端的更复杂运动的局部纵向分量。合适的发生器为得自Ethicon Endo-Surgery,Inc.(Cincinnati,Ohio)的GEN11型发生器。当声学组件106被供能时，振动运动驻波通过声学组件106生成。超声外科器械10被设计为在共振下工作，使得产生预定振幅的声学驻波图案。沿着声学组件106的任何点处的振动运动振幅取决于用于沿着声学组件106测量振动运动的位置。振动运动驻波的最小或零交点通常称为波节(即，纵向运动最小的位置)，驻波的局部最大绝对值或峰值通常称为波腹(例如，局部运动最大的位置)。波腹和距其最近的波节之间的距离为四分之一波长(λ/4)。
线材120和122将电信号从超声信号发生器20传输到正电极114和负电极116。由超声信号发生器20响应于致动器224(诸如脚踏开关)而提供的电信号激励压电元件112，从而在声学组件106中产生声学驻波。电信号在压电元件112中产生反复小位移形式的扰动，致使材料内出现较大的交替压缩力和张力。反复的小位移使压电元件112沿电压梯度的轴线以连续方式伸展和收缩，从而生成超声能量的纵波。通过细长轴组件14的传输部件或超声传输波导部分78将超声能量通过声学组件106传输至端部执行器组件26的刀66部分。
在一个示例性实施例中，为了使声学组件106能够向端部执行器组件26的刀66部分递送能量，声学组件106的所有部件必须在声学上联接至刀66。超声换能器16的远侧端部可以在表面110处通过螺纹连接(诸如螺柱124)在声学上联接至超声传输波导78的近侧端部。
在一个示例性实施例中，优选地对声学组件106的部件进行声学调谐，使得任何组件的长度均为整数个半波长(nλ/2)，其中波长λ是声学组件106的预选或操作的纵向振动驱动频率fd的波长。另据设想，声学组件106可以包括任何合适的声学元件布置方式。
在一个示例性实施例中，刀66的长度可基本上等于系统半波长的整数倍(nλ/2)。刀66的远侧端部可设置在波腹附近，以便提供远侧端部的最大纵向偏移。当换能器组件被供能时，刀66的远侧端部能够以例如55kHz的预定振动频率在例如大约10至500微米峰到峰的范围内移动，并且优选地在约30至64微米的范围内移动。
在一个示例性实施例中，刀66可联接到超声传输波导78。所示的刀66和超声传输波导78由适于传输超声能量的材料形成为单个单元构造。此类材料的示例包括Ti6Al4V(含有铝和钒的钛合金)、铝、不锈钢、或其他合适的材料。作为另外一种选择，刀66可以与超声传输波导78分开(并且由不同的组合物制成)，并且通过例如螺柱、焊接、胶水、快速连接或其他合适的已知方法联接这两个部件。超声传输波导78的长度可基本上等于例如整数个半波长(nλ/2)。超声传输波导78可以优选地由使用适合高效传播超声能量的材料(诸如上述钛合金(即，Ti6Al4V)、或任何合适的铝合金、或其他合金)构造的实芯轴制成。
在一个示例性实施例中，超声传输波导78包括在近侧端部处的纵向突出的附接柱，用于通过诸如螺柱124的螺纹连接而联接到超声传输波导78的表面110。超声传输波导78可包括定位在多个波节处的多个起稳定作用的硅氧烷环或适形支撑件82(图5)。硅氧烷环82抑制不可取的振动并将超声能量与外部保护护套80(图5)隔离，以确保纵向的超声能量流以最大的效率到达刀66的远侧端部。
图9示出近侧旋转组件128的一个示例性实施例。在该例示的实施例中，近侧旋转组件128包括插在圆柱形毂135上的近侧旋钮134。近侧旋钮134包括多个径向突出138，这些突出被接收在形成于圆柱形毂135的近侧端部上的相应狭槽130中。近侧旋钮134限定用于接收超声换能器16的远侧端部的开口142。径向突出138由柔软的聚合材料形成，并且限定了尺寸比超声换能器16的外径相对较小的直径，以便在超声换能器16的远侧端部时形成摩擦过盈配合。聚合物径向突出138沿径向突起到开口142中，以形成牢牢地抓住超声换能器16的外壳的“抓具”肋。因此，近侧旋钮134牢固地抓住超声换能器16。
圆柱形毂135的远侧端部包括周边唇缘132和周边支承表面140。周边唇缘与形成于外壳12中的沟槽接合，周边支承表面140则与外壳12接合。这样，圆柱形毂135便机械地保留在外壳12的两个外壳部分(未示出)内。圆柱形毂135的周边唇缘132位于或“被捕获”在第一外壳部分12a和第二外壳部分12b之间，并且可在沟槽内适当地自由旋转。周边支承表面140倚靠着外壳的内部，以协助正确的旋转。这样，圆柱形毂135便可在外壳内适当地自由旋转。使用者利用其手指或拇指接合在近侧旋钮134上形成的凹槽136，以旋转外壳12内的圆柱形毂135。
在一个示例性实施例中，圆柱形毂135可以由耐用塑料诸如聚碳酸酯形成。在一个示例性实施例中，圆柱形毂135可以由硅化聚碳酸酯材料形成。在一个示例性实施例中，近侧旋钮134可以由柔韧的、有弹性的、柔性的聚合材料(包括例如GLS公司制造的TPE合金)形成。例如，近侧旋钮134可以由弹性体材料、被称为的热塑性橡胶、其他热塑性硫化橡胶(TPV)、或弹性体形成。然而，实施例并不限于此背景中。
图10示出了包括外科器械210的外科系统200的一个示例性实施例，该外科器械210具有单元件端部执行器278。系统200可包括联接到端部执行器278的换能器组件216，以及围绕如图所示的端部执行器278的近侧部分定位的护套256。换能器组件216和端部执行器278可以与上述换能器组件16和端部执行器18相似的方式操作，从而产生可通过刀226'传输至组织的超声能量。
多年以来，已经开发出多种微创机器人(或“远距离外科手术”)系统以增加外科手术的灵活性，并允许外科医生以直观的方式对患者进行手术。机器人外科系统可以与许多不同类型的外科器械一起使用，这些外科器械包括例如超声器械，如本文所述。示例性机器人系统包括由Intuitive Surgical,Inc.(Sunnyvale,California,U.S.A)制造的那些。此类系统以及得自其他制造商的机器人系统在以下美国专利中进行了公开，这些美国专利各自全文以引用方式并入本文：名称为“Articulated Surgical Instrument ForPerforming Minimally Invasive Surgery With Enhanced Dexterity andSensitivity”的美国专利5,792,135、名称为“Robotic Arm DLUs For PerformingSurgical Tasks”的美国专利6,231,565、名称为“Robotic Surgical Tool WithUltrasound Cauterizing and Cutting Instrument”的美国专利6,783,524、名称为“Alignment of Master and Slave In a Minimally Invasive Surgical Apparatus”的美国专利6,364,888、名称为“Mechanical Actuator Interface System For RoboticSurgical Tools”的美国专利7,524,320、名称为“Platform Link Wrist Mechanism”的美国专利7,691,098、名称为“Repositioning and Reorientation of Master/SlaveRelationship in Minimally Invasive Telesurgery”的美国专利7,806,891，以及名称为“Surgical Tool With Wristed Monopolar Electrosurgical End Effectors”的美国专利7,824,401。然而，许多此类系统在过去尚未能生成有效切割和紧固组织所需量级的力。
