JPH07163574A - Foldable socket joint assenbly for endoscopic operation instrument and track of fastener for operation - Google Patents

Abstract

PURPOSE: To provide an articulable endoscope operation device by providing an assembly capable of controlling folding of an end effector of the endoscope operation device. CONSTITUTION: A far end 31 is connected through a folding joint to a support housing 34. This joint is provided with a hollow socket 40 and a protruded member 44 to be contained in it. The protruded member 44 is tightly assembled in the support housing 34. A socket 40 is rotated on the protruded member 44 by a folding operator 48 installed on the support housing 34. An end effector 36 at a far end is then actuated. The protruded member 44 is provided with a passage 50 to contain an actuator member. The actuator member 52 is extended from an end effector actuator 54 through the joint to actuate the end effector 36.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical instrument used in endoscopic surgery.

[0002]

2. Description of the Related Art Endoscopic surgery has been widely accepted as a surgical technique. In the present specification, the term “endoscope” is a concept that generally includes a surgical instrument that is inserted into the same body cavity where the endoscope is inserted. With the endoscope, it is possible to perform a visual inspection inside the body cavity with or without enlargement, and to observe a pattern of operation of a surgical tool for the purpose of treatment or diagnosis.

In a typical endoscopic surgery, the abdominal cavity of a human or animal is inflated with a sterilized gas (for example, carbon dioxide) in order to expand the space for operating the endoscopic surgical instrument in the body cavity. A trocar is then inserted into the body cavity of the subject, penetrating the surrounding skin, tissue and muscular system. A typical trocar comprises a cannula containing an elongated obturator. Obturators typically have perforated ends, but there are other types of obturators.

After each trocar is positioned within the body cavity adjacent to the intended surgical site, the obturator is removed, leaving a cannula that provides a passageway to the body cavity. In this way
Usually, multiple cannulas are installed. The surgeon then inserts the endoscope through one of the cannulas and introduces the surgical endoscopic surgical instrument through the other one or more cannulas to the surgical site to be diagnosed or treated.

[0005] The endoscope is typically connected to a video camera, and the output from the video camera is sent to a video monitor showing the surgical site and the end of the endoscopic surgical instrument on the surgical site side. The term “endoscopic surgery tool” as used herein includes a ligation clip loading tool, a tissue cutter, a needle grasper, a cannula, a tissue manipulator, and the like.

[0006]

Although endoscopic surgery has many advantages, it has been found that there have been problems as a result of attempts made so far. For example, while operating a surgical tool in a body cavity, a surgeon usually sees an image projected on a video monitor, but a video display only gives the surgeon a two-dimensional image of the surgical site and Information on the depth of the part is missing.

[0007] Another problem is that the surgical instrument may get caught in the tissue from its insertion direction. To engage tissue at the distal end (body edge) of conventional endoscopic surgical tools such as graspers and scissors in a manner that achieves the desired effect (eg, grasping or cutting tissue) Mechanism is provided. Such a far end mechanism is commonly referred to as an "end effector". In conventional endoscopic surgical tools, the end effector is often mounted linearly on a rigid straight shaft of the surgical tool.

Depending on the nature of the surgery performed on the tissue within the body cavity, it may be desirable to have a terminal effector that is angled or bent with respect to the longitudinal axis of the surgical instrument shaft. This may allow the surgeon to more easily engage the tissue with tissue in some situations.

A further problem is that endoscopic surgical tools can obstruct the field of view. However, with an endoscopic surgical tool having a bendable distal end, the surgeon can engage the distal end of the end effector with the tissue and laterally offset the tissue from the main shaft of the surgical tool. .
This allows the tissue engaging the end effector and the distal end of the end effector to be better viewed through the adjacent endoscope with little obstruction by the main shaft.

Many designs have been proposed for bendable endoscopic surgery. Although bendable endoscopes and other surgeries are commercially available, it is desirable to have a better design that allows the degree of bending of the end effector to be adjusted.

In particular, it would be extremely useful if a bendable surgical instrument could be provided with the ability to tilt the end effector at an angle to the longitudinal axis of the surgical instrument. Moreover, it would be of great benefit if the end effector could bend in any radial direction about the longitudinal axis of the surgical instrument.

In endoscopic surgery, it may be desirable to be able to sense environmental characteristics (eg, temperature, chemicals, etc.) at the surgical site. Furthermore, it would also be desirable if the presence or position of an element of the surgical tool could be sensed. At the surgical site, it is desirable to introduce a conduit for cleaning and suction. It is also necessary to provide a device that supplies clips and staples to the surgical site and attaches the clips and staples as part of the end effector. Therefore, inside the sensor conductor, suction conduit
Contains a cleaning conduit, flexible actuator means, etc.
It would be highly desirable to be able to provide a bendable assembly that would also allow fasteners (eg, clips or staples) to be dispensed / applied. Such a bendable assembly is preferably
It is preferable to contain internal conduits and elements and to have sufficient internal space to allow such elements to move within the assembly.

If such a bendable assembly of an endoscopic surgical tool has a relatively smooth exterior with minimal dents or protrusions, it reduces the risk of surgical site contamination and the assembly. This is desirable because it facilitates the cleaning of the tissue and eliminates the risk of being caught on the adjacent tissue or damaging the tissue.

Also, if such a bendable assembly is strong enough to withstand relatively large moments and forces in both the straight and bent directions during operation of the end effector. It is desirable to have.

The bendable assembly is
It is preferable that the orientation of the terminal effector with respect to the longitudinal axis of the surgical instrument can be controlled relatively accurately. Furthermore, it would be even better if such orientation control could be done with minimal force and torque. And, such a foldable assembly should allow for easy adjustment of manipulation and control through the proximal end of the surgery outside the body cavity.