图11-图26示出机器人外科系统的示例性实施例。在一些实施例中，所公开的机器人外科系统可以利用本文所述的超声或电外科器械。本领域的技术人员将会知道，所示的机器人外科系统不仅仅限于本文所述的那些器械，而是可以利用任何兼容的外科器械。本领域的技术人员还将认识到，虽然本文所述的各种实施例可以与所述的机器人外科系统一起使用，但是公开内容并不如此受到限制，而是可以与任何兼容的机器人外科系统一起使用。
图11-图16示出若干示例性机器人外科系统及其部件的结构和操作。图11示出示例性机器人外科系统1000的框图。系统1000包括至少一个控制器508和至少一个臂车510。臂车510可机械地联接到一个或多个由方框512指示的机器人操纵器或机器人臂。机器人臂512中的每一个可以包括一个或多个外科器械514，用于对患者504执行各种手术任务。臂车510(包括臂512和器械514)的操作可由临床医生502从控制器508进行指挥。在一些实施例中，由第二临床医生502'操作的第二控制器508'也可与第一临床医生502'协力指挥臂车510的操作。例如，临床医生502、502'中的每一位可以控制臂车的不同臂512，或在一些情况下，可在临床医生502、502'之间传递对臂车510的完全控制。在一些实施例中，可将另外的臂车(未示出)用于患者504。这些另外的臂车可由控制器508、508'中的一个或多个控制。臂车510和控制器508、508'可经由通信链路516彼此通信，该通信链路可以是根据任何合适的通信协议传递任何合适类型的信号(例如，电信号、光信号、红外信号等)的任何合适类型的有线或无线通信链路。机器人外科系统(诸如系统1000)的示例性具体实施在已经以引用方式并入本文的美国专利7,524,320中有所公开。因而，本文将不详细描述此类装置的各个细节，除了理解受权利要求书保护的装置的各种实施例可能必需的细节外。
图12示出机械臂车520的一个示例性实施例。机械臂车520能够致动多个外科器械或器械，它们在工作包封空间519内一般被指定为522。名称为“Multi-ComponentTelepresence System and Method”的美国专利6,132,368中公开了使用主控制器和机械臂车布置的各种机器人外科手术系统和方法，该专利的全部公开内容以引用方式并入本文。在各种形式中，机械臂车520包括基座524，在该例示的实施例中，该基座支撑有三个外科器械522。在各种形式中，外科器械522各自由一系列可在手动操作下进行关节运动的连杆(一般称为装置接头526)和机器人操纵器528支撑。本文示出的这些结构具有在机器人连杆的大部分之上延伸的护盖。这些护盖可以是任选的，并且可在尺寸上有所限制或在一些实施例中完全消除，以使用于操纵此类装置的伺服机构遇到的惯性最小化、限制移动部件的体积以避免碰撞、并且限制车520的总重量。车520将通常具有适于在手术室之间搬运车520的尺寸。车520能够通常适于穿过标准的手术室门并放置到标准的医院电梯上。在各种形式中，车520将优选地具有一定的重量并包括轮(或其他运输)系统，该轮系统使得车520可被单个维护人员定位在邻近手术台的位置。
图13示出机械臂车520的机器人操纵器528的一个示例性实施例。在图13所示的例子中，机器人操纵器528可包括约束外科器械522的运动的连杆530。在各种实施例中，连杆530包括由旋转接头以平行四边形布置方式联接在一起的刚性连接件，使得外科器械522围绕空间532中的某一点旋转，如在已公布的美国专利5,817,084中更完整地描述，该专利的全部公开内容以引用方式并入本文。平行四边形布置方式将旋转约束为围绕轴线534a(有时称为俯仰轴)枢转。支撑平行四边形连杆的连接件以枢转方式安装到装置接头526(图12)，使得外科器械522还围绕轴线534b(有时称为偏航轴)旋转。俯仰轴534a和偏航轴534b在远程中心536处相交，该远程中心沿着外科器械522的轴538对齐。当由操纵器540支撑时，外科器械522可具有另外的从动自由度，包括外科器械522沿着纵向器械轴线“LT-LT”的滑动运动。当外科器械522沿着器械轴线LT-LT相对于操纵器540滑动时(箭头534c)，远程中心536相对于操纵器540的基座542保持固定。因此，整个操纵器540通常发生运动从而重新定位远程中心536。操纵器540的连杆530由一系列马达544驱动。这些马达544响应于控制系统处理器的命令而主动使连杆530运动。如将在下文中进一步详细论述，马达544还用于操纵外科器械522。
图14示出具有另选的装置接头结构的机械臂车520'的一个示例性实施例。在该示例性实施例中，外科器械522由位于两个组织操纵器械之间的另选的操纵器结构528'支撑。本领域的普通技术人员将会知道，受权利要求书保护的装置的各种实施例可以包括多种另选的机器人结构，包括在美国专利5,878,193中描述的那些结构，该专利的全部公开内容以引用方式并入本文。另外，虽然本文结合外科器械522和控制器之间的通信初步描述了机器人部件和机器人外科系统的处理器之间的数据通信，但应当理解，类似的通信可发生在操纵器、装置接头、内窥镜或其他图像捕获装置等的电路和机器人外科系统的处理器之间，所述机器人外科系统的处理器用于部件兼容性核实、部件类型识别、部件校准(诸如偏移等)通信、部件与机器人外科系统的联接确认等。
图15示出控制器518的一个示例性实施例，该控制器可以与机械臂车诸如在图12-图14中描绘的机械臂车520、520'结合使用。控制器518通常包括主控制器(在图15中一般表示为519)，在临床医生通过立体显示器521观察手术的同时，该主控制器由临床医生抓持并在空间中操纵。外科医生反馈计515可通过显示器521而被观察并为外科医生提供正施加于切割器械或动态夹紧构件的力的大小的视觉指示。主控制器519通常包括手动输入装置，该手动输入装置优选地以多个自由度移动并且通常还具有用于致动器械(例如，用于闭合抓持锯、施加电势到电极等)的柄部或触发器。
图16示出适于与机器人外科系统一起使用的超声外科器械522的一个示例性实施例。例如，外科器械522可以联接到上文所述的外科操纵器528、528'中的一个。如在图16中可以看出，外科器械522包括外科端部执行器548，该外科端部执行器包括超声刀550和夹持臂552，该外科端部执行器可联接到细长轴组件554，在一些实施例中，该细长轴组件可包括关节运动接头556。图17示出器械驱动组件546的一个示例性实施例，该器械驱动组件可联接到外科操纵器528、528'中的一个，用于接收和控制外科器械522。器械驱动组件546还可以可操作地联接到控制器518，用于接收临床医生的输入而对器械522进行控制。例如，夹持臂552的致动(例如，打开和闭合)、钳口551A、551B的致动(例如，打开和闭合)、超声刀550的致动、刀555的延伸以及能量递送表面553A、553B的致动等可通过器械驱动组件546基于由临床医生通过控制器518提供的输入而加以控制。外科器械522通过器械安装部分(一般称为558)可操作地联接到操纵器。外科器械522还包括以机械方式和电电方式将器械安装部分558联接到操纵器的接合部560。
图18示出包括超声外科器械522的图17的器械驱动组件的另一个视图。器械安装部分558包括器械安装板562，该器械安装板可操作地支撑多个(图17中示出了四个)可旋转主体部分、从动盘或从动元件564，所述每个从动盘或从动元件各自包括从从动元件564的表面延伸的一对销566。一个销566比同一个从动元件564上的另一个销566更靠近每个从动元件564的旋转轴线，这有助于确保从动元件564的正向角对准。从动元件564和销566可定位在器械安装板562的适配器侧567上。
接合部560还包括能够与安装板562以安装方式接合的适配器部分568，如将在下文中进一步论述。适配器部分568可包括一系列电连接销570，这些电连接销可通过器械安装部分558内的电路板而联接到存储器结构。虽然参考机械联接元件、电耦合元件和磁力耦合元件在本文中描述了接合部560，但是应当理解，可以使用多种遥测形式，包括红外、电感耦合等。
图19-图21示出图17的器械驱动组件546的适配器部分568的附加视图。适配器部分568通常包括器械侧572和保持器侧574(图19)。在各种实施例中，将多个可旋转主体576安装到浮动板578，该浮动板相对于垂直于适配器568主表面的周围适配器结构具有受限的运动范围。当致动沿着器械安装部分外壳582的侧面的杠杆580时(参见图16)，浮动板578的轴向运动有助于使可旋转主体576从器械安装部分558脱离。可采用其他机构/布置以可释放的方式将器械安装部分558联接到适配器568。在至少一种形式中，通过弹性径向构件将可旋转主体576弹性地安装到浮动板578，该弹性径向构件围绕可旋转主体576延伸到周边凹痕中。可旋转主体576可通过这些弹性结构的挠曲而相对于板578轴向运动。当设置在第一轴向位置(朝器械侧572)时，可旋转主体576自由旋转而没有角度限制。然而，当可旋转主体576朝器械侧572轴向运动时，突出部584(从可旋转主体576径向延伸)横向接合浮动板上的棘爪以便限制可旋转主体576围绕其轴线的角旋转。当驱动销586将可旋转主体576推动至受限的旋转位置直到销586与开口590对准(并滑动到其中)时，可使用该受限的旋转来帮助可旋转主体576与机器人系统的对应器械保持器部分588的驱动销586驱动接合。
可旋转主体576的器械侧572上的开口590以及保持器侧574上的开口590能够将器械安装部分558的从动元件564(图18、图28)与器械保持器588的驱动元件592准确对准。如上文关于从动元件564的内部和外部销566所述，开口590位于相距其各自的可旋转主体576的旋转轴线不同的距离处，以便确保与之要达到的位置不呈33度对准。另外，每个开口590可能略微径向伸长，以便适当地接收周边方向上的销566。这允许销566在开口590内径向滑动并适应器械522和器械保持器588之间的一些轴偏差，同时使驱动元件和从动元件之间的任何角偏差和角侧隙最小化。器械侧572上的开口590可与保持器侧574上的开口590(以虚线示出)成约90度的偏置，如在图21中可以最清楚地看到。
各种实施例还可以包括位于适配器568的保持器侧574上的一系列电连接销570，并且适配器568的器械侧572可包括狭槽594(图21)，用于接收器械安装部分558的销阵列(未示出)。除了在外科器械522、523和器械保持器588之间传输电信号外，可通过适配器568的电路板将这些电连接件中的至少一些联接到适配器存储器装置596(图20)。
可使用可拆卸的闩锁布置598以可释放的方式将适配器568附连到器械保持器588。如本文所用，术语“器械驱动组件”在用于机器人系统的背景中时至少涵盖适配器568和器械保持器588的各种实施例，并且其在图17中一般称为546。例如，如在图17中可以看出，器械保持器588可包括第一闩锁销布置600，该第一闩锁销布置的大小被设计成接收在适配器568中相应的连接叉狭槽602中。另外，器械保持器588还可以具有第二闩锁销604，该第二闩锁销的尺寸被设计成保持在适配器568中相应的闩锁连接叉606中。参见图20。在至少一种形式中，闩锁组件608被活动地支撑在适配器568上，并且能够在第一闩锁位置和未闩锁位置之间偏置，在第一闩锁位置中，闩锁销600保持在它们各自的闩锁连接叉606中，在未闩锁位置中，第二闩锁销604可进入闩锁连接叉606或从中移除。使用一个或多个弹簧(未示出)以将闩锁组件偏置到闩锁位置。适配器568的器械侧572上的唇缘可以可滑动地接收器械安装外壳582的横向延伸的突出部。
如前所述，从动元件564可与器械保持器588的驱动元件592对准，使得驱动元件592的旋转运动致使从动元件564的相应旋转运动。驱动元件592和从动元件564的旋转可(例如)响应于经由控制器508从临床医生502接收的指令而受到机械臂612的电子控制。器械安装部分558可将从动元件564的旋转转化成外科器械522、523的运动。
图22-图24示出器械安装部分558的一个示例性实施例，显示了用于将从动元件564的运动转化成外科器械522的运动的部件。图22-图24示出具有轴538的器械安装部分，该轴在其远侧端部处具有外科端部执行器610。端部执行器610可以是用于对患者执行外科任务的任何合适类型的端部执行器。例如，端部执行器能够向手术部位处的组织提供超声能量。轴538可旋转地联接到器械安装部分558并在轴538的联接器650处由顶部轴保持器646和底部轴保持器648固定。
在一个示例性实施例中，器械安装部分558包括将各种从动元件564的旋转转化成轴538的旋转、构件沿轴的轴线的差动平移(例如，用于进行关节运动)、以及一个或多个构件沿轴538的轴线的往复式平移(例如，用于延伸和缩回组织切割元件诸如555、外套管和/或其他部件)的机构。在一个示例性实施例中，可旋转主体612(例如，可旋转卷轴)联接到从动元件564。可旋转主体612可与从动元件564整体地形成。在一些实施例中，可旋转主体612可与从动元件564分别形成，前提是可旋转主体612和从动元件564固定地联接以使得驱动从动元件564将致使可旋转主体612旋转。可旋转主体612中的每个联接到齿轮系或齿轮机构，用于提供轴的关节运动和旋转、夹持钳口的打开/闭合、以及刀致动。
在一个示例性实施例中，器械安装部分558包括用于引起两个或更多个构件沿轴538的轴线发生差动平移的机构。在图22-图24提供的例子中，该运动用于操纵关节运动接头556。在该例示的实施例中，例如，器械安装部分558包括齿条和小齿轮传动机构以提供差动平移并因而提供轴关节运动功能。在一个示例性实施例中，齿条和小齿轮传动机构包括联接到可旋转主体612的第一小齿轮传动装置614，使得相应从动元件564的旋转致使第一小齿轮传动装置614旋转。轴承616联接到可旋转主体612并提供于从动元件564和第一小齿轮传动装置614之间。第一小齿轮传动装置614啮合到第一齿条传动装置618以将第一小齿轮传动装置614的旋转运动转化成第一齿条传动装置618的线性运动，从而控制轴组件538的关节运动段556沿向左方向620L的关节运动。第一齿条传动装置618附接到第一关节运动带622(图22)，使得第一齿条传动装置618沿远侧方向的线性运动致使轴组件538的关节运动段556沿向左方向620L进行关节运动。第二小齿轮传动装置626联接到另一个可旋转主体612，使得相应从动元件564的旋转致使第二小齿轮传动装置626旋转。轴承616联接到可旋转主体612并提供于从动元件564和第二小齿轮传动装置626之间。第二小齿轮传动装置626啮合到第二齿条传动装置628以将第二小齿轮传动装置626的旋转运动转化成第二齿条传动装置628的线性运动，从而控制关节运动段556沿向右方向620R的关节运动。第二齿条传动装置628附接到第二关节运动带624(图23)，使得第二齿条传动装置628沿远侧方向的线性运动致使轴组件538的关节运动段556沿向右方向620R进行关节运动。可以在可旋转主体与相应齿轮之间提供另外的轴承。可以提供任何合适的轴承以支撑和稳定安装，并且减小例如轴和齿轮的旋转摩擦。