Furthermore, it is also desirable to provide a system for delivering fasteners, such as ligation clips or staples. Such a system should allow movement of the fastener not only when the end effector extends along the main shaft of the surgical instrument, but also when the end effector is bent. Further, such a fastener transfer system has the following features within the assembly:
The fasteners must be separated from adjacent features to avoid mutual interference between the fasteners and these features and contamination of the fasteners.

[0017]

SUMMARY OF THE INVENTION It is an object of the present invention to provide a bendable assembly for an endoscopic surgical instrument that incorporates a design having the above advantages and features.

In accordance with the principles of the present invention, a characteristic bendable assembly is provided for endoscopic surgical tools. This assembly can control the bending of the end effector of an endoscopic surgical tool. This assembly
It is relatively strong and can withstand the moment forces and forces applied during operation of the end effector as well as during bending.

The assembly of the present invention can be easily operated from the front end of the surgical instrument without applying particularly strong force or torque.

The assembly of the present invention has sufficient internal void space to accommodate the elements extending from the proximal end of the surgical instrument to the end effector. The inner region of the assembly can also be threaded with fasteners such as ligation clips and staples.

The exterior of the assembly of the present invention is relatively smooth and minimizes potential contamination or tissue damage.

The assembly of the present invention includes a distal end for supporting an end effector that handles tissue during intraluminal surgery.

A bendable joint connects the distal end to the elongate support housing. The joint includes a hollow socket and a convex member housed in the socket. The convex member has a passageway from the housing through the joint that houses an actuator that actuates the end effector.

An actuator is provided on the housing and extends to either the socket or the convex member to move the distal end into or out of alignment with the housing.

Another aspect of the present invention (aspect)
According to the present invention, there is provided a track capable of guiding at least one surgical fastener through a bendable joint provided in an endoscopic surgical tool.

The track comprises a tube made of a material that is sufficiently flexible to accommodate bending within the joint. The tube has an elongated passageway with a cruciform cross section that orients and maintains the fastener in a predetermined orientation as it passes through the passageway.

The tube passage is defined at least in part by two opposing walls. The walls each define a longitudinal groove which directs its open sides towards each other on the side of the other wall. The shape of the groove changes according to the compressive / tensile load related to bending.

[0028]

DETAILED DESCRIPTION OF THE INVENTION One aspect of the present invention is a unique feature used in endoscopic surgical tools to adjust the bending of the end effector with little force or torque required at the proximal end of the endoscopic surgical tool. Bendable assembly.
The foldable assembly has a substantial void therein for containing the end effector actuator member, sensor lines, clips or staples, irrigation conduits, aspiration conduits, and the like. The bendable assembly has a relatively rigid outer sheath that minimizes protrusions that can damage tissue and accumulate contaminants.

Further, the bendable assembly of the present invention can be loaded into a wide variety of surgical instruments that can perform a variety of procedures on a surgical site. These various treatments
For example, incision, cutting, grasping, clamping of clamps, attachment of staples or ligation clips, application of ultrasonic energy,
Treatment with an electric scalpel, cleaning at the surgical site, removal of substances from the surgical site by suction, etc.

Elements used in various sensor systems are transported through the novel bendable joint assembly of the present invention. Such sensor systems include systems that measure tissue thickness and the degree of compression, tumor detection, pulse oxygen measurement, and Doppler effect detection of blood in blood vessels. Also, light guides and other fiber optic system elements can be delivered through the assembly of the present invention.

In addition, the bendable assembly of the present invention may be designed to vent or seal the surgical tool and may be equipped with filters for gases and smoke.

While the present invention is capable of various embodiments, the specification and the accompanying drawings only disclose specific ones of the embodiments as embodiments of the present invention. The present invention is not limited to the embodiments described herein. The scope of the invention is as set forth in the claims.

For simplicity of description, the surgical instrument of the present invention will be described in various operating positions. And in this specification, in relation to these operating positions, "upward",
The terms "down", "horizontal", etc. are used. However, the surgical instrument of the present invention is manufactured in a manner other than the one described here,
It will be appreciated that it may be stored, shipped, used and even sold.

Some of the mechanical elements contained in the figures showing the surgical instrument of the present invention are well known and well understood by those skilled in the art. Therefore, a detailed description of such elements is not necessary for an understanding of the present invention, but is provided here only to the extent necessary to aid in the understanding of the novel features of the invention.

Elements known in the art are also used in the surgical instrument of the present invention. I won't go into detail about this element,
It will be obvious to those skilled in the art who can understand the required function of such elements.

1 and 2 show the basic features of the bendable assembly of the present invention. The device shown in FIGS. 1 and 2 has a front end on the support housing 34 (FIG. 1) or 34A (FIG. 2). This part of the surgical tool is grasped by the surgeon and remains outside the patient's body,
The remaining portion of the surgical tool is inserted into the body cavity through the cannula of the trocar. The surgical instrument comprises a distal end 31 (FIG. 1) or 31A (FIG. 2) positioned at the surgical site and actuated to manipulate tissue in the desired manner.

[0037] Johnson & Johnson Co., Ltd. catalog "Price list for hospitals--ETHICON AND YOU. THE U
LTIMATE SURGICAL TEAM --ETHICON ENDO-SORGERY-- ''
(Valid from February 24, 1992; Published by Ethicon Corporation [4545 Creek Road, Cincinati, Ohio, 45242 USA])
Shows various types of end effectors for endoscopic surgical tools. For example, see the next page of the above catalog for the following end effectors for endoscopic surgical tools:
Micro Scissors DMS11-Page 5, Straight Grasp
DSG20-Page 5, straight dissector;
Dissector) -Page 13, Extractor DEX40-Page 13, Clamp BC10-Page 13, Clip Mounter ER320-Page 21
Page, linear cutter ELC60-page 28, and stapler ES100-page 29. The structure and operation of such end effectors are well known. Some termination effectors are described in detail in US patents and patents of other countries. See, for example, Ethicon US Pat. No. 5,163,945 for clip appliers.