在一个示例性实施例中，器械安装部分558还包括用于将从动元件564的旋转转化成围绕轴538的轴线的旋转运动的机构。例如，旋转运动可以是轴538自身的旋转。在该例示的实施例中，第一螺旋蜗轮630联接到可旋转主体612，第二螺旋蜗轮632联接到轴组件538。轴承616(图17)联接到可旋转主体612并提供于从动元件564与第一螺旋蜗轮630之间。第一螺旋蜗轮630啮合到第二螺旋蜗轮632，后者可联接到轴组件538和/或器械522、523的需要其纵向旋转的另一个部件。旋转可基于第一螺旋蜗轮630和第二螺旋蜗轮632的旋转方向而沿顺时针(CW)方向和逆时针(CCW)方向进行。因此，第一螺旋蜗轮630绕第一轴线的旋转被转换为第二螺旋蜗轮632绕第二轴线的旋转，第二轴线与第一轴线正交。如图22-图23所示，例如，第二螺旋蜗轮632的顺时针旋转致使轴组件538以634CW所指示的方向顺时针旋转。第二螺旋蜗轮632的逆时针旋转致使轴组件538以634CCW所指示的方向逆时针旋转。可以在可旋转主体与相应齿轮之间提供另外的轴承。可以提供任何合适的轴承以支撑和稳定安装，并且减小例如轴和齿轮的旋转摩擦。
在一个示例性实施例中，器械安装部分558包括用于生成一个或多个构件沿轴538的轴线的往复式平移的机构。这种平移可用于例如驱动组织切割元件诸如555、驱动外套管以使端部执行器610闭合以及/或者进行关节运动等。在该例示的实施例中，例如，齿条和小齿轮传动机构可提供往复式平移。第一齿轮636联接到可旋转主体612，使得相应从动元件564的旋转致使第一齿轮636以第一方向旋转。第二齿轮638围绕在器械安装板562中形成的柱640自由旋转。第一齿轮636啮合到第二齿轮638，使得第二齿轮638以与第一齿轮636相反的方向旋转。在一个示例性实施例中，第二齿轮638是啮合到沿线性方向移动的齿条传动装置642的小齿轮。齿条传动装置642联接到平移块644，该平移块可与齿条传动装置642一起朝远侧和近侧平移。平移块644可联接到轴组件538和/或端部执行器610的任何合适的部件以便提供往复式纵向运动。例如，平移块644可机械地联接到射频外科装置523的组织切割元件555。在一些实施例中，平移块644可以联接到外套管，或端部执行器610或轴538的另一个部件。
图25-图27示出器械安装部分558的另选实施例，显示了用于将从动元件564的旋转转化成围绕轴538的轴线的旋转运动的另选示例性机构，以及用于生成一个或多个构件沿轴538的轴线的往复式平移的另选示例性机构。现在参见另选旋转机构，第一螺旋蜗轮652联接到第二螺旋蜗轮654，后者联接到第三螺旋蜗轮656。可出于各种原因提供这样的布置，这些原因包括维持与现有机器人系统1000的兼容以及/或者实际情况是空间可能有限。第一螺旋蜗轮652联接到可旋转主体612。第三螺旋蜗轮656与联接到轴组件538的第四螺旋蜗轮658啮合。轴承760联接到可旋转主体612并提供于从动元件564与第一螺旋蜗轮738之间。另一个轴承760联接到可旋转主体612并提供于从动元件564与第三螺旋蜗轮652之间。第三螺旋蜗轮652啮合到第四螺旋蜗轮658，后者可联接到轴组件538和/或器械522的需要其纵向旋转的另一个部件。旋转可基于螺旋蜗轮656、658的旋转方向而沿顺时针方向和逆时针方向进行。因此，第三螺旋蜗轮656绕第一轴线的旋转被转换为第四螺旋蜗轮658绕第二轴线的旋转，第二轴线与第一轴线正交。如图26和图27所示，例如，第四螺旋蜗轮658联接到轴538，并且第四螺旋蜗轮658的顺时针旋转致使轴组件538以634CW所指示的方向顺时针旋转。第四螺旋蜗轮658的逆时针旋转致使轴组件538以634CCW所指示的方向逆时针旋转。可以在可旋转主体与相应齿轮之间提供另外的轴承。可以提供任何合适的轴承以支撑和稳定安装，并且减小例如轴和齿轮的旋转摩擦。
现在参见用于生成一个或多个构件沿轴538的轴线的往复式平移的另选示例性机构，器械安装部分558包括齿条与小齿轮传动机构以提供沿轴538的轴线的往复式平移(例如，射频外科装置523的组织切割元件555的平移)。在一个示例性实施例中，第三小齿轮传动装置660联接到可旋转主体612，使得相应从动元件564的旋转致使第三小齿轮传动装置660以第一方向旋转。第三小齿轮传动装置660啮合到沿线性方向移动的齿条传动装置662。齿条传动装置662联接到平移块664。平移块664可联接到装置522、523的部件，诸如，射频外科装置的组织切割元件555和/或外套管或期望其纵向平移的其他部件。
图28-图32示出器械安装部分558的另选实施例，显示了用于将从动元件564的旋转转化成围绕轴538的轴线的旋转运动的另一个另选示例性机构。在图28-图32中，轴538经由联接器676和轴衬678联接到安装部分558的其余部分。联接到可旋转主体612的第一齿轮666、包括第一和第二开口672的固定柱668、联接到轴组件的第一和第二可旋转销674、以及缆线670(或绳索)。缆线缠绕在可旋转主体612周围。缆线670的一个端部定位穿过固定柱668的顶部开口672并固定地联接到顶部可旋转销674。缆线670的另一个端部定位穿过固定柱668的底部开口672并固定地联接到底部旋转销674。出于各种原因提供这样的布置，这些原因包括维持与现有机器人系统1000的兼容以及/或者实际情况是空间可能有限。因此，可旋转主体612的旋转基于可旋转主体612的旋转方向致使围绕轴组件538以顺时针和逆时针方向旋转(例如，轴538自身的旋转)。因此，可旋转主体612绕第一轴线的旋转被转换为轴组件538绕第二轴线的旋转，第二轴线与第一轴线正交。如图28-图29所示，例如，可旋转主体612的顺时针旋转致使轴组件538以634CW所指示的方向顺时针旋转。可旋转主体612的逆时针旋转致使轴组件538以634CCW所指示的方向逆时针旋转。可以在可旋转主体与相应齿轮之间提供另外的轴承。可以提供任何合适的轴承以支撑和稳定安装，并且减小例如轴和齿轮的旋转摩擦。
图33-图36A示出器械安装部分558的另选实施例，显示了用于使构件沿轴538的轴线发生差动平移(例如，用于进行关节运动)的另选示例性机构。例如，如图33-图36A所示，器械安装部分558包括双凸轮机构680以提供轴关节运动功能。在一个示例性实施例中，双凸轮机构680包括第一凸轮部分680A和第二凸轮部分680B。第一从动件臂682和第二从动件臂684可枢转地联接到相应的枢转卷轴686。当联接到双凸轮机构680的可旋转主体612旋转时，第一凸轮部分680A作用于第一从动件臂682，而第二凸轮部分680B作用于第二从动件臂684。当凸轮机构680旋转时，从动件臂682、684绕枢转卷轴686枢转。第一从动件臂682可附接到待发生差动平移的第一构件(例如，第一关节运动带622)。第二从动件臂684可附接到待发生差动平移的第二构件(例如，第二关节运动带624)。当顶部凸轮部分680A作用于第一从动件臂682时，第一构件和第二构件发生差动平移。在第一构件和第二构件为相应的关节运动带622和624的示例性实施例中，轴组件538沿向左方向620L进行关节运动。当底部凸轮部分680B作用于第二从动件臂684时，轴组件538沿向右方向620R进行关节运动。在一些示例性实施例中，两个单独的轴衬688、690安装在相应的第一从动件臂682和第二从动件臂684之下，以允许轴在不影响第一从动件臂682和第二从动件臂684的关节运动位置的情况下旋转。对于关节运动动作，这些轴衬与第一从动件臂682和第二从动件臂684一起进行往复运动，而不影响钳口902的旋转位置。图36A示出轴衬688、690和双凸轮组件680，该双凸轮组件包括第一凸轮部分680B和第二凸轮部分680B，并且第一从动件臂682和第二从动件臂684被移除以提供更详细且更清楚的视图。