In general, the end effector that performs the above listed functions can be incorporated into the bendable assembly shown schematically in FIGS. However, the structure and operating method of such a special end effector are not included in the present invention.

In FIG. 1, the distal end 31 is connected to the support housing 34 via a bendable joint. The joint includes a hollow socket 40 and a convex member 44 housed in the socket. The convex member 44 is firmly incorporated in the support housing 34.

The socket 40 is provided with a convex member 44 by a bending operation device 48 attached to the support housing 34.
Rotate on. Then, the end effector 36 at the far end is activated. The structure and operating method of such a special bending operation device will be described in detail below.

The convex member 44 is the actuator member 42.
A passage 50 for accommodating Actuator member 52
Extends from the end effector actuator 54 mounted to the support housing 34 through the joint to actuate the distal end end effector 36. The actuator member 52 may be considered as part of the end effector actuator 54 or an extension thereof. As such an actuator member 52, a flexible band for pressing a terminal effector mechanism (for example, a link for rotating a scissors type blade) located at the far end can be used.
The actuator member 52 may also be an electrical cable for an electrical circuit that operates a power operated termination effector. Alternatively, the actuator member may be a pull cable that pulls and actuates the distal end effector mechanism at the far end. Further, the actuator member 52 may be an air or water channel that depresses a suitable operator that actuates the distal end effector. However, the detailed structure of such a special termination effector and its operating method, and the actuator for this purpose,
Not included in the present invention.

The passage 50 through the convex member 44 is not only an additional element such as a rinsing conduit, a suction conduit and sensor line (electrical lead, air path, etc.), but also the end effector actuator. It is preferably large enough to accommodate one or more members 52.

In another type of surgical tool, shown in FIG. 2, the convex member 44A is firmly incorporated into the distal end 31A. The convex member 44A has a passage 50A, and is a socket 4 that is firmly assembled to the end of the support housing 34A.
It is stored in 0A.

A bend manipulator 48A attached to the support housing 34A causes the distal end 31A (and the end effector 36A attached thereto) to bend in a desired direction oblique to the longitudinal axis of the surgical instrument. In order to rotate the terminal convex member 44A in the socket 40A,
Operablely connected to the convex member 44A.

The end effector actuator 54A on the support housing includes a end effector member 52A extending through a passage 50A through the convex member to actuate the end effector 36A at the distal end.

The embodiment shown in FIGS. 1 and 2 is the basic form of the bendable joint assembly of the present invention. In particular, the detailed construction of such joint assemblies used in specialized surgical tools is described in detail below.

3 to 6 show a surgical instrument equipped with a bendable assembly having the basic structural features shown in FIG. The surgical instrument specifically has an elongated distal end 60 extending from a proximal housing 62.

At the far end of the far end 60, jaws 64 and 6 are provided.
Six pairs are provided. The jaw 64 is fixed to the far end of the far end 60, while the jaw 66 is rotatably attached to the far end of the far end 60 via a screw 68,
It can move toward and away from the fixed jaw 64. A leaf spring 70 attached to the distal end of the distal end 60 normally biases the jaws 60 in an open condition. The jaw 66 has a downwardly projecting leg 72 to which is attached a cable 74 extending through the surgical instrument to the proximal end, where it is connected to a lever 76. As shown in FIG. 5, the lever 76 is rotatably attached to a U-link 80 extending from the rear plate 82 via a pin 78. The lever 76 can be pivoted forward or backward to close the jaw 66, and the spring 70 can keep the jaw 66 open, as shown by the arrow in FIG.

As shown in FIGS. 3 and 5, the longitudinal distal end 60 has an internal passage 88 for receiving a cable or cord 74. As shown in FIG. 5, the front end of the distal end portion 60 is an open end that defines the socket or the concave surface 90. The socket 90 houses a convex member or ball 92 that is the distal end of the longitudinal shaft 94. Convex member 92
And shaft 94 have an internal passage 96 for receiving the cable 74.
To share.

As shown in FIG. 6, the longitudinal shaft 94 is
Two outwardly projecting keys or guide members 1
It has 01 and 103. The first drive member 105 has a longitudinal slot 107 for receiving the guide portion 101. The second drive member 109 is the first drive member 10
5, a slot 111 is provided on the opposite side of the longitudinal shaft 94 in the radial direction, and receives the guide member 103. Each drive member 105 and 109 is thus transported by the longitudinal shaft 94 and moves longitudinally along the shaft 9 to move toward and away from the convex member 92.

As best shown in FIGS. 3-5, drive member 105 has a distal end that defines teeth 115. The tooth 115 meshes with the notch 117 at the near end of the distal end 60. In the preferred embodiment, the distal end 60 has a cylindrical profile and includes the notches 117 and 12
2 face each other in the radial direction.

The first drive member 105 defines an outward facing left hand thread segment 124, and also the second drive member 1
09 defines an outward facing right hand thread segment 126. Threaded segments 124 and 126 mate with a bend actuator nut or sleeve 130. The nut or sleeve 130 has a front cylinder surface defining the left hand threaded portion 132 and a rear cylinder surface defining the right hand threaded portion 134. The left-handed threaded portion 132 is separated from the right-handed threaded portion 134 via a cylindrical void 136.

The left hand thread segment 124 of the first drive member 105 meshes with the left hand thread portion 132 of the sleeve 130, while the right hand thread segment 126 of the second drive member 109 meshes with the right hand thread portion 134 of the sleeve 130.

When the sleeve 130 rotates, the meshed left hand screw segments 124 and 132 move the first drive member 105 in the longitudinal direction (the front end direction or the far end direction depending on the rotation direction of the sleeve 130).
At the same time, the second drive member 109 moves longitudinally opposite due to the engagement of the right hand screw segments 126 and 134. That is, when one drive member moves toward the far end, the other drive member moves toward the front end by the same distance. The distal end of the drive member moving in the distal direction exerts a force on the distal end 60 of the surgical tool to rotate it about the convex member 92. The degree of rotation is adjusted by another driving member that moves toward the front end.

The drive members 105 and 109 are housed in an outer tube 140. The outer tube 140 has a flange 142 at its proximal end that is fastened to the retaining ring 146 with, for example, a screw 144. The retaining ring 146 is
It defines a pair of access holes 148. This hole 148
Is to allow one or more fingers to touch the outer surface of the sleeve 130 and rotate the sleeve 130 with the fingers.

A screw 15 is attached to the front end of the retaining ring 146.
The end plate 82, which is clamped to the end plate 82 by 4 and has an annular flange 152 projecting inward, defines an opening 162 for receiving a cord or cable 74 connected to the lever 76. Edge plate 8
2 also serves as the base to which the lever clevis 80 is attached.

When operating this surgical tool, the surgeon must:
Hold the outer surface of the outer casing 140 of the surgical instrument with one hand.
Then, with the finger of the other hand, the sleeve 130 is rotated as much as necessary to bend the end portion at the far end to a desired orientation. The lever 76 is then operated to actuate the end effector.

It will be appreciated that the embodiments of the bendable assembly shown in FIGS. 3-6 have many advantages. First, the degree of bending can be fully adjusted via a threaded drive system. Thus, the bendable assembly need not include an energy storage mechanism (such as a spring or a tensioned or compressed member) to maintain the folded position. Therefore, even if a failure occurs in the element, the movement of the distal end of the surgical instrument can be controlled.

Further, the bendable assembly of the present invention may be preloaded (without backlash) to maintain preload during the single stroke (stroke) of the surgical tool.

The novel design of the bend assembly of the present invention can accommodate various types of end effector actuator systems. For example, a special termination effector could be provided with a flexible compression member actuator system instead of the pull cable 74. Central passage 96
Other types of actuator systems extending through are also used. These types of actuator systems are waterways, conductors, etc. Further, the central passage 96 can accommodate other systems besides the actuator system. For example, a sensor wire or optical fiber can be routed through the central passage 96. in addition,
A conduit for delivering fluids to the surgical site or for expelling gas or liquid from the surgical site can also be passed through the central passageway 96.

7 to 13 show a bendable assembly according to another embodiment of the present invention. As shown in FIG. 10, the surgical instrument includes a proximal handle portion 160, an elongated housing or support tube 162 defining a longitudinal axis 161, and a distal end portion 164 that supports a termination effector 166. The termination effector 166 may be one of the types described above with respect to FIGS. But,
The detailed structure of the end effector 166 and its operating method are not included in the scope of the present invention.

The apparatus shown in FIGS. 7 to 13 incorporates the basic principles of the invention already described in FIG. In particular, as shown in FIGS. 7 and 8, the housing or support tube 162 is generally hollow and cylindrical and has a configuration defining a socket at the distal end. Tab 1
70 projects inward from the open end of tube 162 in the socket area. In the preferred embodiment, the tab 170 has a rectangular prism shape.

The distal end 164 has a convex member 174 housed in the socket 168. The convex member 174 includes a passage 178 whose longitudinal axis 180 (FIG. 8) makes an oblique angle with the longitudinal axis 161 of the surgical tool. Convex member 174
Defines an arcuate groove 184 for receiving tab 170.

The elongate support tube 162 is provided with a bender for moving the distal end 164 to place or release it in alignment with the elongate support tube 162. The bend manipulator comprises a shaft 188 disposed inside the support tube 162. Shaft 188 typically has a proximal end 190 that is aligned with the longitudinal axis 161 of the surgical tool. In the embodiment of FIG. 7, the proximal end 190 of the shaft has a support tube 162.
With two bearings 194 mounted inside,
Supported for rotation about the longitudinal axis 161 of the surgical tool.

The shaft 188 also has an intermediate portion 19 extending from the front end portion 190 in an oblique direction with respect to the longitudinal axis 161.
Have six. The distal end 198 extends from this intermediate portion 196 and is rotatably arranged in the passage 178 of the convex member.

The distal end of shaft distal end 198 defines a groove 202 (FIG. 8) into which a snap ring or clip 204 is fitted. The bottom of the convex member 174 is generally orthogonal to both the slot 184 and the shaft 180, and is a void or slot 2 for fitting the clip 204.
08 (FIG. 7). Further, the shaft 188 is
A flange 210 is provided at the distal end 198 (FIGS. 7 and 8). For this reason, the far end 198 has a flange 2
It can be inserted into the passage 178 of the convex member until the 10 contacts the generally planar and annular bearing surface 212. The clip 204 is adapted to engage the distal end 198 of the shaft in the groove 202 so that the slot 2 of the convex member will
It is inserted through 08. Clip 204 holds convex member 174 on shaft distal end 198. However, the distal end 198 of the shaft has a passage 17 in the convex member.
8 is free to rotate about axis 180 (FIG. 8).

The shaft 188 is hollow and the cable 216 is
Contains one or more end effector actuator elements,
It may also house sensor elements (not shown), fluid transfer tubes (not shown), and the like. Such elements are
Typically flexible, it accommodates rotation of shaft 188 and associated rotation of end effector 166, described in detail below.

In the preferred embodiment, the proximal end 190 of the shaft is rotatable about the longitudinal axis 161 by the gear drive system shown in FIG. In particular, the gear 220 in the center is rotated by
Is attached to the proximal end 190 of the shaft to evoke rotation about an axis 161 of the. Gear 224 is attached to a mounting pin 226 that projects from flange 228 at the proximal end of support tube 162 for rotation. The gear 224 meshes with the gear 220.