在各种实施例中，器械安装部分558可另外包括内部能量源，用于驱动电子器件并向外科工具提供所需的超声和/或射频频率信号。图36B-图36C示出包括内部功率源和能量源的工具安装部分558'的一个实施例。例如，利用工具安装部分558'安装的外科器械(例如，器械522)不需要用线材连接到外部发生器或其他功率源。相反，本文所述的发生器20的功能可在安装部分558上实施。
如图36B-图36C所示，器械安装部分558'可包括远侧部分702。远侧部分702可包括用于将驱动元件612的旋转联接到例如如上文所述的各种外科器械522的端部执行器的各种机构。在远侧部分702的近侧，器械安装部分558'包括内部直流(DC)能量源以及内部驱动和控制电路704。在该例示的实施例中，能量源包括第一电池706和第二电池708。在其他方面，工具安装部分558'与上文所述的工具安装部分558的各种实施例类似。控制电路704可以与上文关于发生器20所述相似的方式工作。例如，控制电路704可以与上文关于发生器20所述相似的方式提供超声和/或电外科驱动信号。
图37-图38示出包括定位在远侧的钳口组件1003的外科器械远侧部分1000的一个实施例。远侧部分1000还包括超声刀1014和沿着纵向轴线1002延伸的轴1004。联接到轴1004的远侧部分的连接叉1006以能够枢转的方式接收钳口组件1003。例如，钳口组件1003的腕构件1008可围绕第一轴线或腕枢转轴线1018以能够枢转的方式联接到连接叉1018。钳口组件1003围绕腕枢转轴线1018的枢转可致使钳口组件1003以箭头1022所指示的方向枢转。腕构件1008可利用任何合适的可枢转连接器或连接器组件联接到连接叉1006。例如，在一些实施例中，腕构件1008可使用销1011联接到连接叉1006，所述销可坐置在由连接叉1006限定的孔穴1013内。
第一钳口构件1010和第二钳口构件1012可以能够枢转的方式联接到腕构件1008并且能够围绕第二轴线或钳口枢转轴线1016枢转。钳口构件1010、1012围绕钳口枢转轴线1016的枢转可致使相应的钳口构件1010、1012以箭头1020所指示的方向枢转。钳口构件1010、1012可以围绕钳口枢转轴线1016相对于彼此且绝对地枢转。例如，钳口构件1010、1012可相对于彼此从打开位置枢转到闭合位置，在打开位置中，钳口构件1010、1012如图37所示彼此分开，在闭合位置中，钳口构件1010、1012基本上彼此平行(以及任选地彼此接触)。例如，可在钳口构件1010、1012处于或靠近闭合位置时，将组织夹持在所述钳口构件之间。在一些实施例中，钳口构件1010、1012中的一者或两者也可围绕钳口枢转轴线1016发生绝对枢转。这可允许钳口组件1003出现围绕轴线1016枢转的一般取向(图37中所示的从左到右取向)。
图39示出图37-图38的外科器械远侧部分1000的一个实施例的正面图。在图39中，示出了各种控制滑轮1026、1028、1030、1032，连同连接叉1006中的用于控制线穿过的开口1031、1032。各种控制线和控制滑轮的附加细节在下文提供。图39还示出了钳口构件1010、1012的附加细节。在图39所示的实施例中，例如，钳口构件1010、1012限定齿1024。在一些实施例中，当钳口构件1010、1012相对于彼此处于闭合位置时，齿1024互锁。然而，在其他实施例中，当钳口构件1010、1012相对于彼此处于闭合位置时，齿1024不互锁。
图40-图41示出图37-图38的外科器械远侧部分1000的一个实施例，其联接到与机器人外科系统(诸如上文所述的系统500)一起使用的器械安装部分1034。轴1004可联接到器械安装部分1034。器械安装部分1034可包含各种机构和接合部，用于(例如)致动超声刀1014、使钳口组件1003进行关节运动，以及在一些实施例中使超声刀1014缩回和延伸，如下文所述。
图42-图44示出图37-图38的外科器械远侧部分1000的一个实施例，显示了附加控制机构。钳口构件1010、1012中的每个可包括中心位于钳口枢转轴线1016上的相应滑轮1041、1043。滑轮1041、1043的旋转可致使相应钳口构件1010、1012的对应枢转。可利用控制线1038、1040、1048、1050引起滑轮1041、1043的旋转(以及钳口构件1010、1012的对应枢转)。例如，控制线1040可联接到滑轮1043以及/或者缠绕在滑轮1043周围，使得控制线1040的近侧平移致使钳口构件1012围绕钳口枢转轴线1016朝着控制线1040枢转(例如，自图42-图43中所示透视图的页面离开)。可利用也联接到滑轮1043以及/或者缠绕在滑轮1043周围的控制线1048来致动钳口构件1012沿相反方向的枢转(例如，进入图42-图43中所示透视图的页面)。控制线1048的近侧平移可致使钳口构件1012朝着控制线1048枢转。当控制线1048联接到滑轮1043时，其可以在与控制线1040联接到滑轮1043的位置基本上相对的位置处联接。另外，在一些实施例中，控制线1048、1040可以是缠绕在滑轮1043周围的单条缆线的相对的两端。
相似地，控制线1038可联接到滑轮1041以及/或者缠绕在滑轮1041周围，使得控制线1038的近侧平移致使钳口构件1010围绕钳口枢转轴线1016朝着控制线1038枢转(例如，再次自图42-图43中所示透视图的页面离开)。控制线1050也可联接到滑轮1041以及/或者缠绕在滑轮1041周围，使得控制线1050的近侧平移致使钳口构件1010围绕钳口枢转轴线朝着控制线1050枢转(例如，进入图42-图43中所示透视图的页面)。控制线1038、1050可以单独地联接到滑轮1041，或者在一些实施例中，可以代表缠绕在滑轮1041周围的单条缆线或另外的线的分开的两端。应当理解，当钳口组件1003围绕腕枢转轴线1018枢转时，控制线1038、1040、1048、1050相对于滑轮1041、1043的取向可以改变。
为了防止控制线变得张紧以及/或者与滑轮1041、1043脱离，可包括各种惰轮1026、1028、1036、1042、1046、1044、1030、1032(图39)以将控制线1038、1040、1048、1050引导至轴1004。另外，在一些实施例中，控制线经由连接叉1006中的孔穴被引导至轴1004。图39示出可分别被缆线1048、1050利用的示例性孔穴1031、1032。