The housing 160 has an inclined groove surface 23 on the outside.
Rotatable frustoconical drive sleeve 230 with two
Equipped with. The beveled groove 232 is rotated by the surgeon so that the surgeon holds it with his thumb and forefinger. At the distal end of sleeve 230 is a cylindrical inner surface that engages a portion of the outer surface of support tube 162. Further, a ring gear 236 engaging with the gear 224 is engraved on the inner surface of the sleeve 230. Thus, as sleeve 230 rotates, shafts 188 rotate, causing gears 236, 224 and 220 to rotate.

When the shaft 188 rotates, the orientation of the end effector 166 changes, as shown in FIGS. It will be apparent that the tab 170 (FIG. 7) engages the sidewall of the slot 184 of the convex member 176. The tab 170 includes a convex member 174, and a slot 184 that allows the distal end 178 of the shaft 188 to branch.
When they move together in socket 168, they act as fixed pivot points.

10 to 13, the operation handle or lever 234 is schematically shown as being connected to the front end of the shaft 188. The operating handle 234 corresponds to the gear drive system and drive sleeve 2 of FIG.
Used in place of 30.

The handle 234 is primarily shown in FIGS. 10 to 13 for the purpose of simply indicating the rotational position of the shaft with respect to the bending direction of the end effector 166. The handle 234 is fixed at a right angle to the front end of the shaft 188. Therefore, the relationship between the rotation of the shaft 188 and the movement of the end effector 166 is shown in FIGS.
It can be easily understood by 3.

The termination effector 166 is shown schematically as having four sides A, B, C and D with rectangular parallel pipes. Therefore, the azimuth of the termination effector can be easily set in the two-dimensional diagrams of FIGS. 10 to 13.

In particular, FIG. 10 illustrates an end effector 16 oriented substantially along the longitudinal axis 161 of the surgical tool.
6 is shown. The end effector 166 can be captured at an angle from the front and above. Surface A faces upward and surface C faces downward. In this position, the handle 234 is at a right angle to the proximal end 190 of the shaft 188 and projects vertically upward.

As shown in FIG. 11, since the front end portion 190 of the shaft is rotated 90 ° counterclockwise, the handle 2
When 34 is rotated 90 ° counterclockwise, the end effector 16
6 swings upward in the observation direction of the drawing. Surface C is now visible with surface D.

As shown in FIG. 12, when the handle 234 is rotated clockwise by 90 °, the end effector 166 swings upward away from the viewing direction of the drawing, and is generally a mirror image opposite to that shown in FIG. Move to position. Surface A is now visible with surface D.

When the handle 234 is rotated 180 ° from the position shown in FIG. 10 to the position shown in FIG. 13, the end effector 16
The far end of 6 is maximally branched above the longitudinal axis 161, so that the end effector 166 is located exactly in the middle of the two end effectors shown in FIGS. 11 and 12. Now you can see the surfaces C and D.

The handle portion 160 of the surgical tool is a suitable trigger for actuating a flexible end effector actuator element (eg, flexible cable, hydraulic system, etc.) or other device, system, element, or the like. 241 and 24
3 (FIG. 10).

Although not shown, the elongate support tube 162 may be equipped with suitable gas seals, filters, exhaust systems and the like. Further, in some embodiments it is desirable to line the socket 168 with a low friction bearing material such as a suitable thermoplastic polymer.

Another aspect of the bendable assembly of the present invention incorporated into a surgical instrument is shown in FIGS. The embodiments shown in FIGS. 14 to 20 employ the principle of the present invention which takes the form schematically shown in FIG. In particular, as shown in FIG. 18, the surgical instrument has a proximal end 250 from which a hollow support tube or housing 252 defining a longitudinal axis 254 (FIG. 14) extends. The support tube or housing 252 comprises an inner tube 253, best shown in FIGS. As shown in FIG. 17, the support tube 252 has an open socket 254.
An open socket 254 having a longitudinal end defining a
Accommodates a convex member 256 that partitions the near side portion of the distal end 260 of the surgical instrument. The far end 260 is the end effector 2.
Support 62. The termination effector 262 may be one of the various termination effectors described with reference to FIGS.

As shown in FIGS. 15 and 17, preferably, the convex member 256 defines an annular groove 257 for receiving the O-ring 259. O-ring 259 seals the joint assembly within the surgical tool.

The convex member 256 also has passages for accommodating internal elements such as actuator members, channels, sensor lines, and the like. 15 and 16 show two flexible lines 268 extending within the surgical tool.

As shown in FIGS. 15, 17 and 20, the convex member 256 has four evenly spaced radially extending protrusions 270. A cord or cable 274 is looped around each protrusion 270 or clamped to each protrusion 270. The clamping end of each protrusion 270 and the cord 274 that engages it is housed in a circumferentially extending channel or recess 278 at the longitudinal end of the support tube 252.

As shown in FIGS. 15 and 16, the socket 2
The interior of tube 252 adjacent 54 defines four openings 282, each of which passes a cord 274.
The cord 274 extends along the inside of the support tube 252, traverses it, and leaves away from the longitudinal axis of the support tube 252 on the opposite side.

As shown in FIG. 20, the front end of each cord 274 is loosely fixed to the plate 286.
It is tightened to. As shown in FIG. 19, the plate 28
6 is retained against a flange on a post 290 that projects from a bracket carried inside the proximal end 250 of the surgical tool. Extending between plate 286 and bracket 292 are tension springs 296 (only two of which are shown in FIG. 19). These springs hold the plate 286 against the flange 288.