也可以利用控制线来致动腕构件1008(因而钳口组件1003)的枢转。例如，参见图42和图44，可看到控制线1052在与腕枢转轴线1018偏置的位置处联接到腕构件1008。控制线1052的近侧平移可将钳口组件1003拉离超声刀1014，例如，从图42中所示的透视图向上并自图44中所示透视图的页面离开。类似的控制线1053可联接到腕构件1008的下部，使得控制线1053的近侧平移致使钳口组件1003朝着超声刀1014枢转(例如，从图42中所示的透视图向下并进入图44中所示透视图的页面)。在一些实施例中，控制线1052、1053可以是缠绕穿过且联接到腕构件1008的单条缆线或控制线的两端。另外，在一些实施例中，控制线1053可被省略。可通过控制构件1052的远侧平移来引起钳口组件1003朝着超声刀1014的枢转。
各种控制线1038、1040、1048、1050、1052、1053可朝近侧延伸穿过轴1004，在该情况下这些控制线可在机器人外科系统的柄部或器械安装部分(诸如本文所述的器械安装部分1034)处被致动。如上所述，控制线对(1038/1050、1040/1048、1052、1053)的差动平移可致使钳口组件1003的各种部件发生关节运动。可以(例如)如上所述的任何合适的手动和/或自动方式来引起控制线的差动平移。
图45A示出器械安装部分1034的一个实施例，显示了用于致动图37-图38的外科器械的各种控制线的示例性机构。各种控制线1038、1040、1048、1050、1052、1053可朝近侧延伸穿过轴1004并进入器械安装部分1034。各种控制线可通过引导器1056被引导至安装在上述可旋转主体上的各种卷轴1039、1041、1043。图45B示出引导器1056的一个实施例的侧视图。例如，图45B所示的引导器1056包括用于接收和引导各种控制线的多个沟槽1058。可(例如)基于能够引导的控制线的数量而在引导器1056中包括更多或更少的沟槽。
重新参见图45A，在一些实施例中，控制线1038和1050可被引导至卷轴1039。根据图示的构造，卷轴1039的顺时针旋转致使控制线1038的近侧平移和控制线1050的远侧平移。如上所述，这可致使钳口构件1010围绕钳口枢转轴线1016从图44的透视图向左枢转并自图42-图43的透视图的页面离开。卷轴1039的逆时针旋转致使控制线1038的远侧平移和控制线1050的近侧平移。再次如上所述，这可致使钳口构件1010围绕钳口枢转轴线1016从图44的透视图向右枢转并进入图42-图43的透视图的页面。控制线1040和1048可被引导至卷轴1040。卷轴1041的顺时针旋转和逆时针旋转可使控制线1040和1048发生差动平移，从而致使钳口构件1012类似于上述钳口构件1010围绕钳口枢转轴线1016枢转。控制线1052和1053可以类似地联接到卷轴1043，用于在卷轴1043顺时针旋转和逆时针旋转时控制钳口组件1003围绕腕枢转轴线1016的枢转。
根据各种实施例，图37-图38的外科器械可被实施为具有可回缩的超声刀1014。例如，超声刀1014可沿近侧方向回缩，使得其部分或完全地位于轴1004和/或连接叉1006内。这可增大钳口组件1003围绕腕枢转轴线1018的运动范围。图46-图47示出图37-图38的外科器械远侧部分1000的一个实施例，其具有可回缩的超声刀1014。现在参见图46，刀1014被示出为沿箭头1060所指示的近侧方向回缩在轴1004内。如可以看到的那样，这增大了钳口组件1003围绕腕枢转轴线1018枢转的运动范围。例如，如图46所示，钳口组件1003可以枢转到并经过其原本与超声刀1014接触的位置。这可以增大钳口组件1003能够夹持组织的范围。在使用时，当枢转到图46所示的位置时，钳口组件1003可以夹持组织。钳口组件1003随后可以枢转返回以及/或者超过图47所示的位置，使得刀1014可朝远侧延伸以便作用于被夹持的组织。
超声刀1014可以联接到超声波导1058，该超声波导可朝近侧延伸穿过轴1004到达超声换能器，诸如上述换能器16。在一些实施例中，可通过刀1014、波导1058和换能器组件的平移来引起超声刀1014的平移。图48示出图37-图38的外科器械远侧部分1000的一个实施例，其联接到机器人外科系统的能够伸展和回缩超声刀1014的器械安装部分1034。如图所示，波导1058自超声刀1014朝近侧延伸穿过轴1004到达器械安装部分，在此处其联接到位于器械安装部分1034内的超声换能器组件1064。齿条传动装置1062联接到波导1058并且可被定位成被联接到器械安装部分1034的旋转主体612中的一个的圆形齿轮接合。例如，图45示出联接到齿轮1047的齿条传动装置1062，齿轮1047继而联接到随旋转主体612旋转的齿轮1045。旋转主体612的交替旋转可致使相应齿轮1045、1047的旋转，相应齿轮1045、1047的该旋转可继而致使齿条传动装置1062的远侧平移和近侧平移。当齿条传动装置1062联接到波导1058时，齿条传动装置1062的远侧平移和近侧平移也可致使波导1058、刀1014和换能器1064的远侧平移和近侧平移。
在图48所示的实施例中，换能器1064定位在器械安装部分1034之内。柔性/可延伸的缆线1066可以联接到换能器1064并最终联接到外部缆线1067。当换能器随波导1058和刀1014朝远侧和朝近侧平移时，缆线1066可以交替地松弛和绷紧以便保持其到外部缆线1067的连接。图49示出图37-图38的外科器械远侧部分1000的另选实施例，其联接到机器人外科系统的具有外部换能器1070的器械安装部分。如图所示，换能器延伸超过器械安装部分1034。图49还示出联接到波导1058的轨道齿轮1062，其可以用于(与可旋转构件612之一结合)将波导1058、刀1014(图49中未示出)和换能器1070朝近侧和朝远侧平移。图50示出如图49所示的图37-图38的外科器械远侧部分1000的附加视图。
图51示出包括夹持垫1072的钳口组件1003的一个实施例。夹持垫1072可包括联接到腕构件1008和/或钳口构件1010、1012中的一者的至少一个面的一个或多个部件。例如，图51示出腕构件1008的朝向超声刀1014的面1074以及钳口构件1012的朝向超声刀1014的面1076。这些面中的一个或多个可联接到夹持垫1072。夹持垫1072可类似于本文所述的夹持臂组件64。例如，夹持垫1072能够与超声刀1014发生物理接触，而基本上不影响刀1014的操作。这样，临床医生便可利用钳口组件1003，采用与上文结合夹持臂组件64所述类似的方式将组织夹持到刀1014。
图52-图55示出包括钳口组件1100的外科器械远侧部分1101的一个实施例。远侧部分1101可另外包括轴部分1110、连接叉1102和超声刀1106。如上文所述，超声刀1106可以与超声波导(图52中未示出)机械连通，该超声波导可朝近侧延伸到换能器，诸如图1的换能器16。在一些实施例中，超声刀1106可以是可回缩的，如上文所述。
钳口组件1100可包括钳口构件1102和可与之相对的U形钳口构件1104。钳口构件1102、1104可以能够枢转的方式联接到连接叉1102，该连接叉1102可继而联接到轴1110。钳口构件1102、1104可以单独地围绕轴线1109枢转，采用的方式类似于上述的钳口构件1010、1012凭借其可单独地围绕轴线1016枢转的方式。例如，钳口构件1102、1104可以单独地围绕轴线1109枢转到钳口构件1102、1104枢转远离彼此的打开位置。钳口构件1102、1104还可单独地围绕轴线1109枢转到钳口构件1102、1104彼此靠近和/或接触的闭合位置，例如，如图53和图55中所示。在各种实施例中，钳口构件1102、1104可以相对于轴的纵向轴线1002成各种角度处于打开位置或处于闭合位置。例如，图52显示钳口构件1102、1104处于枢转远离纵向轴线1002的打开位置。图53显示钳口构件1102、1104处于基本上平行于超声刀1106的闭合位置。轴线1109可以基本上平行于纵向轴线1002。