When the front end portion 250 of the surgical instrument is held by one hand, the peripheral portion of the plate 286 can be pressed inward with the thumb. This causes one or several of the springs 296 to contract and the other springs 296 to expand.
When the plate 286 is tilted from the normal rest position shown in FIG. 19, one or more cords 274 are pulled rearward (front side), while one or more other cords 274 are loosened. . As a result, the socket 25
4, the convex member 256 rotates and the end effector 262 bends. The cords 274 intersect in opposite directions as shown in FIG. 20 and thus press on one of the four regions of the plate 286, which results in termination effector 262.
Generally folds towards its pressed area.

The support tube 252 may further include a seal, an exhaust pipe, a filter and the like (not shown).
In addition, various actuator mechanisms, end effectors, sensor lines, lead tubes, etc. can be housed in 253 and passed through the passage 266 of the joint assembly.

21 and 22 show a surgical instrument which is a modification of the embodiment shown in FIGS. 14 to 20. This surgical tool
It includes an elongate support tube or housing 252A that supports the distal end 260A extending from the convex member 256A. The cord or cable 274A extends from the projection 270 of the convex member and passes through the tube 252A to the proximal end 250A of the surgical instrument. The elements described thus far are substantially the same as the elements with reference numerals without the "A" for the embodiment described with respect to FIGS. However, in the embodiment shown in FIGS.
There is no actuator plate 286 attached to the front end as shown in FIG. Rather, the actuator plate 286A is mounted within the proximal end 250A of the surgical tool and the T-shaped operating lever 287A extends upward through the top of the surgical tool. The handle 287A includes a spherical base 291A housed in an arcuate socket 293A. Cables 274A are mounted around the front of plate 286A in four evenly spaced positions. The rear surface of plate 286A is coupled to tension spring 296A in a corresponding position. The front end of the spring 296A is attached to a bracket 292A installed inside the front end portion 250A of the surgical instrument.

The four springs 296A are normally each cord 2
The plate 286 while applying an even tension to the 74A.
Hold A in the neutral position shown in FIG. Handle 2
When 87A moves from the position shown in FIGS. 21 and 22, some of the cords 274A are pulled and the other cord 27A
4A causes convex member 256A to rotate and loosen to cause distal end 260A to bend.

23-29 illustrate another aspect of the present invention that includes a track for guiding surgical fasteners, such as staples or clips, along a bend joint. In particular, this fold joint assembly, similar to the embodiment described above with respect to FIGS. 14-20, is used in a device for delivering and attaching ligation clips to tissue such as blood vessels.

23-25 show a portion of a surgical instrument having an elongated support tube or housing 302 defining a socket 304 to which a convex member 308 is attached. The convex member 308 is defined at the distal end 310, which carries the end effector in the form of a jaw assembly 314. Convex member 308 and distal end 31
0 is the passage 31 to which the jaw assembly 314 is attached
8 (FIG. 25). Jaw mold assembly 314 has legs that generally define jaw 320 in a U shape and has a U shape. Each jaw 320 has a jaw shape 310 (FIG.
3) The cam surface 32 that engages with the slope 324 at the far end.
Have two. Jaw assembly 314 connects at its proximal end to flexible member or cable 332 via pin 328. The cable 332 is pulled rearward by suitable means (not shown). The jaw assembly 314 is then advanced further into the surgical tool and the jaws are cammed to close around the tissue, such as blood vessel 336 (FIG. 23).

Each jaw 320 also defines a channel 337 (FIG. 23) that receives a ligation clip 340 that is generally U-shaped and located at the distal end of jaw 320 (described in detail below). Clip 314 when jaw 320 is closed
Are crushed and clamped around tissue 336.

The elongate support tube 302 has an inner tube 344 extending from the socket 304 around the jaw actuator cable 332. Longitudinal support tube 3
The space between 02 and the inner tube 344 defines an area to accommodate the bend manipulator cable 348. The cable 348 is fastened to a protrusion 350 that extends radially outward from the surface of the convex member 308. In the preferred embodiment, there are four such protrusions 350 and four associated cables 348. And these have substantially the same arrangement as the embodiment described in FIGS. 14 to 20 in which the convex member 256 has four protrusions 270 each having a cable 274 attached thereto.

If one or more cables 348 are pulled while the other cables 348 remain loose, the convex member 308 will rotate within the socket 304 and the distal end 310 will bend. The cable 348 can be pulled or loosened using any suitable operating mechanism, such as the wobble plate 286 in the embodiment previously described in FIGS. 14-20.

According to one aspect of the invention, the ligation clip 3
40 is guided in a bendable joint assembly along a single track. The track comprises a tube 400. The tube 400 is made of a material that is sufficiently flexible to accommodate bending of the joint. For now, the tube 400 is envisioned to be extruded from a suitable elastomeric or thermoplastic material.

Tube 400 defines a longitudinal passageway for delivery of ligation clip 340. The passageway has a cruciform cross-section so that each clip 340 can be oriented and held in a predetermined orientation while moving through the passageway. The clip 340 is pressed along the tube 400 at the proximal end of the surgical instrument by a suitable flexible push bar (not shown). Clip 3
Designs and operating methods for feeding 40 along tube 400 are not included in the present invention.

As shown in FIG. 27, at least a portion of the passage is defined by two opposing walls 408 and 410. Opposing walls 408 and 410 are thin connecting portions 41.
Connect through 1. The wall 408 defines a longitudinal groove 412, while the wall 410 defines a longitudinal groove 416. Groove 41
2 and 416 each have a V shape, and their openings face each other.

As shown in FIG. 29, the track tube 4
When 00 deforms or bends to the right, the degree of opening of groove 412 decreases, while the degree of opening of groove 412 increases somewhat. On the other hand, if the track tube 400 deforms or bends to the opposite side (not shown), the groove 412 will be more open and the groove 416 will be less open.

If the track tube 400 bends as shown in FIG. 28, or the degree of bending becomes 90 ° as shown in FIG. 29, the grooves 412 and 416 both reduce the degree of their opening, or Block and flatten.

The track tube 400 is positioned within the surgical instrument so that its distal end terminates inside the convex member 308 to drive the ligation clip 340 into the passage 318 (FIG. 25). As shown in FIG. 25, a portion of the passage 318 is defined by the upwardly sloping surface 422. This surface 322 attaches the clip 340 to the track tube 40.
Guide from the zero end to channel 337 in jaw 320. When the surgical distal end 310 is bent, the distal end of the track tube 400 moves with the convex section material 308, and the track tube 400 responds to the movement of the member at the front (rear) side of the convex member 308. Turn around.

23 to 25, the jaw assembly 3 is shown.
Although only the track tube 400 within 14 and the passage 818 is shown, it will be readily understood that modifications may be made to add additional elements if desired.
Such additional elements include sensor lines, suction lines, fiber optics, and the like.

The track tube 400 can also be used to guide fasteners such as ligation clips, staples, etc. in other types of bendable joints in endoscopic surgical tools. The track tube 400 is particularly suitable for guiding fasteners where the tube bends under compressive or tensile bending loads.

As is apparent from the above description of the present invention and the accompanying drawings, numerous modifications and changes can be made within the spirit and spirit of the novel concept and principle of the present invention.

Specific embodiments of the present invention are as follows. 1) The assembly of claim 3, wherein the passage of the convex member is cylindrical and the distal end of the shaft is also cylindrical. 2) The assembly of claim 4 wherein said socket is firmly incorporated into said distal end and moves together. 3) The assembly of claim 4, wherein the socket is securely incorporated into the support housing. 4) The assembly of claim 4 wherein said convex member is rigidly incorporated and moves with said distal end. 5) The assembly of claim 4, wherein the convex member is rigidly incorporated into the support housing. 6) The assembly of claim 4, wherein the housing has a front end with a handle portion. 7) The assembly of claim 4, wherein the convex member has a convex surface and the socket is defined by the open end of a tube provided with the convex surface. 8) The distal end comprises a tube having an open end defining the socket and the housing comprises a shaft to which the convex member is attached and which defines a longitudinal passage.
The convex member has a partially spherical outer diameter defined as a central opening where the passage communicates with the passage of the shaft, and the operating device is provided on the shaft and extends along the shaft. A first and second pair of drive members that move longitudinally toward and away from the convex member, each drive member having a distal end that engages the distal end; Of the drive member defines outward facing left hand thread segments and rightward hand thread segments, respectively, and the actuator includes sleeves mounted on the drive members for rotation about the shaft, the sleeves respectively 5. The assembly of claim 4 including an actuator having inner surfaces defining left and right hand threaded portions operably engaging the left and right hand threaded segments of the member. . 9) The housing comprises a tube having an open end defining a longitudinal axis and defining a socket having tabs projecting inward, the distal end having the convex member,
The convex member defines a passage having an axis oriented in an oblique direction with respect to the longitudinal axis of the tube, and defines an arcuate groove for receiving the tab, and the actuator includes a shaft, The shaft has (1) a front end aligned with the longitudinal axis of the housing tube, (2) an intermediate portion of the tube extending from the front end at an oblique angle with respect to the longitudinal axis of the housing tube, and (3) 5. The assembly of claim 4, comprising an actuator, which is a shaft extending from an intermediate portion to the passage of the convex member and having a distal end disposed within the passage for rotation. 10) The housing comprises a hollow support tube defining a longitudinal axis and having an open end defining a socket having tabs projecting inward, the distal end having the convex member, The assembly of claim 4, wherein the vessel comprises a plurality of pull cables spacedly attached to the convex member at the tube. 11) The track according to claim 5, wherein each groove has a V-shaped cross section when the tube is not pressed. 12) The track according to claim 5, wherein the passage has a height smaller than a width. 13) The truck according to claim 5, wherein the tube has two facing connecting portions connected to the two facing walls.

[0105]

As described above, according to the present invention,
A distinctive bendable assembly is provided for endoscopic surgical tools. This assembly can control the bending of the end effector of an endoscopic surgical tool. Also,
The assembly is relatively strong and can withstand the moments and forces applied during operation of the end effector as well as during bending. Further, the assembly of the present invention can be easily operated from the front end of the surgical instrument without applying any force or torque.

[Brief description of drawings]

FIG. 1 is a schematic view of a surgical instrument incorporating the general form of the bendable assembly of the present invention.

FIG. 2 is a schematic view of a surgical tool incorporating an assembly having a configuration different from that of FIG.

FIG. 3 is a simplified perspective view of a surgical instrument incorporating the first aspect of the bendable assembly of the present invention.

4 is a diffusion exploded view of the surgical instrument of FIG. 3 (partially omitted).

5 is an enlarged cross-sectional view (partially omitted) taken along the plane 5-5 of FIG.

FIG. 6 is a sectional view taken along the line 6-6 of FIG.

FIG. 7 is a cross-sectional view (partially omitted) of the second embodiment of the bendable assembly incorporated in the endoscopic surgical instrument.

8 is a diffusion exploded view of the surgical instrument of FIG. 7 (partially omitted).

9 is a diffusion exploded view (partially omitted) of the front end portion of the surgical instrument of FIG.

10 is a schematic view showing bending of the end effector in the surgery shown in FIGS. 7 to 9. FIG.

FIG. 11 is a schematic diagram showing bending of the end effector in the surgery shown in FIGS. 7 to 9;

FIG. 12 is a schematic view showing bending of the end effector in the surgery shown in FIGS. 7 to 9.

FIG. 13 is a schematic diagram showing bending of the end effector in the surgery shown in FIGS. 7 to 9.

FIG. 14 is a perspective view (partially omitted) of the third embodiment of the bendable assembly incorporated in the endoscopic surgical instrument.

15 is an enlarged cross-sectional view (partially omitted) of the surgical instrument shown in FIG.

16 is a cross-sectional view taken along the plane 16-16 of FIG.