在各种实施例中，可利用钳口构件1102、1104来捕获组织并将捕获的组织朝着超声刀1106操纵，以便进行切割和/或凝结。例如，U形钳口构件1104可包括一对尖齿1104a、1104b。尖齿1104a、1104b可以限定尖齿1104a、1104b之间的开口1105。钳口构件1102和超声刀1106可与所述开口对准。这样，钳口构件1102、1104可以枢转到打开位置，此时至少钳口构件1102远离纵向轴线1002以捕获组织，诸如图55中所示的组织1114。在一些实施例中，钳口构件1102可以至少配合到尖齿1104a、1104b之间的开口1105中。因此，钳口构件1102可以推动组织1114的一部分穿过开口1105，在该开口中，组织1114的一部分可以接触超声刀1106以便进行切割和/或凝结，如图55所示。
可以任何合适的方式来控制钳口构件1102、1104。例如，参见图56，滑轮1116可定位于轴线1109周围并且联接到钳口构件1104。类似的滑轮1118可围绕轴线1109定位并且联接到钳口构件1106。缆线1120、1122可以联接在相应的滑轮1104、1106周围，采用的方式与上文结合滑轮1041、1043和缆线1038、1040所述的方式类似。缆线1120的差动运动可致使钳口构件1104围绕轴线1109枢转，如上所述。相似地，缆线1120的差动运动可致使钳口构件1104也如上所述围绕轴线1109枢转。现在参见图54，轴1112可以限定腔1115。相应的缆线1120、1122可自钳口组件1100朝近侧延伸穿过腔1115。可以任何合适的方式来控制缆线1120、1122。例如，缆线可由与图45所示的器械安装部分类似的器械安装部分以及/或者由手持式控制器诸如上文所述的柄部12来控制。
非限制性实施例
各种实施例涉及外科器械，该外科器械包括端部执行器、轴和钳口组件。端部执行器可包括超声刀，该超声刀基本上平行于纵向轴线朝远侧延伸。轴可沿纵向轴线从端部执行器朝近侧延伸。钳口组件可包括第一钳口构件和第二钳口构件。钳口组件可围绕基本上垂直于纵向轴线的第一轴线从第一钳口构件和第二钳口构件基本上平行于超声刀的第一位置枢转到第二位置。另外，第一钳口构件和第二钳口构件可围绕基本上垂直于第一轴线的第二轴线枢转。
在一些实施例中，钳口组件包括腕构件、第一钳口构件和第二钳口构件。腕构件可围绕基本上垂直于纵向轴线的腕枢转轴线从腕构件基本上平行于超声刀的第一位置枢转到腕构件枢转远离超声刀的第二位置。第一钳口构件可从腕构件朝远侧延伸并且以能够枢转的方式联接到腕构件。第一钳口构件还可围绕基本上垂直于腕枢转轴线的钳口枢转轴线枢转。第二钳口构件可从腕构件朝远侧延伸并且还以能够枢转的方式联接到腕构件。第二钳口构件还可围绕钳口枢转轴线枢转。第一钳口构件和第二钳口构件还可围绕钳口枢转轴线相对于彼此从第一钳口构件和第二钳口构件枢转远离彼此的打开位置枢转到第一钳口构件和第二钳口构件朝彼此枢转的闭合位置。
申请人还拥有以下专利申请，这些专利申请各自以其相应全文以引用的方式并入：
2012年6月28日提交并且名称为“Flexible Drive Member”(代理人案卷号END7131USNP/120135)的美国专利申请序列号13/536,271；
2012年6月28日提交并且名称为“Multi-Functional Powered Surgical Devicewith External Dissection Features”(代理人案卷号END7132USNP/120136)的美国专利申请序列号13/536,288；
2012年6月28日提交并且名称为“Rotary Actuatable Closure Arrangement forSurgical End Effector”(代理人案卷号END7134USNP/120138)的美国专利申请序列号13/536,295；
2012年6月28日提交并且名称为“Surgical End Effectors Having AngledTissue-Contacting Surfaces”(代理人案卷号END7135USNP/120139)的美国专利申请序列号13/536,326；
2012年6月28日提交并且名称为“Interchangeable End Effector CouplingArrangement”(代理人案卷号END7136USNP/120140)的美国专利申请序列号13/536,303；
2012年6月28日提交并且名称为“Surgical End Effector Jaw and ElectrodeConfigurations”(代理人案卷号END7137USNP/120141)的美国专利申请序列号13/536,393；
2012年6月28日提交并且名称为“Multi-Axis Articulating and RotatingSurgical Tools”(代理人案卷号END7138USNP/120142)的美国专利申请序列号13/536,362；和
2012年6月28日提交并且名称为“Electrode Connections for Rotary DrivenSurgical Tools”(代理人案卷号END7149USNP/120153)的美国专利申请序列号13/536,417。
应当理解，结合临床医生操纵用来治疗患者的器械的一端在说明书中通篇使用术语“近侧”和“远侧”。术语“近侧”是指器械的最靠近临床医生的部分，术语“远侧”是指离临床医生最远的部分。还应当理解，为简明和清楚起见，本文可以参考所示实施例使用诸如“竖直”、“水平”、“上”或“下”之类的空间术语。然而，外科器械可以在许多取向和位置使用，并且这些术语并非意图是限制的或绝对的。
本文描述了外科器械和机器人外科系统的各种实施例。本领域的技术人员应当理解，本文所述的各种实施例可以与所述的外科器械和机器人外科系统一起使用。提供的说明只是为了举例，本领域的技术人员应当理解，所公开的实施例不只是限于本文所公开的装置，而是可以与任何兼容的外科器械或机器人外科系统一起使用。
本说明书通篇提及的“各种实施例”、“一些实施例”、“一个示例性实施例”或“实施例”意味着结合所述实施例描述的具体特征、结构或特性包括在至少一个示例性实施例中。因此，在整篇说明书中出现的短语“在各种实施例中”、“在一些实施例中”、“在一个示例性实施例中”或“在实施例中”并不一定都指相同的实施例。此外，在没有限制的情况下，结合一个示例性实施例示出或描述的具体特征、结构或特性可全部或部分地与一个或多个其他实施例的特征、结构或特性组合。
虽然已经通过描述若干实施例来例示了本文的各种实施例，并且虽然已经相当详细地描述了例示性实施例，但是申请人的意图不在于将所附权利要求的范围约束或以任何方式限制到这些细节中。本领域的技术人员可容易看出另外的优点和修改形式。例如，在不限制其预期用途的情况下，本发明所公开实施例中的每个可用于内窥镜式手术、腹腔镜式手术、以及开放式手术中。
应当理解，本文的附图和描述中的至少一些已被简化以示出适于清楚地理解本公开的元件，同时为清晰起见移除了其他元件。然而，本领域的普通技术人员将认识到，这些和其他元件可为所需的。然而，由于此类元件为本领域所熟知并且由于它们不利于较好地理解本公开，因此本文未提供对这些元件的论述。