FIG. 17 is an enlarged perspective view (partially omitted) of the surgical instrument of FIGS. 14 to 16;

FIG. 18 is a rear perspective view of the surgical instrument of FIGS.

FIG. 19 is an enlarged cross-sectional view (partially omitted) taken along the plane 19-19 of FIG. 18.

FIG. 20 is a diagram in which the outer shape of the surgical instrument is shown by a chain double-dashed line in FIG. 18 to clarify internal details.

FIG. 21 is a perspective view (partially omitted) showing a modified example of the surgical instrument shown in FIGS.

22 is an enlarged cross-sectional view (partially omitted) taken along the plane 22-22 of FIG.

FIG. 23 is a cross-sectional view (partially omitted) showing a fourth aspect of the bendable assembly of the present invention incorporated into a surgical instrument having a track for guiding a ligation clip according to another aspect of the present invention.

FIG. 24 is a cross-sectional view taken along the plane 24-24 of FIG.

25 is a cross-sectional view taken along the plane 25-25 of FIG.

FIG. 26 is a perspective view (partially omitted) of a ligation clip used in the surgical instrument shown in FIGS. 23 to 25.

27 is a front view of the end portion of the truck shown in FIG. 26. FIG.

FIG. 28 is a perspective view (partially omitted) of one surface of a bent track.

FIG. 29 is a perspective view (partially omitted) of a curved track on a surface different from that of FIG. 28.

[Explanation of symbols]

 31 Far End 34 Support Housing 36 End Effector 40 Socket 44 Convex Member 48 Bending Operator 50 Passage 52 Actuator 54 End Effector Actuator

 ─────────────────────────────────────────────────── ─── Continued Front Page (72) Inventor Steven Barnett Caindlewood Drive, West Chester, 45069, Ohio, USA 5307 (72) Inventor Jack E. Smith Dayton, Ohio, 45414, USA , Little York Road 3477 (72) Inventor Mark Fogelberg United States, 97070 Wilsonville, Oregon, Southwest Eligsen Road 8275 (72) Inventor E. David Allen United States, 45053 Ohana, Ohio , South Dwyer 7513

Claims (5)

[Claims] 1. A bendable assembly for a surgical instrument for use in endoscopic surgery, the distal end supporting a tissue-processing end effector for surgical operation within a body cavity, the socket comprising: A long shaft having a distal end having an open end for partitioning and a longitudinal passage and terminating in a convex member housed in the socket, the convex member having a partially spherical contour. A shaft defining a passage communicating with the passage of the shaft for accommodating an actuator extending from the housing for actuating the end effector; alignment of the shaft with the distal end on the shaft; A manipulator for moving to a condition or moving away from the aligned condition, the manipulator being provided on the shaft and along the shaft. A pair of first and second drive members that move longitudinally toward and away from the convex member, the drive members each having a distal end that engages the distal end; And the second drive member defines an outward facing left hand thread segment and a right hand thread segment, respectively, and the manipulator comprises a sleeve mounted on the drive members for rotation about the shaft, the sleeve comprising: An assembly comprising an actuator having inner surfaces defining left and right hand threaded portions operatively engaging the left and right handed thread segments of the drive member, respectively. 2. A bendable assembly for a surgical instrument for use in endoscopic surgery, the hollow support tube defining a longitudinal axis and having an open end defining a socket, and surgery in a body cavity. A distal end having a terminating effector for handling tissue during surgery, the distal end having a convex member housed in the socket and defining a passageway, the passageway extending from the support tube to the support tube. A distal end for accommodating an actuator for actuating the end effector through a passage and a plurality of pull cables extending from the support tube and attached to the convex member, the cable comprising: A cave mounted in spaced apart positions for moving the distal end into or out of alignment with the support tube. Assembly with a module. 3. A bendable assembly for a surgical instrument for use in endoscopic surgery, the longitudinal support tube having an open end defining a longitudinal axis and defining a socket having an inwardly projecting tab. And a distal end for supporting a terminal effector for handling tissue during a surgical procedure within a body cavity, the distal end having a convex member housed in the socket to define a passage, A convex end member defining a passage having an axis oriented obliquely to the longitudinal axis of the tube and defining an arcuate groove for receiving the tab; and a distal end on the shaft. An operating device for moving the distal end portion into or out of alignment with the longitudinal shaft, the operating device comprising a shaft, the shaft comprising (1) A front end of the tube aligned with the longitudinal axis, (2) an intermediate portion of the tube extending from the front end at an oblique angle to the longitudinal axis, and (3) a passage of the convex member from the intermediate portion. A shaft having a distal end extending into the passage for rotation and having a distal end disposed therein for rotation, a portion of the shaft extending from the support tube through the shaft for driving an end effector. An assembly with a manipulator to house. 4. A bendable assembly for a surgical instrument for use in endoscopic surgery, the distal end supporting a terminal effector for treating tissue during surgery within a body cavity, and an elongate support housing. And a bendable joint connecting the housing to the distal end, the joint being a hollow socket and housed in the socket to actuate the end effector from the housing through the joint. A joint provided with a convex member that defines a passage for accommodating an actuator, and an operating device that extends to one of the socket and the convex member on the housing, the far end being in alignment with the housing. An assembly with a manipulator for moving or moving it out of alignment. 5. A track for guiding at least one surgical fastener through a bendable joint in a surgical instrument for use in endoscopic surgery, the track being flexible enough to accommodate bending through the joint. A tube made of material, the tube having a passageway of longitudinal and cruciform cross-section, adapted and maintained in a predetermined orientation during movement of the fastener along the passageway, The passage of the tube is defined at least in part by two opposite walls, which each define a respective longitudinal groove opening towards the other of the walls, which groove is therefore subject to a compressive or tensile bending load. A truck with a tube that can be deformed in response to.