虽然已经描述了若干实施例，但应当知道，本领域技术人员在掌握了本公开的一些或全部优点之后可能对这些实施例作出各种修改、改变和改型。例如，根据各种实施例，单个部件可替换为多个部件，并且多个部件也可替换为单个部件，以执行给定的一种或多种功能。因此，在不脱离所附权利要求书限定的本公开的范围和实质的情况下，本专利申请旨在涵盖所有此类修改、变型和改型形式。
以引用方式全文或部分地并入本文的任何专利、专利公布或其他公开材料均仅在所并入的材料不与本公开所述的现有定义、陈述或其他公开材料相冲突的范围内并入本文。由此，在必要的程度下，本文所明确阐述的公开内容将取代以引用方式并入本文的任何相冲突的材料。据述以引用方式并入本文但与本文所述的现有定义、陈述或其他公开材料相冲突的任何材料或其部分仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。

Claims (22)

1.一种外科器械，包括：
端部执行器，所述端部执行器包括超声刀，所述超声刀基本上平行于纵向轴线朝远侧延伸；
轴，所述轴从所述端部执行器沿所述纵向轴线朝近侧延伸；和
钳口组件，其中所述钳口组件包括：
腕构件，所述腕构件能够围绕基本上垂直于所述纵向轴线的腕枢转轴线从所述腕构件基本上平行于所述超声刀的第一位置枢转到所述腕构件枢转远离所述超声刀的第二位置；
第一钳口构件，所述第一钳口构件从所述腕构件朝远侧延伸并且以能够枢转的方式联接到所述腕构件，其中所述第一钳口构件能够围绕基本上垂直于所述腕枢转轴线的钳口枢转轴线枢转；
第二钳口构件，所述第二钳口构件从所述腕构件朝远侧延伸并且以能够枢转的方式联接到所述腕构件，其中所述第二钳口构件能够围绕所述钳口枢转轴线枢转，并且其中所述第一钳口构件和所述第二钳口构件还能够相对于彼此围绕所述钳口枢转轴线从打开位置枢转到闭合位置，在打开位置中，所述第一钳口构件和所述第二钳口构件枢转远离彼此，在闭合位置中，所述第一钳口构件和所述第二钳口构件朝彼此枢转。
2.根据权利要求1所述的器械，还包括：
第一控制线和第二控制线，所述第一控制线和所述第二控制线从所述第一钳口构件朝近侧延伸穿过所述轴，其中所述第一控制线和所述第二控制线的差动平移致使所述第一钳口构件围绕所述钳口枢转轴线枢转；以及
第三控制线和第四控制线，所述第三控制线和所述第四控制线从所述第二钳口构件朝近侧延伸穿过所述轴，其中所述第三控制线和所述第四控制线的差动平移致使所述第二钳口构件围绕所述钳口枢转轴线枢转。
3.根据权利要求2所述的器械，其中所述第一钳口构件包括围绕所述钳口枢转轴线定位的滑轮，并且其中所述第一钳口构件的所述第一控制线和所述第二控制线围绕所述滑轮延伸。
4.根据权利要求3所述的器械，其中所述第一控制线和所述第二控制线是围绕所述滑轮定位的单条控制线的端部。
5.根据权利要求1所述的器械，其中所述第一钳口构件和所述第二钳口构件能够单独地和共同地围绕所述钳口枢转轴线枢转。
6.根据权利要求1所述的器械，还包括在与所述腕枢转轴线偏置的位置处联接到所述腕构件并且朝近侧延伸穿过所述轴的第一腕构件控制线，其中所述第一腕构件控制线的近侧平移使所述腕构件围绕所述腕枢转轴线朝近侧向所述第一腕构件控制线枢转。
7.根据权利要求1所述的器械，其中所述超声刀能够沿平行于所述纵向轴线的方向从延伸位置平移到回缩位置。
8.根据权利要求7所述的器械，其中当所述超声刀处于所述回缩位置时，所述腕构件围绕所述腕枢转轴线的运动范围增大。
9.根据权利要求1所述的器械，其中所述腕构件、所述第一钳口构件和所述第二钳口构件中的至少一者限定朝向所述超声刀的面，并且还包括联接到所述面的夹持垫材料。
10.一种外科器械，包括：
端部执行器，所述端部执行器包括超声刀，所述超声刀基本上平行于纵向轴线朝远侧延伸；
轴，所述轴沿所述纵向轴线从所述端部执行器朝近侧延伸；和
钳口组件，所述钳口组件包括第一钳口构件和第二钳口构件，其中所述钳口组件能够围绕基本上垂直于所述纵向轴线的第一轴线从所述第一钳口构件和所述第二钳口构件基本上平行于所述超声刀的第一位置枢转到第二位置，并且其中所述第一钳口构件和所述第二钳口构件能够围绕基本上垂直于所述第一轴线的第二轴线枢转。
11.根据权利要求10所述的外科器械，其中所述第一钳口构件和所述第二钳口构件能够相对于彼此围绕所述第二轴线从所述第一钳口构件和所述第二钳口构件基本上平行于彼此的闭合位置枢转到打开位置。
12.根据权利要求10所述的外科器械，其中所述钳口组件还包括能够围绕所述第一轴线枢转的腕构件，其中所述第一钳口构件和所述第二钳口构件围绕所述第二轴线以能够枢转的方式联接到所述腕构件。
13.根据权利要求10所述的器械，还包括：
第一控制线和第二控制线，所述第一控制线和所述第二控制线从所述第一钳口构件朝近侧延伸穿过所述轴，其中所述第一控制线和所述第二控制线的差动平移致使所述第一钳口构件围绕所述第二轴线枢转；以及
第三控制线和第四控制线，所述第三控制线和所述第四控制线从所述第二钳口构件朝近侧延伸穿过所述轴，其中所述第三控制线和所述第四控制线的差动平移致使所述第二钳口构件围绕所述第二轴线枢转。
14.根据权利要求13所述的器械，其中所述第一钳口构件包括围绕所述第二轴线定位的滑轮，并且其中所述第一钳口构件的所述第一控制线和所述第二控制线围绕所述滑轮延伸。
15.根据权利要求10所述的器械，其中所述第一钳口构件和所述第二钳口构件能够单独地和一起围绕所述第二轴线枢转。
16.根据权利要求10所述的器械，还包括在与所述第一轴线偏置的位置处联接到所述钳口组件并且朝近侧延伸穿过所述轴的第一腕构件控制线，其中所述第一腕构件控制线的近侧平移使所述钳口组件围绕所述第一轴线朝近侧向所述第一腕构件控制线枢转。
17.根据权利要求10所述的器械，其中所述超声刀能够沿平行于所述纵向轴线的方向从延伸位置平移到回缩位置。
18.根据权利要求17所述的器械，其中当所述超声刀处于所述回缩位置时，所述钳口组件围绕所述第一轴线的运动范围增大。
19.根据权利要求10所述的器械，其中所述钳口组件限定朝向所述超声刀的面，并且还包括联接到所述面的夹持垫材料。
20.一种外科器械，包括：
端部执行器，所述端部执行器包括超声刀，所述超声刀基本上平行于纵向轴线朝远侧延伸；
轴，所述轴沿所述纵向轴线从所述端部执行器朝近侧延伸；和
钳口组件，其中所述钳口组件包括：
第一钳口构件，所述第一钳口构件能够围绕基本上垂直于所述纵向轴线的第一轴线枢转；
第二钳口构件，所述第二钳口构件也能够围绕所述第一轴线枢转，其中所述第二钳口构件限定第一尖齿和第二尖齿，其中所述第一钳口构件和所述第二钳口构件能够围绕所述第一轴线从所述第一钳口构件和所述第二钳口构件彼此分离开的至少一个打开位置枢转到所述第一钳口构件和所述第二钳口构件朝彼此枢转的闭合位置，并且其中所述第一尖齿和所述第二尖齿限定与所述第一钳口构件和所述超声刀对准的开口。
21.根据权利要求20所述的外科器械，其中所述第一钳口构件包括围绕所述第一轴线定位的滑轮，并且其中所述器械还包括围绕所述滑轮定位以使所述第一钳口构件围绕所述第一轴线枢转的第一缆线。
22.根据权利要求20所述的外科器械，其中所述第二钳口构件包括围绕所述第一轴线定位的滑轮，并且其中所述器械还包括围绕所述滑轮定位以使所述第二钳口构件围绕所述第一轴线枢转的第二缆线。
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